2008 ALSO Course

As usual, I had a blast at our annual multi-residency ALSO Course, held in Baytown last week. I enjoyed working with both our residents and the others and working with my FMOB faculty colleagues from across the region.

I think the residents had fun too, or at least if anyone didn't, they didn't tell me! Several of you commented to me that you learned a lot and had a good time. And now you all have the basic tools you need for managing urgent and emergent situations in L&D. You just need some experience putting them into practice.

Click on the photo to access the photo set.

new FM baby!

Drs. Hanan Hussein and Saleh Elsaid (both faculty) welcomed a new addition to their family today!!

baby Saad, 6lb and 6oz

Everyone is doing well.

More end of Block 1 photos

End of Block 1 Party - Galveston Country Club

updates on Edouard

Keep abreast of the UTMB emergency management plans re: Edouard here.

All residents should have received your individual assigments from Residency staff already. If you have questions or did not receive the message, contact me on my cell phone or staff at the office until 3pm.

Why Your Doctor Needs A Raise...

The good news: A year into our grand healthcare experiment, nearly everyone in Massachusetts has insurance. The bad: It's never been harder to actually get in to see a doctor. The fix? Pay primary care physicians more. Lots, lots more.

Sound interesting? Read the entire Boston Magazine article here.

kudos to Dr. Gomez!!

Dr. Gomez' presentation has been accepted by the NAPCRG Program Committee for presentation at the 2008 NAPCRG Annual Meeting being held Nov 15 - 19 at Wyndham Rio Mar, Rio Grande, PR.

Poster on Research in Progress Submission
Submission Title: Relationship between Depression and glycemic control and its correlation with medication adherence in patients with Diabetes Mellitus type 2: a cohort study in a primary care setting

Interesting discussions

Today I attended a school of medicine committee meeting where one of the agenda items involved a discussion about teaching behavior change counseling techniques to medical students. As part of the discussion, a concern was raised about identifying and teaching skills for students to deal with their own personal biases that might affect their patient care... primarily biases that center around choices patients make that are not in the best interest of their health. And whether or not students personally make some of those same choices and how that impacts their patient care. Interesting discussion.

Which led me to remember something that happened to me during medical school and residency, and some lingering thoughts about how the things that happen TO us during training also create some biases that have the potential for affecting our patient care.

Have you ever read the book House of God? I hadn't read it until medical school. There was a great deal of discussion about that book among a group of my peers at some point and I was pretty out of the loop, having not read it. So, as a first year medical student, I read it. I was horrified and apalled that anyone could possibly conceive of health professionals thinking about and acting toward their patients in some of the ways described. Horrified. And personally insulted, actually. Certainly I would never do such things. Would I?

Five years later, as a second year resident, I read the book again. (Because, let's face it, who has time as an intern to read anything not absolutely necessary and related to what might confront you immediately or in the next 24 hours?!) My experience this time was vastly different. Vastly. So much that I'm at least a little bit ashamed. I remember laughing until tears ran out my eyes at some points. I remember completely identifying with some of the circumstances and situations described. At the time, I remember thinking how naive and idealistic I was as a first year medical student.

Now, a good number of years removed (we won't go into detail about how many) from the supreme endurance test of q3 call blocks and 100+ hour work weeks (yes, I pre-date duty hour restrictions), I once again have a different perspective. I think about discussions among my current faculty peers, about how we seem to do our best to "train out" some of the very best qualities in medical students and residents. We all seem to lose some of our humanity in the process. I like to think that these days that I'm a lot closer to the humanity and idealism I started out with than to the ridiculously over-fatigued and callous R2 I became for a time.

I invite your thoughts and reflections on this topic...

Play-Doh Workshop

We recently had our Circumcision workshop for the interns during Orientation. They were all quite excited about getting to play with Play-Doh during this experience. Unfortunately, we had a few untoward outcomes with detachment of certain important anatomic structures, but in the end it was a successful activity. And a good time was had by all, including me! What a great group of interns!

Information for applicants 2009

Update to reflect the impact of Hurricane Ike:

10/16/08 The UTMB campus continues its recovery efforts. As of today, FM is seeing patients in three clinical sites... a new shared/borrowed space on the mainland at League City, our faculty clinic Stewart Rd location and temporary space in the Fast Track area of the ER. We are in negotiations at present for the relocation of our hospital service, which I expect to take place in the next week or two. This will be a temporary measure until the John Sealy Hospital on campus reopens.

We will be recruiting for a class of 4 in the 2009 Match and have just as of yesterday begun to issue interview invitations. I anticipate that we will interview about 40 - 45 applicants. You can help us greatly by keeping your application status up to date and advising whether you plan to accept or decline the invitation to interview once received.

Thank you for your interest in our program. If you enjoy being part of building something new and dynamic, you will find great experiences, training and professional community as we emerge from the effects of hurricane Ike!

Dear Applicant,

Thank you for your interest in our residency training program.

Our basic requirements for consideration for interview include:

• graduation from medical school within the past five years (not flexible)
• passage of USMLE I and II, including CSA (preferably on first attempt) OR COMLEX for Osteopathic students. Obviously, the better your scores, the stronger will be your application.
• some U.S. clinical experience
• three letters of recommendation, at least two of which MUST be from family doctors.

We accept applications only through ERAS. Please do not email me long attachments in an attempt to circumvent the process because I will not read them. If you meet our criteria outlined above, then apply through ERAS. This will ensure that your application is reviewed.

Osteopathic students may apply to our program through either or both Match processes, however you will only be guaranteed a dual-accredited slot by matching through the AOA Match.

We will begin our interview season for the class entering in 2009 in September 2008 for Osteopathic students and October 2008 for all. We hope to conclude interviews by end of January 2009. We will begin screening applications immediately as they become available through ERAS. We will schedule interviews until we have interviewed sufficient candidates to fill our class, so you are encouraged to apply early.

Our program does sponsor J1 visas. Our program does NOT sponsor H-1 visas.
UTMB does NOT sponsor externships or observerships for persons who have already graduated from medical school.

Please see our Residency website for more detailed information regarding our program. For specific questions that may not be covered, please contact our recruiter, Mr. Louis Johnston. His contact information is listed on the webpage.

Lisa R. Nash, D.O.
Program Director
UTMB Family Medicine Residency

UTMB FMR Graduation 2008

Click to view the 2008 graduation photos!

Many thanks to Cassie Boatwright (our photographer) and Becky Hamilton (our video producer). The photos and video are outstanding and I know our graduates will cherish them for years to come.

salary increases!

We are pleased to announce the pending salary increases for House Staff have been approved effective September 1, 2008, reflecting the October 1st paycheck.

PGY-1: $42,757
PGY-2: $44,015
PGY-3: $45,620

PHNP

Our Grand Rounds presentation June 5th was given by Dr. Ana Malinow. It was an excellent presentation covering U.S Health Care Policy. I encourage you to look at the following resources:



Physicians for a National Health Program

Healthcare for All Texans



One of the most sobering points in her presentation was when she asked how many of us in the room had ever been uninsured. This was an audience of medical students, residents and faculty physicians and other faculty members. About 50% of the people in the room raised their hand. I was one of them. Can you imagine?! Fifty percent of the healthcare professionals in that room have been uninsured at some time in their life. Unbelievable. And unacceptable.

exciting faculty developments

Yesterday I met with our new part-time faculty member (Peter Curka, DO) who starts next week and we enjoyed planning our Osteopathic Manual Medicine (OMM) conferences for next year and some of the other projects he will be involved with. DO and Alternative & Integrative Medicine track residents will be required to attend, our other MD residents are welcome and we have two MD faculty members who already have requested to attend the course.

Our OMM Consult Clinic will be open for scheduling in the next six weeks or so. Of course, all the DOs in our practice also are able to schedule OMM in their continuity clinic, but the consult clinic will allow our MD colleagues to easily refer patients for OMM.

We are in the process of setting up an interview with another DO candidate for a full-time faculty position with the residency as well.

Today I interviewed a faculty candidate for Residency who has a CAQ in Sports Medicine (MD) and will take the lead on development of our Sports Medicine fellowship if we are successful in recruiting him. You may remember that one of our 2007 graduates is starting his Sports Medicine fellowship next month and we hope to also recruit him back to join the faculty.

It’s exciting times around here at UTMB!

Departmental Review

Recently, our Department underwent the most recent formal review. These occur roughly every 5 years and are rather a big deal in the land of academic medical centers. Among other things, the Departmental Review identifies strengths and suggests areas for improvement. For this post, I'd like to share with you the strengths identified by our reviewers.

• 8/8/8 FMRP scheduled for next review in about 18 months
• Adequate patient volume to support most aspects of outpatient and inpatient training, with the exception of maternity care. (Maternity care being an area we've been working on with various strategies for the past several years. More to follow on that front...)
• Resident graduates who remain to practice in the region
• Unusually high percentage of residents graduating this year entering various fellowship programs
• Strong commitment to rural education via a rural track residency program
• Residen tcohort who reports satisfaction with attending support in both the hospital and ambulatory settings
• Adequate administrative resources in support of residency training
• Strong faculty commitment to residency teaching in all clinical venues
• Appropriate educational relationships with other disciplines providing training for Family Medicine residents

Sports Physicals day

AODME Conference

I've been away this week, attending the Association of Osteopathic Directors and Medical Educators annual meeting.

Many of you know that we have received our Osteopathic certification this past year for the residency program. Our Osteopathic residents will be eligible upon completion of the program to sit for both the ABFM and AOBFM certification exams.

The meeting I'm currently attending includes educators from both undergraduate and GME settings, as well as across multiple specialties. One of the things I've been struck with during the course of the meeting is how closely aligned allopathic FAMILY MEDICINE is with Osteopathic Philosophy and Practice (OP&P). What I mean by that is primarily related to the bio-psycho-social approach, the doctor-patient relationship and communication skills. All of my allopathic/ACGME residents are being instructed in OP&P... you just didn't know it!

As a result of our recent certification and the inclusion of more DOs in our program from here forward, I will be making more of an effort to explicitly point out OP&P where it occurs in our training program. We will also begin an Osteopathic Manual Medicine workshop series as a component of our Thursday afternoon didactics. Our DO residents will be required to attend and the MD residents will be invited.

I've learned a lot of good things at this conference and I plan to share a number of them here through the blog over the next few days.

A FM kid turns 1!

Josie (& Family!) blow out the candle

My girls looking at a HUGE redfish in the aquarium

Abbye & Dani

(children of Dr. Nash (L) and Dr. Alonso (R))

Dr. Montiel in the background

The big event was held at Moody Gardens and I think everyone had a blast. Many thanks to Dr. Montiel for inviting us to the party. :-)

Welcome, Class of 2011!!!

Michael Crawford – University of Texas Medical Branch – Galveston
Richard Donaldson – W. Virginia School of Osteopathic Medicine
Cesar Gerez - Universidad Autonoma de Tamaulipas, Tampico Mexico
Eduardo Guerra Valencia - Universidad Peruana Cayetano Heredia, Peru
Toni Hernandez – University of Texas Medical Branch – Galveston
Jose Rodriguez – Universidad de Oriente, Venezuela
Lisset Parets - Saint George's University, Grenada
Bhanu Yadiki - Jss Medical College, India

Match Results Show Resurgence

According to AAFP, the 2008 Match results show a resurgence in interest in Family Medicine.

Although helpful, the increase still falls short of estimated manpower needs for 2020.

The fill rate for FM was 91% this year, which explains what the Scramble pool liked like to me... more US grads unmatched than I expected.

Read the full story on the AAFP website here.