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March 2016 Archives

24
2016

The EMR drove him to it

It was the summer of 2014, and Darren S. Witte M’96, H’00, was facing the stress of migrating eight years of patient data into a new electronic medical record.

He’d merged his internal medicine and pediatrics practice with the VCU Health System and was getting to know the system’s Cerner EMR. After long nights of sweating the details, he got a suggestion from his clinical coordinator: find a distraction and blow off some steam.

Darren Witte, M’96, H’00, behind the wheel of his 1970 Karmann Ghia.

Good thing there was a Vintage Volkswagen show coming up that weekend.

“I have this memory from when I was about 7,” Witte says, “of this gorgeous green car. It was frequently parked at a store where I went with my parents.”

Back then, he wasn’t yet a Volkswagen fan and didn’t know what the car was. But 35 years later, he spotted the same compelling curves that were a vivid reminder of his childhood love. It was a Volkswagen Karmann Ghia.

He started frequenting car shows hoping to catch another glimpse, but sightings were rare. That weekend’s show was no different. When he recounted his disappointment to his clinical coordinator, Lesli Davis, she made another suggestion, “Maybe you just need to find one of your own?”

Witte began doing some research. After work or before bedtime he’d snatch a few minutes, but the car proved elusive, especially on the east coast where either harsh winters plus road salt or high heat and humidity take a toll on paint and cause body panels to rust out.

An aerial view of Bug Out, the all-Volkswagen car show based in Virginia that’s one of the largest in the country.

“They made about 445,000 Karmann Ghias between 1954 and 1974,” says Witte. “It is estimated that maybe only about 10 percent of those remain on the planet today, and many are getting consumed two-for-one as donors for restorations. I found a few really rusty ones that would have taken more work and money than I was willing to put in. I didn’t need more stresses.”

Then one night, he spotted a pastel blue 1970 Karmann Ghia for sale online that looked to be in great shape. Originally from California, the car was owned by a surgeon who’d moved the car with him to South Dakota and kept it garaged. The seller sent him some high quality photos and answered his questions.

“I’m surrounded by neighbors who are car guys so I showed them the pictures, and we talked it all over. … Then I told my wife! I decided to take a calculated risk.”

A few weeks later, an enclosed auto trailer brought it from South Dakota to his practice’s parking lot. “My clinical coordinator, Lesli, was right there snapping pictures in the early morning hours when it was delivered.”

Darren Witte, M’96, H’00, with his wife and daughters at the May 2015 Bug Out where his Karmann Ghia took first place in her class.

Forty-four years spent in western climes had left Witte’s vintage car in near perfect condition, but he and his neighbor enjoyed tinkering with it, nonetheless. “I’m pretty good at paint and body work, and my neighbor, Wally, has been great to teach me a lot of mechanical skills. We decided to get it in tip top shape in time for Bug Out the next spring.”

The aptly named all-Volkswagen car show is based in Virginia and is one of the largest in the country. Volkswagen enthusiasts race their cars, enter them in competitions for best of show and swap stories about their passion.

Witte and his neighbor were rewarded when the car took first place in her class. More blue ribbons followed at other local shows. “I’ve maintained a long-distance friendship with the surgeon who owned the car before me and tell him about the shows we go to and what we win. He’s happy to see that it went to a good home and is being enjoyed.

“I like meeting others who have stories about their own connections to Karmann Ghias,” he says of the car events he now frequents. “It’s fun to drive, but I also really love just sitting back and admiring its shape. There’s just something about the shape of that car.”

Witte is a regular at the local Cars and Coffee event that’s held every other Saturday in Richmond. He often takes his 8- and 12-year-old daughters along. “There’s a big car culture in Richmond, and it’s important that we expose our youth to it so that we can continue to preserve the interest in and value of vintage vehicles as time goes on.”

He says that Karmann Ghias are great starter collector cars. In the past few years they have been starting to see an uptick in popularity and value. “I feel like I got in on the ground floor.”

By Erin Lucero

19
2016

MacGyver medicine: Medical school team wins wilderness medicine event

Stabilizing a patient with spinal cord injury. Emergency tracheotomy. Intubation. It’s all in a day’s work.

Except now imagine doing these procedures while mountain biking, canoeing, running through the woods with map and compass, and carrying all your supplies on your back.

The Class of 2016’s Phil Griffith, Chris Woleben, M’97, H’01, and the Class of 2017’s Jenika Ferretti-Gallon prevailed in the Mid-Atlantic MedWAR that combines wilderness medicine and adventure racing.

Sounds almost impossible, but the medical school’s Lactated Ringers team prevailed at the Mid-Atlantic MedWAR (Medical Wilderness Adventure Race) competition on March 19.

MedWAR events pit three-person teams of wilderness medicine enthusiasts against each other for a day-long event that challenges their medical knowledge, orienteering skills and stamina. The competition, held in several locations throughout the U.S., was created in 2000 by two emergency medicine physicians with a passion for adventure racing. MedWAR events have no route markers, water stations or cheering spectators; instead they simulate backcountry rescue situations so participants can test and improve their skills.

The Class of 2016’s Phil Griffith heard about the event last year and decided it was the perfect venue for his love of the outdoors and career plans as an emergency physician. “Emergency medicine fits with wilderness medicine,” he noted. Except in the outdoors, “You’re practicing with fewer resources, higher evacuation times and the same principles of stabilize and improvise.”

He participated in the event for the first time last year with Chris Woleben, M’97, H’01, on a team dubbed the Lactated Ringers. This year, the Class of 2017’s Jenika Ferretti-Gallon joined them.

An associate professor in the Division of Pediatric Emergency Medicine, Woleben is also associate dean for student affairs in the medical school. Though he’s far more experienced in medicine, Woleben calls the students “the masterminds to our team’s success.”

The competition, held in Newport News, includes three loops (four for more advanced competitors) consisting of questions and hands-on scenarios. Each team must navigate to checkpoints where they will encounter physical challenges or wilderness medicine simulations, which they must successfully complete before moving forward.

The team takes its name from Ringer’s lactate solution that’s often used for fluid resuscitation after blood loss due to trauma, surgery or other injury.

During the race, which the Lactated Ringers completed in under seven hours by mountain bike, canoe and foot, they performed a cricothyrotomy on a pig trachea and removed a fish hook from someone’s skin (using a pig’s foot as a stand-in). One memorable scenario involved stabilizing a skydiver who had landed in a tree and sustained spinal cord injury.

The trio capitalized on the lessons learned from the experiences of the 2015 team.

“The reason for our success was that we planned in advance,” said Ferretti-Gallon. “We practiced orienteering the weekend before the race at a Boy Scout camp.”

The group also knew what to carry in their pack, smaller than last year’s but still a hefty 20 pounds of wilderness supplies. “The most important thing you can have is gloves,” said Griffith. “And a knife is always useful.” The group also hauled water purification equipment, shelter, epinephrine for anaphylactic shock, gauze and a CPR mask. A skin stapler came in handy, too, for making quick repairs on their simulated victims so the team could get back on the course.

With few penalties for wrong answers and some bonus points for their knot-tying skills, the team was named winner of the Intermediate division. In addition to bragging rights, the team won a copy of “Improvised Medicine,” a book Griffith dubs MacGyver medicine. “Actually, I’ve had my eye on that for a while,” he said.

It also gave them confidence. “MedWAR can change the way you think about practicing medicine,” Ferretti-Gallon said. “It gives you skills to apply in the field. It’s encouraging and it’s empowering.”

She’ll hold down the fort next year at MedWAR, as Griffith moves to Ohio for residency.

However, he remains prepared for anything he encounters. “I always try to keep my medical bag with me. And my keychain is just exploding now with a bag of gloves, a pocket knife and other supplies.”

By Lisa Crutchfield

19
2016

M3 student Nehal Naik shares his experiences on national surgery blog

M17 Naik,Nehal _MG_3615 (3)

The Class of 2017’s Nehal Naik.

A Friday evening in Ecuador gave the Class of 2017’s Nehal Naik a first-hand view on how a break down in emergency communications can impact patient care.

As an M1 observer, he was slated to spend time that evening in the city of Cuenca’s 911 call center as well as at Hospital Vincente Corral Moscoso, the region’s only trauma center. So he was on hand when the call came for an ambulance in the aftermath of a motor vehicle collision.

“En route, the patient was determined to be a critical trauma patient,” Naik recounted in a first-person essay published by The Academic Surgeon, the official blog of the Association for Academic Surgery.

“Little communication had been made to either the dispatchers or the receiving hospital, so the trauma team I was working with found themselves with a critical head trauma and no prior preparation. Despite the best efforts of the trauma surgeons at HVCM, the patient died from the traumatic head injuries. Many on the trauma team felt that if the patient had arrived earlier, with adequate preparation she may have been saved.”

Naik’s road to Ecuador began nearly three years ago when he joined the International Trauma System Development Program as a first-year student in the VCU School of Medicine. That opened an opportunity to visit Ecuador and study the South American country’s emergency response system.

His unforgettable Friday evening as an M1 observer was just the first day of his summer experience, and it laid a foundation for a quality assessment and improvement project on trauma communication between Cuenca’s pre-hospital and hospital providers.

Working with him on the project was the Class of 2016’s Michael Rains and four medical students from Liga Académica de Trauma y Emergencias. The work began with a close look at the Richmond Ambulance Authority, a model EMS system in Richmond, Va.

But, Naik points out, “Like many global development projects, it was imperative to have local leaders guide the mission of new projects.” So he and his collaborators also met with Ecuadorian EMS and 911 teams as well as hospital staff to better understand the problems they faced.

While Naik initially struggled with professional level of medical Spanish spoken by his peers and mentors, their patience, local language classes and the Latin-rooted medical jargon he knew from medical school filled the gaps in his proficiency.

His team’s partnership reached beyond the research they performed. “We shared on-call nights in the emergency department learning basic emergency care. During down time, we had impromptu lessons from our trauma surgery mentors.”

Naik also joined his teammates at events where they taught basic first aid and trauma care to non-medical students, churchgoers and even driving school participants.

M17 Naik,Nehal LATE first aid

While in Ecuador, Naik worked with students from the Liga Académica de Trauma y Emergencias to teach basic first aid and trauma care to non-medical students, churchgoers and even driving school participants.

The Ecuadorian student group’s commitment to service and teaching have inspired Naik to emulate their programs on the MCV Campus. Students involved with VCU’s International Trauma System Development Program are modeling offerings after what Naik saw in Ecuador, with programs like a hands-only CPR class for locals.

Naik reconnected with his teammates last August at the Panamerican Trauma Society 2015 Congress in Bolivia where they presented their findings. They also discussed continuing the project and what opportunities there might be for further collaboration.

The experience has convinced Naik how valuable international experiences are for networking with likeminded student leaders in other countries. “Future physicians in nations that face a growing burden of disease from trauma and other surgical diseases can benefit from a global network for exchange and collaboration.”

Naik is chair of the student subcommittee of the Panamerican Trauma Society. He hopes to pursue a career in emergency medicine and continue working in global health, focusing on sustainable development of emergency health infrastructure, especially in low- and middle-income countries.

By Erin Lucero

18
2016

Dean Jerry Strauss honored for mentorship

Jerry Strauss III, M.D., Ph.D., dean of the School of Medicine, was honored in March with the 2016 Frederick Naftolin Award for Mentorship. Presented by the Society for Reproductive Investigation, the award recognizes the contributions of a society member to training and career development of investigators in the field of reproductive and women’s health.

Strauss has always placed a priority on mentoring young scientists and has found time to nurture those relationships even during his nearly 11 years as dean.

Eun Lee, Ph.D., one of Strauss’ mentees, was on hand for the ceremony at the SRI 2016 Annual Scientific Meeting in Montreal, Canada.

Strauss_Dist_Scientist
SRI President Hugh S. Taylor, M.D., presented the Frederick Naftolin Award for Mentorship to Jerry Strauss III, M.D., Ph.D., at the SRI 2016 Annual Scientific Meeting in Montreal, Canada.

An assistant professor of obstetrics and gynecology, Lee met Strauss almost four years ago. At that time, “I was in a unique situation because I had taken a hiatus from research due to my family situation. It was very difficult to return to the work force, especially with the current funding climate and as a woman with three little children. But he saw the potential in me and offered me the position I am currently in now. I will always be grateful for Dr. Strauss believing in me and continuing to support me in my research.”

The two have weekly meetings and exchange emails at all hours of the day, says Lee. She shares with Strauss an interest in preeclampsia, which is a leading cause of maternal and fetal morbidity and mortality in the United States.

“His interest in all our projects is amazing. He gently leads us to the right path and gives us the intellectual freedom to explore on our own to make discoveries. His suggestions and feedback have made our projects successful.”

The Frederick Naftolin Award for Mentorship was established in 2003 in honor of the former president of SRI who was a staunch advocate for creating a mechanism for the society to celebrate outstanding service to the scientific community through excellence in mentoring.

Strauss is a past president of SRI and in 2006 was honored with its Distinguished Scientist Award, the society’s highest honor for contributions to the field of women’s health research.

An accomplished researcher, Strauss has authored over 300 original scientific articles and holds 12 issued U.S. patents for discoveries in diagnostics and therapeutics. An elected member of the Academy of Medicine for more than two decades, he currently chairs the Board of Scientific Counselors of the NIH’s National Institute of Child Health and Human Development. He is senior editor of Yen and Jaffe’s Reproductive Endocrinology, the major textbook in the field of reproductive medicine and has served as a member of the Board of Reviewing Editors of Science.

By Erin Lucero

12
2016

Guests from a dozen states pack reception celebrating the Kirkpatrick Professorship

Affection and respect for Barry Kirkpatrick, M’66, filled the reception hall on March 12. The evening celebrated the successful completion of a campaign to honor a pediatrician who was as dedicated to the tiniest babies as he was to training medical students and residents.

Longtime faculty member Barry Kirkpatrick, M’66, with seven of the neonatal‐perinatal medicine fellows he’s trained. Dozens of former trainees were on hand to celebrate the creation of a professorship that bears his name.

In 1973, Kirkpatrick established the first Neonatal ICU at MCV Hospitals. It was also the first in Central Virginia and would grow to become one of the largest on the east coast. He shared his knowledge and skill with generations of future physicians, creating a fellowship training program in neonatal‐perinatal medicine and an innovative community pediatric clerkship for medical students and residents. He ultimately was named vice chairman for education in the Department of Pediatrics.

Those former residents and students en masse supported a campaign to endow the Barry V. Kirkpatrick, M.D., Professorship. The campaign enjoyed the broadest base of support of any in the medical school in recent years, with scores of commitments coming in from 21 states.

About 150 of those Kirkpatrick fans were on hand in March at Lewis Ginter Botanical Gardens to celebrate the professorship that will support the teaching mission of the Department of Pediatrics. kirkpatrick-gallerybuttonTogether they recalled the many firsts that Kirkpatrick pioneered: the first 600-gram baby, introducing mechanical ventilation for infants and designing a van to transport newborns from surrounding hospitals to the MCV Campus. In addition, he and surgeon Tom Krummel, H’83, established the east coast’s first ECMO program in 1980 at a time when it had only been offered for infants at UC Irvine, the University of Pittsburgh and the University of Michigan. They went on to help other university medical centers get their own programs up and running. These were dramatic advances at a time when the medical field was just beginning to learn how to save the lives of very premature babies.

Dawn Mueller, M’72, F’75, a retired associate professor of pediatrics at VCU, was the first of Kirkpatrick’s seven fellows. She was also the chief champion of the professorship campaign, writing letters and making phone calls to ensure everyone had an opportunity to participate.

At the March reception she noted the Kirkpatrick Professorship now takes its place beside endowed professorships honoring Walter Bundy, M’45, and Edwin Kendig, H’36, two other longtime faculty members in the medical school. Mueller characterized the three physicians as “the pantheon of iconic Richmond pediatricians,” and added, “This trio of professorships extends their legacies and influence for generations to come.”

By Erin Lucero

02
2016

Building rapport: Medical Spanish class helps students connect with patients

Unlike many young children, the Class of 2016’s Arhanti Sadanand looked forward to going to the doctor.

“I loved my pediatrician,” she said. “I felt like there was always someone there to help me feel better. My doctors were always my role models, and that stuck with me.”

Once she entered VCU’s School of Medicine, she made it her mission to establish a similar rapport with her patients. One major tool she had at her disposal was her ability to speak Spanish.

There’s a big difference between avergonzado – embarrassed – and embarazada — pregnant. M4 Arhanti Sadanand leads her classmates through an OB patient case.

“I’m lucky enough to have a background in Spanish,” said Sadanand, who minored in Spanish at New York University. “But many doctors don’t. Part of our responsibility is to communicate with all our patients as best we can so that we can build rapport.”

To help other medical students on the MCV Campus form a closer relationship with Spanish-speaking patients, she is teaching a Medical Spanish elective. The four-week class, offered twice this year, has an emphasis on listening comprehension and oral fluency in realistic healthcare scenarios.

“This is critical for medical students,” she said. “The class has a focus on clinical dialogue they will use every day in the exam room.”

Sadanand is teaching common phrases and medical terms in a fun way. Participants often role play or compete in Spanish Jeopardy, bingo and other games to bring some fun to the classroom.

“I wanted to make it more interactive,” Sadanand said. “Still, I don’t want anyone overestimating their abilities when they leave the class. They won’t be fluent, but it’s a great start.”

The class is Sadanand’s community-based capstone project, a requirement of the school’s International/Inner City/Rural Preceptorship (I2CRP) Program. I2CRP is a four-year program that fosters the knowledge, skills and values needed by doctors to provide quality and compassionate care in medically underserved communities.

“This class helps bring our students much closer to making that all-important connection with patients,” said Mark Ryan, M’00, H’03, medical director of I2CRP.

Each session addresses specific topics: physicals, abdominal pain, respiratory infections, diabetes, hypertension, pregnancy, musculoskeletal complaints and pediatrics. At the end of the four weeks, Sadanand will assess Spanish proficiency with the help of a fluent Spanish speaker acting as the patient in a mock medical encounter.

“I’m lucky enough to have a background in Spanish,” said the Class of 2016’s Arhanti Sadanand. “But many doctors don’t. Part of our responsibility is to communicate with all our patients as best we can so that we can build rapport.”

Sadanand will also compare improvement of and confidence in Spanish proficiency by using standardized pre-tests, post-tests and student surveys. She will present the results to the school’s curriculum council with hopes the class will be added to the School of Medicine’s catalogue.

“The vision and the drive she has brought to this project has been extraordinary,” said Mary Lee Magee, M.S., who serves as educational director of I2CRP. “There are limited resources available for our medical students in this area, and the need is so great.”

The class, however, does not replace a medical student’s obligation to use certified Spanish interpreters. Healthcare providers can call on live interpreters to visit patients and translate for them or use technology assisted interpretation that are phone or web based.

But, “There’s nothing like the personal touch,” Sadanand said. “When I put myself in the patients’ shoes, it must be terrifying. Imagine not being able to communicate with your doctor.”

Sadanand’s class builds upon the work of two previous I2CRP students, Irving Phillips, M’15, and Patrick Lam, M’15. Their research showed the Teaching Proficiency through Reading and Storytelling method is an effective alternative to Rosetta Stone, which is more general. Sadanand’s fellow I2CRP student Deborah Me sees so much value in the approach that she volunteered to help out with teaching duties when Sadanand was busy with her fourth-year rotation in pediatric hematology-oncology.

Shanti Nambiar, M’16, is one of about 20 students enrolled in the class this year. “This has been extremely helpful,” she said. “It’s giving me the tools to get through a clinic visit.”

During her third year, when Sadanand completed her clinical rotations, she met at least one Spanish-speaking patient every day, she said. She is confident that number will only rise. According to the U.S. Census and other government sources, the United States is home to more than 41 million native Spanish speakers.

“What’s so important is building that trust with your patients,” said Sadanand, who is pursuing a pediatrics residency. “When you establish that link, when you bring your patients that comfort, everyone wins.”

By Janet Showalter