October 2016 Newsletter

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Department of Medicine eNewsletter
October 2016
:: Interview
:: Department News
:: Department Events
:: Department Events
Twenty-Five Years of Service Milestone

The Department of Medicine is thankful for the outstanding service and commitment of the faculty members who have diligently worked in the department for 25 years. Please join us in congratulating the following faculty members:
  • Keith Armitage, MD
  • Amitabh Chak, MD
  • Gregory Cooper, MD
  • Nathan Levitan, MD
  • Anthony Post, MD
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department interview
Nathan Stehouwer, MD, Assistant Director of Medicine-Pediatrics (Med-Peds) residency program at University Hospitals Cleveland Medical Center and University Hospitals Rainbow Babies & Children's Hospital, shares his objectives for the recruitment season of the program, details how the Med-Peds Consult service is helping young patients transition to adult hospital and describes plans for the service to grow in the future.
What are some of the strengths of the Med-Peds program that applicants should be excited about?

We have a fantastic program here at UH Cleveland Medical Center, UH Rainbow Children & Babies Hospital and Case Western Reserve University School of Medicine. The strength of any Med-Peds program certainly rests on the two categorical programs in internal medicine and pediatrics. Our programs are both excellent; the pediatrics training takes place at UH Rainbow Babies & Children's Hospital, which is physically linked to UH Cleveland Medical Center. This physical proximity ensures seamless training for our applicants. Residents in our program are outstanding trainees who are not only intelligent and talented physicians but also individuals with great personalities who enjoy working with each other and spending time together as a group outside of the hospital. It is great for a program to have such a tight-knit supportive community.

What will you be looking for in candidates applying to the Med-Peds program?

We want to attract people who have demonstrated success academically, especially on clinical rotations. Though it is rewarding to train in two specialties, at times it can be demanding, so in order to do it successfully, trainees often have to invest additional time into studying and preparation. We look for applicants who have shown commitment to go the extra mile, have good emotional intelligence, and can work well in teams as they move between two clinical settings. Though past research experience is not a requirement for our program, it is always exciting to meet applicants who have initiated research projects to support their scientific aspirations.

You have experienced the Med-Peds program firsthand by graduating from it and serving as a Med-Peds Chief Resident a few years ago. How has this experience helped you see the big picture and reinvigorate the program to attract strong candidates this year?

One of the great things about being in the Med-Peds program is that residents develop a unique clinical perspective. One of the benefits of doing the combined training lies in discovering ways physicians care for similar patients in adult and pediatric settings and observing the benefits of different strategies and styles of care.

I think residents entering the Med-Peds program are interested in getting involved in meaningful projects. Over recent years I have witnessed our institution develop an increasing awareness of the need to effectively transition young adults with chronic illnesses and improve care for them across clinical settings. Recently we have initiated a Med-Peds Consult service that concentrates on this issue in the inpatient setting. This is just one example of many ways our Med-Peds trainees contribute to innovative models of care. There is a tremendous amount of enthusiasm and support for this initiative from the hospital leadership. We are certainly looking forward to developing this program further and exploring this outstanding learning opportunity with our intern class.

How was the Med-Peds Consult service initiated? What needs does it address for patients?

Across many specialties we have large and growing populations of young adults with chronic illnesses of childhood. Some of the most common conditions that our consult service handles are patients with sickle cell disease, congenial heart disease, genetic disorders such as Down syndrome, and neurodevelopmental impairment commonly diagnosed as cerebral palsy. Due to clinical and scientific advancements, many of these patients now enjoy a longer life span. For example, in the 1970s, patients with sickle cell disease had a life expectancy of 14 years; now they live into their 50s and 60s and their life expectancy continues to grow. While these positive changes exemplify success in the care of these patients, at the same time we are faced with new challenges of clinical care, as young patients with chronic illnesses become adults and transition to adult services. Families and patients often struggle with the unfamiliar environment and feel of the adult hospital when they have spent 20 years being cared for within the pediatric hospital. Additionally, they may come with diagnoses or problems that are less familiar to providers who have trained only in adult medicine. Our consult service was initiated to address these gaps and support patients and families as they transition to the adult hospital.

How does the Med-Peds Consult service help young adults make the transition?

Making a transition means more than a transfer of care from a pediatric to adult provider; it includes the preparation of patients and their families to be cared for by a new team in an unfamiliar setting. Ultimately a successful transition requires long and careful planning and coordination in the outpatient setting. Our work currently focuses on the inpatient side where many problems in transition can be unmasked. Some of the common issues that have come to the surface include ambiguity of timeline to transfer a patient to an adult service, unfamiliarity of a patient's history by a new team, discomfort family members may experience when new teams do not involve them in patient care at the level pediatric service used to and stress of an unfamiliar environment a patient may experience.

What are some of the common pitfalls in the transition of care for young adults with chronic illnesses?
One of the barriers to transition for patients with chronic illnesses lies in the challenge of changing trusted pediatric providers with whom patients have developed close relationships. In addition, many young patients with chronic conditions have become used to being admitted to the same hospital throughout their life, so a new setting can come across as unfamiliar and uncertain. Our adult hospital provides excellent care but the style and frequency of communication is certainly different than what patients are used to in the pediatric hospital, a change that can be jarring for many patients and amplify their inherent distrust or fear of the adult hospital. The Med-Peds Consult service guides these patients through the process and manages their expectations in a new setting. We educate patients and their families about the cultural differences between adult and pediatric settings, help initiate strong relationships with a new team and ensure patients receive high-quality care.

What is the direction you want to take the Med-Peds Consult service in the future? How do you see it developing over the next few months?

We hope to increase the number of patients we are seeing as the awareness of the consult service grows. We have been proactive about meeting the families of complex patients who will be transitioning in the future, preparing them for the upcoming transition of care. Another goal we have been actively working on is identifying barriers to quality care for this population and finding opportunities to improve by being closely involved with patients during this transition. This includes educating adult providers on the management of pediatric problems, and quality improvement work to develop more effective systems of care for young adults. As the consult service grows we hope to be able to develop an outpatient component particularly for patients with significant neurodevelopment disorders who lack a natural medical home in the adult hospital.
department news report
Division of Cardiovascular Medicine
Mukesh Jain, MD, was elected to the National Academy of Medicine (NAM). This high honor recognizes Dr. Jain's contributions to health, medicine and science. NAM unites eminent professionals from health and medicine and works to advance initiatives in health, medicine and related policy, inspiring positive change.



Sanjay Rajagopalan, MD, was appointed Division Chief of Cardiovascular Medicine. Dr. Rajagopalan is an accomplished clinical scientist with vast experience in leading multidisciplinary teams of experts to treat complex heart conditions. Dr. Rajagopalan's research interests are centered around the role of inflammation in cardiometabolic disease and molecular imaging or atherosclerosis.




Division of Gastroenterology & Liver Disease

Fabio Cominelli, MD Fabio Cominelli, MD, PhD, received a $250,000 grant from the National Institutes of Health (NIH) to support his work with medical students. The funding will go towards the T35 Case Medical Student Summer Research Program that offers an eight-week research training for medical students. The program exposes students to a physician-scientist career path and provides high-quality mentorship in research projects related to NIDDK mission through careful guidance offered by faculty.




Division of Infectious Diseases & HIV Medicine

Henry Boom, MD, and James Karuza, MD, renewed the postdoctoral training grant titled "Training in Georgraphic Medicine and Infectious Diseases, starting its 36th year of funding.

Federico Perez, MD, was appointed to the Infectious Diseases Training Program Directors' Committee of the Infectious Diseases Society of America for a three-year term.




Amy Ray, MD,
was appointed to the Quality Improvement Committee of the Infectious Diseases Society of America for a two-year term.




department conferences & events
State of the Department of Medicine
Date: Tuesday, November 29
Time: 5:30 - 6:30 p.m.
Location: Kulas Auditorium
Livestream: VA-K119

Grand Rounds
Time: 12 - 1 p.m.
Location: Kulas Auditorium
November 8
"Tuberculosis" by Thomas Daniel, MD
November 15
"The FDA and the Drug Industry: Too Close for Comfort?" by Sidney Wolfe, MD
November 29
"Sjögren's Syndrome: Beyond Dryness of Mouth and Eye" by Frederick Vivino, MD, MS, FACR
department development & diversity
Women in Leadership: Will 2016 Be a Tipping Point for Change?
Date: Monday, November 7
Time: 5:30 p.m.
Location: Tinkham Veale University Center, Suite 248
Speaker: Kathleen Buse, MD, Faculty Director, Leadership Lab for Women, Case Western Reserve University
Sponsor: Flora Stone Mather Center for Women
Audience: Women faculty interested in joining a discussion about leadership and politics

Finding Your Voice in Academic Medicine
Date: Wednesday, November 9
Time: 5:30 - 7:00 p.m.
Location: Wolstein Building, Room 1403
Speaker: Karen Horowitz, MD, Professor of Medicine, Immediate Past President, Women Faculty School of Medicine, Editor-in-Chief, SGIM Forum
Sponsor: Women Faculty School of Medicine
Audience: All School of Medicine faculty, especially junior faculty, are invited to attend this program about career vision.

How to Publish Your Teaching Innovations
Date: Wednesday, November 9
Time: 1:00 - 2:00 p.m.
Location: MetroHealth Medical Center
Speaker: Klara Papp, PhD, Professor and Director, CAML
Sponsor: Center for the Advancement of Medical Learning
Audience: All School of Medicine faculty interested in improving their educational scholarship; especially faculty who have designed new courses, teaching methods, or who have developed instructional products or new ways of assessing student performance that may be considered innovative.

Interrupting Bias in Faculty Searches
Date: Friday, November 11
Time: 9: 00 - 10:30 a.m.
Location: Adelbert Hall, Room M1
Sponsor: Case Western Reserve University Office of Inclusion, Diversity and Equal Opportunity
Audience: All faculty interested in improving their faculty searches; the session explores barriers within the faculty search process that prevent the fair evaluation of underrepresented candidates.

Learning Climate and Professionalism
Date: Tuesday, November 15
Time: 5:00 - 6:30 p.m.
Location: School of Medicine, Room E408
Speaker: Lynda Montgomery, MD, Medical Assistant Dean for Student Affairs, Associate Professor of Family Medicine and Community Health
Sponsor: Center for the Advancement of Medical Learning
Audience: Faculty working with learners at all levels of the continuum. Participants will identify and discuss the relationship between learning climate and demonstration of professional values in the clinical setting. Participants will review and discuss and develop the skills needed to coach peers and learners on learning climate and professional behaviors. In addition, participants will review how behaviors that one exhibits as a teacher or healthcare professional can impact the development of professional values in learners.