NORTHEAST OHIO MEDICAL UNIVERSITY

About the cover:

Branden Vondrak is a graduate of Kent State University, a NEOMED partner school.

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DEPARTMENTS FEATURES

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22 TASTES LIKE HOME 26 CLASS NOTES 30 DONOR SPOTLIGHT

e Association of American Medical Colleges (AAMC) selected “ e LMSA E ect: 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 e Robert G. Fenley Writing Awards/General Sta Writing category of the national 2021 AAMC Group on Institutional Advancement (GIA) Awards for Excellence competition. e 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

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FORGING FUTURES Mary Massie-Story, M.D., has determination to spare — and share. MAKING A BIGGER IMPACT A medical student found his way into working on an app for emergency departments to coordinate treatment during the COVID-19 pandemic.

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WHEN THE VIRUS MET THE ADDICT e collision of a viral pandemic and drug epidemic has had an exponential impact — again.

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

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

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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.”

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

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. at’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 nds 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 with mental illness, trouble “I can shape minds and talk to young people ABOUT THAT HAIR Authenticity, from her with drugs, even homeless- about how to maneuver, not just through natural hair to her warm, ness for a few years. Still, someone always medicine but through life. I’m stubborn. I direct manner, de nes Dr. Massie-Story. came through for Mary at know I can help someone see there are ways Historically, Black womthe right time, allowing her to deal with obstacles and grievances. I can en seeking acceptance in to pursue an inner drive to professional work settings become a physician. e help them do it the right way and not have have straightened their hair tough early start shaped Dr. all the head knocks I had when I was younger to fit into white norms. Massie-Story, and today she Whether it’s cornrows, Afros works to raise appreciation and sometimes my mouth got in the way!” 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 re- professional” when they venceiving end of health care. ture outside of straight hair e 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 want- When 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 ght 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

minute you enter the examination room, other providers muttering “frequent ier” 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 rst name. It’s mitted infection (STI) check. When Dr. the attention they need. ere 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.

One sure sign of respect There are certain words that a Black eir reaction? “My stuis to look at your patient with person may hear differently than a white dents were like, “Oh my your whole body facing gosh, that’s really something them: “ at tells them that person. “History” is one. If you ask a Black to see it from the perspective you’re there to attend to their person if another doctor asked her about of the other victims." she needs,” she says. Transition- says. Laura Allen, a College ing to electronic medical re- her history, they’ll answer, ‘No, she never of Medicine student, says the cords two decades ago was asked me about my mama or my daddy.’ way Dr. Massie-Story talks tough for her because she had to look at a computer key- You need to say, “Did the doctor ask you about her own life is “extremely relatable,” making board to type notes while about your medical history?” her a valued mentor. conversing with the patient. “I’m all about storytelling, A BATTLE A DAY story sharing and appreciat- One 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 o 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. e 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 nancial stress that can lead shelter. the patient can’t see me when I give advice to anxiety and depression. ese 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. “ is one week, the le 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 speci c 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. e 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! ey 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 con ded that growing up, of doctors are Black women, patients are that a student might miss? she had a drug-addicted brother who re- just getting used to the idea that people

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.”

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 ag 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 de ant 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 stu 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 o 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 quali ed for the job.’ ere 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 con rming, 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. ey’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 nd 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

How 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 rst for 30 minutes with the group of medicine students in a nearby co ee shop to carefully discuss the patient and the neighborhood they were about to step into. What were the social determinants of health a ecting 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 co ee shop, to debrief, leaving Javier to re ect 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.

WHEN THE VIRUS MET THE ADDICT

BY RODERICK L. INGRAM SR.

What a time it was. e virus was spreading at an alarming rate. e recommended solution — conduct more testing, focus on prevention, provide treatment until a vaccine arrived — was somewhat e ective, 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 ngers at population groups. Travel restrictions were implemented, albeit inconsistently. Some governments were ahead of the curve; others took a last-in, rst-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 di erent kind: drug addiction. E-ve-r-y single day, as we wondered who the virus’ next victim would be, recreational drugs in ltrated 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? e time: the mid- 80s. e virus: HIV. e drug: crack cocaine. e devastating impact on the African American and Latinx communities is well-documented. Hundreds of studies, 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 immunode ciency 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 (“ e Crack Cocaine Epidemic: Health Consequences and Treatment,” sent from the United States General Accounting O ce 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 o enses including drug use, and many of those imprisoned su ered 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.

ly exposed myself to HIV-contaminated blood. As a relative

It is not a crime to have a mental illness,” says Ruth H. Simera, newlywed and Air Force O cer

M.Ed., LSW, who serves as executive director of Northeast with a medical career ahead of me, my whole world had in-

Ohio Medical University’s Coordinating Centers of Excellence. stantly changed.

“Our Criminal Justice Coordinating Center of Excellence You became the patient. (CJ CCoE) identifi es the best mental health practices I had to see an internist and to successfully divert people with mental illness from the an infectious disease doctor and 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

CJ CCoE of Ohio, which celebrates its 20th anniversary this year, combines with months for HIV and hepatitis. the Ohio Program for Campus Safety and Mental Health and with the Best Practices Fortunately, all tests were in Schizophrenia Treatment (BeST) Center to comprise the Coordinating Centers negative. And while none of of Excellence in the University’s Department of Psychiatry. the protocols changed immediately following that incident, eventually — as other incidents occurred — protocols Randon S. Welton, M.D., e Margaret Clark Morgan Chair of Psychiatry around needles and how you handle at NEOMED, will help helm a NEOMED opioid use disorder clinic as part of the them did change. University’s new integrated primary and mental health care services set to roll out through the next year. Dr. Welton’s own experience as a young physician in the 80’s Did you have any experiences with and his work now with the Coordinating Centers of Excellence at NEOMED gives patients addicted to crack cocaine him a unique understanding of what happens when epidemics collide. during that time? 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 willteaching changed from the height of procedure was to take the blood from the ing to discuss. At the time, admitting to the crack cocaine and AIDS epidemics patient and put it in separate vials so that drug use or homosexual activity could to the current opioid use epidemic blood cultures could be drawn to check cause serious administrative problems, so and COVID-19 pandemic? for bacteria. So, I did it, but as I was on no one would talk about those things. e

I had a fairly frightening experience the HIV unit, there was some heightened acceptable standard response was that you that highlights the di erences between anxiety. visited a prostitute one time, and that was 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 rst 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. out of hospitals for fear that they would to change the needle between each vial so After leaving the military I worked at be exposed to the virus. In 1987, when there’s no contamination. As I was pulling an addiction recovery center for women. 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 re exively brought my hands contracted hepatitis or HIV. (So-called ter Reed Army Medical Center in D.C. back together. Upon doing so I drove the “crack babies” resulted as well.) Unfortu-

I had a patient with HIV who had a needle into my left thumbnail. ere 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 ngernail 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

the other. ings are much better now.

blaming, and general di culty in focusing and attitudes; access to health care; access on a desire to treat instead of to punish. to technology for telehealth; substance In what ways? How are COVID-19 Our country seems to be able to only abuse; racial disparities; co-morbidities. patients treated if they are also manage one crisis at a time. In this case, NEOMED’s integrated primary and menaddicted to opioids? with more than 543,000 deaths in about tal health care services is an example of

Understanding the multiple interac- the first 13 months of the pandemic, how care has evolved to take a holistic tions between addiction and overall health the virus became the focus. Some sub- approach to an individual. We’ve gained a is becoming more common. All of the stance abuse facilities actually closed lot by focusing on specialization and techaddiction programs that I’m aware of now down because they couldn’t make social nological interventions, but I fear we’ve provide education about COVID-19, HIV distancing work. lost some of our awareness of the other and hepatitis. People su ering from aspects of patient’s lives. It’s good opioid use disorder (OUD) typi- that 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 common. is is leading to a dual blood pressure or diabetes, because epidemic. Although it’s still very any of those individual factors may early, all of the reports that I’ve seen Our country seems to be able to also lead to the worsening of the show a dramatic increase in opiate only manage one crisis at a time. ” others — including drug addiction. deaths, from suicide and overdose. ere are all sorts of terms for this We’ve seen a dramatic increase in – Randon S. Welton, M.D. — 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. e isolation, job loss uses of technology, especially telehealth. of our society as a whole. and other stresses have reversed the trend What we‘re hearing is that telehealth end- And we have a better understanding of abuse that had been dropping. e ed up being just as e ective 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 to come. about training future physicians to think Dr. Welton and many in the scienti c 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 di erent 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 e ects. ere 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 bene ts 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 months, even years, so peer specialists are As far as the social determinants of the virus meeting the addict, this meeting invaluable. e 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 a ect people’s health — cultural awareness It can actually be a beautiful thing.

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 o ers Continuing Medical Education credit.

Dr. Girgis talks here about the groups and the non-clinical skills she has developed to lead her peers.

In 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 nd 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 o of each other, and we o er 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. [ e 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 certi cation. You used to take an exam every 10 years, but in 2019 the board o ered 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 certi ed. Although many felt it was convenient to do the work at your own pace, and were happy not to have to take 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 nding a need and lling it, and so, I started a journal club on Facebook Live with CME available. As far as I know, this is the rst series like it that anyone in medicine has created.

Twice a week, di erent 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 ve companies with tables. And in 2018 I set up a women's psychiatry conference which I think was the rst 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? at could be within clinical medicine or outside of clinical medicine as well. Physicians out there are teaching other physicians about managing their nances or how to invest their money in real estate or doing some type of leadership coaching. ere are so many di erent 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!

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 rst 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. is patient, who I’ll call Mr. J, was admitted for cocaine use and suicidal 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 ne,’ 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.

In retrospect, this patient was “likely trying to disturb the doctor-patient power dynamic — and he succeeded, re ects 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 physicians 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. ey may feel too vulnerable to speak up, knowing that they will be evaluated by the person they speak to. ey may not trust those in authority, and they may fear being considered weak, writes Dr. Girgis. ey 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

While all specialties in medicine are affected by sexual 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. is 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 e ects on feelings of safety and comfort at work, attitudes toward patients, ability to perform duties and general mental health.”

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

NOTICE if a patient is sexually harassing you or someone else.

IDENTIFY

any possible safety concerns in the room.

COMPOSE yourself in order to determine next steps.

EXIT when feeling unsafe; express yourself if feeling uncomfortable.

TALK about the behavior and not the person.

REPEAT and redirect as needed during the discussion.

Y

OU have a right to a safe and comfortable work environment.

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

If 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 nding 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 rst year at NEOMED, Hong took over the helm of the Committee for Student Clinical Research. is 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. e 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

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

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. e 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 di erent clients: health care providers, department leaders and even hospital CEOs. e 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 di erent 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 rst met Dr. Lawrence, she was applying for a job at NEOMED — a position as associate dean for clinical faculty a airs at NEOMED, which she began 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. e 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. e 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 di erence! 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 speci cally, 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 fi ll a gap.

broader health care community. at’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 di erent 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.”

Gordon Hong had just fi nished his fi rst 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.

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.

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 fi eld, 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). rough this highly selective program, students from across the country experience research at the highest level and interact with world-class scientists. Yerigeri re ects here on what the standards of excellence and leadership at the NIH have meant to him. Asimple drive-by does not do justice to the sprawling NIH Bethesda campus. Unlike the austere white edi ces 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. e 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. e lead faculty are premier experts in their eld, yet the ego of excellence is

Even if I never hit the bench again, my wet lab experience taught me to appreciate the patience and thoroughness required of experiments. Delayed gratifi cation 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 identi ed 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 nish 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 insu cient 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 grati cation 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 rst visit to the NIH, other MRSP applicants and I were taken past a “hall of fame” to an introductory dinner. e walls were lined with Nobel prize winners and biomedical pioneers from the NIH. at 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 de ne my career as a physician-scientist? When that opportunity strikes, I’ll be ready.