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12th & Marshall archives

15
2018

Through your eyes

From the time he was 5 years old, R. Randolph Duffer, M’72, H’75, worked on the family farm in Charlotte County, Virginia, milking cows and harvesting tobacco.

"Being a country doctor, your patients become family," says the Class of 72's Randolph Duffer. "I may help them as their doctor, but they are always helping me with plumbing, electrical work or whatever needs doing."

“Being a country doctor, your patients become family,” says the Class of 72’s Randolph Duffer. “I may help them as their doctor, but they are always helping me with plumbing, electrical work or whatever needs doing.”

At 13, he began spending his summers curing tobacco leaves inside one of several tobacco barns on the property, sleeping under the barn’s attached shed.

“My father would bring me breakfast, I’d buy lunch up the road, and then my father  would bring me dinner,” Duffer says. “It was hard work, but it was all we knew. It was a way of life then.”

Tobacco was the major crop in rural south central Virginia. As far as the eye could see, tobacco barns dotted the landscape.

Today, not so much.

“Very few are surviving,” Duffer says. “Most are rotting. It’s sad to see them disappear.”

Duffer is doing his part to preserve his past. In 2013, he began disassembling the pine log structures on his family’s land and rebuilding them on his 200-acre farm
in Gretna, about 40 miles away. He has completed two, making the second one his home. He plans to begin work on the third barn this spring.

“This is part of my history,” says Duffer, who has been practicing rural family medicine in Gretna for 42 years. “I have a responsibility to save it.”

The first barn originally featured four rows of tier poles, used to dry the tobacco. Duffer transformed it into a log cabin, complete with a living room, dining room and kitchen. He added on a rescued shed that contains the bedroom and bathroom.

The second barn is larger, with a front and back porch and a guest bedroom and bath. Duffer moved from the first to second barn earlier this year.

“It’s a piece of art, just like a painting or a sculpture,” Duffer says.

Duffer used reclaimed wood from homes in the area for kitchen cabinets, doors and floors. He learned construction skills from his father, Rufus Joe Duffer, who was a
part-time carpenter, and receives help on his projects from neighbors, friends and family.

“Being a country doctor, your patients become family,” he says. “I may help them as their doctor, but they are always helping me with plumbing, electrical work or whatever
needs doing.”

Duffer knew early on that he would practice medicine. His uncle, Aubrey, an MCV alumnus, practiced dentistry. “My father, in all his wisdom, sat me down and encouraged me to go to medical school,” Duffer says.

He chose rural medicine because he is “a country boy at heart.” Today, he inspires others to do the same. Over the years, he has precepted dozens of students, including his first from the MCV Campus last year.

“There is such a need for rural family health care, and the reward is great,” he says. “It may not be as lucrative, but the satisfaction completes you.”

At 72, Duffer has no plans on retiring. “That’s not in my vocabulary,” he says. “When you have a passion for something, you want to do it as long as you can.”

That includes restoring tobacco barns.

“The little gravel road that leads to my house is called Farmers Road,” Duffer says. “What a perfect name. Every day, it takes me back to my roots. It takes me home.”

By Janet Showalter

15
2018

Continue the work

The Class of 53’s Julie Møller Sanford

The Class of 53’s Julie Møller Sanford.

There’s a Danish proverb that says “Alle Baader hioelpe.”

“Every little helps.”

Julie Møller Sanford, M’53, discovered at a young age that a little kindness could go a long way.

Born in Alabama to Danish parents, Møller and her family lived in Copenhagen, Denmark, for much of her childhood, enjoying the company of aunts, uncles and cousins who lived within walking distance. Yet all of that quickly changed in April 1940 when Germany invaded Denmark during World War II.

Møller was just 13 years old.

At the time of the invasion, her parents were overseas so, alone, she and her 10-year- old sister fled through Germany, Austria and Italy to catch a boat to New York. Although they were able to travel under an American passport, their journey wasn’t without peril. Germany had invaded the Lowlands in Western Europe and as the sisters reached the Brenner Pass between Austria and Italy, the border closed. German soldiers marched on their train and turned it back to Innsbruck, Austria, forcing all passengers from the train.

“Despite maintaining a calm facade for the sake of her little sister, my mom was scared to death,” says Møller’s daughter, Ann Sanford, recounting the stories her mother shared with family before her passing in 2017. It wasn’t until adulthood that she and her  siblings learned many of the details of what happened, thanks to Møller’s inquisitive  grandchildren.

The Møllers’ dearest family friends in Denmark were Jewish and “she had heard of the concentration camps and didn’t know what would happen as she sat with her sister on the train platform in Austria,” Sanford says. “Then a kind young man took notice and helped them find food and a place to stay. The next day, they were able to get back on the train and continue their journey.”

The Class of 53’s Julie Møller Sanford and her sister were passengers on one of the last ships to safely reach the U.S. during WWII. s Julie Møller Sanford led a storied life, filled with family, kindness, acceptance and a commitment to paying it forward.

The Class of 53’s Julie Møller Sanford and her sister were passengers on one of the last ships to safely reach the U.S. during WWII.

Ultimately the sisters reached the boat in Genoa, Italy — one of the last passenger ships to safely cross the Atlantic Ocean. At last safely aboard, Møller recognized the dire circumstances around them; they were fortunate to share a cabin with an elderly woman while many passengers slept in common areas.

Their mother met the boat in New York City with tears of relief and joy, having searched for them on each ship that arrived.

“The impact of that period in her life helped her understand the hardships faced by many and the difference one person could make,” Sanford says. “She also was mindful of and grateful for the opportunities she had for learning and to make a positive contribution. She just appreciated life. In her medical practice and in her community, she was calm and resourceful, kind and accepting. She understood the importance of recognizing the dignity in others, whatever their origins or circumstances.”

So it came as no surprise to Sanford that her mother decided to endow a scholarship in the School of Medicine. In coordination with her husband John Sanford, also a physician, she made provisions for the MCV Foundation in her estate and also named the foundation as a beneficiary on her retirement accounts.

“My parents had families that supported them when they worked to become physicians — emotional support and financial support,” Sanford says. “They appreciated that and wanted to pay it forward. Medicine wasn’t just a job or profession to them. It was a calling and an opportunity to make an impact. Both viewed this scholarship as a wonderful way to continue that work, their life’s work, and to share that with others.”

Møller also had an impact in Duluth, Minnesota. In 1964 she became the first female doctor at the Duluth Clinic, where she practiced internal medicine. Sanford remembers pictures from her mother’s early years of training in Chicago and in practice — all men and “then there’s mom. Women in medicine were all pioneers back in those days.”

Møller made a point to treat each patient as an individual — not a lab result or diagnosis, a lesson she passed on to the two of her four children who became physicians and to her students in her role as a clinical preceptor for the University of Minnesota Medical School in Duluth.

“My brother told me of her advice to him — to make sure to find out something personal about each patient,” Sanford says. “What’s the most exciting thing they’ve ever done or the most beautiful thing they’ve ever seen? And then remember it. Treat each patient as a unique person, with dignity and respect.”

The Class of 53’s Julie Møller Sanford and her husband John Sanford, M.D.

The Class of 53’s Julie Møller Sanford and her husband John Sanford, M.D.

Both lifelong scholars, Møller and her husband instilled a love of learning in all their children, as well as an appreciation for their Danish heritage. Their home was always “hyggeligt” — cozy and welcoming, filled with family, friends and plenty of books.

This warm and accepting spirit, impressed upon Møller by the experiences of her childhood, now extends to the School of Medicine and future scholarship recipients. To Julie Møller and John Sanford, the commitment was about more than money.

“My sister, a physician, summed it up well noting that our parents would have said to the students, ‘It’s us next to you. We’re here for you and we believe in you,’” Sanford says.

“That’s just how they were. All four of us kids are so proud and happy that they were able to do this. Our family will grow with this scholarship.”

How she did it
Planned giving donors like Julie Møller Sanford, M’53, help shape the future of the MCV Campus. In addition to including the MCV Foundation in her estate plan, Møller also named the foundation as a beneficiary on her 401k and IRA accounts.

“Using a retirement account is such an easy way to include a charity in your long-term plan,” says Jane Garnet Brown, director of gift planning at the MCV Foundation. “There’s no need to update your will or work with a lawyer, and the beneficiary designation can be made anytime.”

Retirement assets are generally included as a taxable estate asset and taxed as income to the named beneficiary. As a result, your beneficiary may ultimately receive only a fraction of the account’s value.

“By naming the medical school as your beneficiary, you can avoid these taxes entirely with 100 percent of your gift supporting your charitable intentions and thus leave more tax-efficient assets to your beneficiaries,” Brown says. “It’s certainly another tool to consider in your estate and philanthropic planning, especially if you have other ways of providing for your loved ones.”

Planned gifts are one way to support the School of Medicine’s 1838 Campaign, which aims to increase the number and size of scholarships to students. Full- and half-tuition scholarships, created with a commitment of $750,000 or $375,000, are most urgently needed and serve as one of the medical school’s best resources for recruiting and rewarding top students.

The MCV Foundation houses the medical school’s endowment funds and offers planned giving expertise to our alumni and donors. If you want to begin a conversation about how to use estate planning to your advantage, please call Jane Garnet Brown at (804) 828-4599. If you are already speaking with a representative from the School of Medicine about making a gift, please let them know you’ve seen this article and would like more information.

By Polly Roberts

15
2018

Leading the charge

As the nation grapples with how to treat children with mental health illnesses, the Commonwealth of Virginia and the Department of Psychiatry invest in a future that’s inspirational, not institutional.

One in five children nationwide will experience a serious mental health issue. Yet 75 percent of them will not receive the care they need, according to the National Institute of Mental Health.

Access is the biggest barrier — waiting six months for treatment or living in a remote area nowhere near a practicing psychiatrist. With increasing demand and retiring specialists, an escalating psychiatrist shortage further complicates the issue.

The new VTCC will double its faculty and staff, quadruple its research space and build a pipeline of child and adolescent psychiatrists for Virginia and the nation.

The new VTCC will double its faculty and staff, quadruple its research space and build a pipeline of child and adolescent psychiatrists for Virginia and the nation.

In Virginia, the mental health needs of children and adolescents took center stage in the aftermath of the 2007 Virginia Tech mass shooting.

“After Virginia Tech, we asked ourselves, ‘how are we helping to advance the national conversation on mental health?’” says Joel Silverman, M.D., H’73, chair of the School of Medicine’s Department of Psychiatry.

Part of the answer came in the form of $56 million in funding from the Virginia General Assembly to build a state-of-the-art child psychiatric facility on Children’s Hospital of Richmond at VCU’s Brook Road Campus. Authorized in 2013, the new Virginia Treatment Center for Children opened this spring, replacing the 50-year-old cinderblock facility on the outskirts of the MCV Campus that some alumni may remember.

“It’s so important to start with children because so much of mental illness, when we look back — when we see them at 22 and 23 — there were signs at 11 and 12 that we missed and we had the opportunity to grow a healthier child,” Virginia’s then-Secretary of Health and Human Resources William Hazel Jr., M.D., said at the facility’s November ribbon-cutting ceremony.

The 119,000-square-foot facility will triple the number of outpatient visits at the VTCC over the next three yea

rs to 21,000 a year. In-patient rooms will increase from 24 to 32, expanding access for children who come from all corners of the state.

Along with improving access, the new VTCC will double its faculty and staff, quadruple its research space and build a pipeline of child and adolescent psychiatrists for Virginia and the nation. In addition to increasing the number of medical students and residents who complete clinical rotations at the center, the number of child and adolescent psychiatry fellows will rise from four to six.

At the heart of the new VTCC is an opportunity to show the community and future psychiatrists what a caring treatment philosophy looks like in physical form.

At the heart of the new VTCC is an opportunity to show the community and future psychiatrists what a caring treatment philosophy looks like in physical form.

Ross Yaple , M.D., H’09, remembers when word came through that the General  Assembly had approved the funding for the new VTCC. He had just been named the division’s new fellowship program training director. “I hit the floor,” he says. “A brand new facility just for child psychiatry, with that level of funding, is unheard of.”

As work began to design an accessible, family-friendly facility, Yaple envisioned a new curriculum that could take advantage of the benefits of the new space and provide an unparalleled training experience for medical students, residents and fellows.

“It was a chance to up our game,” he says.

‘NOTHING SHORT OF REMARKABLE’
The beauty of the new VTCC is that it doesn’t feel like a child psychiatric facility at all. Filled with natural light, glass walls, green spaces, bright colors and home-like furnishings, its in-patient rooms include chalk walls and overnight accommodations for family members to stay with children throughout their treatment.

The center has long emphasized family involvement throughout the treatment process, encouraging parents or guardians to be present as much as possible during their child’s hospitalization and providing them with 24-hour visitation access.

A therapy mall offers occupational, recreational, art, music and play therapy, while a half-court gym and outside areas give patients space to play, all while providing the highest level of safety. The final product is the result of input from doctors, nurses and families, led by Silverman and VTCC Executive Director Alxandria Lewis, Ed.D.

“The level of community engagement, collaboration and creativity that comes together in this state-of-the-art facility is nothing short of remarkable,” says School of Medicine Dean Peter F. Buckley, M.D. “We are most grateful to Dr. Silverman, Dr. Lewis and their entire team for their dedication and innovation here.”

Buckley, a psychiatrist and schizophrenia expert, is no stranger to the impact a facility can make on patient care and education. At his previous position as dean of the Medical College of Georgia, Buckley led a multiyear evaluation of all of Georgia’s public health facilities that resulted in statewide improvements in quality of care as well as new collaboration between the public facilities in Augusta and MCG. Prior to that, he served as medical director for Ohio’s Northcoast Behavioral Healthcare system, where under his leadership the hospital became the best-rated psychiatric hospital in the state.

“I can say with absolute certainty that the VTCC is setting the standard for children’s psychiatric care on a national level,” Buckley says. “We wanted a facility better than anything we had ever seen and that’s exactly what we have built for the citizens of Richmond and the Commonwealth of Virginia.”

A NEW VISION
For his two-year child psychiatry fellowship on the MCV Campus, Yaple recalls a small program with superb training and faculty. Despite the facility’s physical limitations, the staff delivered compassionate and innovative care, for example implementing a no-seclusion policy in 2006.

But Wi-Fi was hit or miss among the cinderblock walls, keeping learners and physicians at their desktops and limiting collaboration. Lecture-style learning was the norm. The building’s one lackluster observation room was hardly used, leaving attending physicians to observe residents and fellows in the exam room with patients.

At the new VTCC, all of that changes. “I looked at the entire building from the perspective of teaching,” Yaple says.

To start, teaching and learning can happen from anywhere. Multiscreen learning modules dot the new building, providing teachers and learners easy access to impromptu learning spaces. “Sometimes all you need is a 15-20 minute debrief and you can get back to seeing patients,” Yaple says. “You don’t have to walk halfway across the building to find a conference room with Wi-Fi.”

Two observation suites give trainees more autonomy and one-on-one interaction with patients while supervisors monitor the patient care; meanwhile, learners can observe attending physicians perform forensic evaluations, a skill they previously couldn’t observe firsthand.

The observation rooms carry a benefit for families, too. Therapists can watch parents interact with their children and even coach their behavior through an ear piece, setting the stage for parents to return home with their children with the tools they
need.

Outpatient rooms will increase from 12 to 20 and be outfitted with complete audio/video capabilities so faculty can record sessions, letting them observe students without being in the room — allowing for a less disruptive experience for patients.

As Yaple envisioned a shift to a more technology-driven, active-learning curriculum, he realized he didn’t want to wait for the building’s 2018 opening to begin implementation. Research in adult-learning theory showed added technology and active learning could improve retention and lead to higher marks on board exams.

So in 2016, with the help of the medical school’s technology team, the program partnered with the Department of Psychology to launch the country’s first fully integrated online didactic curriculum for child and adolescent mental health. It serves as a permanent repository for all curriculum resources, flips the classroom and emphasizes a multidisciplinary approach.

Take a lesson on brain circuits, for example. Instead of Yaple spending 60 minutes describing each circuit in depth, the students download and watch a video on fear and panic. Together, they map out the brain and then each pick a brain circuit to research and teach to one another. “They’re really engaged,” Yaple says.

‘NOW WE CAN MAKE IT REALLY SHINE’
The facility’s advanced technological capabilities also provide more opportunities for telemedicine and video-conferencing, expanding treatment and education to patients and physicians across the state, particularly in rural Southwest Virginia where few psychiatric resources exist. Now Yaple talks by phone to many providers but soon he hopes to video chat with them and possibly even see patients on screen.

“Many pediatricians in rural areas are seeing patients who also could benefit from a psychiatrist’s care,” Yaple says. He’d like to offer these pediatricians access to online conferences to grow their knowledge of children’s mental health.

At the heart of the new VTCC is an opportunity to show the community and future psychiatrists what a caring treatment philosophy looks like in physical form.

“We’ve actually built a structure out of our treatment philosophy,” Yaple says. “It’s a testament to the center’s success that we could translate that to a design that enhances patient care. It complements what we’re already doing and now we can make it really shine.”

According to the American Association of Medical Colleges, a top factor in medical students choosing psychiatry is providing a high-quality medical school psychiatry clinical rotation. The new facility opens doors to more experiences for medical students along with residents and fellows.

“It’s an opportunity they’re not going to find anywhere else,” Yaple says.

It’s also Virginia’s answer to a call for more comprehensive child psychiatry throughout the state and beyond by increasing access to care today and building a pipeline of psychiatrists for the future.

By Polly Roberts

11
2018

A Therapeutic Window

Looking onto I-95 and into brain injury

When John Povlishock, Ph.D., came to the Department of Anatomy and Neurobiology  in 1973, he could almost see his calling from his office window: Interstate 95, with a reputation for speed – and unfortunately, horrific crashes. Those resulting injuries – especially neurotrauma – were claiming way too many lives.

A showstopper: many alumni remember John Povlishock, Ph.D., and his ability to draw with both hands simultaneously. This ambidextrousness, he says, comes from being able to turn off the conscious mind. “You cannot really think through the motions or it all breaks down. You’ve got to let your body take over.” Photography by Allen Jones, VCU University Marketing

A showstopper: many alumni remember John Povlishock, Ph.D., and his ability to draw with both hands simultaneously. This ambidextrousness, he says, comes from being able to turn off the conscious mind. “You cannot really think through the motions or it all breaks down. You’ve got to let your body take over.”  Photography by Allen Jones, VCU University Marketing

But from his MCV Campus vantage point on the I-95 corridor, Povlishock and colleagues found a way to help. Not only did their research save lives, they put VCU on the world stage while inspiring generations of other researchers around the globe.

Today, Povlishock leads a department that in addition to its role in the formal M.D. curriculum, participates in VCU’s Interdepartmental Neuroscience program for Ph.D. students while also providing research training opportunities for postdoctoral scientists. He’s considered a pioneer in traumatic brain injury research and has developed an international reputation as a scholar and educator. His department’s research groups concentrate on glial cell biology, neuroplasticity, and central nervous system injury and repair.

IDENTIFYING NEEDS, SOLVING PROBLEMS
When Povlishock arrived at VCU, the field was uncharted, the equipment limited and  the research needs high.

“There was no protocol for management of traumatic brain injuries, which today sounds
unbelievable,” Povlishock recalls. “Many people who were seriously injured in automobile accidents came in and the chance of dying … the mortality rate was about 73 percent.”

Former neurosurgery chair Donald Becker, M.D., was frustrated, Povlishock says, trying to understand what was going on with the injured brain, so he began to form a dream team of researchers to investigate. “We were focused on severe traumatic brain injury, and we thought traumatic brain injury was a singular disease,” Povlishock says. “That sounds naïve today, but we thought it was one-size-fits-all.”

Povlishock, with expertise in the blood-brain barrier, was pulled onto Becker’s team. The VCU team grew, “and we created this perfect environment, employing a very scholarly and translational approach. It really was a wonderful time.

“It was like the Camelot of neurotrauma research.”

What Povlishock and colleagues generated during that Camelot era was revolutionary and established them as pioneers in the field. But, of course, that research required funding, so Povlishock approached the National Institutes of Health, which led to a career of interaction with the agency.

“At first, there was some reluctance, because many were afraid we were going to take those 73 percent of people who were dead or dying and move them to a vegetative state,” he recalls. But ultimately VCU received NIH funding, and went on to complete groundbreaking work that has helped reduce the neurotrauma mortality rate to about 30 percent, while also improving other outcomes.

“Part of that was increased recognition that good medical management impacted these patients,” Povlishock says. “The VCU team focused on admitting the patients rapidly, getting them promptly intubated, and getting them physiologically stable as soon as possible. And that was extremely powerful in improving outcomes.”

What Povlishock did in the research lab translated to better bedside care, says Harold Young, M.D., professor and former chairman of the Department of Neurosurgery. “He has made this a better medical school and a better hospital.”

During this period, Povlishock also recognized that damage to the brain’s axons was a delayed reaction to the traumatic brain injury and a major contributor to the patient’s morbidity. “It was not an immediate event and thus, there was a therapeutic window that we could get at,” he explains. For his research contributions, he was awarded two Javits Neuroscience Investigator Awards from the National Institute of Neurological Disorders and Stroke, which also awarded him its Gold Medal for Brain Injury Research.

“Increased recognition that good medical management impacted these patients. The VCU team focused on admitting the patients rapidly, getting them promptly intubated, and getting them physiologically stable as soon as possible. And that was extremely powerful in improving outcomes.”

One of the most important findings of the VCU team was to understand the problem of intracranial pressure in brain-injured patients – and to develop targeted treatment protocols. To this day, he says, “it remains a very important and controversial issue. We know that intracranial pressure management saves peoples’ lives. The question we don’t understand is: does it alone improve their outcome in terms of their return to their families and workplaces?”

SHARING LESSONS
With new data, and because there was so little knowledge regarding the brain’s response to injury, Povlishock and colleagues published a definitive two-volume series that became standard reading for neurotrauma research at both the bedside and the
laboratory bench.

VCU’s current chair of neurosurgery Alex Valadka, M.D., H’93, trained as a post-doc scholar with Povlishock a quarter century ago during his residency, and admits to being a little in awe. “He was a pioneer in the field. He’s been at the top of his game for a long time. To this day, when you read journal articles, manuscripts or book chapters, his
name keeps coming up. It’s not just classic works. He continues to lead modern research as well.

“He stands out, because while he’s not a clinician, he’s very well-known in the clinical world, especially among the hard-core neurotrauma and vascular researchers and the neurosurgeons involved with NIH. That’s rare as we get more compartmentalized,” Valadka says.

Povlishock acknowledges his work helped define the field, even as that field has evolved. Treatment options were refined and auto accidents began to decline, thanks to increased use of passive restraints, air bags and increased awareness of drunk driving. Unfortunately, he notes, accident rates have crept up in the past few years, perhaps because of distracted driving. Today he continues his work as principal investigator for research on how mild traumatic brain injury alters axonal structure, neuronal electrophysiology, vascular function and brain circuit reorganization.

With important science has come important recognition. Povlishock’s work has been reported in more than 250 papers, reviews, books and chapters and, to date, his work has been cited over 21,000 times. He’s been honored locally, nationally and internationally, including with the Commonwealth of Virginia’s Outstanding Scientist Award in 2006.

Povlishock was a big draw for the university, says Young, who holds the James W. and Frances G. McGlothlin Endowed Chair. “Everybody wanted to come here, study here and work with him. I used to sit in on his lectures. When he gets on the podium,
everybody listens.”

He could have continued his career anywhere – and had attractive offers – but supportive colleagues, improved equipment and recognition from VCU were good reasons to stay at the university, he says. During his tenure he has been honored repeatedly for teaching as well as with the University Award of Excellence.

Former and current students are glad he stayed. Mary D. Ellison, PhD’85 (ANAT), chief external relations officer at United Network for Organ Sharing, credits Povlishock as an inspiration. “Among other things, John has an amazing talent for connecting the dots among various research efforts and for always being ready with the next questions that require investigation. He’s smart, approachable and remembers everything he’s  ever read, when it was published and by whom. He seems to thrive on hard work and the relentless pursuit of creating new knowledge.

“It’s been almost 30 years since I left his lab, and even though I’m now an administrator, not a scientist, I still remember things he taught me (and all of his students) about interpreting data, drawing appropriate conclusions, identifying next questions and how one goes about getting work funded and published.”

GLOBAL IMPACT
One quirk that many students remember is Povlishock’s ability to draw with both hands simultaneously. This ambidextrousness, he says, comes from being able to turn off the conscious mind. “You cannot really think through the motions or it all breaks down. You’ve got to let your body take over.” The trick he learned from a professor during his studies at St. Louis University “is a showstopper,” he admits. “It got students’ attention, and alumni remember me for that.”

Alumni remember him for a lot more, too. “He’s a tremendous ambassador for VCU, getting the university’s name out around the world,” Valadka says. Povlishock has, in essence, created a global VCU footprint of scientists who continue his work. In addition to successful grads like Ellison and Valadka who have a high profile from their Richmond bases, Povlishock trained preeminent researchers such as Dalton Dietrich, PhD’79 (ANAT), who leads the Miami Project to Cure Paralysis; Dan Erb, MS’87 (ANAT), PhD’89 (ANAT), founding dean of the School of Health Sciences at High Point University; and David Okonkwo, MD-PhD’00 (ANAT), director of neurotrauma at UPMC Presbyterian. Other students have gone on to become deans in Japan, China and Eastern Europe.

He gets to see some of them, thanks to a rigorous travel schedule for speeches and conferences. China is a frequent destination, he says, sadly, because of the amount of neurotrauma that rapid industrialization has brought.

Despite his research and speaking schedule, he’s found time for professional service and is a chartered member and chair of numerous NIH review panels, a past president of the National Neurotrauma Society and editor-in-chief of the Journal of Neurotrauma since 1991.

By virtue of his tenure, he’s become a historical figure in the field, Povlishock admits. At last year’s National Neurotrauma Society meeting, he was asked to give a founder’s address. But by his own reckoning, “I’m a guide in the journey to study and treat one of the most complex conditions known to man in the most complex of all organs found in the body.”

By Lisa Crutchfield

11
2018

Restoring the Joy in Family Medicine

Anton Kuzel, M.D., M.H.P.E., looks forward to celebrating the Department of Family Medicine and Population Health’s 50th anniversary in 2020.

Being around to lead a golden anniversary is not something Kuzel, professor and chair of the department for 15 years, necessarily imagined when he joined the faculty fresh out of residency in 1984. A Midwesterner at heart, he grew up and trained in Chicago (his office reflects his love of his hometown, with Bulls, Cubs and other sports memorabilia).

Pre-med student Joshua Rawson works as a scribe in the clinic of Tony Kuzel, M.D., getting briefed ahead of the patient’s arrival and sitting in on the appointment. It’s one measure that can streamline workflow for physicians. Photography by Allen Jones/VCU University Marketing

Pre-med student Joshua Rawson works as a scribe in the clinic of Tony Kuzel, M.D., getting briefed ahead of the patient’s arrival and sitting in on the appointment. It’s one measure that can streamline workflow for physicians. Photography by Allen Jones/VCU University Marketing

“I had an itch to get out of the Midwest and go to a coast,” he says. While in his residency, he started asking around for recommendations. “More than one person said, ‘You ought to check out MCV. They’re strong in family practice.’ That’s all I had to go on; I had no idea that people like [founding chair] Fitzhugh Mayo, M.D., and Maurice Wood, M.D., had done this incredible study on more than 450,000 encounters in Virginia and published in the Journal of Family Practice.”

Mayo and Wood, along with David W. Marsland, M.D., were authors of “The Virginia Study,” which compiled data from physicians across the state to help create an accurate picture of the needs of patients and physicians and ultimately served as the cornerstone for the department’s undergraduate and graduate curriculum and practice-based research.

“I wrote Dr. Mayo cold, told him my strengths and said I was looking for a job,” Kuzel says. Fortuitously there was one, and after interviewing, Kuzel concluded it was a great fit for him. “I said ‘these are the people I want to work with.’” Kuzel came on board in 1984 as associate director of the Fairfax Family Medicine Residency program.

At VCU, Kuzel found a supportive department, dedicated colleagues and a mission he could believe in. Years later, when talking to Marsland (the department’s second chair) about his career path and possibly competing for the chair position opening up in 2003, “I told him the only way I can imagine doing something like that was in service of the larger mission.”

BUILDING ON TRADITION
It’s that mission that’s kept him at the university. The department is unique in that it was created by Virginia’s governor and General Assembly in 1970 to address reports that an aging population and the state’s rural residents would need more care than was available. It was one of the first six family medicine departments in the country, and it was charged with preparing competent family physicians to ensure Virginians’ access to quality primary medical care.

As the department’s accomplishments grew, Kuzel has never strayed from its original intent, colleagues say. “I think we all live and breathe that mission pretty strongly,” says Steven Crossman, M’95, associate professor and vice chair of Family Medicine Education and Clinical Operations.

RECLAIMING YOUR PRACTICE AND TIME
Kuzel, who continues to see patients, has championed expanded research to help family physicians address a changing health care landscape. A past president of the Association of Departments of Family Medicine, he’s co-edited two books on qualitative and health services research and authored many articles and book chapters on the subject, as well as having served as associate editor of the journal Qualitative Health Research.

Kuzel also is principal investigator and lead faculty on the $10 million Heart of Virginia Healthcare initiative, a program aiming to help deliver better care, improve heart health and increase clinician satisfaction. The program is one of seven grantees across the nation funded by the Agency for Healthcare Research and Quality.

As Kuzel has put to work what he’s learned about streamlining workflow and using resources like medical scribes, he’s reclaimed some favorite pastimes. In good weather, he and his wife enjoy their sailboat, moored near Deltaville, Virginia.

As Kuzel has put to work what he’s learned about streamlining workflow and using resources like medical scribes, he’s reclaimed some favorite pastimes. In good weather, he and his wife enjoy their sailboat, moored near Deltaville, Virginia.

The study is timely, as today’s family physicians are facing reduced reimbursements, increased paperwork and a decline in morale. The data collection phase of the three-year grant wraps up this spring, and Kuzel is eager to review the data and develop plans to go forward.

Research like the Heart of Virginia Healthcare initiative was something he’d hoped to be able to undertake for years. “I mean to help primary care practices in Virginia to redesign how they do some of the basic processes so they are more efficient, effective and, importantly, turn down the stress level in the practice.” [see call out box]

Streamlining the workflow and using resources like medical scribes already has worked for him. “On a bad day, I might stay a half an hour after I see the last patient. On a good day, it might be five minutes. And I have no take-home work. Contrast that from what I hear from typical physicians, who say that when the kids are in bed they’ve got up to two hours in the EMR just to keep up.”

Another issue that’s surfaced through the research is the need to give primary care practices tools for dealing with obesity, which, he says, dwarfs every other health crisis today, even opioids. “I worry a lot of primary care physicians look at obesity as the new normal, and it sort of disappears from their attention. Or they’ll give it brief attention, admonishing their patients to eat less and exercise more. But we don’t really have the tools to help our obese patients lose weight. That’s probably the next area I’ll focus on.”

LESSONS FROM THE HEART OF VIRGINIA
While he waits for the final results of the three-year Heart of Virginia study,
Kuzel already has identified some simple changes physicians can make to help avoid some of the burnout many are feeling today. Those might include:

Pre-Visit Planning – Prior to a patient’s appointment, have staff pull together records, conditions and concerns so that the physician is teed up and won’t have to scroll through the medical record to pull together the information during the visit. At VCU, there’s an automated program for this. Pre-visit planning can identify patients’ chronic conditions and prevention needs, and the physician can be ready.

Lab Work Ahead of Visit – Ensure that patients have appropriate lab work done before their office visit, and have the results on hand so the physician doesn’t have to go back later and share results.

Synchronize Medications – Instead of dealing with patients’ prescription refill requests as they randomly come in, synchronize patients’ medications once a year when they come in for an annual visit. Give the first prescription for three months and then order four more refills. It’ll save time – and money – since physicians typically can’t bill for the time it takes to handle prescription medication management between visits.

For more tips, Kuzel recommends the AMA’s website: stepsforward.org.

CREATING THE NEXT GENERATION OF PHYSICIANS
While Kuzel’s research aims to improve physician satisfaction, on campus he works to equip the next generation who’ll enter family medicine. One low-tech way the department supports new medical students as they explore options is to reach out early.

“We try to find everyone who’s interested in family medicine the first week of school,” Crossman says. “We invite them up to the department, show them where the coffee machine is, try to get them connected to us and the north wing of West Hospital – which has been our home since before I even started school here.”

The department’s Student Family Medicine Association is an important way students get an early, positive look at the specialty and encouragement to explore the field. VCU’s chapter has received multiple national awards for excellence from the American Academy of Family Physicians.

In addition, every M3 is required to do a month-long family medicine clerkship. “The M3 clerkship is really pivotal,” says JUDY GARY, M.ED., assistant professor and assistant director of the department’s medical education programs. “Many students make their decision to pursue family medicine after they go through the clerkship.”

In order to meet its mission, the department has created a strong network of community-based residencies in locations similar to the places where their graduates will eventually practice.

The department offers two track programs for students. The I2CRP (International/Inner City/Rural Preceptorship) program was created nearly 20 years ago and has grown to include about 24 students per class who plan to practice in underserved communities.

There’s also the newer Family Medicine Scholars Training and Admission Track (fmSTAT), a dual-admission program to the VCU School of Medicine. Established in 2012, it is designed for students certain of their goal to be family physicians. The fmScholars receive special opportunities to learn among a smaller group of students and faculty, and receive 1:1 mentorship with a family physician, a specialized curriculum and other benefits – including a personal recommendation from either Crossman or Kuzel as they apply for residencies.

The department’s investment in students paid off at Match Day this year with the best family medicine match in more than two decades. Thirty-four students matched into family medicine through the National Resident Matching Program, with an additional four students matching into family medicine through the military match and the NRMP’s Supplemental Offer and Acceptance Program.

LOOKING AHEAD
Kuzel’s personal implementation of what he’s learned from the Heart of Virginia initiative – and the resulting efficiencies – has allowed him to return to some favorite pastimes. In good weather he can be found on his sailboat, moored near Deltaville, Virginia, or in the kitchen. Cooking is a favorite hobby, and he credits Julia Child and Galloping Gourmet Graham Kerr for inspiring him. And though he plans to step down as chair in 2020 to focus on research and patient care – after celebrating the department’s 50th anniversary – he knows the department is in good hands: true to its founding mission of equipping upcoming trainees to care for Virginians – and making sure those family physicians continue to find joy in their practice.

OF NOTE
For all of its programs, the department relies heavily on community family physicians, many of whom are alumni. Their efforts as teachers and mentors are invaluable. Alumni also have been philanthropic partners, supporting the 1838 Campaign by making gifts to build an endowment that will provide scholarships to fmSTAT Scholars. To learn more about the department’s programs, contact Judy Gary, M.Ed., assistant director of the department’s medical education programs, at judy.gary@vcuhealth.org.

16
2017

Through your eyes

Tom Eichler, M’87, H’92, auditioned for the play “Music Man” on a lark.

By the end of his first performance, there was no turning back.

“I remember delivering my lines and the audience roared,” he says. “I was thinking, ‘Hey, I’m funny!’ I was hooked.”

This story first appeared in the fall 2017 issue of the medical school’s alumni magazine, 12th & Marshall. You can flip through the whole issue online.

Tom Eichler, M’87, H’92, as the character of Andrew Carnes in a production of “Oklahoma!”

Tom Eichler, M’87, H’92, as the character of Andrew Carnes in a production of “Oklahoma!”

Since that first performance with St. Michael Theatre Group in 2007, Eichler has appeared in several other theatrical productions around the Richmond, Virginia, area. He’s taken on a wide variety of roles, including Kris Kringle in “Miracle On 34th Street” and Andrew Carnes in “Oklahoma!”

“People think you just go out there and say a few lines and make a few faces,” says Eichler, who has also appeared in five radio productions. “But it’s so much more than that. It requires a lot of discipline. You really have to think on your feet. It’s the same with medicine. Every patient is different and you have to respond to that.”

Eichler, a radiation oncologist with Virginia Radiation Oncology Associates, sees other parallels between acting and medicine. Both, for example, are pressure-packed.

“Every patient expects you to be on your game every day,” Eichler says. “On stage, the actors around you expect you to be at your best as well. Obviously, the stakes are higher with medicine. But in theater, no one wants to be the one who forgets a line. No one wants to lay an egg on stage.”

A graduate of the University of Notre Dame with a degree in American Studies, Eichler worked as an orderly before taking pre-med classes at Le Moyne College. After failing to gain admission to medical school, he accepted a friend’s offer to serve as the stage manager for First Street Theater in Dayton, Ohio. He later relocated to Northern Virginia with his future wife, Alison, and worked at the Folger Theatre as the box office manager.

One night, his parents and future in-laws joined him for dinner.

“I got up to use the restroom, and when I returned they had decided I was going to be a cardiologist,” Eichler says. “It got me thinking.”

He applied again to medical school and this time was accepted to Virginia Commonwealth University.

“I just love the whole process of medicine,” he says. “Being responsible for helping people, along with the rigor and discipline involved, really excites me.”

Despite working 12-hour days and serving on the board of directors for the American Society for Radiation Oncology, Eichler continues to carve out time for theater. Sometimes he works with his wife who serves as costume mistress and producer for several Richmond-area theater companies.

“Everyone has something they do that provides a release,” he says. “It might be riding a motorcycle or mountain climbing. For me, it’s theater.”

Eichler, who plans to retire from his practice later this year, hopes to continue acting for years to come.

“Usually I’m the oldest person at auditions,” the 65-year-old says. “And that’s OK. I have a lot of life experiences that I can pull from. You may be called upon to play a happy role or a sad one. I can get there by remembering the best day of my life or the worst day. I get such a rush from standing on stage and hearing the applause from the crowd. Everyone wants to be loved.”

By Janet Showalter

 

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Updated: 04/29/2016