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School of Medicine Virginia Commonwealth University VCU Medical Center
School of Medicine discoveries

02
2015

Piece of the past

Piece of the PastThe young doctor stares in disbelief at his patient. How could this be? No blood, no torn flesh, no bullet wound.

This is, after all, 1942 North Africa. World War II wages all around. But this latest patient shows no sign of trauma. He is, however, suffering from chronic tonsillitis and needs surgery. With no medical equipment readily available to handle a procedure unrelated to combat, the resourceful surgeon fabricates a tonsil snare out of an aluminum propeller from a downed French airplane.

“Necessity is the mother of invention,” said Jodi Koste, university archivist and head of Tompkins-McCaw Library’s Special Collections and Archives. “It certainly shows the ingenuity of the surgeons during that time.”

The tonsil snare is one of about 6,500 pieces in the library’s Medical Artifacts Collection. When J. Warren Montague, M.D., H’41, donated the piece in 1982, he told Koste the story of how he created it while serving in North Africa during World War II. When faced with the unanticipated tonsillectomy, he and an Air Force sergeant improvised. They carved the finger pieces from the aluminum propeller, while the other parts were made from a drill rod, part of a typewriter and a bicycle spoke.

Montague used the snare to remove the tonsils of about 300 U.S. servicemen throughout the course of the war in both Africa and southern France.

“This is how many medical instruments were developed,” Koste said. “Surgeons would work with a bioengineer to develop a piece that would help them become more proficient. It still happens today based on need or to make a procedure simpler and less invasive.”

Few, however, are fabricated on the spot by a quickwitted surgeon like Montague. Koste said only about one percent of the school’s collection was fabricated, the rest manufactured.

“It is not unusual for medical schools to have a collection of medical artifacts,” she said. “And there are larger ones out there. But we are proud of our collection here because of the stories it can tell about the unusual.”

By Janet Showalter

01
2015

Class of 2017’s Jackie Britz to serve as AMSA’s Environmental Health Coordinator

Jackie Britz

Jackie Britz

When one thinks of environmental issues, terms like climate change, deforestation or renewable energy often come to mind. But in the field of health care, challenges like water sanitation, housing and disaster preparedness are also included.

The Class of 2017’s Jackie Britz has been named to a national leadership role that will give her a forum for raising awareness of the damaging impact environmental issues can have on public health. She’ll use her position to encourage fellow medical students to advocate for the health of communities that have too few health care providers to serve their population’s needs.

For Britz, it all started with trips to medically underserved communities in places like South Africa, Peru, the United Kingdom and the United States. “In each context,” she says, “I have seen the devastating impact that conditions of poverty can have on health.”

These trips sparked her passion for public health, and she has followed this interest across the globe. She’s spent time in London, where she researched healthcare barriers experienced by vulnerable populations, and in Washington D.C., where she worked for a non-profit organization focused on public health policy. Now on the MCV Campus, she’s is taking on a new role as the American Medical Student Association’s Environmental Health Coordinator.

“I hope to increase awareness among medical students about the relationship between environmental factors and public health and inspire them to take action around these issues.” By engaging medical students she aims to create a vocal group that will get involved on the national and local levels, while also informing future doctors about issues they will encounter when they treat patients.

Britz and her colleagues at AMSA have several events planned that aim to increase student engagement. She is coordinating a webinar series and is also working on National Primary Care Week, the Public Health Scholars Program and increasing the AMSA’s involvement in policy discussions on climate change.

To accomplish her goals, Britz will rely on her past experiences in the public health field. While studying for a master’s degree in public health from the London School of Hygiene and Tropical Medicine, she completed an award winning thesis project on England’s proposed policy of charging immigrants to access primary healthcare services. Britz also has past experience with AMSA, having served as co-president for the organization’s VCU chapter and as a member of the Advocacy Leadership Course.

Britz just returned from AMSA’s national leadership meeting, where she learned about the organization’s environmental health priorities for this year. Now she’s ready to tackle the challenge of engaging her classmates and medical students around the country in environmental public health issues.

“There are many ways medical students can get involved, such as planning local chapter events to educate other medical students about these issues, or engaging in advocacy efforts at the state or national level that help promote the health of overall communities.”

By Jack Carmichael

29
2015

Dozen with ties to medical school played roles at ACP’s Internal Medicine 2015 meeting

The American College of Physicians is the second-largest physician group in the United States. Its annual meeting, also its centennial celebration, was held April 30 – May 2, 2015, in Boston, Mass. From behind the scenes to center stage, a dozen with ties to the medical school played roles at the meeting.

Fisher,John-M69

John F. Fisher, M’69, H’77

John F. Fisher, M’69, H’77, received the Jane F. Desforges Distinguished Teacher Award at the American College of Physicians’ national meeting in Boston, Mass., on April 30, 2015.

A professor emeritus of Georgia Regents University, Fisher’s academic career spans 38 years. The ACP honor is that latest of nearly five dozen teaching awards, including the Clinical Teacher Award from the Infectious Diseases Society of America, the ACP Georgia Chapter’s J. Willis Hurst Teaching Award and two dozen Educator of the Year awards from Georgia Regents University.

During residency training at VCU, he was given the William Harrison Higgins Award. As an infectious disease fellow, he received the Best Fellow Award two years in succession. Following his training, Fisher joined the faculty of the Medical College of Georgia (now Georgia Regents University), where he was professor of medicine and program director for the Infectious Disease Fellowship. He also served as chief of the Division of Infectious Diseases at the VA Medical Center in Augusta, Ga.

Fisher has served on the education committees for both the IDSA and the National Foundation for Infectious Diseases. He has 101 publications including 57 articles in refereed journals and 44 book chapters. At the ACP annual meeting, he was advanced from Fellow of the American College of Physicians to Master of the American College of Physicians.

Wenzel_Richard

Richard “Dick” P. Wenzel, M.D.

Richard “Dick” P. Wenzel, M.D., was the Massachusetts Chapter Lecturer at the ACP meeting. An emeritus professor and former chairman of the Department of Internal Medicine, Wenzel has been long been involved with the ACP and has frequently presented at the annual meeting, keeping physicians up to date with the latest information on topics in internal medicine and infectious disease. His topic at Internal Medicine 2015 was evidence-based physical diagnosis.

In 1988, the Massachusetts Chapter Award Lectureship was established to honor a distinguished Massachusetts internist and to honor an outstanding member of the annual meeting faculty. Today, the recipient of the award is selected by the chair of the Internal Medicine Scientific Program Planning Committee.

Robert Centor

Robert M. Centor, M’75

Robert M. Centor, M’75, concluded his one-year term as chair of the ACP Board of Regents at the annual meeting. The Board of Regents is the main policy-making body of the College.

A member of ACP since 1978, Centor was named a Fellow of ACP in 1985 and became a Master of ACP on October 1, 2014. He has served on the Board of Regents since 2008 and also on many of ACP’s committees, including the Membership Committee, Finance Committee, Strategic Planning Committee and the Health and Public Policy Committee, which he chaired from 2009-2011. Centor was awarded the Laureate Award for outstanding service to medicine and ACP from the Alabama Chapter of ACP in 2009.

He is currently professor of medicine and regional dean of the University of Alabama at Birmingham, Huntsville Regional Medical Campus. He was on the internal medicine faculty on VCU’s Medical College of Virginia Campus until 1993.

Ellis,Lisa-M01-H04

Lisa L. Ellis, M’01, H’04

Lisa L. Ellis, M’01, H’04, chaired the Scientific Program Committee that created a mix of small group sessions, classic lectures and hands-on activities for the annual meeting. Faculty presented new findings in internal medicine and its subspecialties, presented new approaches in practice management and discussed issues related to health care policy as well as lead sessions to hone leadership and teaching skills.

“When I attend each year, I bring back new ideas for managing patients as well as techniques for enhancing my own leadership style,” says Ellis who as the ACP Governor for Virginia represents the state on the ACP’s national Board of Governors. In that role, she helps implement national projects and initiatives at the chapter level and represents member concerns at the national level. Ellis also is on the Board of Governors’ executive committee, which advises the Board of Regents.

Ellis currently is the chief medical officer for the Medical College of Virginia Physicians at VCU and has an appointment as an associate professor in internal medicine and OB-GYN.

A student and young alumnus have taken leadership roles in the organization:

Khan,Ali-M09-Headshot-IAS-1

Ali M. Khan, M’09

Ali M. Khan, M’09, is chair of the ACP’s National Council of Resident/Fellow Members that represents the interests of over 22,000 residents and fellows-in-training. He’s been on the 11-member council since his intern year at Yale and has helped lead ACP’s High Value Care initiative that educates and engages physicians as well as resident and fellow members in how to practice in a value-sensitive, thoughtful manner for resource stewardship and patient engagement.

At the ACP’s annual meeting, he co-hosted the council’s marquee event, a TED talk-style national forum for promising innovations and bright ideas for teaching high-value care. Moderated by author Sandeep Jauhar, M.D., and the New York Times’ Lisa Sanders, M.D., the event showcased winners from the second annual Teaching Value and Choosing Wisely Challenge sponsored by the ABIM Foundation and the national non-profit Costs of Care.

“We’ve read articles, attended lectures and held forums making the case for value-based care delivery,” Khan says. “Now, however, those words are being bolstered by action – on the ground, at institutions all across the country, led by talented health professionals with the creativity and drive to effect the collective change we seek. Award Winning Innovations isn’t about making the theoretical case for value – it’s about sharing the best work being done nationally to make that case a reality.”

Cockburn,Chelsea-MD-PhD-student

MD-PhD student Chelsea Cockburn

MD-PhD student Chelsea Cockburn began her four-year term as a representative on the National Council of Student Members in April 2015. Council members organize programming for medical students at the national ACP conference every year, and Cockburn attended the annual meeting in Boston where she was looking forward to meeting the rest of the council members as well as internal medicine physicians.

As a member of the student council, Cockburn is assigned a region of medical schools in the U.S. and will help advise the internal medicine interest groups at those schools to strengthen activities at the chapter level. She’s also been selected to represent the council on the ACP Education and Publication Committee that provides scientific and professional information to physicians, trainees and patients.

ACP-meeting

ACP attendees with ties to the medical school reunited during the Internal Medicine 2015 meeting. Each year, the Department of Internal Medicine hosts a reception. This year it was held at Boston’s Atlantic Beer Garden overlooking the harbor.

A number of faculty from the Department of Internal Medicine presented at Internal Medicine 2015:

  • Stephanie A. Call, M.D., MSPH, professor in the Division of General Medicine and Primary Care.
  • Alan W. Dow III, M.D., associate professor in the Division of General Medicine and Primary Care.
  • Mary H. Hackney, M.D., associate professor in the Division of Hematology/Oncology.
  • Puneet Puri, M.D., assistant professor in the Division of Gastroenterology.
  • George W. Vetrovec, M.D., professor in the Division of Cardiology.

Others were honored at the meeting:

  • Wendy Klein, M.D., associate professor emerita, was awarded the designation of ACP master and was recognized as the Virginia ACP chapter’s 2015 Laureate winner. Klein was co-founder of the VCU Institute for Women’s Health and was the department’s first program director for an innovative residency in Women’s Health.
  • Curtis N. Sessler M.D., the Orhan Muren Distinguished Professor of Medicine, and professor in the Division of Pulmonary Disease, was named an ACP fellow.
  • John R. Strunk, M.D., assistant professor in the Division of General Medicine, was named an ACP fellow.
  • Darren Witte, M.D., in General Medicine and Pediatrics, was named an ACP fellow.
20
2015

Internal Medicine’s Cultural Competency Program: “Bring Back the Humanism”

Krista Edelman

Krista Edelman, M’11

A patient doesn’t fill his prescriptions. Another doesn’t exercise, worsening chronic conditions. Still another is always late to appointments.

It’s frustrating for physicians, and easy to assume these patients just don’t care. But there are other sides to these stories, and an innovative program is helping interns find them.

“When there’s a disconnect between providers and patients, we sometimes don’t realize the issues that are affecting patients so they cannot adhere to a treatment plan,” said Bennett Lee, M’94, ambulatory clerkship director and associate professor in the Department of Internal Medicine. “We were thinking about how to really engage the interns with their patients and make sure they understand what a privilege it is to take care of them.”

Chief Resident Krista Edelman, M’11, along with Lee and Stephanie Call, M.D., M.S.P.H., associate chair for education in the Department of Internal Medicine, developed a cultural competency program, a four-week rotation designed to help the department’s interns:

  • Discover social and physical environments affecting health.
  • Reflect on how a better understanding of health is affected by the conditions in which patients are born, live, work and age.
  • Communicate and share these experiences.
Residents must learn sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
– ACGME


The program began in 2014, and about 30 interns have completed it so far. “The experience has been eye-opening,” said Edelman.

The interns are encouraged to go beyond standard medical examination questions to try to understand patients’ lives. They ask about family dynamics, income and whether or not they have convenient ways to obtain healthy food and necessary medicines.

They then go out into the community, sometimes using public transportation, and explore the neighborhoods where their patients live. Edelman prompts them to look around and see:

  • Are there signs of disrepair (broken windows, graffiti, overgrown grass)?
  • Are there parks or recreational areas in the neighborhood?
  • What supermarkets are available and do they carry affordable fresh produce, meat and other healthy food?
  • Are there functioning street lights or a sidewalk?
  • Where is the closest bus stop?

What they’re finding is changing the way they practice medicine and view patients, said Edelman. “They’ve taken photos of the food available, which might be something like a packet of bologna and potato chips, maybe an onion. It’s a revelation for these physicians, who wonder why patients aren’t eating more fruits and vegetables.

“Seeing the neighborhoods where the patients live, they come back and say, ‘I don’t think I would feel comfortable walking there alone either, let alone a 60-year old female patient.”

Interns might discover that a patient has to travel several miles in a wheelchair to get a prescription filled, or is too frightened to go out or maybe has to depend on three city buses to get to a physician’s appointment.

“In medical school, people are so keyed in to the science of how to take care of folks that sometimes they lose track of the idea that this is a person,” said Lee. “You need to ask, ‘how do I communicate with them? How do I understand?’”

Watch a digital story

Mrs. Hope
by Christina “Nina” Vitto, M.D., resident in the Emergency Medicine-Internal Medicine combined residency program

The culmination of the cultural competency program is creating a reflection piece on the experience, usually a digital video on a subject or patient who affected interns deeply.

Edelman believes this reflection will make them better, more compassionate physicians.  She’s also heartened by recent updates to the MCAT exam that tests prospective medical students.  In 2015, the exam was expanded to include a section on behavioral and socio-cultural factors.

“My parents are social workers, and I’ve always had a passion for the service in medicine,” she said. “It’s easy to get so jaded when you’re working long hours and patients come in who are obviously neglecting their health.

“But that’s not acceptable for physicians. I want to bring back the humanism.”

By Lisa Crutchfield

16
2015

The Art of Reconstruction

Taking advantage of today’s emphasis on active learning, Jennifer Rhodes, M.D, director of VCU’s Center for Craniofacial Care, partnered with a local sculptor, creating a pilot program of art workshops to enhance the plastic surgery residents’ experience.

“We are trying to foster the residents’ imagination, to encourage creativity,” said Rhodes. “Learning about aesthetics of the human body through sculpture is ideal for plastic surgery residents. In sculpting, we can talk about the things we used to talk about in lecture: proportions in face, different features in face, concept of lighting and how it changes your perception of proportion…all things they must understand when they are doing a surgical procedure that affects the aesthetics of the face.

“I think it clicks much better in the residents’ minds when they learn these concepts during a hands-on approach in the artist’s studio rather than on the black board. I have never had the same kind of enthusiasm from them for a lecture.”

“Oh, we do enjoy a good lecture,” said Collier Pace, M’11, a fourth year plastic surgery resident. “But especially for us as surgical types, the hands-on stuff is what we remember and get excited about. Most of us are tactile learners.”

To reach those tactile learners, Rhodes works with VCU sculpture department alumna Morgan Yacoe to design programs that allow residents to learn sculptural techniques and see how they relate to surgery – allowing them to test out aspects of their skill set before they apply them in the operating room.

For example, Yacoe developed a workshop for residents to practice flap design, for which she created replicas of a face with silicone skin and underlying foam.

“They could practice local tissue rearrangement and then suturing to learn about how best to reconstruct different types of skin cancer defects,” said Yacoe. “I tested different silicones to get the elasticity right. They got to practice tool handling, cutting, suturing, rotating the skin and other aspects of flap design and execution before they cut a real patient.”

The lesson was invaluable. “The next time I do this flap, I will have vision in my mind of how I want it,” said Pace. “These are helpful, subtle points that are hard to learn outside the operating room.”

Other workshops have included sculpting clay busts and anatomical drawing. The skills they learn teach residents that healing the body is art as well as science.

“Historically, plastic surgeons had set numbers for things – this is normal range for how thick lips should be or how much eyelid you should see or how far apart the eyes should be,” said Rhodes. “Now, our sensibilities are evolving and in resident education, we stress getting away from the numbers and into developing residents’ own ways of looking at the face, understanding balance and harmony, and understanding what features would be appropriate for a particular individual.”

Mixing up the learning environment by going outside the hospital has another benefit. “Residents can get burned out,” Rhodes said, “and that affects not only their ability to learn, but their empathy towards patients, their outlook on life, their health and their perception of their career path and what they want to do.

“I think transforming a lesson into an experience that they might not have sought on their own and outside their comfort zone is a way to help not only learning but to keep them inspired, foster creative thinking, and enhance their connection to their chosen field.”

By Lisa Crutchfield

16
2015

Acting Up

Physicians Learn New Skills in the Theater

Catherine Grossman, M.D., H’06, doesn’t expect any of the residents she supervises to ever pursue a career on stage, as entertaining as they may be. But she does see the value in learning theatrical improvisation skills. This year she incorporated an improv workshop into residency training.

Medicine, like theater, she believes, is an art as well as a skill, and improvisation enables residents to use different parts of the brain and approach ideas through a new lens.

“The millennial learner needs to be actively engaged and this is one way we engage them,” she said.

Grossman, associate professor of internal medicine, is not the first to see the parallel between art and science. Medical improv is an emerging field designed to improve cognition, communication and teamwork in medical settings. Actor Alan Alda was recently honored by Stony Brook University for helping to establish a center using improvisation techniques to aid in communicating scientific information.

Tips from a Pro

To get the most from improv, performer and teacher Townsend Hart says you should:

  • Leave your ego at the door.
  • Be open to feedback.
  • Ask for help.

Grossman was introduced to improvisation during a medical simulation course at Harvard and recognized its value as a teaching tool. After an introductory class, she signed up for more.

“It was really neat looking at how the skills transferred back and forth. It made me think about how I teach, how I am at adapting rapidly, being in the moment and responding.”

When she returned to Richmond, Grossman contacted the Richmond Comedy Coalition.

“Improv can be very funny, but it’s more than making jokes on stage,” said Matt Newman, the Coalition’s managing director.  “You really need to listen and respond to your scene partner with openness, honesty and empathy. It helps you become a more thoughtful and responsive communicator.”

Grant Farr, D.O., a chief resident in internal medicine who participated in the workshop, agreed. “Improv can help you express yourself so people will listen,” he said. Besides being fun, he added, it also helped loosen up the Type A personalities in his class.

Grossman, who was honored last fall for her innovative approach to education with the medical school’s Irby-James Award for Excellence in Clinical Teaching, notes that improv also is used in the school’s simulation center, where actors portray patients and physicians-in-training are required to react quickly.

Grossman has found her improv skills handy in many areas. “In improv, like real life, you have no idea how someone is going to respond.

“We’re always looking for ways to apply techniques from other fields into the way we teach. It’s interesting for me to work through different problems with different approaches. We’re walking down different pathways to be better at what we do.”

 By Lisa Crutchfield