Tampa Bay Medical News August 2015

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PHYSICIAN SPOTLIGHT PAGE 3

Kevin Makati, MD ON ROUNDS

USF Health: An Integral Cog Coming to Downtown Tampa’s Wheelhouse Heart Health Institute will Center USF Medical Corridor

By LyNNE JETER

Editor’s Letter The Times They Are a-Changin’ Undergoing transformative change, this industry has been tasked with fundamentally altering delivery methods and asked to meet heightened consumer expectations and increased demands for interaction and engagement. ... 4

The University of South Florida (USF) is moving ahead with a bold plan to build its new medical school in downtown Tampa, buoyed by state lawmakers’ allocation of $17 million for the project. The funding was approved as part of the state budget in an early summer special session.

The USF Health Morsani College of Medicine (MCOM), to be co-located downtown in a single facility with the USF Health Heart Institute, will bring together medical education, translational research and clinical care under one roof.

The co-location will help transform healthcare in the region by putting students closer to major teaching partner (CONTINUED ON PAGE 7)

WHO’S TENDING OUR DOCTORS?

The Plight of Physicians-in-Training Starting in medical school, stress and depression impact rising percentage of students; profession-wide, suicide claims a doctor a day

By LYNNE JETER

On the night of June 21, 2012, Greg Miday, MD, scribbled a note before settling in for a hot soak with candles flickering, music playing – and a scalpel in hand: “This is just the end of the line for my particular train,” he wrote in a goodbye note. The following morning, his body was discovered, major arteries severed.

Miday, 29, an instructor of medicine for the Washington University School of Medicine (WUSM) and a hospitalist with Barnes-Jewish (CONTINUED ON PAGE 10)

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Keep your finger on the pulse of Tampa Bay’s healthcare industry at TampaBayMedicalNews.com

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PhysicianSpotlight

Restoring Old to New Electrophysiologist Kevin Makati, MD, Making History at St. Joseph’s

By JEFF WEBB

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cardiothoracic surgeon Andrew Sherman, MD, said Gay. “We were already recognized as a Center of Excellence,” Makati said earlier this year before making a presentation to the 2015 Heart Rhythm Society conference, “but now we are recognized as having the expertise to allow people to be trained by us.”

Makati said he “wears a lot of hats” outside the labs. In addition to his private practice in Lutz, Tampa Cardiac Specialists, which he co-founded in 2009 with interventional cardiologist Christopher

Pastore, MD, Makati also does clinical research, and is working on two grants now.

He also sits on the board of directors of the BayCare Physicians Partners Clinically Integrated Network, which serves as an umbrella organization for the health system’s 13 not-for-profit hospitals, 17 outpatient clinics and more than 2,800 physicians. “I probably spend about 25 percent of my time” doing administrative duties, he said.

Unlike many physicians who decide as children they want to be doctors, Makati’s interest in medicine did not blossom until “very late in college,” he said, when

his father, who emigrated from India and is a civil engineer in Tampa, was diagnosed with chronic diabetes. But after earning the prestigious Scholar of the College award at Boston College, he enrolled at the University of Connecticut School of Medicine, where he knew early on he was destined to be a cardiologist.

Upon graduation, Makati completed his internal medicine residency at Washington University School of Medicine in St. Louis. He then returned to Boston, where he did a residency in interventional (CONTINUED ON PAGE 6)

BayCare Medical Group Welcomes K. Eric Sommers, MD, FACS | Thoracic Surgery

Dr. K. Eric Sommers is board certified in thoracic surgery, and his clinical interests include robotic surgery and surgical thoracic oncology. In addition, he has held a number of academic appointments, including associate professor of surgery at University of South Florida in Tampa, Florida. Dr. Sommers is a fellow of the American College of Surgeons.

Education ■ Doctor of Medicine – Northwestern University Medical School; Chicago, Illinois Internship ■ General and Thoracic Surgery – University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania Residency ■ General and Thoracic Surgery – University of Pittsburgh Medical Center; Pittsburgh, Pennsylvania BC1505369_0715

LUTZ - If Kevin Makati had not become a very specialized cardiologist, he most likely would have become a very special carpenter.

“I spent most of my childhood as an apprentice to a carpenter, repairing homes” in suburban Boston, he said. “So many of the structures were old, and if you can’t build new, you have to repair old. …

Essentially you are restoring old to new.” said Makati, who now sees why “cardiology seemed to be a perfect fit.”

“It requires an understanding of fluid mechanics, is highly dependent on manual dexterity as a craftsman would need, and it has benefitted from technological innovation to fix and restore old parts to new,” said Makati.

In carpentry, “there is a satisfaction one gains from creating something and knowing the attention to detail, and the patience required has paid off in the final product,” Makati continued, extrapolating his analogy with cardiology. He gets a similar gratification from helping patients.

“I have been teased that sometimes I take more time admiring work than it actually takes to create it,” he said. “I take pride in what I do …”

Indeed, Makati’s accomplishments thus far indicate a determined combination of academic acumen, hard work and innovation. He has five board certifications: Cardiovascular diseases, clinical cardiac electrophysiology, internal medicine, nuclear cardiology and echocardiography. But it is Makati’s expertise in the subspecialty of electrophysiology that has brought him notoriety in treating atrial fibrillation with the Convergent Procedure, a minimally invasive cardiac operation that integrates the expertise of electrophysiologists with cardiovascular surgeons.

Makati is using an as-yet-unnamed hybrid technique that combines Convergence with cryoablation balloons. “The actual catheter was invented in North Carolina, but we were the first to combine the catheter with cryo balloon technology.

We were the first in the world to apply that,” said Makati.

When Makati says “we” he is referring to St. Joseph’s Hospital Heart Institute, where he is co-director of the electrophysiology labs at both the main campus in Tampa and St. Joseph’s-North in Lutz. Since becoming the only hospital in Hillsborough County to offer Convergent in 2012, St. Joseph’s has grown to be one of busiest of 10 Convergent sites in the world, according to spokeswoman Nancy Gay. The hospital was the first Convergent training center in Florida and physicians travel from all over the world to learn the procedure from (Makati) and

Now accepting new patients. Most major insurance plans are accepted.

Call for assistance in scheduling an appointment: (813) 238-0810 4007 N. Taliaferro Ave., Suite C | Tampa

BayCareMedicalGroup.org AUGUST 2015

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Editor’s Letter

The Times They Are a-Changin’

Undergoing transformative change, this industry has been tasked with fundamentally altering delivery methods and asked to meet heightened consumer expectations and increased demands for interaction and engagement.

While the above statement is certainly representative of the healthcare industry … in this case, we are actually referencing the media’s role in the dissemination of information.

The way we consume news has dramatically changed over the past decade.

Yet, how, when and where we receive information is often a matter of personal choice. Some people love the feel of newsprint between their fingers. Others like to get information on their tablet. Still others want the highlights in 140 characters or less, giving them control of whether or not the topic is worthy of a click through to more information.

Recognizing our readers embody these varied preferences, Tampa Bay Medical News is excited to announce major changes to our product. If you love the monthly paper (and we certainly hope you do), no worries … you’ll still receive it faithfully each month in the mailbox.

However, we’ve long realized the static nature of our websites left much to be desired from both an aesthetic standpoint and the ability to adequately offer information between print cycles. Additionally, the editorial and publishing teams have looked at various solutions to quickly alert our readers to major breaking news stories and to have a platform to put important information in your hands in the immediate fashion audiences have come to require.

To achieve these goals and meet your personal expectations, we are debuting our new website this month and offering you the flexibility of following us on social media platforms to receive updates.

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Knowing how many journals, magazines and e-mails you receive on a daily basis, we promise not to flood your devices with a constant stream of data. Instead, we will format key information into brief updates and breaking news alerts as warranted.

For many of you, we already have your email addresses on file so you will automatically receive an e-blast. If you aren’t currently receiving electronic notifications from us, feel free to contact me at Lynne@ MedicalNewsInc.com with your email address, and I’ll make sure you are added.

You can also make such a request online at www.TampaBayMedicalNews.com.

Our mission … as it has always been … is to make sure we get the latest clinical, business, research and regulatory news in your hands, in addition to updating you on industry events and happenings among colleagues. The new format of the website makes it easier than ever for you to see the latest information in each of these categories, find related content, and share articles on your own social media platforms. Additionally, the design was created to be scalable to desktop, tablet and smartphone formats.

As Bob Dylan aptly noted – The Times They Are a-Changin’ – and we’re excited to embrace that change with enhanced capabilities to deliver the best possible product to you in a manner that suits your busy life. We hope you enjoy the new look, flexible formats, and ability to receive industry updates in between print cycles. Please feel free to share your thoughts and comments with us. As always, we’re open to suggestions on how to continue to improve our publication and our performance.

Sincerely, Lynne Jeter Editor Lynne@MedicalNewsInc.com www.TampaBayMedicalNews.com

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WHO’S TENDING OUR DOCTORS?

Medical School Answers: The Saint Louis University Experiment

Program Helps Medical Students Build Resistance to Stress, Maintain Happiness

By LYNNE JETER

Two years ago, Stuart Slavin, MD, MEd, stepped onto the podium at the Association of American Medical Colleges’ annual meeting to pick up one of the nation’s most prestigious teaching awards for his career accomplishments, most notably spearheading a plan to restructure Saint Louis University’s medical school curriculum to help students reduce stress, depression and anxiety – and to make a dent in reversing the national trend of rising medical student suicides. The revised four-year curriculum has been heralded as a national model.

“Dr. Slavin is very courageous,” said Keith Frederick, DO, a Missouri state representative who proposed legislation also aimed at reversing the trend via the “Show-Me Compassionate Medical Education Act.” “Academics were concerned about test scores going down as a result of changes, but it didn’t happen. In fact, it had the opposite effect and blew the lid off this problem.”

Slavin took an interest in medical students’ mental wellbeing soon after joining Saint Louis University (SLU) School of Medicine as director of curriculum, after a 21-year run at UCLA, where he logged 75 to 80 hours a week as a professor of pediatrics and full-time pediatrician.

“No singular event occurred to pique my interest,” said Slavin, who gave up a pediatric practice to focus on his admin-

istrative role. “I kept reading in medical education literature about problems with mental health issues among students, interns, residents and physicians. I viewed medical student mental health as my responsibility. Medical schools place a great deal of emphasis on academic outcomes … if a medical student comes out of four years with good clinical skills, has done well on all exams, but they’re depressed and suicidal, what’s really been accomplished?”

Slavin began walking the campus, talking to students about their medical school experiences. “Our students seemed really happy,” he said. “They smiled a lot, seemed pleased with administration and education.

I developed good relationships with them.”

Still, Slavin wanted hard numbers.

“Trying to understand what students are experiencing traditionally hasn’t been part of the medical education culture,” he said.

PhysicianSpotlight

Kevin Makati, MD, continued from page 3 cardiology, followed by a fellowship in electrophysiology, at Tufts Medical Center.

Before moving to Florida, Makati seized a unique opportunity to advance electrophysiology skills. “I had the good fortune to spend time (about 6 months) as a temporary resident in Bordeaux, France to learn a procedure from the pioneer (of atrial fibrillation ablation), Michel Haisseguerre MD. The experience was immeasurable,” said Makati, adding that “as far as I know, I may be the only one from the U.S.” who has done so.

As busy as Makati is in his professional life, he is thankful for the help he has at home. “I’m highly efficient with my time,” said Makati, but he relies heavily on his wife Poonam to raise their two girls, aged 10 and 7. “She has more responsibilities than I do,” he said.

Makati also was “bitten by the en6

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durance sports bug” about two years ago, he said. “Triathletes are a special breed because a successful competitor must be competent in multiple sports (running, biking and swimming) within the same competition. Understanding exercise physiology in multiple sports and how each one relates with the other has been very rewarding,” said Makati, who is on pace to complete seven events by the end of this year.

Although he can’t find much time for it now, Makati said he would like to revisit a creative hobby he has had since he was at Boston College. “I came close to doublemajoring in Fine Arts,” he said. “I enjoy painting in acrylics, oil, pastel and watercolors. … I have a very neat stack of paintings somewhere in my house,” he laughed.

And he is still drawn to woodworking.

“I dabble,” he said.

In May 2008, he dispatched program evaluation questionnaires to SLU’s 175 medical students to be answered anonymously.

“I remember the day I got the survey results,” he said, shaking his head. “It was like a kick in the gut.

It was devastating to see how many negative mental health outcomes we had in the school. Medical students are very good at hiding the pain they’re suffering. It can be very invisible from faculty and administration, and they’re hiding it from each other. I felt a sense of urgency with this problem.”

Survey results showed that, in the first year of medical school, 57 percent of students expressed moderate-to-high symptoms of anxiety; 27 percent reported moderate-to-severe symptoms of depression.

Similar results were found for second-year students. They cited the volume of material, level of detail of material, and competition for grades among their greatest stressors in the first two years of the curriculum.

“I really started thinking about ways to design and implement curricular changes that would directly address these stressors and produce a less toxic educational environment,” said Slavin. “I knew if we let students get further down the road without addressing this issue, the problem would only grow worse.”

With the blessing of SLU leaders, Slavin implemented initial curricular changes in the 2009-10 academic year for the incoming class of 2013. First, a pass/fail grading system for preclinical courses replaced the existing grading system. Second, contact hours were reduced across the first two years of the curriculum by 10 percent to allow students more time to participate in new learning communities and longitudinal electives. Third, longitudinal electives were instituted.

“Before, electives for first- and secondyear students included a half-day per week over seven weeks,” said Slavin. “In the new system, electives extended across the majority of years 1 and 2, with a half-day session every two weeks for a total of 12 days per academic year. This change allowed students more freedom to explore their interests, to create mentorship relationships with faculty and School of Medicine alumni, and to engage in service and/or research with more continuity. We retrofitted existing electives to fit the new system and developed new electives designed specifically to take advantage of the longitudinal nature of the experience.”

Fourth, five learning communities were established – service and advocacy, research, global health, wellness, and medical

education – to include students and faculty who share common interests and passions for research and/or service beyond the classroom.

“We charged the learning communities with designing and implementing new electives, developing a lunch lecture series, identifying faculty mentors, and expanding service and research opportunities,” said Slavin.

In the 2010-11 academic year for the incoming class of 2014, Slavin implemented additional curricular changes. A required resilience and mindfulness (R/M) program, spanning six hours of curricular time in the fall semester, was added to the Applied Clinical Skills 1 course. R/M sessions, Slavin explained, focus on energy management, mindfulness cultivation, stress reduction, cognitive distortions/restructuring, optimistic explanatory styles, and character strengths.

Slavin also refined the pass/fail grading system by eliminating norm-referenced exam performance data from feedback given to students.

In the 2011-12 academic year for the incoming class of 2015, SLU implemented a third set of changes. For example, after students identified the Human Anatomy course as the most demanding and challenging in the preclinical curriculum – and a major source of stress – Slavin made two changes to the course. The medical school dean instructed course directors to produce exams that yielded a higher mean score, to be consistent with other courses in the preclinical curriculum “so that fewer students would feel at risk of failing,” Slavin noted.

Also, the course was moved from its traditional position as the first course in the first year to follow courses in Cell Biology and Metabolism.

Because students typically have less than three months to choose a specialty, “we allowed them more time,” said Slavin.

Slavin has continued surveying students with questionnaires, resulting in improvement every year.

“In first year students, we have it down to 8 percent (moderate-to-severe symptoms of depression),” he said. “Moderate-to-severe symptoms of anxiety are down to 23 percent in our first-year students.”

“We wanted to impact the curriculum in a completely different way to give students better coping skills and to reduce stressors in the environment,” said Slavin. “Other medical schools haven’t looked at (this issue) hard enough.”

Editor’s Note: Please see series companion articles in this month’s edition: “Missouri Leads States on Medical Student Well-Being Advocacy” and “The Plight of Physicians-in-Training.”

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USF Health: An Integral Cog, continued from page 1 Tampa General Hospital and the university’s state-of-the art simulation learning center (CAMLS), enhancing opportunities to recruit National Institutes of Healthfunded researchers and creating synergies with biotechnology companies and other community partners, said Charles J. Lockwood, MD, senior vice president for USF Health and dean of MCOM. “It’s a unique opportunity to bring USF Health closer to our primary teaching hospital, into what will be a thriving downtown waterfront district with tremendous appeal to both students and faculty,” Lockwood said.

The move bodes well for the USF medical school, the only one of the top 100 ranked NIH grant-funded medical schools located more than 25 minutes away from its teaching hospital – a competitive disadvantage in attracting the best and brightest millennial students. In addition to USF, three highly regarded schools are also addressing this problem and moving closer to their academic teaching hospitals – SUNY at Buffalo, Michigan State, and the University of California at Davis.

USF’s current 40-year-old medical school facility -- designed for a large lecture hall based curriculum – can no longer support the demands of modern medical education that emphasizes newer modes of smaller, team-based and technologyintensive, simulation-dependent learning.

“The existing MCOM facilities on campus were designed for a different era of medical teaching, when classroom instruction was the primary focus rather than hands-on clinical exposure,” Lockwood said.

Co-locating the USF Health Heart Institute, originally slated for the USF main campus in North Tampa, with the Morsani College of Medicine building downtown puts the institute within five minutes of the Tampa General campus, where students do most of their clinical rotations and the primary site where USF’s cardiology faculty provide inpatient and outpatient services and inpatient clinical trials. It would connect the institute to CAMLS Innovation Center, allowing greater collaboration among cardiovascular researchers, clinicians and engineers to assist companies in developing and testing medical devices at the forefront of addressing heart disease.

The USF Board of Trustees unanimously approved the ambitious plan to relocate the medical school and heart institute to downtown Tampa at its Dec. 4 board meeting; and the move was subsequently approved in February by the Florida Board of Governors, which oversees the State University System.

The project will be built with a combination of state funds and private money.

The $17 million from the state is part of a $62-million multi-year request. Additionally, an $18 million gift received in 2011 from Carol and Frank Morsani to assist in construction of a new College of Medicine facility will be supplemented by private donations that USF has committed to raise.

The location proposed for the new

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$152.6-million co-located MCOM/Heart Institute is a one-acre site at the intersection of Channelside Drive and Meridian Avenue to be donated by Tampa Bay Lightning owner Jeff Vinik and his partners. It would anchor Vinik’s proposed 30-acre redevelopment of the Channelside district.

While an additional $15.8 million requested for the USF Health Heart Institute was not included in the state budget this year, the state has already allocated $34.4 million for the heart institute since March 2012. That funding, plus the $17 million for the Morsani College of Medicine, positions USF to launch the planning and design of a downtown facility to house both.

A downtown location will also free up academic space on the university’s main Tampa campus to expand programs in nursing and physical therapy – healthcare occupations considered in high demand and undersupply by the state. The relocation of the medical school would also provide more room to grow interdisciplinary research programs in such areas as neurosciences, cancer and biomedical engineering, university officials noted.

“This successful (reaccreditation) outcome speaks volumes about our comprehensive and meticulous preparation,” said Bryan Bognar, MD, MPH, vice dean for educational affairs at MCOM. “It wouldn’t have been possible without the hard work, collaboration and dedication of our administration, faculty, staff and students, including our colleagues at the Lehigh Valley campus in Allentown and our incredible Tampa Bay area hospital and community partners.”

More Momentum For the first time, the LCME reviewed USF Health’s MD SELECT Program – a new partnership with the nationally recognized Lehigh Valley Health Network (LVHN) --- which graduated its first 16 students this spring. The program admits medical students demonstrating a high level of emotional intelligence and leader-

ship potential, and develops their skills in medical leadership, values-based, patientcentered care and health systems. After two years of classes in Tampa, SELECT students spend two years at the USF Lehigh Valley campus in Pennsylvania to focus on their clinical education.

“This is a huge victory for everyone, both on the USF Tampa campus and the Lehigh Valley campus. Even though we’re 1,000 miles apart, there’s no distance between us when it comes to working together to improve medical education,” said Robert Barraco, MD, associate dean for educational affairs at MCOM’s Lehigh Valley campus.

The move downtown is expected to make MCOM even more attractive to top medical student talent in the near future.

The project was overwhelmingly supported by USF medical students who see its value for those who come after them.

A recent survey indicated 84 percent of student respondents said that establishing the Morsani College of Medicine downtown will have a “large” to “very large” positive impact on students’ educational experiences.

“We look forward to being there well before our next LCME visit,” Lockwood said. “USF Health will continue to pursue academic excellence wherever we conduct education, research and clinical care.”

Confluence of Efforts The state green lighted the project funds around the same time the medical school’s MD program was reaccredited by the Liaison Committee on Medical Education (LCME) through 2023, the maximum period allowed.

The news also comes at a time when the medical school marked a record number of applications – 5,235 applicants for the incoming class of 175 students expected this August, a 24 percent increase over 2014.

Additionally, the average MCAT score for the newly admitted students showed a 7 percent increase from the previous year, placing the incoming class in the top quartile for average MCAT scores among medical schools ranked by U.S. News & World Report.

The LCME highlighted USF’s ongoing efforts to minimize medical student debt as a notable strength. Among Lockwood’s priorities since arriving at USF in 2014: reducing student debt by freezing tuition, and also boosting the number of medical student scholarships.

“Student tuition and fees will not increase as a result of the downtown facility,” he emphasized.

Over the last seven years, scholarship and grant funding has increased 300 percent, and USF’s student debt rate remains below the national average for all LCMEaccredited medical schools.

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WHO’S TENDING OUR DOCTORS?

Missouri Leads States on Medical Student Well-Being Advocacy Proposed State Legislation Could be Model for Proactive Mental Health Measures at Medical Schools Nationally

By LYNNE JETER

On an unusually chilly spring day, a fourth-year medical student in northern Missouri completed his mission with such surety that only dental records could identify his remains.

“He was going to get it right this time,” lamented his father, who declined to have the family identified. His son, who died from a self-inflicted gunshot wound, was weeks away from earning a DO. More than 300 mourners were on hand for the premature burial of the 26-year-old, including state lawmakers attempting to push through legislation to deter the alarming rate of depressions and thoughts of suicide amid medical students in Missouri. Among them, Keith Frederick, DO, one of four doctors serving in the Missouri Legislature, and a state representative (R-Jefferson City) who proposed House Bill 867, the “Show-Me Compassionate Medical Education Act” in the 2015 regular legislative session.

By the time Frederick’s bill had churned through the legislative process and was awaiting a final look acknowledging the acceptance of a conference committee report, a Senate filibuster over a Right-toWork vote killed it, along with a couple of dozen bills awaiting similar action during the volatile last week of session.

“This topic – a dirty little secret of medical education for decades – badly needs the light of day,” said Frederick. “One of the biggest problems is that medical schools say, ‘we’ve got this covered,’ but they don’t.”

Even though HB 867 nearly crossed the finish line, medical school deans balked early on. As originally drafted, the bill would have established an anonymous online survey to screen medical students for depression and provided for access to immediate help through an existing 24-hour hotline for students in crisis. It would have also required the state’s six medical schools – two public, four private – to conduct the screening. Results would have been made public after three years.

Strong opposition came from the Washington University School of Medicine (WUSM) in St. Louis, consistently ranked among the nation’s top medical schools by U.S. News & World Report, and world-renowned for its 124-year history of groundbreaking research.

“Washington University’s primary concern – voiced by all six Missouri medical schools – was a provision that would have required the State of Missouri to publish the rates of depression among MD students at each of the state’s medical schools,” said Lisa Moscoso, MD, PhD, associate dean

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for students affairs at WUSM. “In its earliest form, House Bill 867 would’ve required the Missouri Department of Mental Health to determine rates of depression using a statemandated survey tool, though student participation in the survey would’ve been optional. We noted that a voluntary survey instrument would give schools an unreliable view of the scope of any mental health challenges. We also worried that a government-mandated survey and reporting process for what is unquestionably a sensitive matter would undermine the culture of trust each school strives to build with its student body.”

Frederick modified the bill while it was held for more than a month in the Social Services Committee, and then medical schools unofficially removed their opposition to the bill, which Frederick plans to pre-file this fall.

“The measure that was before the Senate in the final weeks of the session represented a reasonable approach to raise awareness about medical students’ mental health and to encourage Missouri medical

schools to collaborate to identify best practices, particularly those efforts that are most effective at destigmatizing mental illness and encouraging students to seek support and services to cope with mental health issues,” said Moscoso.

Margaret Wilson, DO, dean of A.T. Still University’s Kirksville School of Osteopathic Medicine in Kirksville, Mo., expressed concern about “confidentiality and potential to cause stigma to students.”

Since modifications have been made, “the bill meets with my school’s support,” she said.

In its final form, HB 867 dropped the requirement that medical schools undertake this study, but protected medical students and medical student organizations from interference or retribution from the medical schools when planning or conducting screening for depression or other mental health issues among medical students.

Britani Kessler, MD, immediate past president of the American Medical Student Association (AMSA), traveled from Virginia to testify before the Social Services Commit-

tee that “mental wellness” is the organization’s most frequently clicked-on website link.

“The culture of the current medical education system is that you can’t show weakness,” said Kessler. “The rigors of medical school make you sometimes think this sustained high level of stress is normal.”

The AMSA Board of Trustees has expressed interest in launching a national pilot program to survey medical students anonymously at various intervals of their educational training. To Kessler’s knowledge, Missouri is the only state to have attempted to pass legislation relating to medical students’ mental well-being.

“The purpose of the AMSA is to help premed and medical students learn things they aren’t taught in traditional medical education,” said Kessler. “We’re very feisty about medical education reform and making sure the social determinants of health are included.”

Frederick said more changes are needed in medical education, like national award-winning modifications made to the four-year curriculum at Saint Louis University (SLU) School of Medicine in St. Louis, Mo., to reduce the damage rather than emphasize that medical students need to learn to cope with the existing medical education structure and harshness.

“As SLU’s groundbreaking study revealed, medical education can greatly reduce the harm inflicted on medical students,” he said, “without adversely affecting achievement and board scores.”

THE STRENGTH TO HEAL

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WHO’S TENDING OUR DOCTORS?

The Plight of Physicians-in-Training, continued from page 1 Hospital, was days from beginning an oncology fellowship when he committed suicide. In his obituary, his parents – both MDs – wrote: “With all his talents and accomplishments, he struggled in a world that didn’t fully understand him.”

“Greg knew it was a career killer to ask for (mental health) help,” said his mother, Karen Miday, MD, a psychiatrist from Ohio. “At the end, he must’ve felt there was no way out.”

Every day, a medical student or doctor calls it quits in the most permanent way.

Because of the stigma surrounding mental health issues, medical students remain wary of seeking help.

“We must see change to de-stigmatize mental illness,” said Miday. “From the beginning, medical students should be allowed to seek help if they’re struggling. Unfortunately, medical people seem to be the most judgmental when it comes to mental illness.”

Colin West, MD, PhD, co-director of the Mayo Clinic Department of Medicine Physician Well Being Program, told The New York Times: “If this is the way that students view each other – survival of the fittest – how do they view their patients who are depressed or struggling with mental illness?”

Medical students are prone to maladaptive perfectionism and imposter syndrome disorders, cautioned Stuart Slavin, MD, MEd, director of curriculum for Saint Louis University School of Medicine, where he successfully implemented program changes to improve the wellbeing of medical students and received a national teaching award for restructuring medical education.

“Maladaptive perfectionism is always setting the bar so high for yourself that you’re continually disappointed,” explained Slavin. “Imposter syndrome is the belief of being incompetent despite overwhelming objective evidence to the contrary. Both maladaptive perfectionism and imposter syndrome are particularly risky when medical graduates are starting residency. All of a sudden, they have their MD, they’re writing orders and making decisions for which they may feel terribly unprepared. They’re terrified of doing something wrong. Both can be setups for emotional distress and potentially suicide. The fear of being ‘discovered’ or disappointing those who have supported you along the way … suicide is sadly an out as having potential advantages when you’re desperate.”

Haunting Actions Because of their intrinsic knowledge of medicine, suicide success rates are alarmingly high among medical professionals.

Nearly every physician knows of colleagues who took their own life.

Many remain haunted by their actions.

Jay Bitar, MD, FACC, an interventional cardiologist at Cardiology Care Center in Lake Mary, Fla., recalled an intern – Brent Branham, MD – from Detroit, 10

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AUGUST 2015

Mich., who committed suicide in 1985.

“On the night Dr. Branham was on call (alone), he’d start having anxiety as my time to leave approached,” said Bitar, then BranDr. Jay Bitar ham’s rounding resident on the infectious disease floor of a medical complex in downtown Detroit. When Branham’s one-month rotation ended without incident, Bitar wrote a favorable evaluation.

Two months later, as he was about to take night call on another medical floor, Branham had a meltdown at the nurses station. A psychiatrist called to evaluate Branham determined he wasn’t suicidal and recommended the night off, calling for further psychiatric evaluation.

Branham didn’t return home that night. Instead, he checked into a hotel room, injected himself with insulin he’d stolen from the hospital, and lapsed into a hypoglycemic coma.

“The next morning, when the hotel maid found him unconscious, he’d already sustained permanent brain damage,” lamented Bitar. “He lived for a few months in a vegetative state before succumbing.”

Over the years, Bitar has wondered what went wrong, how the signs were missed, who was to blame, and if actions could have been taken to positively impact Branham.

“Each one of us has a Brent Branham inside,” said Bitar. “The system is quick to weed out physicians who cannot survive long, sleepless nights, withstand the pressure, and take abuse from senior staff … with pride. The system of residency training doesn’t address collateral damage like the physician’s marriage getting destroyed, or when the children become neglected, or when the physician’s physical or mental health is permanently degraded.”

After hearing about a nearby physician who committed suicide, Pauline Chen, MD, wrote in The New York Times that his death came up repeatedly in conversations for days afterward.

“It wasn’t the details of his life that haunted us; it was the details of his death,” she noted. “He’d locked himself in a room in the hospital, placed a large needle in his vein and injected himself with a drug that so effectively paralyzed his muscles, he was unable to breathe. Or call for help.”

Pam Wible, MD, a family physician from Oregon and a national voice for physician suicide prevention, pointed out the ripple effects of such tragedies. A year after Kaitlyn Elkins, a third-year medical student at Wake Forest School of Medicine, died by asphyxiation due to helium inhalation, Wible attended the funeral of Kaitlyn’s mother, who chose the same method to end her life.

Miday was so devastated by her son’s suicide that “the first year after Greg died, I don’t think I could string three words together,” she said.

Wible admitted: “Many of us have considered suicide, but we’re so resilient that we smile and head back into the next room to see the next patient.”

Seeking Solutions Missouri jumped ahead as arguably the first state to introduce legislation aimed at facilitating change at the medical school level. Keith Frederick, DO, one of four doctors serving in the Missouri Legislature, and a state representative (R-Jefferson City), proposed the “Show-Me Compassionate Medical Education Act” in the 2015 regular legislative session. House Bill 867 raises awareness about medical students’ mental health and encourages Missouri medical schools to collaborate to identify best practices, particularly those efforts most effective at de-stigmatizing mental illness and encouraging students to seek support and services to cope with mental health issues.

In June, the American Medical Association (AMA) launched an ambitious new initiative to address physician burnout, a step toward addressing mental health wellness in the profession. The interactive practice transformation series, AMA STEPS Forward, was developed after research revealed the overall burnout rate of U.S. physicians approaching 40 percent.

That’s “more than 10 percentage points higher than the general population, which is why the AMA is taking a hands-on approach to meeting their dayto-day concerns,” said AMA CEO James L. Madara, MD. The Accreditation Council for Graduate Medical Education requires that programs assess fatigue and burnout among trainees and provide access to confidential counseling, “but these regulations should go further to require specific strategies to promote mental health among all trainees,” according to an article published March 4 in JAMA Psychiatry by Matthew Goldman, MD, of Columbia University Medical Center and New York State Psychiatric Institute and colleagues.

Depression and burnout are separate entities, some medical professionals cautioned, noting that some overlap exists.

West believes that mental health wellness begins eroding with “first-years”: “We have to assume that starting in medical school, a pipeline of experiences leads to an increased risk of suicide,” he said. “That’s where we need to start.”

Editor’s Note: Please see series companion articles in this month’s edition: “Missouri Leads States on Medical Student Well-Being Advocacy” and “The Saint Louis University School of Medicine Experiment.”

PUBLISHED BY: SouthComm, Inc. GROUP PUBLISHER Dennis Triola dtriola@southcomm.com 310.422.6637 PUBLISHER James Howard james.howard@cln.com 813.956.4428 BUSINESS DEVELOPMENT DIRECTOR Chris Madalena chris@cln.com 813785-8073 NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com LOCAL EDITOR Lynne Jeter lynne@medicalnewsinc.com CONTRIBUTING WRITERS Lynne Jeter, Cindy Sanders Jeff Webb CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley Amy Gomoljak, James Osborne CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: editor@medicalnewsinc.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 • Two years $78

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GrandRounds Moffitt Cancer Center Teams Up with MD Anderson to Discover, Test Novel Agents to Prevent Cancer Moffitt Cancer Center has joined MD Anderson’s National Cancer Institute (NCI) Phase 0/I/II Cancer Prevention Clinical Chemoprevention Trials Consortia. Sponsored by the NCI’s Division of Cancer Prevention, the consortia conducts early clinical development of promising new preventive agents through its Phase 0/I/II Cancer Prevention Clinical Trials Program. As part of the drug discovery process, researchers will look at a number of new agents that intervene in specific molecular pathways thought to be critical to cancer development. Since cancer prevention studies focus on high-risk populations that do not necessarily harbor a detectable cancer, these studies require extensive biomarker analysis, investigation of the biologic effects of the cancer preventive agents on their intended molecular targets and correlation with clinically relevant endpoints. The Moffitt team has developed several agents using this systematic approach for the past few years according to Nagi B. Kumar, Ph.D., R.D., F.A.D.A., consortium principal investigator and director of Cancer Chemoprevention.

Other cancer centers in the MD Anderson consortium include Dana Farber, Columbia, the University of Michigan, Memorial Sloan Kettering, Cornell and an international site in Italy.

Dr. Douglas Stevens Recognized as a ‘Top Doctor’

by National Industry Resource Dr. Douglas Stevens of Douglas M. Stevens, MD, Facial Plastic and Laser Center, has been awarded the recognition of the Castle Connolly ‚ÄòAmerica’s Top DocDr. Douglas tors.’ Castle Connolly is Stevens a company dedicated to helping the public identify the very best in healthcare resources. The award is recognized nation-wide as one of the most respected and sought after physician awards. Only those doctors who are among the very best in their specialties and in their communities are selected to be a Castle Connolly Top Doctor and included in related publications.

Dr. Douglas Stevens, American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology Head and Neck Surgery, has been recognized numerous times over his career for his work in the industry. His most recent accomplishments include the development and trademarking of his in-office facelift procedure, the Active Lift®, and appointment to the Suneva Medical Physicians Advisory Council as a designated expert in his field.

Each year, Castle Connolly receives over

ta m pa b ay m e d i c a l n e w s

.com

Nursing Director at Blake Medical Center Honored by DoD with Patriot Award Blake Medical Center is proud to announce that the Florida Committee for Employer Support of the Guard and Reserve (ESGR), an agency of the Department of Defense, announced that Jody Nader, Nursing Director at Blake Medical Center, was honored with a Patriot Award in recognition of extraordinary support of employee(s) who serve in the Florida National Guard and Reserve. U.S. Air Force Reservist and Blake Medical Center Registered Nurse Staff Sergeant Christopher Dziuban nominated Nader. Dziuban noted Nader hired him for the nursing position at Blake and that from the very beginning of his employment she has fully supported his military service.

According to James Dicks ESGR Florida State Chair, the Patriot Award was created

by ESGR to publicly recognize individuals who provide outstanding patriotic support and cooperation to their employees, who like the citizen warriors before them, have answered their nation’s call to serve.

100,000 nominations. Those recognized as a Top Doctor are nominatewd by their peers in an extensive survey process of doctors all over the country. The physician-led research team carefully reviews the credentials of every physician being considered, and the Castle Connolly editors, the Chief Medical and Research officer, and the research staff ultimately determine who is selected for inclusion. For more information about Dr. Douglas Stevens and his practice, visit DouglasStevensMD.com.

Sarasota Memorial Welcomes New Physicians to South County Sarasota Memorial Health Care System welcomed two new primary care physicians into its First Physicians Group (FPG) network. In July, Mitchel Beasley, DO, Dr. Mitchel Beasley and Rachel Dahlborg, MD, began accepting new patients at FPG’s Venice and Blackburn Point practices. A Family Practice physician, Dr. Beasley joined Drs. Dr. Rachel Christopher Jefferson Dahlborg and Veronica Nabizada at their family medicine practice on the Venice Bypass. Dr. Beasley earned his osteopathic medicine degree at Lake Erie College of Osteopathic Medicine in 2012. He completed his internship

and residency at St. Petersburg General Hospital. He came to Sarasota from St. Petersburg, where he served as a resident physician at Family Care at Bardmoor, the practice of Bridget Bellingar, DO, and Community Health Centers of Pinellas. Dr. Dahlborg, an Internal Medicine & Pediatrics physician, joined Drs. Karen Hamad, Alan King, Jack Rodman, John Wassenaar and Joseph Yeh at the Internal Medicine & Pediatrics practice located in Sarasota Memorial’s Health Care Center at Blackburn Point, 929 S. Tamiami Trail, Ste. 101, Osprey.

Dr. Dahlborg earned her medical degree at New York Medical College in 2011. She completed her residency in Internal Medicine/Pediatrics at Medical University of South Carolina in Charleston, SC. She came to Sarasota from the Charleston, SC, where she served as chief resident at Medical University of South Carolina.

St. Joseph’s Hospital Opens $43 Million Operating and Interventional Radiology Suites In July, St. Joseph’s Hospital began operating in one of five new state-ofthe-art surgical suites. The new suites are part of an 18-month, $43 million, expansion project that brings the total number of operating suites at St. Joseph’s Hospital to 18. The new suites are connected to the existing surgical unit, which provides the ideal layout for minimally invasive and conventional procedures.

One of the new operating suites is the VISIUS Surgical Theatre with intraoperative MRI (iMRI) Suite, an advanced neurosurgical operating room where a diagnostic quality scanner can move to the patient using ceiling-mounted rails.

This incorporates imaging and surgery in the same setting without introducing additional risk to the patient associated with transport, while delivering real-time information to clinicians to improve patient outcomes.

The new operating suites also offer: · More Space- The new operating rooms are at least 100 sq. ft. larger than the older suites to accommodate advanced technology and equipment allowing physicians to perform complicated orthopedic and neurological cases. · System Integration and Technology- Everything from patient information systems to audio, video, lighting and medical equipment is functionally connected, allowing surgeons to control all devices from a single touch screen.

Plus, the operating rooms now have teleconferencing capabilities and everything, including wires and cords, are up and off of the floor reducing safety hazards. · Pediatric Surgery- The pediatric surgery area will be converted into a single space for admitting, pre-op holding, surgery and post-anesthesia recovery care.

In addition to five new operating suites, the newly renovated interventional radiology suite will be home to a sophisticated imagining system, giving patients safe, effective alternatives to surgery. The renovations allow for: · Advanced 3-D Images- These 3-D CT, MR, PET and SPECT scans help to plan and assess procedures, which assist the interventional radiologist who will perform the exam. · Blended Road mapping- This helps the interventional radiologist navigate easily and clearly in complex anatomy using quality digital images. · TrackVision- By providing live 3-D guidance to move the needle as planes, TrackVision helps radiologists precisely plan needle procedures and show any deviations from the desired path. · AngioViz- Shows the vascular flow on a single image, while digital subtraction angiography (DSA) generates vascular flow data, which allows radiologists to easily compare images with just a glance. · 3T MRI-Ultra Field Tesla MRI- This is the strongest clinically available scanner and it allows for more comfort, quicker exams and the highest quality images.

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section.

Content and accuracy of the releases is the sole responsibility of the issuer.

AUGUST 2015

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