Ignite Magazine | Spring 2021 by NEOMED

A P U B L I CAT I O N O F N O RT H E A S T O H I O M E D I CA L U N I V E R S I T Y • V O L 2 2 .1 S P R I N G 2 02 1

ZOOMING IN AND OUT OF MEDICAL EDUCATION AND PRACTICE

s with most industries, there are many facets to health care’s evolution. Perhaps the ones that we most commonly share with others are the technological advancements. We often also share a tendency to be slow in embracing and operationalizing those advancements. But not always. Throughout this issue, we introduce you to transformational leaders in health care. Among them is a common thread of compassion for people and an understanding of complex systems. During the pandemic, engagement via digital screens has become the norm. From distance learning to telehealth, we have all had to pivot — and to handle more than one crisis at a time. In “When the Virus Meets the Addict,” Dr. Randy Welton, The Margaret Clark Morgan Chair of Psychiatry, says, “We‘re hearing telehealth ended up being just as effective as in-person visits,” but adds that he does have reservations about that conclusion. Transformative leaders recognize that if you see a need but no solution, sometimes you must create one. That’s what Christina Girgis, M.D., (’05), did. After experiencing a miscarriage, she felt isolated. She thought, “There must be a group of psychiatrists on Facebook.” When she couldn’t find one, she started the Women’s Psychiatry Group. In “Social Media for Psychiatrists,” she describes her journey — some 17,000 members later. When unprecedented challenges occur, leaders often adapt technologies for speed to market. Such sustaining innovation is what medicine student Gordon Hong (“Making A Bigger Impact”) experienced during a summer internship. Hong served on a team at a startup company that designed a COVID-19 app to help emergency departments coordinate their response while following rapidly evolving CDC guidelines. Sometimes solutions are available but underused, as described in “Taking a Better Look at Dark Skin.” Upon realizing that many conditions are undiagnosed or misdiagnosed on people of color because they look different from the images of white patients typically provided to medical students, Sarah Eley, a College of Medicine student, found VisualDx. Through the help of her faculty advisor and a pair of donors, the diagnostic tool was made available to all NEOMED students. How we see ourselves matters, too. In “Forging Futures,” Dr. Mary Massie-Story, clinical assistant professor of family and community medicine, describes why it’s important for students (and patients) to see people who look like them — including their skin, hair and other features. Throughout medical schools and clinical institutions, we need to enhance and diversify our pedagogy and our practice with an improved awareness of how we see ourselves and others. New processes and technologies are typically ahead of the operational curve, so leadership training is needed to ensure that educators, practitioners and scientists are on the right trajectory to take advantage of them. I’m hopeful that what the medical community has learned over the past year will lead to ever-higher standards of operating procedures and excellence. And I’m proud that NEOMED’s own continue to lead the way in how we practice and teach. Sincerely,

John T. Langell President 02 I G N I T I N G

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VOL 22.1 SPRING 2021 Northeast Ohio Medical University is a communitybased, public medical university with a mission to improve the health, economy and quality of life in Northeast Ohio through the medicine, pharmacy and health science interprofessional education of students and practitioners at all levels. The University embraces diversity, equity and inclusion and fosters a working and learning environment that celebrates differences and prepares students for patient-centered, teamand population-based care. Ignite magazine (Spring 2021, Volume 22, No. 1) is published twice a year by the Office of Marketing and Communications, 4209 St. Rt. 44, P.O. Box 95, Rootstown, OH 44272-0095 Email: eguregian@neomed.edu President John T. Langell, M.D., Ph.D., M.P.H., M.B.A. NEOMED Board of Trustees Richard B. McQueen, Chair Phillip L. Trueblood, Vice Chair E. Douglas Beach, Ph.D. Sharlene Ramos Chesnes William H. Considine, M.H.S.A. Robert J. Klonk Chander M. Kohli, M.D. Darrell L. McNair, M.B.A. Susan Tave Zelman, Ph.D. Student Trustees AuBree R. LaForce Joshua L. Tidd

Editor: Elaine Guregian Contributing Editors: Roderick L. Ingram Sr., Jared F. Slanina Publication Design: Scott J. Rutan Illustrations: Cover and page 12, Branden Vondrak, B.F.A., Kent State University School of Visual Communication Design; page 4, Elise Radzialowski, University of Akron Myers School of Art (’19); page 8, Malieka Gurrera, University of Akron Myers School of Art (’18); page 14, Caitin Kane, University of Akron Myers School of Art (’18) Photography: Chris Smanto As a health sciences university, we constantly seek ways to improve the health, economy and quality of life in Northeast Ohio. The Accent Opaque White Text paper used for this magazine has earned a Forest Stewardship Council (FSC) and a Sustainable Forestry Initiative (SFI) certification. Strict guidelines have been followed so that forests are renewed, natural resources are preserved and wildlife is protected. Ignite was printed by Printing Concepts in Stow, Ohio, using soy inks. No part of this publication may be reproduced without prior permission of the editors. Copyright 2021 by Northeast Ohio Medical University, Rootstown, Ohio 44272.

About the cover: Branden Vondrak is a graduate of Kent State University, a NEOMED partner school.

DEPARTMENTS

FEATURES

22 TASTES LIKE HOME

FORGING FUTURES

MAKING A BIGGER IMPACT

Mary Massie-Story, M.D., has determination to spare — and share.

A medical student found his way into working on an app for emergency departments to coordinate treatment during the COVID-19 pandemic.

26 CLASS NOTES 30 DONOR SPOTLIGHT

The Association of American Medical Colleges (AAMC) selected “The LMSA Effect: How a Student Organization Is Raising Awareness of Latino Health Needs,” written by Elaine Guregian, editor of Ignite, to receive a Bronze Award for Excellence in The Robert G. Fenley Writing Awards/General Staff Writing category of the national 2021 AAMC Group on Institutional Advancement (GIA) Awards for Excellence competition. The article appeared in the Spring 2020 issue of Ignite. Ignite magazine won second place in the category of Best of Show/Trade Publications in Ohio’s Best Journalism Contest, sponsored by the Cincinnati, Cleveland and Columbus Society of Professional Journalists (SPJ) chapters statewide. Recognition was for work done in 2019 — namely, the Spring 2019 and Fall 2019 issues of Ignite.

Current and past issues of Ignite can be accessed free from issuu.com

08 WHEN THE VIRUS MET THE ADDICT

The collision of a viral pandemic and drug epidemic has had an exponential impact — again.

A CRASH COURSE IN RESEARCH

A gap year spent in the Medical Research Scholars Program at the NIH will be time well spent “even if I never hit the bench again.”

SOCIAL MEDIA FOR PSYCHIATRISTS

LEADERSHIP SPOTLIGHT

Christina Girgis, M.D. (’05) tapped into the power of Facebook to connect her colleagues.

Princess Ogbogu, M.D., and Costas Kefalas, M.D., are each bringing about change.

14 GET USED TO IT Bringing to light one reason that female physicians burn out.

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FEATURE

FORGING FUTURES: MARY MASSIE-STORY BY ELAINE GUREGIAN

utter and sugar heated up on the a group of approximately three percent of With her own three children (ages 17, stove. That’s what substituted physicians who are female and Black. And 18 and 19 at the time of this conversation), for too-expensive medicine when while she has collected accolades from the she finds herself having similar dialogues young Mary Massie was growing up in MetroHealth System in Cleveland, where about tough situations: “Let’s talk about the projects in Pittsburgh with her single she has practiced family medicine for more how to deal with this the right way.” mom and four brothers. Members of the family dealt ABOUT THAT HAIR “I can shape minds and talk to young people Authenticity, from her with mental illness, trouble with drugs, even homelessnatural hair to her warm, about how to maneuver, not just through ness for a few years. direct manner, defines Dr. medicine but through life. I’m stubborn. I Still, someone always Massie-Story. know I can help someone see there are ways came through for Mary at Historically, Black womthe right time, allowing her en seeking acceptance in to deal with obstacles and grievances. I can to pursue an inner drive to professional work settings help them do it the right way and not have become a physician. The have straightened their hair tough early start shaped Dr. to fit into white norms. all the head knocks I had when I was younger Whether it’s cornrows, Afros Massie-Story, and today she and sometimes my mouth got in the way!” works to raise appreciation or the latest style, they’re offor racial and gender equity – Mary Massie-Story, M.D. ten told, “You don’t look on both the giving and reprofessional” when they venceiving end of health care. ture outside of straight hair The associate director of NEOMED's than two decades, she can also easily give standards. Massie-Story embraces her integrated pathway program hasn't for- examples of the ways her medical knowl- ethnicity in the professional world and gotten what it was like to be a student edge has been doubted because of the in- she insists on not changing her appearance with aspirations but no privilege. tersectionality of being a physician who is — namely, her short-cropped, naturally “Every day, I think back to the folks female and Black. curly hair. “I think it’s important for stuwho gave me the chance when others wantWhen she treats NEOMED students dents to see people who look like them ed to send me packing because I wasn’t in the Student Health Center or when she and know that their skin, hair and features legacy, I wasn’t from money, I had no teaches them how to diagnose patients, she are acceptable,” she says. political or social associations,” she says. sets out not just to treat their ailments but Patients will judge you — on your “It’s hard to fight that battle.” As a Black to strengthen them for the professional hairstyle and everything else — and likewoman, Dr. Massie-Story is not only a and life challenges they’ll face, especially wise, may think you will judge them. minority in the U.S. population; she’s in if they are underrepresented in medicine. Try to remove any sense of hierarchy the

Illustration: Elise Radzialowski

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FEATURE

minute you enter the examination room, other providers muttering “frequent flier” show up are all the time, with respect to she tells her students. Lead with humility: to describe the 20-something woman who the emotional cost of a child's addiction “When I introduce myself to patients, I was back for yet another sexually trans- what happens is that the siblings don’t get never call them by their first name. It’s mitted infection (STI) check. When Dr. the attention they need. There you are, Mr., Mrs., Ms., unless they invite me to Massie-Story talked to the patient about trying to grow up with no direction somecall them something else,” times, because it’s scarce,” she she says. told her students. There are certain words that a Black One sure sign of respect Their reaction? “My stuis to look at your patient with dents were like, “Oh my person may hear differently than a white your whole body facing gosh, that’s really something person. “History” is one. If you ask a Black them: “That tells them that to see it from the perspective you’re there to attend to their of the other victims." she person if another doctor asked her about needs,” she says. Transitionsays. Laura Allen, a College her history, they’ll answer, ‘No, she never of Medicine student, says the ing to electronic medical records two decades ago was way Dr. Massie-Story talks asked me about my mama or my daddy.’ tough for her because she had about her own life is “exYou need to say, “Did the doctor ask you to look at a computer keytremely relatable,” making board to type notes while her a valued mentor. about your medical history?” conversing with the patient. “I’m all about storytelling, A BATTLE A DAY story sharing and appreciatOne of Dr. Massie-Story's ing a person’s narrative. If we make as- barrier protection to keep her safe, she roles at MetroHealth is to take care of sumptions right off the bat, we miss a noticed that the patient put her head down patients who were hospitalized or in an whole lot of everything,” she says. in shame and started to cry. Gently asked urgent care setting and have just been to tell a bit more, the patient responded released to a COVID-19 team. The careCLUES IN THE STORIES that her boyfriend had multiple partners givers monitor and manage them outside Tops on her list is listening for clues but she relied on him for everything and the hospital, and they need to have touch to the social determinants of health — felt powerless. Dr. Massie-Story explained points with them each day, so they use environmental dangers in homes or work- that this was emotional abuse and gave telemedicine rather than in-person visits. places, food deserts, lack of access to trans- the woman information about a women’s “Occasionally the IT doesn’t work and portation, and financial stress that can lead shelter. the patient can’t see me when I give advice to anxiety and depression. These factors “If I hadn’t taken the time to hear her through a telephone or a prompter,” says shape every patient’s biopsychosocial pro- story, I would have just treated her for the Dr. Massie-Story. “This one week, the file but may not always come up during infection,” she told the students. “Her device didn’t work for a patient and his a medical exam for a specific complaint. health inequity in this case was social iso- wife, but I was giving some advice and it During the 2020-21 academic year, lation and a lack of access to community was all great. The following week, the Dr. Massie-Story and colleague Sonja services (the women’s shelter) that could camera worked. I think they were more Harris-Haywood, M.D., associate dean help her.” astounded by the fact that I was a Black of curriculum integration and professor A class conversation recently centered woman than by the information they were of family and community medicine, on how students of all ages now misuse given! They were like, ‘Are you a doctor? co-moderated a virtual NEOMED panel ADHD medication to stay awake and “I said, ‘Yes, I’m Dr. Massie-Story, I on increasing diversity in health care. improve their performance. When the spoke with you last week.’ It’s just weird! Among the questions asked by students: topic turned to drugs in general, Dr. I think because such a small percentage What is an example of a health disparity Massie-Story confided that growing up, of doctors are Black women, patients are she had a drug-addicted brother who re- just getting used to the idea that people that a student might miss? Dr. Massie-Story told them about the quired most of their mother’s attention. who see patients look like me — including day she was working at a clinic and heard “When the critical times for the parent to my skin color and my natural hair.”

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Dr. Massie-Story can connect just as easily with a CEO as with people who live on the streets. She calls it a life skill, and it serves her well. Patients open up to her, which helps her to treat them. Yet after almost 25 years as a physician, Dr. Massie-Story says she still faces daily battles to prove herself. “I remember a gentleman who came into the examining room with this Confederate flag on his hat. He looked at me and rolled his eyes and I said, ‘Good morning, what brings you in today, how may I be of assistance?’ His response was, ‘You tell me.’ “When people come in with a defiant attitude, I refuse to leave the room, because I want to do my job. At the end of the visit, I always feel like I’ve opened up someone’s eyes to something they weren’t aware of. So, I was going to help him anyway. I got him to give me a history and I ended up doing an EKG that showed that he was having a heart attack. I did everything stat: got him labs, called EMS. All this stuff happened in minutes, after I got him to open up to me. If I had not been persistent, if I had not sensed there was a story behind his wall and been determined to help, I could have just blown him off and said, bye! But I wasn’t

going to let that happen. “Sometimes you’re dealing with folks who might not trust you and half the visit is having to tell them, ‘I’m qualified for the job.’ There are times when my visits last longer than my colleagues’, which has nothing to do with being slow. It’s just that part of the visit is spent confirming, yep, I’m a graduate of Case Western Reserve University School of Medicine. I’ve been a physician for almost 25 years.” “I tell my students (she sighs sympathetically) that they may not want to take that on as they are going through training, because they have so much coming at them. They’re learning something new; they’re trying to please their attending physicians on their rotation and the attendings change every four to six weeks. I tell them they may want to find a space where it’s ok to talk about how frustrating that was — but it may not be at that moment with that patient who, based on your response, may not even get it. You have to decide, how much do you want to truly invest?” But as she told students at a recent panel on increasing diversity in health care, “I show up ready to serve, and my patients know: I always have hope.”

A MENTOR TO STUDENTS

ow can a physician and patient both make the most of a home visit? Fourth-year College of Medicine student Carmen Javier prepared for such a house call with Dr. Massie-Story as the attending physician. Before visiting a patient’s residence in an underserved East Cleveland neighborhood, Dr. Massie-Story met first for 30 minutes with the group of medicine students in a nearby coffee shop to carefully discuss the patient and the neighborhood they were about to step into. What were the social determinants of health affecting the community? What available resources could they direct their patient to? During the home visit, “because of her own experience being raised in an underserved community, Dr. Massie-Story was able to uncover parts of the patient history that would otherwise have gone unnoticed,” Javier said. “For

example, she was quick to sense that our patient had a suicide plan in mind after our patient revealed that she wished she could ‘get away’ in her car.” Afterward, Dr. Massie-Story met with the students again at the coffee shop, to debrief, leaving Javier to reflect on her compassionate and thorough approach. Laura Allen, a third-year College of Medicine student, calls Dr. Massie-Story “a trustworthy, empathetic, and reliable mentor that we Black and Latinx students can wholeheartedly rely on,” not only in the classroom but as a moderator, panel member or attendee of events organized by the Student National Medical Association, Latino Medical Student Association or Black Student Association — NEOMED chapters of national organizations to serve underrepresented minorities in medicine.

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FEATURE

WHEN THE VIRUS MET THE ADDICT BY RODERICK L. INGRAM SR.

hat a time it was. The virus was spreading at an alarming rate. The recommended solution — conduct more testing, focus on prevention, provide treatment until a vaccine arrived — was somewhat effective, but not enough to stop the uncertainty that permeated every conversation held and every step taken. Progress seemed slow, with some dragging their feet due to lack of information, others from phobias or the pointing of fingers at population groups. Travel restrictions were implemented, albeit inconsistently. Some governments were ahead of the curve; others took a last-in, first-out approach to safety measures. And as the virus spread freely across every state in the country, many communities were also dealing with an epidemic of a different kind: drug addiction. E-ve-r-y single day, as we wondered who the virus’ next victim would be, recreational drugs infiltrated cities and homes, destroying the lives of thousands of individuals who became addicted. In their altered states of consciousness, they were the easiest prey of all.

ISN’T ONE CRISIS ENOUGH? The time: the mid- 80s. The virus: HIV. The drug: crack cocaine. The devastating impact on the African American and Latinx communities is well-documented. Hundreds of studies, Illustration: Malieka Gurrera

books and analyses have been written and conducted since then. Many conclude that our country’s systems not only failed these communities but aided in their demise. More than 30 years later, while there’s acknowledgement of society’s failure to provide equitable treatment for the aforementioned population groups, questions still remain about our country’s tendency to have an “us versus them” approach when faced with epidemics — today, with COVID-19 and opioid abuse. When the infected met the addicted, no one seemed to care — largely because they both were convicted. Blamed and ostracized. Shamed and criminalized as if they deserved what was happening to them. Left behind because they were mostly within certain populations — gays, Blacks, Hispanics, the poor, women. In an article titled “Measuring Crack Cocaine and Its Impact,” Harvard University and University of Chicago scholars dissect the myriad issues — the War on Drugs, media coverage, gang activity, acquired immunodeficiency syndrome (AIDS) — that combined with the prevalence of crack to create an exponentially more harmful impact on certain populations than crack itself. Among the social indicators were a doubling of homicides of Black males aged 14-17, increased incarceration of Black men, and increases in low birth weight and infant mortality for Black babies. While the

crack epidemic was also damaging to the Latinx community, its impact on whites was generally smaller.

HEALTH CARE AMONG OTHER SYSTEMS Where was the medical community during all of this? Was it just another system that failed these populations? And what was the discourse among mental health experts during this period? Health professionals associated crack use with the spread of AIDS and other sexually transmitted diseases. Yet a government document (“The Crack Cocaine Epidemic: Health Consequences and Treatment,” sent from the United States General Accounting Office to the Committee on Narcotics Abuse and Control, House of Representatives) dated January 1991 documented that no state-of-the-art treatment for crack users existed. Behavior and blame resulted in the mass incarceration, rather than treatment, of Blacks and Latinx people. Most of those imprisonments were for non-violent drug offenses including drug use, and many of those imprisoned suffered from mental illness. According to a 1990 National Institute of Mental Health study, more than 76 percent of cocaine users had at least one serious mental disorder, such as schizophrenia, depression or antisocial personality disorder.

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FEATURE

It is not a crime to have a mental illness,” says Ruth H. Simera, M.Ed., LSW, who serves as executive director of Northeast Ohio Medical University’s Coordinating Centers of Excellence. “Our Criminal Justice Coordinating Center of Excellence

ly exposed myself to HIV-contaminated blood. As a relative newlywed and Air Force Officer with a medical career ahead of me, my whole world had instantly changed.

You became the patient. (CJ CCoE) identiﬁes the best mental health practices I had to see an internist and an infectious disease doctor and to successfully divert people with mental illness from the go under an observation protocriminal justice system and to get them treatment.” col for the next several years. I had to be tested every six months for HIV and hepatitis. CJ CCoE of Ohio, which celebrates its 20th anniversary this year, combines with Fortunately, all tests were the Ohio Program for Campus Safety and Mental Health and with the Best Practices negative. And while none of in Schizophrenia Treatment (BeST) Center to comprise the Coordinating Centers the protocols changed immeof Excellence in the University’s Department of Psychiatry. diately following that incident, eventually — as other incidents occurred — protocols around needles and how you handle Randon S. Welton, M.D., The Margaret Clark Morgan Chair of Psychiatry them did change. at NEOMED, will help helm a NEOMED opioid use disorder clinic as part of the University’s new integrated primary and mental health care services set to roll out Did you have any experiences with through the next year. Dr. Welton’s own experience as a young physician in the 80’s patients addicted to crack cocaine and his work now with the Coordinating Centers of Excellence at NEOMED gives during that time? him a unique understanding of what happens when epidemics collide. Walter Reed is a military hospital, so How has medical treatment and and took all necessary precautions. Our there are limits on what patients are willprocedure was to take the blood from the ing to discuss. At the time, admitting to teaching changed from the height of the crack cocaine and AIDS epidemics patient and put it in separate vials so that drug use or homosexual activity could blood cultures could be drawn to check cause serious administrative problems, so to the current opioid use epidemic for bacteria. So, I did it, but as I was on no one would talk about those things. The and COVID-19 pandemic? I had a fairly frightening experience the HIV unit, there was some heightened acceptable standard response was that you visited a prostitute one time, and that was that highlights the differences between anxiety. what we’re doing today compared with 30 I drew blood from the patient with no how you contracted HIV. I heard that years ago. When the COVID-19 virus first problem, then I had to transfer the blood story countless times. No one on those hit last year, medical students were taken to the vials. When you do that you have wards at that time was talking about crack. After leaving the military I worked at out of hospitals for fear that they would to change the needle between each vial so an addiction recovery center for women. be exposed to the virus. In 1987, when there’s no contamination. As I was pulling HIV was getting big, I was a medical stu- the needle out of its sheath, it got stuck, Because of their addiction, some would dent on an internal medicine rotation. My so I pulled it especially hard. As the needle sell themselves for drugs. As a result, many team helped cover the HIV ward at Wal- jerked out, I reflexively brought my hands contracted hepatitis or HIV. (So-called back together. Upon doing so I drove the “crack babies” resulted as well.) Unfortuter Reed Army Medical Center in D.C. I had a patient with HIV who had a needle into my left thumbnail. There was nately, for a very long time when you treatfever. Our standard fever protocol was to enough force that it went through my ed someone for HIV, you didn’t treat them draw blood to see if patients had sepsis. I fingernail and into my thumb. I started for addiction — that was considered somegowned up, put on my mask and gloves bleeding and realized that I had potential- one else’s job. You treated one problem or

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the other. Things are much better now.

blaming, and general difficulty in focusing on a desire to treat instead of to punish. Our country seems to be able to only manage one crisis at a time. In this case, with more than 543,000 deaths in about the first 13 months of the pandemic, the virus became the focus. Some substance abuse facilities actually closed down because they couldn’t make social distancing work.

and attitudes; access to health care; access to technology for telehealth; substance In what ways? How are COVID-19 abuse; racial disparities; co-morbidities. NEOMED’s integrated primary and menpatients treated if they are also tal health care services is an example of addicted to opioids? Understanding the multiple interachow care has evolved to take a holistic tions between addiction and overall health approach to an individual. We’ve gained a is becoming more common. All of the lot by focusing on specialization and techaddiction programs that I’m aware of now nological interventions, but I fear we’ve provide education about COVID-19, HIV lost some of our awareness of the other and hepatitis. People suffering from aspects of patient’s lives. It’s good opioid use disorder (OUD) typithat as a psychiatrist I will be able cally are not socially distancing and to focus on mental illness, while unprotected sexual encounters are my colleagues may be looking at blood pressure or diabetes, because common. This is leading to a dual epidemic. Although it’s still very any of those individual factors may Our country seems to be able to early, all of the reports that I’ve seen also lead to the worsening of the show a dramatic increase in opiate others — including drug addiction. only manage one crisis at a time. ” deaths, from suicide and overdose. There are all sorts of terms for this – Randon S. Welton, M.D. We’ve seen a dramatic increase in — comprehensive care, whole-perOUD and a generalized increase son treatment, total patient care, or in mental health disorders. Healthy integrated care — but whatever you social support networks have disappeared want to call it, we need to treat each person for a lot of people during the pandemic, So, what have we learned? as an individual; a member of their family; so they rely on unhealthy coping strategies, We’ve learned a lot about the potential a member of their culture; and a member such as drug use. The isolation, job loss uses of technology, especially telehealth. of our society as a whole. And we have a better understanding and other stresses have reversed the trend What we‘re hearing is that telehealth endof abuse that had been dropping. The ed up being just as effective as in-person of that than we had 35 years ago. reports I’ve seen suggest that we’re going visits for many aspects of medicine. I perto be dealing with that outcome for years sonally have some concerns. I’m worried NEXT TIME Dr. Welton and many in the scientific about training future physicians to think to come. that patient care is something that we do community say this won’t be our last panHow is mental health care and medical over a phone or computer. What about demic. And one thing we learned from education different from in the 1980s? when this (COVID-19) goes away? Will the novel coronavirus of 2019 is that once We have a variety of medications today most care remain as telehealth visits be- we know what “it” is, our public health that we didn’t have years ago, with fewer cause it’s more convenient for providers and health professionals and researchers side effects. There has been an increase in and patients? Sure, there is a decrease in will again rise to slow its spread until we therapy and counseling, including social no-shows, a decrease in time needed be- can reduce its ability to harm us. But how workers and addiction counselors, along tween patients, and easier access. But what will we prepare for social cognition — the with peer counseling from folks who have about the benefits of listening, eye contact, various psychological processes that enable recovered from addiction themselves. Ad- touch and whole-person treatment? Treat- individuals to take advantage of being part diction and mental health disorders require ment via digital means doesn’t always of a social group? Will we continue to play help over an extended period of time — provide what can be given at the bedside. a blame game of “us versus them”? Unlike As far as the social determinants of the virus meeting the addict, this meeting months, even years, so peer specialists are invaluable. The idea that addiction is a health go, we’ve certainly come a long way of two forces — us and them — doesn’t disease has been around for some time, since the ‘80s in identifying the issues that have to be disastrous. but there is still a lot of shaming, a lot of affect people’s health — cultural awareness It can actually be a beautiful thing.

NORTHEAST OHIO MEDIC AL UNIVERSITY

FEATURE

SOCIAL MEDIA FOR PSYCHIATRISTS BY ELAINE GUREGIAN

Tapping into the power of social media, Christina Girgis, M.D. (’05), an associate professor of psychiatry at Loyola University in Chicago, connects psychiatrists across the country. More than 5,000 members belong to the Women’s Psychiatry Group that she founded on Facebook, and her Psychiatry Network group has 12,000 members. Dr. Girgis also established a psychiatry journal club on Facebook Live that offers Continuing Medical Education credit. Dr. Girgis talks here about the groups and the non-clinical skills she has developed to lead her peers.

n 2015 I was on maternity leave at home. I had lost the baby at the very end of the pregnancy, which was terrible. I was at home on social media a lot, biding my time, and I felt isolated. I thought, there must be a group of psychiatrists on Facebook, but I couldn’t find anything, so I started the Women’s Psychiatry Group. I added 50-75 people I knew or knew of, either from school or from the Chicago area, where I live. People added their friends and colleagues, and now we have over 5,000 members — all women psychiatrists. Initially, the purpose was to be a support group for women’s issues. We also have case discussions or bounce ideas off of each other, and we offer professional opinions related to our careers, which is a nice aspect of the group. In 2016, a lot of group members were saying, “Can I add my husband, who is also a psychiatrist?” or “I have residents in my program who would be really excited to join,” so I thought, why not start a group for all psychiatrists — residents, residents, men, women — that’s less a personal support group and more a professional network. Psychiatry Network snowballed to about 12,000 members. [The American Psychiatric Association has 38,000 members.]

LEADING BY LISTENING It’s easy to see what people’s needs are, because they’re constantly talking about them. For example, a couple of years ago, the American Board of Psychiatry and Neurology changed its process for 10-year board certification. You used to take an exam every 10 years, but in 2019 the board offered a pilot program that has since become permanent, in which psychiatrists would read a number of journal articles and then answer questions about them. If you passed, then you could continue to be certified. Although many felt it was convenient to do the work at your own pace, and were happy not to have to take

Illustration: Branden Vondrak

another standardized exam, others found the process to be anxiety-provoking and felt it would be a more worthwhile venture with CME attached. I heard my peers saying, “Give me CME!” I love finding a need and filling it, and so, I started a journal club on Facebook Live with CME available. As far as I know, this is the first series like it that anyone in medicine has created. Twice a week, different psychiatrists would present an article on Facebook Live video. People could watch live and ask questions, then there was a discussion. Afterward, they would go to this link that I had set up and answer a couple of questions and they could get CME credit for having watched the video. I’ve just uploaded all the videos to the Psychiatry Network YouTube channel. Even if you’re not in the Facebook Live group, you can still watch the videos and get the education there. I found a sponsor for the CME; it’s not cheap to set up. Even before the journal club idea, I Facebook messaged several educational companies. One of them responded and has since been a sponsor. At the last conference we had a room with four or five companies with tables. And in 2018 I set up a women's psychiatry conference which I think was the first of its kind in the U.S.

LAUNCHING INTO BUSINESS I don’t know if most medical schools prepare you for business or entrepreneurship. It’s a shame, because doctors have so many great ideas, and when we talk about things like burnout, now one of the recommendations is that if you want to prevent it, spend 20% of your time on something you love. So, what does that mean? That could be within clinical medicine or outside of clinical medicine as well. Physicians out there are teaching other physicians about managing their finances or how to invest their money in real estate or doing some type of leadership coaching. There are so many different things that people can get into if they want to, but physicians can go into them blindly sometimes. Personally, I’ve had to learn everything as I went. For example, I didn’t have any experience with setting up an LLC. I wondered: At what point in the progression of my business should I do it? How can I avoid putting my home address on there for privacy purposes? No one teaches you those things!

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FEATURE

GET USED TO IT BY ELAINE GUREGIAN

“I was eager, young and inexperienced as a new intern in August 2005. It was my second month of psychiatry residency training and the first time I recall a patient making a sexually inappropriate remark to me. I was rounding on one of the two locked inpatient psychiatry units at Rush University Medical Center, where patients with psychiatric issues and substance use disorders were admitted for a few days to weeks at a time. As locked units, this meant that patients could not leave without a physician releasing them. It was a lot of power to hold as a newly graduated physician and 26-yearold woman. “Each morning before we rounded with our attending psychiatrist, who supervised our cases, we would go in to see the patients on our own to check on how their night had gone. This patient, who I’ll call Mr. J, was admitted for cocaine use and suicidal

n retrospect, this patient was “likely trying to disturb the doctor-patient power dynamic — and he succeeded, reflects Dr. Girgis, a 2005 alumna of NEOMED who is the medical director for the Consultation Liaison Psychiatry Service at Edward Hines Jr. VA Hospital and an associate professor of psychiatry at Loyola University in Chicago. When Dr. Girgis dug in to research the topic, she found that women physiIllustration: Caitlin Kane

ideation, with severely depressed mood being a common symptom when withdrawing from cocaine. I knocked on the patient’s room, said good morning, and asked him how his night was. “Mr. J was lying in bed, sleeping, opened his eyes, looked at me, and said he was tired and didn’t want to talk. I explained to him that I needed to see how he was doing so that we could plan his care for the day. Mr. J., becoming visibly irritated, said to me, ‘Baby girl, just come back later and we can talk then.’ Surprised, and not sure how to respond, I said, ‘Uh, okay, that’s fine,’ and quickly left.” – from “Sexual Harassment” a chapter by Christina Girgis, M.D., in the 2020 book Burnout in Women Physicians: Prevention, Treatment and Management, Cynthia M. Stonnington, M.D., and Julia A. Files, M.D., editors.

cians are surrounded by harassers: their supervisors, their peers; their patients and their patients’ families. For women, harassment and silencing begin when they are medical students and residents at the low end of the medical hierarchy. They may feel too vulnerable to speak up, knowing that they will be evaluated by the person they speak to. They may not trust those in authority, and they may fear being considered weak,

writes Dr. Girgis. They may also be quickly put in their place by people like an ER attending physician who told Dr. Girgis, when she complained of being harassed during a medical school rotation, “You’re going into psychiatry; get used to it.” Now, as then, women have coped by doing just that, says Dr. Girgis. She writes, “Notably, perception of harassment (including sexual harassment NORTHEAST OHIO MEDIC AL UNIVERSITY

FEATURE

While all specialties in medicine are affected by sexual

Dr. Girgis has created her own mnemonic that she recommends for physicians in training:

harassment and gender discrimination, certain specialties are disproportionately affected and have historically reported higher rates — in particular, surgery and its subspecialties. One study in cardiothoracic surgery revealed that 90% of women trainees had experienced sexual harassment. Of women residents in general surgery training programs, over 70% reported experiencing sexual harassment. Another study in vascular surgery showed that 52% of women trainees had experienced sexual harassment, with the surgeon in the operating room most commonly being the perpetrator.” – Christina Girgis, M.D. and gender discrimination) has been found to decrease over time with training, as medical students have a higher perception than residents and fellows of the same behaviors. This indicates that either trainees learn to normalize harassment as part of the culture of medicine, or they develop a sense of learned helplessness to make it through the grueling years of residency.” It catches up with them. When women reach the age of residency, she writes, those who have experienced sexual harassment “reported higher rates of ethical or moral distress, and lower levels of vitality, or being energized by work.” Dr. Girgis cites a study surveying medical students and residents that showed those who experienced sexual harassment also reported “negative effects on feelings of safety and comfort at work, attitudes toward patients, ability to perform duties and general mental health.”

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With such alarming evidence of distress and harm to women, Dr. Girgis looked for solutions. So far, she said, “little policy or guidelines have been implemented by governing bodies for our most vulnerable population, resident physicians and medical students, despite that much attention has been paid to other issues impacting their well-being.” One bright spot she cites as an example of how things could improve: Since January 2020, health care professionals who renew their license in Illinois (Dr. Girgis lives in Chicago) have been required to complete sexual harassment training first. The topic of sexual harassment is rarely discussed in medical school or residency, says Dr. Girgis. And in the end, responsibility for ensuring that trainees feel competent to manage the issue rests with those at the top.

T H E PA S S I O N O F P H Y S I C I A N S , P H A R M A C I S T S A N D H E A LT H C A R E R E S E A R C H E R S

N I

C E T

R Y

OTICE if a patient

is sexually harassing you or someone else.

DENTIFY

any possible safety concerns in the room.

OMPOSE yourself

in order to determine next steps.

XIT when feeling

unsafe; express yourself if feeling uncomfortable.

ALK about the

behavior and not the person.

EPEAT and redirect

as needed during the discussion.

OU have a right to a

safe and comfortable work environment.

FEATURE

A NEOMED student and University administrator teamed up on a San Franciscobased initiative to coordinate COVID-19 response by emergency departments.

MAKING A BIGGER IMPACT BY ELAINE GUREGIAN

f you see an opportunity, seize it. If Gordon Hong had a mantra, that might be it. As the second-year College of Medicine student was growing up in a white suburban Cleveland neighborhood, Hong’s father and mother — immigrants who moved to the U.S in the ’70s from Vietnam and China, respectively — expected him to excel academically and to help out at their family restaurant. If it sounds like a model minority stereotype, that’s about right, he said at a Lunar New Year story slam hosted by NEOMED’s Asian Pacific American Medical Student Association. What can often be left out of the stereotype are the microaggressions faced by

Asian-Americans and their search for a sense of identity, Hong explained. As an undergraduate at Emory University in Atlanta, where he spent an additional year doing clinical research, Hong began finding his place in the world and in medicine. Today, he looks for ways that he and others will be able to make a bigger impact, beyond individual patient encounters. During his first year at NEOMED, Hong took over the helm of the Committee for Student Clinical Research. This year, he’s the co-president of that student organization, along with student Keval Yerigeri, who is taking a research year at the National Institutes of Health. The

University has a tradition of holding an annual poster day, when students interact with interested passers-by to explain and entertain questions about their work, which is supported in large part by the University’s annual Summer Research Fellowships. When it became clear that the usual poster day event couldn’t be held, due to continued COVID-19 health concerns, Hong got involved in planning an online version, called the Student Research Symposium. Complete with student hosts and breakout rooms for presentations, that version attracted 88 student posters and a buzz of comments and questions online. Last spring, looking around to learn more about clinical specialties, Hong heard

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The experience showed me a side of medicine that I think medical students don’t often get to see. It built not only my clinical skills but my sense of working with a team, being in a position of leadership, working with different parts of a system.” – Gordon Hong 18 I G N I T I N G

a podcast by a pediatric critical care intensivist out of San Francisco that caught his attention. This physician, Arup Roy-Berman, M.D., was talking about Elemeno Health, a company that he had started in Oakland, California to promote microlearning and sharing of clinical best practices and key information at the point of care in health care institutions. With zero connections to the company, Hong contacted it to see if it could use a summer intern. The answer was yes. And though the ensuing pandemic ruled out any move from Ohio to Oakland for the summer, Hong went to work virtually. His role included documenting best practices and disseminating them among the critical care practices (in particular, emergency departments) that were Elemeno clients. “In meetings, I got to work with a lot of different clients: health care providers, department leaders and even hospital CEOs. The experience showed me a side of medicine that I think medical students don’t often get to see. It built not only my clinical skills but my sense of working with a team, being in a position of leadership, working with different parts of a system,” says Hong. Mostly he was involved with a COVID-19 web app project Elemeno had taken on (see sidebar), and through it, he also came to know a consultant to Elemeno: Linda Lawrence, M.D., who had wide-ranging experience as a U.S. Air Force veteran and as a regional president of U.S. Acute Care Solutions, a physician-owned provider of emergency medicine and hospitalist services working with health care systems across the United States. Dr. Lawrence has also served on the American College of Emergency Physicians board. Talk about a coincidence: When Hong first met Dr. Lawrence, she was applying for a job at NEOMED — a position as associate dean for clinical faculty affairs at NEOMED, which she began

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in fall 2020. (She didn’t mention it to Hong, since she was then in the application process.) “One thing Dr. Lawrence and I talked about a lot was developing a culture of leadership in medicine, which I think is an increasingly important part of conversations in health care today,” Hong remembered in a later conversation. The topic means a lot to Dr. Lawrence, who enjoys mentoring students like Hong. “As a physician, you have much more to give the practice of medicine and your patients through your leadership and getting involved in other things. It can go far beyond just that single patient encounter. The earlier in your career that you start to realize that, the better,” she says. “One of the reasons I stayed in the military for so long was that they kept giving me new opportunities. When I realized all the things in the system that are challenged to make the optimal patient care happen, that’s when I was like, I want to get involved and make a difference! I want to make care better for the team that’s delivering it.” Dr. Lawrence believes Elemeno will help people conquer the frustration of thinking they have to know everything in their head as part of a health care team. When an overwhelming event like the COVID-19 pandemic happens, there is no single, irrefutable source of information — “no Bible truth of knowledge,” as she puts it. “Once you learn the Krebs cycle, you know it, and “It ain’t changin’!” jokes Dr. Lawrence. But experience as an emergency physician has taught her that health care practitioners constantly learn on the job and need to stay mentally nimble, so they can adapt and apply new information. A tool like the Elemeno app (and more specifically, its COVID-19 version of the app), allows physicians to lead in adopting best practices and sharing them with the

Clarity and coordination. That’s what emergency

A COVID-19 APP FOR EMERGENCY DEPARTMENTS

departments need so they can follow best practices under high-stakes circumstances. But with a virus that’s unknown and quickly spreading, chaos could easily take over. When an Oakland, California startup called Elemeno Health saw the confusion sowed by COVID-19, it moved quickly to fill a gap. Gordon Hong had just finished his first year in the College of Medicine and was doing a summer internship with Elemeno, so he was part of the team when the company partnered with the University of California San Francisco (UCSF) Emergency Department and the American College of Emergency Physicians (ACEP). Their goal: a web application that could share CDC guidelines — the gold standard — and the latest treatment protocols, as well as individual hospital practices, with emergency department teams. They adapted a prototype they already had in production, resulting in a model that follows ACEP standards and can be customized to each hospital. The Elemeno team was able to share best practices that started at the hospital where the app began, the University of California San Francisco Emergency Department. As the team learned more, additional information to share was included in the treatment protocols.

broader health care community. That’s the bigger-picture lesson of making a bigger impact that Dr. Lawrence would like students to take away. Hong agrees. “I’ve always had an interest in not only helping my patient but helping the next patient as well. I think this internship provided a unique opportunity for me to make a bigger change, to develop on a bigger scale on a side of medicine that I don’t usually see. I encourage other medical students to seek out opportunities to learn about medicine from a different angle. You’ll always have time to shadow and to do clinical rotations, but our time as medical students is limited. We need to seize these opportunities when we can.”

The ACEP COVID-19 ED Navigator helps staff in emergency departments keep up with updates to protocols and best practices in treating COVID patients. Elemeno offers the app for free to providers across the country. Approved by the American College of Emergency Physicians, it's now used in hospitals across the country. Hong was a co-author on a poster presentation about the app that the team shared at the California American College of Emergency Physicians AdvancED Conference. Sarah Koser, M.D., a UCSF Fresno Emergency Medicine resident, presented the poster, which won the conference’s award for “Highest Impact Project.” “When COVID-19 emerged in the U.S., everything was changing at a very rapid pace. I was able to help contribute to the app’s development and spread the word of this free tool to help health care institutions. The experience really showed me the importance of innovation in medicine and how it can make a difference in our patients,” says Hong.

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Collaboration is at the heart of what makes the NIH exceptional, and a striking humility inspires it. The lead faculty are premier experts in their ﬁeld, yet the ego of excellence is diluted when one’s colleagues are just as cutting edge.” – Keval Yerigeri

A CRASH COURSE IN RESEARCH BY KEVAL YERIGERI

College of Medicine student Keval Yerigeri took a year away from campus to participate in the Medical Research Scholars Program (MRSP) at the National Institutes of Health (NIH). Through this highly selective program, students from across the country experience research at the highest level and interact with world-class scientists. Yerigeri reflects here on what the standards of excellence and leadership at the NIH have meant to him.

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simple drive-by does not do justice to the sprawling NIH Bethesda campus. Unlike the austere white edifices of Walter Reed National Military Medical Center across the street, the National Institutes of Health are hidden behind multiple gates and a tall forest; several buildings such as the Clinical Center rise above the canopy. Once inside, the breadth of the campus becomes more obvious. The grounds are a jigsaw of 27 separate institutions, allowing labs to collaborate on clinical projects and share rare technologies. Collaboration is at the heart of what makes the NIH exceptional, and a striking humility inspires it. The lead faculty are premier experts in their field, yet the ego of excellence is

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Photo courtesy National Institute of Health

Even if I never hit the bench again, my wet lab experience taught me to appreciate the patience and thoroughness required of experiments. Delayed gratiﬁcation may be unpleasant and at times frustrating, but it is the mother of progress.” – Keval Yerigeri

diluted when one’s colleagues are just as cutting edge. Technologies such as gene editing and immunotherapy, which barely graze our med school curricula, are mundane here. I have seen my lab reach out to other specialties to test treatments, borrow customized molecular microscopes or transfer patients between clinical protocols. Medicine lies on a spectrum between the generalist and the specialist, and the NIH is on the extreme end of the latter. Every PI (principal investigator) has identified a niche and thrown their entire career behind exploring each nook and cranny. Just as generalists are critical for patient care, specialization is needed for the process of discovery. Paradigm-altering change may only come with intense focus, and it is the responsibility of the NIH to ensure that the resources are available when called upon. My goal in participating in the MRSP was to earn a crash course in research from the best. I have spent summers at Cleveland Clinic and Johns Hopkins, but two months, no matter how intense, is nothing in the scope of research. It may be enough to organize some clinical data, but seeing a project from start to finish often takes years. Even now, I am using this year to re-purpose our lab’s mesothelioma therapy for pediatric AML; one year would be insufficient to develop a therapy from scratch.

I believe medicine is at its best in a complete loop, where the clinician is aware of all the steps behind a therapy — from the wet lab to animal models to clinical trials and ultimately FDA approval. Even if I never hit the bench again, my wet lab experience taught me to appreciate the patience and thoroughness required of experiments. Delayed gratification may be unpleasant and at times frustrating, but it is the mother of progress. I hope to continue building these skills through residency, and possibly even return to the NIH for a fellowship in pursuit of my own niche. On my first visit to the NIH, other MRSP applicants and I were taken past a “hall of fame” to an introductory dinner. The walls were lined with Nobel prize winners and biomedical pioneers from the NIH. That walk was awe-inspiring for a student. I hope to never forget the feeling of humbled inspiration — a newcomer surrounded by a brilliant community with a hunger to serve, whether in rural medicine, global health or dedicated research. In the “hall of fame” or in the NIH labs, seeing the many ways in which careers can develop — sometimes unexpectedly — constantly reminds me: Strive for excellence and keep your eyes open. Who knows which patient case might present itself to capture my imagination and define my career as a physician-scientist? When that opportunity strikes, I’ll be ready.

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TASTES LIKE HOME

TASTES LIKE HOME BY SANJAY JINKA

he Walking Whales Barbell Club is an interprofessional club on campus for individuals who are interested in weightlifting and powerlifting. However, we’re not just for experienced lifters. WWBC works hard to recruit anyone who is interested in working out, eating healthfully, and maintaining a healthy lifestyle in general. We even have a list of no-equipment home workouts that you can try if you don’t have access to a gym or time to go to one! No matter if you are a beginner or an experienced lifter, nutrition is very important, so I want to share a two-part meal that is perfect after a long workout.

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Part 1 is the recovery shake. Combine 1 cup of milk, half a cup of frozen strawberries, a whole banana and a scoop or two of protein powder. Blend until it’s ready to drink. This snack is full of protein and quick-digesting carbs, exactly what you need after a workout to promote muscle growth. Part 2 is the actual meal: Air-fried chicken shawarma. Air fryers are all the rage these days, so I want to share a simple recipe you can make in 15 minutes (plus some marinade time). I’m Indian, so I was raised on Asian flavors. Chicken Shawarma is a Mediterranean twist on some of these flavors, and my mom used to make it for an afternoon snack, so it definitely reminds me of home!

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Photo: Chris Smanto

AIR-FRIED CHICKEN SHAWARMA Adapted from a recipe at bluejeanchef.com

Ingredients: 2 tablespoons olive oil

1 teaspoon salt

2 garlic cloves, minced

½ teaspoon freshly ground black pepper

Juice of 1 lemon 1 teaspoon ground cumin 1 teaspoon paprika

1½ pounds boneless chicken breasts (about 3 chicken breasts)

½ teaspoon ground allspice

4 pieces naan bread or fresh pita bread

¼ teaspoon turmeric

Hummus

¼ teaspoon ground cinnamon

Spinach

First, make the marinade: Combine the olive oil, garlic, lemon juice and spices in a small bowl and whisk well. Then, place the chicken in a zipper-seal plastic bag with the marinade. Massage the chicken in the bag to coat all sides with the marinade. It’s best if you let the chicken marinate overnight in the fridge, but if you don’t have time, a few hours will work, too. Next, pre-heat the air fryer to 380°F. Transfer the marinated chicken breasts to the air fryer basket and air-fry at 380ºF for 8 to 10 minutes, flipping the chicken over halfway through the cooking process. When done, slice the chicken breasts into pieces. Now, heat the naan/pita on both sides in a skillet with a little olive oil. Spread a little hummus on the warm naan bread. Place the sliced chicken on the naan with the spinach on top. Roll or fold the bread up around the fillings. You can wrap parchment paper or foil around half of the shawarma to keep it together. That’s it! If you freeze the extra, you’ll have meals prepared for the whole week. Adapted from bluejeanchef.com/recipes/chicken-shawarma-wrap/

I’m Indian, so I was raised on Asian flavors. Chicken shawarma is a Mediterranean twist on some of these flavors, and my mom used to make it for an afternoon snack, so it definitely reminds me of home!” – Sanjay Jinka College of Medicine Class of 2023

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LEADERSHIP SPOTLIGHT

nteracting one-on-one with patients housing development has a cockroach inwill always be special to Princess festation; however, because of finances they Ogbogu, M.D. (’00). But as Chief are unable to move to a different location. of the Division of Allergy, ImmunoloThe child has had many episodes of accidental food ingestion, the last one resultgy, and Rheumatology at University Hospitals Rainbow Babies & Children’s ing in an overnight hospitalization for Hospital in Cleveland, Ohio, the anaphylaxis. The parents are frustrated NEOMED alumna also seeks out opand unsure what to do next. portunities to make a broader mark – Excerpted from “Disparities in — for example, to help build pipelines Asthma and Allergy Care: What Can for underrepresented students to enter We Do?” by Princess U. Ogbogu, M.D.; medical school. Quinn Capers IV, M.D.; and Andrea Dr. Ogbogu (pronounced oh-BOJ. Apter, M.D.; published in The Journal goo; the first g is silent) serves on the of Allergy and Clinical Immunology: In American Board of Allergy and Practice, an official publication Immunology Board of Directors of the American Academy of Alas well as on the President’s Dilergy, Asthma & Immunology versity and Equity Advisory (AAAAI), Volume 9, Issue 2, Council at NEOMED. She also February 2021. conducts research, often related to issues of health equity and the FACTORS social determinants of health. A The authors addressed social BY ELAINE GUREGIAN determinants of health, looking recent journal article that she co-authored, “Disparities in at societal factors as well as strucAsthma and Allergy Care: What Can We Do?” looked at the tural bias underlying the family’s situation in Case 3. Among relationship between asthma and COVID-19. factors discussed by the researchers: “Earlier in the pandemic, people with asthma were really Redlining – the structural practice among financial institutions scared: ‘If I get this virus, what’s going to happen to me?’ says to deny loans and more to people based on their race or ethnicity, thus restricting access to better housing and health Dr. Ogbogu. “Over the last 12 months we learned that asthma is not as significant as a risk factor as we thought it could be Food deserts – poor access to healthy food, which in turn — that you might not have more severe [COVID-19] disease increases comorbidities of diseases just because you have asthma.” Jobs – overrepresentation of Black people in service jobs that rarely offer paid time off or paid health care Health education – less access to reliable health information IDENTIFYING INEQUITIES In the paper “Disparities in Asthma and Allergy Care: What Can We Do?” Dr. Ogbogu and her research partners laid out SOLUTIONS five case studies to demonstrate the many ways that social What could clinicians do to help in such a scenario? Dr. Ogbogu and her co-authors recommend: determinants of health — good and bad — affect everyone. Take part in diversity and communication training to help They noted that the COVID-19 pandemic has compounded health inequities. For example, in Chicago, where 30% of the clinicians understand medical recommendations in the context population is Black, 68% of the COVID-19-related deaths of their own beliefs. Training could include attending a were among Black people in summer 2020, when the paper cross-cultural communication course, such as the one created was written. by Dr. Ogbogu for the AAAAI. Case 3 Work with community health workers to understand the A 10-year-old Black boy presents to the allergist with severe patient’s cultural beliefs and help the patient understand medeczema and multiple food allergies. The child lives with his parents ical recommendations in the context of their own beliefs. Join committees or community organizations that are deand four siblings in an urban housing development in a food voted to reducing health disparities, similar to the mission of desert. On allergy testing, the child is sensitized to mouse, cockroach, the AAAAI Committee on the Underserved. dust mite, milk, egg, and peanut. The parents mention that the

ADVOCATING FOR HEALTH EQUITY: Princess Ogbogu

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Since 2003, Costas H. Kefalas, M.D. (’97), M.M.M., FACG, FASGE, AGAF, a professor in the Department of Internal Medicine, has practiced general gastroenterology at Akron Digestive Disease Consultants in Akron, Ohio, where he is the medical director of the Digestive Health Center. He also serves on the medical staff at Summa Health in Akron. Dr. Kefalas is the new president and chair of the board of directors of the GI Quality Improvement Consortium, Inc. (GIQuIC) — an educational and scientific joint initiative of the American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE). As he assumed this national appointment, he reflected on the value of taking leadership roles.

ness degree, a Master of Medical Management, at Carnegie Mellon, where the program's focus was on the core competencies of effective leadership, strategy and management skills. There are numerous business programs, including executive education programs, at other highly regarded universities across the country, and I encourage students to consider all of these options and to choose the program best for them. What advice would you give to help medicine or pharmacy students (or student researchers) prepare for leadership roles? First and foremost, review the mission and vision of the organization that you are considering serving. Do these reflect your personal and/or professional values and goals? If so, then get involved, early. The more experience you obtain in serving, the better. Volunteer for roles and positions in organizations that may not be desired; you can learn a lot about an organization and its members from these positions. Do well and give it your all, no matter in what role or position you serve. Your successful service at any given position will often open doors to you for additional positions within that organization. And of course, as the saying goes, “show up.” Successful service is dependent on being "present," both physically (or virtually, during these times) and mentally. At some point in your service, consider formal leadership education or training, especially if you have identified personal deficiencies in certain skills. The opportunities for education are vast, from weekend or weeklong courses, in person or online, to formal degree programs. The decision largely depends on your leadership educational goals.

SHOWING UP THROUGH SERVICE: Costas Kefalas

What interested you in the leadership/business/administrative side of medicine, and how did additional training prepare you? Over the years, I found that I was increasingly involved in leadership roles as these opportunities arose, not only at my practice and endoscopy center, but also within regional, state and national professional societies. Although over time I accumulated experience with this service, I also noted my deficiencies. The main reason I pursued a graduate degree mid-career was to formalize these experiences and practical knowledge that I had learned during my service, as well as to learn the key skills that I was lacking — namely, a broad understanding of business and finance. Business skills are not generally taught to medical students, residents, and fellows, but to successfully practice medicine in the 21st century, particularly in private practice and in academics, a baseline business education is generally of benefit. I was fortunate to complete my formal leadership training through the American Association for Physician Leaders (AAPL), a professional society that has partnered with multiple universities, including Carnegie Mellon University in Pittsburgh. This partnership allows students to complete prerequisite courses through APPL prior to entering business programs at the affiliated universities. I completed my busi-

Web extra: View videos of health care thought leaders speaking on VITALS — NEOMED’s Visionary Health Leadership in Action speaker series — at neomed.edu/vitals.

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CLASS NOTES

1985

1997

2003 Timothy Ko, M.D., has joined the Pain Management Center staff of St. Vincent Charity Medical Center and its partner, Pain Management Group. Dr. Ko will practice at the Center’s offices in Independence, Ohio.

2008

Donald Malone, M.D., currently the president of Lutheran Hospital, was named the president of Ohio Hospitals and Family Health Centers. In his new role, he will oversee Cleveland Clinic’s main campus, as well as all Ohio regional hospitals, family health centers and ambulatory sites. A practicing psychiatrist, Dr. Malone joined Cleveland Clinic in 1989.

Brandon Weeks, M.D., has been appointed as medical director of Hillside Rehabilitation Hospital in Warren, Ohio. Dr. Weeks has served as a physical medicine and rehabilitation physician at Hillside since 2017. Costas Kefalas, M.D., has been named president and chair of the board of directors of the GI quality Improvement Consortium, Inc., which is the largest gastroenterology quality data registry in the U.S.

1998

1992 Anju Mader, M.D., was appointment chief integration officer at Stark County (Ohio) Mental Health & Addiction Recovery.

1995 Michelle Gill, M.D., has been serving on the Hopi Reservation in Northeast Arizona throughout the COVID-19 pandemic. Shruti Singal, M.D., was named vice president of Medical Management at First Choice Health, focusing on premier medical care and innovation and strategy.

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T H E PA S S I O N O F P H Y S I C I A N S , P H A R M A C I S T S A N D H E A LT H C A R E R E S E A R C H E R S

2009 Vikram Krishnasamy, M.D., won the Samuel J. Heyman Service to American Medal in the Emerging Leaders category. The Service to America awards, known as the Sammies, honor federal government workers who have made significant contributions to the health, safety and prosperity of our country. Dr. Krishnasamy is a medical officer at the Centers for Disease Control and Prevention.

2013

Nida Felicija Degesys, M.D., medical director of the Geriatric Emergency Department (GED) at University of California San Francisco, received a three-year, multimillion dollar grant to improve the care of geriatric and dementia patients in the emergency department. Dr. Degesys also published her research on N95 mask reuse and extended use in JAMA's June 2020 publication and subsequently was awarded a grant from the CDC Foundation to continue this research in a nationwide multi-center study.

Fadi Sweiss, M.D., joined the neurosciences team at UPMC in Pennsylvania. A neurosurgeon, Dr. Sweiss specializes in diagnosis and surgical treatment of degenerative, traumatic and oncologic spinal conditions.

2014

Patrick Divoky, Pharm.D., was recognized as the recipient of the College of Pharmacy’s Distinguished Alumni Award. The award is presented to an individual who has made distinguished contributions to the practice of pharmacy or who has demonstrated major accomplishments in a professional pharmacy practice or in pharmaceutical research and development.

2015

Elizabeth Zeleznikar (Carter), Pharm.D., welcomed twin boys, Owen and Emmett, on November 11, 2020. Dr. Zeleznikar and her husband, Daniel, are also parents of a daughter, Katherine, who recently turned two.

NORTHEAST OHIO MEDIC AL UNIVERSITY

CONGRATULATIONS to the NEOMED CLASS oƒ 2021! Your hard work and perseverance in earning your degrees will be an inspiration for all those who follow in your footsteps. We proudly welcome the future leaders of health care to the NEOMED Alumni Association. Follow us on Facebook to stay connected or visit neomed.edu/alumni. Corrie Stofcho, M.D. (’06) President of the NEOMED Alumni Association

MEHOOL PATEL, M.D. ( ’98 ) Associate Chief Medical Ofﬁcer, IBM

Join Dr. Patel for his frank insight on … VALUE-BASED • INNOVATION • TECHNOLOGY • ADVOCACY • LEADERSHIP • SERVICE

Join the discussion, Thursday, May 6 at 5 p.m. Visit neomed.edu/VITALS to learn more and register. Free CE credits available!

N ORTH E AST OHIO MEDICAL UNIVERSIT Y

A L U M N I A S S O C I AT I O N

Dr. Robert Liebelt and Mrs. Milotka Liebelt Dr. Seilesh Babu '97 and Dr. Abbey Crooks-Babu '99 Dr. David Mallamaci '97 and Mrs. Sarah Mallamaci Ms. Frances Battles Johnson* Dr. Gagandeep Mangat '98 and Dr. Mona Mangat '96 Ms. Dorothy Bench Mr. Ian Oppenheim and Ms. Marta Williger Dr. Robert Blacklow and Mrs. Winifred Blacklow Dr. Ann Otto and Mr. David Otto Mr. Joseph Block** and Mrs. Genevieve Block* Mrs. Janice Parry and Mr. George Parry Dr. Louis Bloomberg* Dr. Vimal Patel '96 and Mrs. Neepa Patel Ms. Martha Boyle* Dr. Marvin Platt Dr. Eleanor Bozeman* Mr. Jim Rapp and Mrs. Judy Rapp Mr. William Bruder* Dr. Gerald Read* and Mrs. Victoria Read* Ms. Emily Bukovec* Mr. Roy Richards and Mrs. Robin Richards Ms. Thelma Clark* Ms. Lesleigh Robinson Mr. Irwin Cohn* Mrs. Maria Schimer Mrs. Mary Kay Davis Price* Dr. Steven Schmidt and Mr. Rick Krochka Mr. Fred Davis* Mrs. Patricia Schubert and Mr. James Schubert* Mrs. Erthelee Dosch* Mr. Bruce Sherman and Mrs. Carol Sherman Mr. Doug Draher Mrs. Jean Smith and Dr. Buel S. Smith* Mr. Ron Edwards Dr. Jimmy Snoga* and Mrs. Harriette Snoga* Dr. Michael Huang '97 and Mrs. Joy Huang Dr. Philip Stepaniak '83 Mr. Brent Hutchinson and Mr. Clarence Strouss, Jr.* Mrs. Amy Hutchinson Mr. Stanley Strouss* Mrs. Mary Jane Huth and Mr. Greg Huth Ms. Alice Taggart* Mrs. Janet Igel and Dr. Howard J. Igel* Mr. Frank Vari and Mrs. Helen Vari Mr. Charles Isenman Mrs. Eleanor Watanakunakorn and Dr. Clarence Josephson* Dr. Chatrchai Watanakunakorn* Dr. Kashyap Kansupada '91 and “We make a living by what we get, but Dr. Philip Westerman and Mrs. Janice Westerman Dr. Ameesha Kansupada Dr. E. Jay Wheeler and Mrs. Carol Wheeler Mrs. Shobhana Kansupada we make a life by what we give.” Mrs. Veronica Willo* and Mr. Bharat Kansupada* – Winston Churchill Mr. Ronald Wire Dr. C. William Keck and Mrs. Ardith Keck Dr. Carmen Julius '87 and Dr. Lyn Yakubov '86 Dr. Albert Kim '97 and Mrs. Mary Anne Kim Mrs. Carole Yassine and Dr. Zouhair C. Yassine* Mr. Lionel Kinney and Mrs. Vilma Kinney Anonymous (3) Dr. Amy Lee '88 Mr. Richard Lewis and Mrs. Joyce Lewis *Of Blessed Memory Mr. Theris Thompson Lewis*

THE NEOMED

{ LEGACY SOCIETY } We thank these generous community members for their foresight in helping to create transformative health leaders through their estate plans. This list is current as of April 7, 2021. Since this is the ﬁrst public listing of the NEOMED Legacy Society, we may not know about your future gift to the NEOMED Foundation. We regret any omissions. Please contact us if we have not listed your name above so we may update our records in future publications.

If you have questions about how any portion of your estate could beneﬁt future NEOMED students and improve the health outcomes in our community, please contact Senior Development Ofﬁcer Michael A. Wolff, J.D., at 330.325.6667 or at mwolff@neomed.edu.

DONOR SPOTLIGHT

TAKING A BETTER LOOK AT DARK SKIN BY ELAINE GUREGIAN

hen the Black Lives Matter movement picked up steam, it resonated with students in the Dermatology Interest Group at NEOMED. “We thought the Black Lives Matter movement was very relevant, obviously, to all societal issues and health care as a whole, but we thought it was especially relevant to dermatology. A lot of conditions are undiagnosed or misdiagnosed on skin of color because medical students aren’t trained to see those images,” says Sarah Eley, a second-year College of Medicine student. Equity in health care is a huge social justice issue, one that needs to be better addressed in training, says Eley. She and her classmate Rachel Krevh realized that physicians don’t always have enough information or training to diagnose conditions on darker skin, due to a lack of representation in textbooks and other resources.

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“It doesn’t make sense to me how we just deny people access to health care for different reasons, like economic status or skin color. I think being able to receive health care is a basic human right, and being misdiagnosed or undiagnosed due to a physician’s not knowing what conditions look like on skin of color is just unacceptable.” Eley went to the interest group’s co-faculty advisor, Eliot Mostow, M.D., a dermatologist and professor of internal medicine. When she told him that she didn’t see many images of people of color on the PowerPoints for a class she was taking, Infection and Immunology, he asked her to do some research. Challenge accepted! Once Eley tallied up a list, she and her classmates went to see Simon Robins, a reference librarian in the NEOMED Library. Did he know of more resources that could be added to the curriculum? She had come to the right place. Robins had more than an

T H E PA S S I O N O F P H Y S I C I A N S , P H A R M A C I S T S A N D H E A LT H C A R E R E S E A R C H E R S

Photo: Chris Smanto

several different plaques are shown that may not have red borders — some appear more white, while others appear darker. This allows psoriasis to be viewed in a more diverse range than what a student or physician may typically think of, which is important for identification in future clinical practice.” And the tool’s usefulness extends beyond dermatology, the students discovered. “For endocrine, gastrointestinal, and cardiovascular diseases, the outward appearance of these conditions may be viewed on diverse patients, which trains one’s brain to see the characteristic features of fat buildup, bloating or blanching on all skin types, instead of solely on the white patient typically shown in textbooks,” says Krevh.

MAKING A RESOURCE A REALITY Dr. Mostow was already a proponent of VisualDx, which he used at Cleveland Clinic Akron General. The only thing standing between NEOMED and this diagnostic tool was a licensing fee. That’s when Dr. Mostow turned to a pair of anonymous donors who had set up a skin cancer and wound education Three conditions, each of which looks different depending on the patient’s skin color: Top, fund at NEOMED Foundation. Being cellulitis; middle, an exanthematous drug eruption; bottom, I Immunoglobulin A vasculitis. able to diagnose skin of every color just made sense to Dr. Mostow, who explains, Excel sheet to back up Eley’s observation. He shared an article “I think this is a really important part of NEOMED’s diverin The Journal of the American Academy Dermatology that had sity, equity and inclusion mission, and it has the potential to recently reviewed 15,445 images in commonly used resources make a big impact on both faculty and students.” The donors agreed to allow Dr. Mostow to use the fund for — six textbooks, two online resources — and found that only 19.5% were dark-skinned images. But one online resource licensing. As of January, VisualDx became a resource on cammentioned in the article included more dark-skinned images pus. Now, any eligible NEOMED Library user can access the than the rest: VisualDx. tool, on campus or off, via a website. Students in the DermaMultiple images are provided for skin conditions, including tology Interest Group have taken it upon themselves to help eczema, psoriasis and melanoma. their peers get familiar with the new tool, with options such as participating in VisualDx national seminars held each month. Rachel Krevh explains, “Under the images for psoriasis in the dermatology section, for example, there are a variety of As Krevh says, “It’s important for us students to fine-tune skin colors represented, each showing the inflammation and our recognition skills and stay updated on new findings for plaque formation. On white skin, these plaques may be rechealth conditions that affect all races, genders, ethnicities — ognized as white with red margins. On black or brown skin, and ultimately, humankind.”

NORTHEAST OHIO MEDIC AL UNIVERSITY

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It’s likely that the health professionals providing care, medical therapies and information to you are connected to NEOMED in some way. Three Colleges – Medicine, Pharmacy and College of Graduate Studies Six Research Focus Areas Programs and centers that provide services and best practices throughout Ohio and beyond

CREATING TRANSFORMATIONAL LEADERS

NEOMED alumni live and practice in every state of the U.S. Physicians, pharmacists and scientists; educators, public and allied health professionals — They serve at hundreds of clinical sites, pharmacies and other institutions. And many of them return to live, work and lead in Northeast Ohio.

FOR AND FROM OHIO

Ignite Magazine | Spring 2021

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