Residents Report - Summer 2012

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Summer 2012Summer 2012

The Residents

Next Accreditation System 1

News from SFGH 3

Out and About 4-7

10 Questions 8-10

Resident Council 11

Housestaff Honors 12-14

Library Update 14

Resident Research 15

APeX Upate 15

Diversity at UCSF 16

Housestaff Incentive 17

The Art of Sleeping 18

Open Enrollment 19

Patient Care Fund 19

GME Cypher 20

in this issue

Newsletter of the Offi ce of Graduate Medical Education I University of California, San Francisco

UCSF School of Medicine

Graduate Medical Education

500 Parnassus Avenue

MU 250 East, 0474

San Francisco, CA 94143

tel (415) 476-4562

fax (415) 502-4166

www.medschool.ucsf.edu/gme

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The recent publication by ACGME leadership of “The Next GME Accreditation System - Rationale and Benefi ts” (NEJM, 2012) has created substantial excitement, but also substantial anxiety and concern in the GME community. The lofty goals of the new system (NAS) - to create a system that focuses more on outcomes and less on process, have been counterbalanced by the lack of clear data to demonstrate that the new system will be an improvement and concern that so much of the new system is still undefi ned.

So what do we know, and what can we do to prepare?

The NAS will have three major components: program accreditation, institutional accreditation, and a new element called the Clinical Learning Environment Review (CLER).

Program AccreditationIn the NAS, each ACGME-accredited residency and fellowship program will have site visits at intervals of up to ten years. Some programs have already received letters from their RRC stating that the next site visit will be in 2022! Moreover, Program Information Forms (the very detailed program descriptions completed before each site visit by the program director and program coordinator) will be eliminated. Although these two features are appealing, the NAS will require substantially more annual data collection and a detailed self-study prior to the every-ten-year site visits.

Much of the attention and concern about the NAS has centered on the “educational milestones.” Milestones are specifi c, observable benchmarks of skills, knowledge, and attitudes that learners must achieve as they progress through training. Milestones document each trainee’s progressive mastery of the six core competencies. The NAS will require twice annual assessment of each learner’s progress as part of the requirement for semiannual evaluations. Milestones are being developed in each specialty for each core residency. (Milestones for fellows will come later and be of more limited focus). The milestones will be aggregated and used as part of each program’s annual accreditation review. Much is still to be learned about using milestones in this way. Pilot testing of the system has been limited and the ability of milestones to assess program quality is unproven. On the other hand, most educators are confi dent that milestones will improve the ability of both educators and learners to assess learner progress towards competence and the ability to practice independently.

Milestones, however, are only one part of the annual program accreditation assessment. Annual reports will also include program attrition, board pass rates, resident surveys,

Preparing for the Next GME Accreditation System

Robert B. Baron, MD, MSAssociate Dean for Graduate and Continuing Medical Education

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(continued from page 1)Preparing for the Next GME Accreditation System

faculty surveys, operative and case logs, and other measures of clinical experience, scholarly activity of trainees and faculty, data gleaned from institutional CLER visits (see below), and other already-collected program characteristics. Of the multiple data sources, three are new: milestones, the faculty survey, and the CLER visits. Important defi ciencies in these annual performance parameters will trigger earlier site visits.

The NAS will be implemented in seven specialties (emergency medicine, internal medicine, neurological surgery, orthopedics, pediatrics, diagnostic radiology, and urology) starting in July 2013. The remainder of core specialties will go live the following July.

Given the uncertainty, what can programs begin to do to prepare? Probably most important is the creation of faculty clinical competence committees. These will be a formal requirement in the new system for all residency programs and getting started now will provide an important head start. A key assumption of the NAS is that groups of experienced faculty will do a better job than any single faculty member in evaluating trainee competence and providing feedback and direction. Secondly, we will need to intensify faculty development in direct observation of trainees and other assessment techniques. Third, each program should defi ne its “core faculty,” since they will be the recipient of the important faculty survey. Finally, we will need to develop new strategies to fi nd faculty time for more direct observation while still preserving progressive responsibility for residents and quality of care and effi ciency in our clinical settings.

Clinical Learning Environment Review (CLER)In many respects the most innovative aspect of the NAS is the CLER. The CLER is a periodic site visit of sponsoring institutions and major teaching sites to assess each clinical setting for the “…quality and safety of the environment for learning and patient care...” The CLER concept is based on growing literature that suggests that the quality of the clinical setting not only effects of the quality of care in the present, but also impacts the quality of care provided by trainees when they practice independently. The CLER process is a response to public pressure for the ACGME to have more direct oversight over the programs and institutions that it accredits. CLER visits will start in the fall of 2012 and will occur every 18 months. Site visitors, experts in GME and in quality and safety, will meet with institutional leadership as well as faculty, trainees, and staff. Visits will be scheduled with short notice (one to three weeks). Site visitors will focus on resident engagement in quality improvement and patient safety, effectiveness of transitions of care (both between trainees and between settings), duty hour compliance, supervision of trainees, and the care of underserved populations.

At least initially, CLER visits primarily will be formative, providing feedback to the institution. In time, however, CLER data will also be used as part of institutional and program accreditation.

What can we do to prepare for CLER visits? Much of our longstanding work on resident engagement in institutional and departmental quality improvement efforts, and our work on resident supervision, handovers, and duty hours positions us well. Similarly, our strong commitment to equality of care and care of the underserved is exemplary. As we transition to our new electronic health record (EHR), however, we will need to continue to be vigilant in each of these areas, particularly the impact of the EHR on patient safety, duty hours, and transitions of care.

Institutional AccreditationThe NAS will also impact institutional accreditation. New Institutional Requirements are being written for release in July 2014. Much of the focus of the new requirements will be to align the institutional process with the new program accreditation system and CLER. For example, longer program accreditation cycles (ten years), but with enhanced annual data reporting, will change the requirement for mid-cycle internal reviews (IR). Rather than routine IR for all, internal reviews may be focused more on programs with challenges. Cycle lengths for institutions will also change, also most likely to ten years. Overall, however, the basic roles and responsibilities of the GME Committee, Program Directors, the GME Offi ce, and the Designated Institutional Offi cial (DIO) will remain consistent with current requirements.

SummaryThe NAS is an ambitious attempt by the ACGME to respond to the public call for greater accountability in GME. It is also an attempt to focus on outcomes rather than process measures, and provide close oversight to programs and institutions that are having diffi culty while giving more fl exibility to programs with high-quality outcomes. High-performing programs and institutions will have relaxed process standards and greater opportunities to innovate. UCSF is extremely well positioned to be in this latter group. Nonetheless, there are specifi c steps we can begin to take now in our continuing goal to be the best GME program that we can be.

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NEWS FROM SFGHDoug Eckman, MBAOperations Manager, SFGH Dean’s Offfi ce

SFGH Rebuild Steel Beam Signing and Topping-Out Ceremony

The fi nal steel beam was installed on the new acute care hospital at SFGH on the morning of Tuesday, June 5th. The mayor and other dignitaries spoke at the steel topping out ceremony and Barbara Garcia, Director of Public Health, emceed the event recognizing this construction milestone. SFGH employees, residents, and faculty along with patients and community members signed their names to the fi nal steel beam at a celebration on Monday, June 4th. Over the course of the next few months the concrete fl oors for each level will be poured and the exterior panels will be installed.

SFGH STATEGIC PLAN

Be on the lookout for information about the hospital’s new strategic plan this summer. Chiefs of Service will be discussing how every physician can contribute to the success of this fi ve-year roadmap. The plan is designed to get SFGH ready for health care reform and to move all inpatient activities into a beautiful new hospital in 2015.

BIKE STORAGE AT SFGH The repair of a design fl aw in the new double-deck bike enclosure is complete. The storage area is located south of the main hospital entrance. It has two levels of racks that will expand the capacity for secure bike storage at SFGH. The area is well lit and electronic access allows employees with a hospital ID to open the bike enclosure gate with a SFGH ID badge. Housestaff should contact the Dean’s Offi ce at SFGH if they need a SFGH ID badge.

MEAL CARDS AT SFGH Effective April 1, 2012, Food and Nutrition Services at San Francisco General Hospital began implementing a new system for residents to access meals during their rotations. The new system utilizes a Cardex system. Every resident doing a scheduled rotation at SFGH will be issued a meal allowance card. The daily allowance for each card is automatically loaded into the system and re-loaded each night at 12:01 AM. Any unanticipated changes to the resident rotation schedule should be made known to the program coordinator at your earliest convenience to ensure a resident is not denied their meal coverage.

HEALTHSTREAM MODULES DUE All employees at SFGH are required to complete the annual HealthStream modules. This year, there are pretests for each module that if passed, allows one to skip the full module. Residents are encouraged to complete this hospital requirement by June 30th. New, incoming residents should complete the modules within two weeks of starting their rotations at SFGH.

Healthstream: www.healthstream.com/hlc/sanfranLogin & password: your fi rst Initial, your Middle initial or an X, your last Initial, plus the last four digits of your SSN.

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OUT & ABOUT from the Resident and Fellow Affairs CommitteeWhere members of the Resident and Fellow Affairs Committee recommend their favorite scenes outside UCSF.

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Climbing: A few hours of indoor exercise or an exciting trip outside

Jeffrey W. Sall, PhD, MDAssistant Professor, Department of Anesthesia and Perioperative CareUniversity of California, San Francisco

Living in San Francisco we are fortunate to have mostly good weather and a wealth of fantastic options if you like to play outside. Climbing is one of those activities I look forward to enjoying with friends and family. Climbing with someone can form a strong bond (your life may depend on them!) and I count several climbing partners among my closest life-long friends. It has also been a great opportunity to foster relationships with colleagues and to facilitate interdepartmental collaboration as well.

Nearby climbing opportunities exist in the city, both indoors and out, as well as in the bay area, Yosemite National Park, Lake Tahoe and throughout the Sierra if you have time to travel a bit further. Climbing generally can be divided into steep hikes, technical rock climbs and mountaineering. Most can be done in summer or winter depending on your tolerance for a bit of discomfort. I’ve

been accused of only knowing hikes that lead to the base of a climb so I’ll focus on the climbing for this article!

Indoor climbing gyms are a fun way to learn about technical rock climbing and can be a great change to mix up your workout routine or a fun (and social) afternoon challenging your friends. On campus you can climb at Mission Bay’s Bakar Fitness & Recreation Center where the climbing wall is actually outside on the roof. Mission Cliffs is a great climbing gym in the mission district, and my kids’ favorite is Planet Granite in the Presidio where huge, often open, windows present sweeping views of downtown, Crissy Field and the bridge - it almost feels like being outside. All of these gyms offer classes if you haven’t climbed before that will teach you the basics of ropes, knots, and safety to get you started. Outdoor climbing exists in the city in a few locations such as the Beaver street wall or in Glen Park Canyon (which also has great short hikes) but most of these only have half a day’s worth of amusement for all but the most intrepid climbers.

Climbing outside means you need some skills and gear or a knowledgable friend or guide and it can

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OUT & ABOUT.....(continued from previous page)

be an amazingly rewarding experience. Outdoor climbing in the bay area includes bouldering and climbing along the beach in the north bay, on Mt. Tamalpais, around Mt. Diablo, near the Berkeley campus and a handful of other locations. Longer climbs can be found around Lake Tahoe and Lover’s Leap while the biggest climbs are in Yosemite Valley and Tuolumne Meadows. Several guide services can be found at these locations to get you out for a day to learn the basics or to tune up your skills if you’re already an experienced climber.

I love to visit the granite walls of Yosemite and have made many trips with friends and family to climb everything from the domes and peaks of Tuolumne to the easier walls of the valley and even the little lumps of granite that sit on the valley fl oor. My daughters (8 and 10) have climbed for several years and we made our fi rst father/daughter only climbing trip this past year and we are all anxiously looking forward to our next chance to spend a day together on the rocks. There is a down side to such a beautiful place. In mid summer tourists crowd the place with most going to the valley and there are sometimes even midday traffi c jams. To avoid the chaos and take advantage of cooler temperatures try the shoulder seasons in spring (sometimes wet) and fall (usually the best climbing).

Beyond Yosemite, bigger mountains await in the Sierra’s. Reaching these climbs requires a bit more commitment. You’ll generally need at least a couple days. In addition to some of the best granite rock climbs in the world, the Sierra’s offer generally stable weather (relative to other big mountain ranges) with many warm days, fantastic light, and summits above 14,000 feet. Most of these peaks also have a hiking route to the summit if technical climbing at altitude seems like too much.

Mt. Whitney is probably the most popular summit in the Sierra because it is also the highest point in the lower 48 states. It is a fantastically beautiful place to climb and is well worth the trip. Unfortunately, the popularity means a complicated permit system for the hiking route, but if you are up for more excitement and better views of the face, the permits for technical climbing are easier to obtain. You will need a fair bit of experience or a guide for the technical routes on this one, but the total distance to the summit is shorter and you’ll be climbing the side of the mountain you see in all the pictures! I’ve climbed a few routes on Whitney and look forward to returning, maybe with my kids next time.

Mt. Shasta, a volcano to the north, offers a chance for some real mountaineering. Like many of the volcanoes in the pacifi c northwest it is isolated from other mountains making it seem massive. It dominates your view for over an hour as you drive up I-5. The routes up Shasta will have snow nearly year round (most Sierra routes dry out by late summer and snow can be avoided until mid fall). The climbing on Shasta ranges from technical hiking, where you need an ice axe, crampons and good lungs, to serious mountaineering over crevassed glaciers and icy cliffs using ropes and specialized ice tools. The year round snow also means that if your willing to carry your sliding boards up you may get as much as 7000 feet of decent long after the lifts have closed for the season in the Tahoe resorts. Guide services can also be found on Mt. Shasta offering everything from 2 day ascents to multi-day comprehensive mountaineering classes if you are unsure of your skills or just want to learn more.

We are lucky to live within a few hours drive of some of the worlds best climbing destinations, and to have several great climbing gyms right here in our city. Find some friends and gear up for an afternoon of fun in the city or a weekend or week long adventure of a lifetime on the soaring cliffs of Yosemite or the high mountains of the Sierra!

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OUT & ABOUT from the Resident and Fellow Affairs CommitteeWhere members of the Resident and Fellow Affairs Committee recommend their favorite scenes outside UCSF.

(continued on next page)

I learned how to windsurf thanks to residency training at UCSF. Thirteen years ago, my family and I moved to the Bay Area in order to start OBGYN residency (my second since the fi rst one in my native Chile did not count) at UCSF. We settled in Alameda, a small island town across the bay, given that for a family of fi ve and a dog, the cost of living in San Francisco was outside of our possibilities. Soon after our arrival I saw a big sign posted four blocks away from our rental unit that offered “windsurfi ng lessons.” Until then I had windsurfed only a few times in the early eighties in Vichuquen, a small lake near the coast in the south of Chile. I said to myself this was a grand chance I would never have again in my life and made a point of learning this elusive sport. Residency of course put a damper on my plans until I started my fi rst night fl oat rotation in early May. It turned out that I was unable to sleep during the day time, and after trying countless strategies suggested by well-intentioned peers and friends, and realizing that nothing would help, I decided to try windsurfi ng instead of tossing and turning in bed all day.

It turns out that the San Francisco Bay is world renowned for its strong, consistent winds, essential requirements for the sport of windsurfi ng. In fact, Hood River, Oregon (population of 7,000), Maui’s north shore, and the San Francisco Bay are the only places in the 50 states where you can practice this sport with any regularity. Learning how to windsurf is diffi cult and somewhat of a slow process. But for those who stick to it, the rewards are immense. Just talk to any windsurfer about windsurfi ng and notice the grin on their faces; I have not seen this this type of reaction among any other sport enthusiasts. The good news is that the sport of windsurfi ng has become so much better, fun, exciting, and easier to learn than when it was fi rst introduced in the late 70’s due to dramatic technological advances. It is ironic that windsurfi ng was so popular in the U.S. in the mid 80’s and early 90’s and now is only practiced by relatively few people when it is SO much better than in its early days.

If you want to learn how to windsurf in the Bay you have several options depending on where you live and your wallet. If you live or work in the East Bay, the Cal Sailing Club in the Berkeley Marina is without question the best option. For a mere $65 dollars membership you have unlimited use of top notch windsurfi ng equipment suitable for all levels. If you stick to it, you’ll rapidly graduate to more advanced equipment so it doesn’t make sense generally to buy entry level equipment (and certainly does not make sense to buy advanced equipment that you’ll grow into it because you won’t). You’ll also fi nd free lessons and a spirited crew that will keep you motivated and help you along the way to increase the slope of your learning curve. Alameda has a windsurfi ng school run by BoardSports (www.boardsportsschool.com) and it might be a good option for the early stages of your windsurfi ng progression (Alameda is not in the wind path during most of the windy season so you’ll soon need to venture out to windier places). On the Peninsula you have a great venue in Coyote Point,

Windsurfi ng in the San Francisco Bay

Juan Vargas, MD is an Associate Clinical Professor of OBGYN and Radiology at UCSF, and Director of Obstetrics at San Francisco General Hospital. He is a nationally ranked freestyle windsurfer.

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OUT & ABOUT..... (continued from previous page)

also run by BoardSports. Coyote Point enjoys many days of excellent wind quality and safe shore conducive to progression at all levels. There are also private instructors that can accelerate the process quite a bit. Equipment is typically included in all beginner packages.

San Francisco has several groups of dedicated, highly competitive teams of formula and slalom course racing that regularly sail, train, and compete in local and national events. There are even junior racing and freestyle teams for kids 17 and under, that are run by volunteer sailors. These are well run, non-profi t organizations that are free of charge for participants (www.teamberkeleywindsurf.com).

If you are a windsurfer and new to the Bay, well my friend, you hit the jackpot. There are amazing sailing venues for all abilities and taste. If you are into freestyle (think of air and spinning moves while hydroplaning, similar to skate or snowboarding but on the water), then head to Candlestick (fi ve minute drive from SFGH parking lot) or Haskins. Swell rider? Then hit 3rd Avenue on an ebb tide or Treasure Island and you are in for a treat. Crissy Field can have it all on the right day, steep port ramps for big air, huge tanker ramps for insane air, fl at water on a fl ood tide for speed or freestyle, smooth large swell, and even wave sailing down the line at the South Tower (please watch out for the surfers!). Crissy (ten minute drive from UCSF Medical Center) is absolutely gorgeous and has great facilities but it is an advance to expert only site due to the strong currents, heavy boat traffi c, and rapidly shifting wind conditions. Do sail there with a friend who is familiar with Crissy before you embark on your own. During the summer when the Bay is blanketed by a thick layer of fog, head to Sherman Island (45 minute drive from SF) and enjoy the sun and 90 degree weather, strong steady wind and nicely shaped starboard ramps. Finally, we have world class wave sailing within one hour away at Wadell Creek, Davenport and Tubamancha, that offer many great days of good wind and waves in the spring and fall.

Windsurfi ng is an amazing sport that requires a bit of patience but once you have surpassed the initial awkward stage and you are in the harness and locked on your footstraps, you are in for an unforgettable experience. The San Francisco Bay is probably one of the best places on earth to go windsurfi ng, with an unmatched number of windy days, and astonishing beauty. What are you waiting for?

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10 QUESTIONS FROM THE RESIDENT AND FELLOW AFFAIRS COMMITTEE

1) Is there money automatically being placed into my UCSF retirement account each month? Yes, you are automatically enrolled in UC’s Defi ned Contribution Plan (the “DC Plan”). In lieu of contributions to Social Security, Residents and Fellows contribute 7.5% of each paycheck into the DC Plan, on a pretax basis.

2) What happens to the money in my retirement account? Is it automatically invested, and if so, how is the investment chosen? You direct how your contributions are invested by setting an investment election for your contributions. If you don’t select investments, your contributions to your DC Plan account are automatically invested in the UC Savings Fund, one of the more conservative investments in the Plan.

3) What are my investment options within the UC Retirement Savings Program? To help you meet your investment goals, the Program offers you a range of options. There is a variety of over 200 individual options available that allow you to diversity your investments across stocks, bonds and stable value options. The Core funds are a diverse group of investment options selected and monitored by the UC Offi ce of the Treasurer. Expanded Core Fund choices are available for participants who may want to build their own portfolio, but are not monitored by the Offi ce of the Treasurer. Other mutual funds are available through a self directed brokerage account.

To learn more about asset allocation and diversifi cation, attend the “Building a Portfolio for any Weather” class.

4) What if I’m not sure where to invest? The UC Pathway Funds, part of the UC Core Funds, let you make a single fund choice based on the year you expect to begin withdrawing money from the plan. The fund provides automatic reallocation based on the fund’s target date, growing more conservative as they near that retirement target date.

Note: The investment risks of each target date Pathway Fund change over time as the Fund’s asset allocation changes. Assets held in the Pathway Funds are subject to the volatility of the fi nancial markets, including equity and fi xed income investments in the U.S. and abroad and may be subject to risks associated with investing in high yield, small cap and foreign securities. Principal invested is not guaranteed at any time, including at or after their target dates.

5) What other opportunities do I have to save for retirement? As an employee of the University of California, you can also participate in the other plans in the UC Retirement Savings Program: the Tax-Deferred 403(b) Plan and the 457(b) Deferred Compensation Plan. These plans are not available to students who normally work fewer than 20 hours per week. Additional information is available online www.ucfocusonyourfuture.com.

Joe Hager, Senior Retirement Counselor from Fidelity Retirement Services®, answers resident and fellow questions about the UC Retirement Savings Program, retirement investing and planning. Joe joined Fidelity as a Sr. Retirement Counselor for UC in 2007. A registered securities representative, he holds a bachelor’s degree in economics from Boston University

UCSF RETIREMENT BENEFITS

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6) What is the difference between the 403(b) and 457(b) plans? The key difference between the 2 plans is how you can access your money. It may boil down to when you expect to leave UC and the fl exibility you need in access your money.

With the 403(b) Plan, you have access to the funds in your account while you are still employed via a loan or a “hardship” withdrawal (if you meet the plan requirements). Also, you can take an “in-service” distribution at or after age 59-1/2.

If you terminate employment and take a withdrawal from the 403(b) Plan prior to age 59-1/2, you will generally incur a 10% early withdrawal penalty in addition to being taxed (since this money is pre-tax money), unless you terminate during or after the year in which you reach age 55, or another exception applies.

With the 457(b) Plan, in-service withdrawals for “unforeseeable emergencies” are available (if you meet the plan requirements), but loans are not. In-service distributions are available in and after the calendar year you reach age 70-1/2. A small ($5,000 or less), one-time, in-service withdrawal is available under certain circumstances. With the 457(b) Plan, you generally have no early withdrawal penalty.

See the 403(b) Plan and 457(b) Plan Summary Plan Descriptions (SPDs) for more information about these plans. The SPDs can be found online under the Getting Started? tab on www.ucfocusonyourfuture.com

To learn more about plan features, attend the “Getting Started with your UC Plan” class.

7) What is a safe harbor and why is it important?

The safe harbor provision is necessary to satisfy state and federal requirements. With safe harbor, certain University of California employees who are not otherwise covered by a retirement system contribute to the University of California Defi ned Contribution Plan (the DC Plan or the Plan) in lieu of paying Social Security taxes. The DC Plan is qualifi ed under section 401(a) of the Internal Revenue Code (IRC). Administered by the University of California Retirement System (UCRS) for the sole benefi t of the participants and their benefi ciaries, the DC Plan provides retirement benefi ts based on participants’ contributions, plus earnings. The Plan is part of the UC Retirement Savings Program, recordkept by Fidelity Retirement Services. Additional information on the plan is provided in the Summary Plan Description available online through atyourservice.ucop.edu or www.netbenefi ts.com.

8) Can I enroll anytime in the retirement plan? Can I make changes anytime in my retirement plan? Eligible participants may enroll in the UC Retirement Savings Plan at anytime by calling 1-866-682-7787 or online at www.ucfocuonyourfuture.com.

Changes to investments can also be done over the phone or online. Participants should consider any potential short term trading policy their investment options may have prior to changing investments.

9) What happens to the money in my retirement fund when I leave UCSF? (547083.3.0 pg. 2)If you leave UC employment, you may: • Keep your money in the Plan if your balance is at least $2,000;• Arrange for a direct rollover of your money to a traditional or Roth IRA or another employer plan that accepts rollovers;• Request a distribution to be paid directly to you; • Receive periodic payments from the Plan; or• Arrange to purchase an annuity through UC’s group insurance contract.

Participants who leave UC employment and have a balance of less than $2,000 in the Plan cannot leave their money in the Plan. Account balances of $1,000 or less will automatically be distributed at the end of the quarter to participants who have not provided distribution directions. Balances greater than $1,000 but less than $2,000 will be rolled over into an IRA in the participant’s name unless the participant provides

10 QUESTIONS FROM THE RESIDENT AND FELLOW AFFAIRS COMMITTEE

(continued on page 12)

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distribution directions. A participant whose balance is defaulted to an IRA will be notifi ed of the default and the name of the IRA custodian. It is important that you maintain your address records to assure delivery of your distri bution.

10) Can I roll over retirement savings from a previous plan? Yes, rollovers of eligible assets from tax-deferred retirement plans are allowed into the UC Retirement Savings Program. Reasons to consider rolling over include cost, investment choice and convenience. For assistance with potential rollovers, call 800-558-9182.

11) Is it appropriate to be contributing to retirement while I’m still paying off student loans and other debt? How should I balance these obligations?Prioritization of debt versus savings is case specifi c to the individual. Factors to consider include interest rates, deductibility of interest, tax status and future fi nancial goals.

To learn more about prioritizing your debt, attend the “Understanding the Power of Debt” class.

12) What resources are available to learn more about the UC Retirement Savings Program and fi nancial education in general?

In Person: You may attend any of the Financial Education Classes offered at UCSF, at no cost to you. To register for a class, visit http://getguidance.fi delity.com/universityofcalifornia

Over the Phone: Employees can call 866-682-7787 between 5am PST and 9pm PST

Online: visit www.ucfocusonyourfuture.com

Before investing in any investment option, please carefully consider the investment objectives, risks, charges and expenses. This and other information on the UC Core Funds is available, free of charge, online at www.netbenefi ts.com or by calling Fidelity® Retirement Services at 1-866-6UC-RSVP (1-866-682-7787). This and other information on mutual fund options that are part of the UC Core Funds lineup and other mutual funds outside the UC Core Fund lineup can be found in each mutual fund’s prospectus or, if available, a summary prospectus, which can be obtained, free of charge, at the same website and toll-free phone number. Read the information carefully before you invest.

Keep in mind that investing involves risk. The value of your investment will fl uctuate over time and you may gain or lose money.

The taxable portion of your withdrawal that is eligible for rollover into an individual retirement account (IRA) or another employer’s retirement plan is subject to 20% mandatory federal income tax withholding, unless it is directly rolled over to an IRA or another employer plan. (You may owe more or less when you fi le your income taxes.) If you are under age 59½, the taxable portion of your withdrawal is also subject to a 10% early withdrawal penalty, unless you qualify for an exception to this rule. The plan document and current tax laws and regulations will govern in case of a discrepancy. Be sure you understand the tax consequences and your plan’s rules for distributions before you initiate a distribution. You may want to consult your tax adviser about your situation.

Any assets distributed from your governmental 457(b) plan will be taxed as ordinary income in the year withdrawn; if you are under age 59½ at the time of the distribution, a 10% early withdrawal penalty may apply to any amounts which were rolled into the plan from an IRA or a plan other than another governmental 457(b) plan. If the distribution is eligible to be rolled over, but is not directly rolled over to an eligible plan or IRA, 20% mandatory withholding of federal income tax applies. Federal income tax will not be withheld if an eligible plan-to-plan transfer is made to another employer’s 457(b) plan that accepts the transfer. Be sure you understand the federal and state tax consequences of any distribution before you initiate one. You may want to consult your tax adviser about your situation.

Fidelity Brokerage Services LLC, member NYSE, SIPC, 900 Salem Street, Smithfi eld, RI 02917599544.1.0

(continued from page 9)10 Questions.....from the RFA Committee

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This has been quite a busy year for the Resident and Fellow’s Council. This spring we focused on several large projects including the Patient Care Fund and the Housestaff Incentive Program as well as advocating for several resident and fellow needs.

The Patient Care Fund, a $50,000 allocation for resident and fellow designed projects to improve the patient experience, underwent two funding cycles this year. We were able to fund a range of wonderful projects among which were a piano for the 11L solarium, care coordination binders for radiation oncology patients, and high quality reusable stethoscopes for the pediatric blood and marrow transplant unit. We are quite excited about being able to bring these creative projects to fruition and encourage housestaff to start to think about projects for the next round of applications. For more information on the Patient Care Fund, please go tohttp://medschool.ucsf.edu/gme/residents/pcf.html

We are happy to report that 18 departments/programs have submitted applications to participate in the 2012-2013 Program Specifi c Housestaff Incentive Program. This program allows residents and fellows to identify, design, and execute a quality improvement project specifi c to their program. The results of the 2011-2012 program were presented at the Poster Symposium on June 12th.

We have also been working to improve housestaff involvement with the current UCSF Medical Center all training program incentive goals centered on increased patient satisfaction, increased hand hygiene, and decreased lab utilization. As a whole, we are currently on track to attain at least two of the three incentives with particularly impressive gains in hand hygiene compliance.

In regard to resident and fellow needs, our members have been busy helping to clarify the new resident and fellow relocation reimbursement, collaborate with other UCSF student groups to design a safe study space at Mission Bay, and create consult “cheat sheet” to maximize the educational aspect of calling consults. If you have any ideas to improve the educational experience or quality of life of UCSF residents and fellows, please contact us or come to a meeting - we generally meet the third Monday of each month and new members are always welcome!

Wishing you all the best, Lisa & Robin

Elizabeth (Lisa) Le and Robin Horak, MDResident and Fellow’s Council Co-Chairs

UCSF RESIDENT AND FELLOW’S COUNCIL

CONFIDENTIAL

GME Helpline502-9400

Confi dential line for housestaff, faculty, and program administrators to voice their

questions, comments, or concerns 24 hours a day. The Offi ce of Graduate Medical Education will

respond to all messages.

12


HONORS AND RECOGNITION FOR HOUSESTAFF - 2011-2012

ADOLESCENT MEDICINEJosephine Lau, MD, MPH - Department of Pediatrics NIH T32 award

ANESTHESIAAngela Lipshutz, MD, MPH - 2011 CTSI Resident Research Funding AwardMichele Arnold, MD - 2011 Recipient of the Stuart C. Cullen Award for Excellence in Clinical AnesthesiaMadina Gerasimov, MD - 2011 Jeffrey A. Katz Award for Excellence for Work Ethic and ProfessionalismAnuj Malhotra, MD - 2011 Recipient of the Mark A. Rosen Award for Resident Scholarship2011 Medical Student Teaching Award, AnesthesiaMichele Arnold, MDJoshua Cohen, MDBrad Cohn, MDEric Shields, MDCatherine Stapleton, MDEmanuel Zusmer, MD2012 UCSF SOM Clinical Teaching Excellence Award for Cherished Housestaff (TEACH) by UCSF SOM Class of 2012L. Stephen Long, MDJoshua Cohen, MD – 3rd Place Poster Presentation, 50th Annual Western Anesthesia Resident ConferenceLaura Lang, MD – 3rd Place Poster Presentation, 50th Annual Western Anesthesia Resident Conference

CARDIOLOGYStephen Waldo, MD – Stethoscope Award, Division of Cardiology, Department of MedicineBabak Nazer, MD - Clinical Fellow Award, Department of MedicineMarwan Refaat, MD – 2011-2012 Kenneth M. Rosen Award in Cardiac Pacing and Electrophysiology

DERMATOLOGYTiffany Scharschmidt, MD - 2011 CTSI Resident Research Funding AwardDeepti Gupta - First Place Award for Poster Presentation, Society for Pediatric Dermatology, Annual Meeting 2011Deepti Gupta - First Place Award for Poster Presentation, American Academy of Dermatology, Annual Meeting 2012Francisco Ramírez-Valle - Dermatologist Investigator Research Fellowship GrantFrancisco Ramírez-Valle - Medical Dermatology Society Mentorship AwardTiffany Scharschmidt - Dermatologist Investigator Research Fellowship GrantJoshua Schulman - First place - American Society of Dermatopathology Resident Abstract CompetitionJoshua Schulman - Women’s Dermatologic Society Mentorship AwardKelly Park (Psoriasis) - UCSF Master of Studies in Law Scholarship Award ($30,000)

EMERGENCY MEDICINEHemal Kanzaria, MD - Robert Wood Johnson Clinical scholar (effective July 2012) Bory Kea, MD – ACEP Best Resident Research paper presented at the 2011 research forumJacob Miss, MD - 2011-12 Department of Emergency Medicine,

Medical Student Teaching award Sean Kivlehan, MD - 2011-12 Department of Emergency Medicine Intern of the year awardEric Silman, MD - 2012 Graduating Resident awardLauren Wooley, MD - 2012 Krevans award for Clinical Excellence2011 CTSI Resident Research Funding AwardHangyul Chung-Esaki, MDM. Kennedy Hall, MDJillian Mongelluzzo, MD Jennifer Wilson, MS, MD

FAMILY MEDICINEHeather Bennett, MD - 2011 CTSI Resident Research Funding AwardLeah Pollock, MD, MPH - Krevans Award for Excellence

INTERNAL MEDICINEMatthew Cascino, MD - Keith Johnson Award (R2)Sanjay Basu, MD, PhD - Jeffrey Weingarten Award (R3)Community Service Awards Devora Keller, MD, MPHPalav Babaria, MD, MHSLisa Le, MD Chris Moriates, MD - Thomas Evans Teaching AwardJoshua Lakin, MD - Reza Gandjei Humanism AwardProfessionalism AwardsCason Pierce, MD, MAJennifer Ross, MD, MPHFloyd Rector Basic Science Research AwardRobert Wirka, MDAnna Malkina, MD2012 UCSF SOM Clinical Teaching Excellence Award for Cherished Housestaff (TEACH) by UCSF SOM Class of 2012Jayson Morgan, MDMatthew Roosevelt, MDAcademy of Medical Educators Cooke Awards for the Scholarship of Teaching and LearningMia Lozada, MDKrishan Soni, MD, MBAJoshua Lakin, MD - Emergency Department Consultant Excellence Award2011 CTSI Resident Research Funding AwardSanjiv Baxi, MS, MDSeth Cohen, MDDavid Lange, MDRushi Parikh, MDRobert Wirka, MD2011 CTSI Resident Research Travel AwardSanjay Basu, MD, PhDSanjiv Baxi, MS, MDSeth Cohen, MDSanket Dhruva, MDSara Murray, MD2012 CTSI Resident Research Travel AwardPalav Babaria, MD, MHSRobert Brownell, MDGreg Burrell, MDJeffrey Dixson, MDAlexander Millman, MDGene Quinn, MS, MDJennifer Ross, MD, MPH

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HONORS AND RECOGNITION FOR HOUSESTAFF - 2011-2012

NEUROLOGYAlpha Omega Alpha Honor Medical SocietyMark Burish, MD, PGY 2Amar Dhand, MD, PGY 42012 UCSF SOM Clinical Teaching Excellence Award for Cherished Housestaff (TEACH) by UCSF SOM Class of 2012Amar Dhand, MD, PGY 4Nilika Singhal, MD, PGY 5 (Child Neurology) – The Shupin Research Funding, Department of NeurologyAudrey Brumback, MD, PGY 4 (Child Neurology) - Editorial board member - Residents and Fellows section of “Neurology” journalAudrey Brumback, MD, PGY 4 (Child Neurology) - NIH grant - National Institutes of Neurological Disorders and Stroke under the Research Education (R25) Program, 2011– 2013Audrey Brumback, MD, PGY 4 (Child Neurology) - Annual Meeting Resident Scholarship - American Academy of Neurology, 2012

NEUROLOGICAL SURGERYDario Englot, MD, PhD - 2011 CTSI Resident Research Funding AwardDario Englot, MD, PhD - 2011 CTSI Resident Research Travel Award

OBSTETRICS & GYNECOLOGYJuno Obedin-Maliver, MD - 2012 Chancellor’s Award for LGBT Leadership Wayne Lin, MD - Special Resident in Minimally Invasive Gynecology – AAGLTracey McLean - Resident Representative at Studer Group Annual Conference - UCSF Medical Center/GME Resident and Fellow AffairsWayne Lin, MD - Resident Research Funding Program - UCSF CTSI Resident Research ProgramCraig Mayr, MD - AUGS Resident Scholar Award - American Urogynecologic SocietyJessica Chan, MD - TEVA Medical Resident Excellence Award - North America Menopause SocietyPavithra Venkat, MD - Frank Lynch Memorial Essay Award for Best Resident/Fellow Research Paper - Pacifi c Coast Obstetrics and Gynecology SocietyWayne Lin, MD, MPH - 2011 CTSI Resident Travel Award

OCCUPATIONAL AND ENVIRONMENTAL MEDICINE2012 CTSI Resident Research Travel AwardThanjira Jiranantakan, MD, MPHXing Yang, MSPH, MD, PhD

OPHTHALMOLOGYMichael Seider,MD - Garcia/Asbury AwardJustin Baynham,MD - Hogan/Garcia AwardMichael Chen, MD - Heed Foundation FellowshipJustin Baynham,MD - Starr E. Shulman Fellowship AwardJonathan Greene, MD - 2011 CTSI Resident Research Travel Award

ORTHOSURGERYJulius R. Krevans Award - For Outstanding Intern at SFGHLindsey Sheffl er, MD, PGY 1Alexander Theologis, MD, PGY 1Adam Warren, MD, PGY 5 - Manning Award for Outstanding Resident Research Paper

Derek Ward, MD, PGY 2 -2nd place research presentation paperAbbey Kennedy, MD, PGY 5 - 3rd place research presentation paper AwardRosanna Wustrack, MD, PGY 5 - Maurer Award for Outstanding Chief ResidentJulia Kao, MD, PGY 3 - OREF/ DePuy Resident Research Project GrantDrew Lansdown, MD, PGY 2 - Arthroplasty Teamwork Award for Excellence in the Arthroplasty serviceFrank Valone, MD, PGY 2 - Spine Team work Award for Excellence in the Spine ServicePaul Toogood, MD, PGY 3 - Spine Team work Award for Excellence in the Spine ServiceAmanda Tencza, MD, PGY 3 - OREF Research Residency GrantLionel Metz, MD, PGY 4 - OREF Resident Journal Club GrantSamantha Piper, MD, PGY 4 - OREF Resident AwardLionel Metz, MD – Oral Presenter, 2012 CTSI Resident ResearchAlexander Theologis, MD, PGY 1 - J. Harold LaBriola Resident Award

OTOLARYNGOLOGYKevin Huoh, MD - Triological Society Western Section Shirley Baron Resident Research AwardKevin Huoh, MD – UCSF Resident Research Symposium - Kevin Huoh, MD – Bay Area Residents Research Symposium Megan Durr, MD - 2011 CTSI Resident Research Funding AwardMegan Durr, MD - 2012 CTSI Resident Research Travel AwardMegan Durr, MD – Bay Area Resident Research Symposium 2011: Best ClinicalMegan Durr, MD – Appointed As American Academy Of Otolaryngology Section For Residents And Fellows Delegate to the American College Of Surgeons 2011-2013

PATHOLOGYStephen Nobles, MD - Julius Krevans Award, Anatomic PathologyCyril Jacquot, MD, PhD - Julius Krevans Award, Laboratory MedicineSarah Calkins, MD - Fellow Teaching AwardRobert Mike Angelo, MD, PhD - MSCLA 2012 Travel AwardBenjamin Buelow, MD, PhD - MSCLA 2012 Travel AwardHan Sung Lee, MD, PhD - Faculty Teaching AwardScott Kogan, MD - Faculty Teaching Award

PEDIATRICSTristan Sands - UCSF Medical Center Exceptional Physician Award, May 2012Maura Madou - Lucy S. Crain, MD AwardSohil Sud - Resident Teaching AwardAllison Moorman - Resident Teaching AwardKaitlyn Bailey - Resident Teaching AwardRyan Padrez - Resident Teaching AwardTaylor Clark - Ahmad GhaneaBassiri, MD Pediatric Intern AwardFrank Cipriano - Volunteer Faculty Teaching AwardPeter Simon - Rudolph AwardAndrea Marmor - Faculty Teaching AwardAlice Chan - Postdoctoral Fellow Teaching AwardKatie McPeak - Compassionate Physician AwardPeter Simon - Brown-Coulter AwardHolly Martin - Grossman AwardJessica Duval - Krevans Award

14


As a resident or fellow, your goal is to ensure your patients get the best care possible based on the best available evidence. Are you comfortable just Googling for that evidence? Google is a good search tool, but has its limitations – particularly it can’t be entirely relied upon for the best and most current evidence. That’s where the Library can help.

The UCSF Library provides access to the full text of thousands of medical and allied health journals, along with resources for fi nding the best available evidence.

Some of the highlights:

Pubmed @ UCSF: Access to MEDLINE, including the full text of thousands of journals subscribed to by UCSF. Also includes literature in nursing, dentistry, bioethics, complementary and alternative medicine, and history of medicine.

MDConsult: Access to the Clinics review articles and other full text journals and textbooks. Also includes clinical guidelines, drug information and medical images.

Access Medicine: Includes textbooks, such as Harrison’s and the Current Medical Diagnosis and Treatment Series, along with full text journals. Also provides images, videos, and audio fi les of major medical conditions.

Cochrane Library: The premier resource for evidence-based health care. Includes systematic reviews and clinical trial information.

UpToDate: A point of care tool for evidence- based reviews, particularly useful for getting quick answers to clinical care questions.

All these resources (and more) can be found on the Library’s home page: http://library.ucsf.edu

To learn more about what the Library offers, check out the Getting Started for Residents and Clinical Fellows guide on the Library website, or contact us through the “Ask Us” page.

News from the UCSF Library

Michelle Henley, MLSEducation and Information Services, UCSF LIbrary

2011 CTSI Resident Research Funding AwardPEDIATRICS Alexandra Channing, MDEsther Lee, MDMelissa Morgan, MD, MSAdam Schickedanz, MD

PSYCHIATRY Mikel Matto, MD, PGY 1 - 2012 APA Child & Adolescent Psychiatry Fellowship AwardAlice X. Huang, MD, MS, PGY 2 - 2012 Geriatric Mental Health Foundation Scholar, AAGP Flavio Casoy, MD, PGY 3 - 2012 National Secretary –Treasurer for CIR/SEIU Flavio Casoy, MD, PGY 3 - 2012 Delegate to SEIU Quadrennial ConventionAbilash A. Gopal, MD, PGY 4 - 2012 Rappeport Fellowship AwardPamela Lyss-Lerman, MD, PGY 4 - 2012 Laughlin Award for Excellence in Clinical CareMolly James-Meyers, MD, PGY 4 - 2012 Public and Community Service AwardJenya Alissa Kaufman, MD - 2012 Outstanding Teacher AwardJason Eric Cheng, MD, PGY 4 2012 Edwin F. Alston Award for Leadership in PsychiatryGabriel Aranovich, MD, PGY 4 - 2012 Academic Scholarship AwardR. Jefferson Joseph, MD, PGY 6 - 2012 Irving Phillips Award

RADIOLOGY2012 CTSI Resident Research Travel AwardAkash Kansagra, MS, MDRonnie Sebro, MS, MD, PhDMarcel Brus-Ramer, MD, PhD - Named president-elect of the residents and fellows section, California Radiological Society

RADIOLOGY ONCOLOGYStephen Shiao, PhD, MD - RSNA 2012 Roentgen Resident/Fellow Research AwardTina Dasgupta, MD, PhD - 2011 CTSI Resident Research Funding Award2011 CTSI Resident Research Travel AwardChien “Peter” Chen, MD, PhDTina Dasgupta, MD, PhD

SURGERYSam Wang, PGY 5 - The Nusz Achievement Award, Garrett Roll, PGY 5 - The Azakie-Chesson Award for Compassion, Department of SurgeryLisa Brown, PGY 5 - The Haile T. Debas Resident Teaching AwardChetan Irwin, PGY 3 - Medical Student Teaching AwardsWillieford Moses, PGY 1 - Medical Student Teaching AwardsMatthew Kutcher, MD - 2011 CTSI Resident Research Funding Anne Warren Peled, MD - 2011 CTSI Resident Research Travel AwardMatthew Kutcher, MD – Oral Presenter - 2012 CTSI Resident Research Symposium

UROLOGY 38th Annual Northern California Urological Resident Research SeminarGlen Yang, MD - Basic Science, 1st PlaceDana Weiss, MD - Basic Science -3rd PlaceHerman Bagga, MD - Clinical Research - 2nd Place

Honors 2011-2012 (continued from page 13)

15


On May 2, 2012 the Resident Research Training Program of UCSF’s Clinical & Translational Science Institute held its 5th annual Resident Clinical & Translational Research Symposium in Milberry Union. The symposium provides an opportunity for residents to present their work and to develop cross-departmental collaborations.

The event began with a welcome from Sam Hawgood, MD, Dean, School of Medicine. Doug Bauer, MD, RRTP Director, gave an overview of RRTP and all the opportunities it offers.

Five oral presentations were selected from among the resident abstracts submitted for consideration.

Seth Cohen, MD, presented “Prophylaxis of Invasive Aspergillosis in Lung Transplant Recipients: Is Inhaled Amphotericin Enough?”Matthew Kutcher, MD, presented “Critical Mediators of Coagulopathy After Trauma” Lionel Metz, MD, presented “Acute Kidney Injury After Total Hip or Knee Arthroplasty in a Veteran Population”Gene Quinn, MS, MD, presented “Selective Serotonin Reuptake Inhibitors Increase Major Hemorrhage Risk in Patients with Atrial Fibrillation Taking Warfarin”Darcy Wooten, MS, MD, presented “Risk Factors for Methicillin-Resistant Staphylococcus Aureus (MRSA) in Patients with Community-Onset and Hospital-Onset Pneumonia.”

In addition, numerous other abstracts were accepted for poster presentation, which were available for viewing during a reception following the oral presentations. In all, 38 resident posters were presented, representing many programs across campus from Anesthesiology to Radiology. There were even residents presenting from as far as UCSF Fresno.

The success of residents embarking on a research project is highly infl uenced by the quality of their mentorship. This year’s recipient of the RRTP Mentor of the Year Award was Lee-may Chen, MD, Professor, Edward C. Hill Endowed Chair, Obstetrics, Gynecology and Reproductive Sciences.The event was informative and entertaining. It provided a unique opportunity for residents to present their work and to exchange ideas with both peers and faculty.

For more information please go to:http://accelerate.ucsf.edu/training/resident

Resident Research SymposiumChristian Leiva CTSI Resident Research Training Program Coordinator

APeX UpdateKim CloidtAPeX Communications Manager

GME GRAND ROUNDS

The Offi ce of Graduate Medical Education sponsors Grand Rounds for residents and

clinical fellows each monthon the third tuesday of each month

(12noon - 1pm)

2012-2013 GME Grand Rounds schedule will be available at:

www.medschool.ucsf.edu/gme/grounds/index.html

The Dean’s Offi ce encourages all trainees to attend and makes every effort to coordinate

Grand Rounds with the residency/fellowship noon teaching conferences.

June 2nd marked a momentous event at UCSF Medical Center with the APeX inpatient and Wave 4 ambulatory go live. Thousands of providers, clinicians, non-clinicians, and staff are now online with APeX, our electronic health record, in the inpatient areas at Parnassus and Mount Zion. Over 25 ambulatory practices also went live including including Organ Transplant Service, Orthopaedic Institute, Reproductive Health, Pediatric Rehabilitation Clinic, and Spina Bifi da Program.

Current residents and fellows who rotate at UCSF in June have completed training. Incoming trainees as well as all others who will rotate at a UCSF site in July are completing training this month. APeX training is required for all providers, including residents and clinical fellows. Required training is dependent upon each individual resident and clinical fellow’s rotations and consists of both web-based training (four to six hours), which must be completed prior to classroom training, and classroom training (four to eight hours).

For additional training information, residents and clinical fellow should contact their program coordinators. With the complexity of workfl ows and patient orders, it is important for residents and clinical fellows to spend extra time communicating with nurses to ensure patient safety and quality of care during the APeX transition. If you experience any issues, call the APeX Provider Hotline at 514-6100.

16


“Diversity – a defi ning feature of California’s past, present, and future – refers to the variety of personal experiences, values, and worldviews that arise from differences of culture and circumstance. Such differences include race, ethnicity, gender, age, religion, language, abilities/disabilities, sexual orientation, socioeconomic status, and geographic region, and more.”

As Vice Chancellor, Diversity and Outreach, I would like to welcome new and returning trainees to our campus community. The Offi ce of Diversity and Outreach established in December 2010, strives to ensure that the University of California, San Francisco embraces and nurtures our commitment to a diverse and just campus community. We recognize that our strength as an institution lies in the full participation and contribution from individuals of different backgrounds and that your participation is an essential component of maintaining our excellence in education, research, patient care, and service.

We are committed to providing an environment that is a supportive place to work, learn, discover, teach, and care for patients and we strive to serve local and global communities to eliminate health disparities. In furtherance of this commitment, I am pleased to announce the establishment of a Multicultural

Resource Center. The Center which will be centrally located on the Parnassus campus, will promote our campus culture of inclusion and equity, cultural competency, and inter-professional collaboration, and will nurture the pipeline and contribute to the recruitment and retention of faculty, students, trainees, and staff. Director Mijiza Sanchez looks forward to building relationships with all groups on campus to create an inclusive and welcoming community. The Center is slated to open this summer.

Through the work of this offi ce and others we have established an Academic Demographic System that facilitates best practices in academic searches and improves the coordination and reach of our recruitment efforts and annual reporting to the campus community from leadership. We have ongoing cultural competency training, support for fi rst generation, underrepresented minorities, GLBT, women, disabled, and others within our community. We host an Annual Leadership Forum on Diversity, the Inside UCSF campus-wide outreach event, Diversity Month Celebrations each October, a joint diversity celebration with Graduate Medical Education in December, and provide ongoing enhancements to our curriculum.

We encourage you to get involved with diversity initiatives within your department or training program. Rene Salazar, MD, Director of Diversity, GME is an excellent resource and provides guidance and support through annual diversity outreach events including involvement in annual medical conferences and activities for top-tier URM undergrads interested in training programs at UCSF.

Please visit the Nurturing Diversity website which will provide you with information on campus resources, demographics, and annual reports, diversity.ucsf.edu/. You may also subscribe to the Diversity Listerv by going to the website.

We invite you to engage in a dialogue directly with us. When there is a concern or something exciting to report, we want to hear about it. Please don’t hesitate to contact our offi ce ([email protected]). I hope your time here at UCSF is both fruitful and rewarding.

Diversity at UCSFJ. Renee Navarro, MD, Pharm DVice Chancellor, Diversity and Outreach

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2011-2012 Incentive UpdateGlenn Rosenbluth, MDDirector, Quality and Safety, GME

We continue to make great progress in achieving the 2011-2012 Housestaff Incentive Goals. We have three goals this year which affect all residents and fellows who rotate at the Parnassus or Mt. Zion campuses for at least 12 weeks.

Patient Satisfaction: Our goal is to maintain an average mean score of 90.7 on the “likelihood to recommend” score for our patient surveys. So far this year we are doing an outstanding job – our scores are consistently above 91! This refl ects the outstanding service provided by our residents and fellows!

Hand Hygiene: The Hand Hygiene goal is to achieve 85% compliance for at least six out of twelve months during 2011-12. As you can see on the graph below, the Medical Center has achieved this goal, though physicians are lagging behind. Hand hygiene is considered the most important measure for preventing health-care associated infections and the spread of antimicrobial resistant pathogens. Please remember to “gel in, gel out” of every room (even if you aren’t going to touch the patient).

Decreasing Lab Test Utilization: Our goal was to reduce aggregate utilization by 5% during this academic year, and unfortunately utilization has remained stable at around 9.5 tests per inpatient day. Although we will not achieve this goal, some departments have made huge gains and have shown us that there is a lot of room for gains. The Neurological Surgery service, for example, has decreased utilization of chloride, calcium, magnesium, and phosphorus by as much as 35%!

In past issues we have distributed tips from the UCSF Clinical Labs on strategies to reduce unnecessary lab test utilization. For additional resources on approaches to improving care effi ciency, check out: www.choosingwisely.org

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By Rachel D. Steinberg, Psy.D.Faculty and Staff Assistance Program (FSAP)

The Art of Sleeping: Setting the stage for sleep during your residency.

Sleep is an essential component to our health and psychological well-being, yet insomnia and other sleep related diffi culties are common. For example, National Sleep Foundation surveys found that 40 million Americans suffer from sleep disorders and that most sleep diffi culties are undiagnosed and untreated. In addition to its importance for metabolic, cardiovascular, and immune system health, sleep is the time when we consolidate new information and store it in memory. The importance of sleep is particularly important during your residency because of its roles in your personal well-being, ability to provide patient care, and learning. In fact, sleep deprivation contributes to medical and diagnostic errors, accidents (i.e. needle stick injuries, car accidents), decreased work performance, and diffi culty in thinking and mood.

Maintaining healthy sleep habits can be diffi cult especially during residency where hours and rotations are changing frequently. Furthermore, many of you are struggling to fi nd a work life balance and are likely feeling overworked and exhausted. These feelings can lead to stress which can impact the quality and amount of your sleep. While setting a regular bedtime and wake time are ideal there are many other useful techniques and tips that can be used during your residency. Sleep techniques generally fall into three categories: stimulus control, general sleep hygiene, and stress reduction and relaxation skills.

Stimulus control• Use your bed for the 3 S’s (sleep, sex, sickness). Other than

these three, avoid activities in your bed and bedroom, such as work, phone or text communications, using the computer, watching TV, and reading. The goal is to create connections in the brain that associate your bed with rest (or sex), but not work.

• Go to bed only when you feel drowsy. Be aware of your internal cues such as heavy eyelids or reading the same passage over and over again, not to external cues such as the clock or when your roommate or partner goes to bed.

• Develop a pre-sleep routine. This might mean turning down the lights, drinking a cup of herbal tea, taking a soothing bath, or reading a relaxing book. This helps signal the brain that the time of sleeping is approaching.

• Develop a sleep routine. When going to bed, immediately turn out the lights and allow for sleep to occur naturally. If you are not asleep within 20-30 minutes, get out of bed, leave the bedroom, and do something quiet and relaxing such as reading a book or listening to calming music. Repeat this last step as often as necessary until you fall asleep. Remember, it is best to avoid watching TV or using the internet when you are trying to fall asleep because the bright screen lights stimulate the brain and keeps you awake.

• Develop a wakeup routine. Establish regular waking hours (if possible). Open the drapes as soon as you wake up, or if possible, get out into the sun. If it is cloudy or foggy, or you must wake up in the middle of the night, turn on some lights. Your body’s circadian rhythms are regulated by light.

Sleep Hygiene• Avoid caffeine (particularly in the two hours before bed),

nicotine (its stimulant effect can last hours and nicotine withdrawal at night can cause you to wake), alcohol (great for getting to sleep but horrible for quality of sleep), and large or heavy meals before bedtime.

• Set the stage for sleep. Arrange a cool, dark, quiet bedroom. • If you nap, nap smart. Limit napping to 45 minutes (if

possible) and avoid napping later than 4:00 pm (if you have the day shift).

• Exercise. Studies fi nd a relationship between insomnia and sendentary lifestyle. Be careful, however, intense exercise two hours before sleep should be avoided.

• Diet and sleep. Maintain a healthy balanced diet and adjust your eating routine around your sleep cycle. Aim to eat a substantial breakfast, moderate lunch, and light dinner

Stress Reduction and Relaxation Skills• Mindful Breathing: Periodically, take a few deep breaths

during the day and to let some tension out. Breathe in for 2-3 seconds and out for 5-6 seconds. Try to notice any tension in your body and breathe out, letting it go.

• Progressive Muscle Relaxation: Involves tightening and releasing of specifi c muscles groups from head to toe. The emphasis is on noticing the differences between tense feelings and relaxed feelings.

• The Body Scan: Similar to progressive muscle relaxation in its focus on the body head to toe, the body scan works by guiding our attention to each part of the body sequentially.

• Visualization and Guided Imagery Techniques: These techniques involve the creation of a detailed mental image of a peaceful setting or environment (e.g. walking along the beach, sitting in the woods, etc.). The goal is to associate the senses of the peaceful images, such that the imagery alone induces relaxation.

Links for audio/video resources for guided mediations:UCLA: http://marc.ucla.edu/body.cfm?id=22UCDavis:http://caps.ucdavis.edu/stress/resources.htm?podcastBody Scan w/ Jack Kornfi eld, Ph.D:http://www.youtube.com/watch?v=COBSzdqDvAkBody Scan: http://www.npr.org/templates/story/story.php?storyId=7650123

Many of you are under extraordinary levels of stress and the demands of residency training can be overwhelming. Physicians are often held in an exalted position in our society which can lead to an internalized expectation that physicians’ don’t have problems. Extraordinary internal resources are necessary to have accomplished the academic success required for residency training, but that doesn’t mean you can’t have problems. If life starts to feel like it’s too much, reach out to someone. We at the Faculty and Staff Assistance Program can provide you with counseling services as well as referrals for therapists in the community. FSAP services are free and confi dential and available for both personal and work-related issues. Please contact us at 415-476-8279 or visit our web site at http://www.ucsfhr.ucsf.edu/assist for more information.

19


The UCSF Medical Center Patient Care Fund, established in 2002, is an opportunity for all UCSF trainees to improve patient experiences at UCSF. Residents and fellows from all disciplines are in a unique position to recognize unmet patient needs and make important contributions! Each year, the UCSF Patient Care Fund Committee, composed of representatives of UCSF Medical Center, UCSF Offi ce of Graduate Medical Education, and the Resident & Fellow Council, accept project proposals for review. In total, $50,000 is made available to fund approved projects which improve the care of our patients at UCSF. Projects are judged based on relative patient care impact, sustainability and compliance with UCSF policies.

UCSF Medical Center approved seven projects in the Fall 2011 cycle:

NeuroBoard communication device to help patients understand their diagnoses - Amar Dhand (Neurology)

Thermometers to parents of febrile neonates - Dina Wallin (Emergency Medicine)

Asthma Education video to teach children and their parents about disease management - Elizabeth Gibb (Pediatric Pulmonology)

DVD players and DVDs for the endoscopy suite to improve patients’ waiting room experience - Aparajita Singh (Gastroenterology)

Electric piano for 11L and 14L chemotherapy and BMT patients - Victoria Wang (Hematology-Oncology)

Brown-bag medications pilot to help ensure that patients leave with the medications they need - Lisa Le (Medicine)

Massages for antepartum patients on bedrest to help relieve stress - Betsy Encarnacion (Obstetrics, Gynecology and Reproductive Sciences)

San Francisco General Hospital has a similar Patient Care Fund, and among the recent projects funded are: TV/DVD/playstation for pediatric patients, condolence cards for patients’ families, a bladder scanner, taxi vouchers for pregnant patients, portable interpreter speaker phones, and more.

For additional information about the Patient Care Funds, check out the websites: UCSF Patient Care Fund: http://medschool.ucsf.edu/gme/residents/pcfund.htmlSFGH Patient Care Fund: http://medschool.ucsf.edu/gme/residents/SFGH_pcf.htmlContact: Etay Ziv ([email protected]) or Nancy Chen ([email protected]) with questions.

Patient Care FundGlenn Rosenbluth, MDDirector, Quality and Safety, GME

Open Enrollment provides an annual opportunity for eligible residents and clinical fellows to change medical plans for the coming fi scal year and add eligible family members.

We have good news to share. UCSF leaders have once again partnered with brokers Barney & Barney during the annual benefi ts renewal process and they have been successful at negotiating fair rates for our GME insurance program.

Similar to past several years, this year there again will be no increase in the monthly premium cost to residents and clinical fellows. In fact UC continues to fully pay the monthly premiums for most plans (Health Net, Delta Dental, Vision Service Plan, Sun Life Disability, Life and Accidental Death & Dismemberment). Those enrolling in the Blue Cross PPO Plan pay a monthly rate based on family tier:

$30: Self $60: Self Plus Child(ren)$60: Self Plus Spouse or Domestic Partner$90: Family

Housestaff that would like access to UCSF physicians should visit the UCSF Primary Care website to view options. Health Net HMO members should select Hills Physicians as their medical group. For more information go to:http://www.ucsfhealth.org/clinics/primary_care/index.html For details about Open Enrollment, the benefi t plans, and how to make changes, please visit the Resident/Clinical Fellow Benefi ts website: http://ucsfhr.ucsf.edu/index.php/residents/

Pamela HayesBenefi ts Manager

Faculty and Staff Assistance Program (FSAP)University of California San Francisco

For additional information, please visit our website at:http://ucsfhr.ucsf.edu/index.

php/assist/

For an appointment, please call (415) 476-8279

3333 California St.Suite 293

San Francisco, CA 94143-0938

(415) 476-8279

Health Benefi ts“Open Enrollment”

June 1, 2012 - July 31, 2012

20

Summer 2012

UCSF School of Medicine

Graduate Medical Education

500 Parnassus Avenue

MU 250 East, 0474

San Francisco, CA 94143

tel (415) 476-4562

fax (415) 502-4166


The Residents

Editorial Staff:Amy DayAmy DayGitanjali KapurGitanjali Kapur

M a n y T h a n k sThe Offi ce of Graduate Medical Education would like to thank the following contributors for submitting articles.

C o n t r i b u t o r sRobert B. BaronKim CloidtDoug EckmanJoe HagerPamela HayesMichelle HenleyRobin HorakElizabeth LeChristian LeivaMary McGrathRenee NavarroGlenn RosenbluthJeffrey SallRachel SteinbergSandrijn VanSchaikJuan Vargas

IMPORTANT GME CONTACT INFORMATION

Offi ce of GME (415) 476-4562GME Confi dential Help Line (415) 502-9400Director, GME (415) 514-0146 [email protected] Dean, GME (415) 476-3414

[email protected] Faculty & Staff Assistance Program (FSAP) (415) 476-8279GME Website www.medschool.ucsf.edu/gme

G M E C Y P H E R

S o l v e t h e S u m m e r 2 0 1 2 C y p h e r

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- Urabyg

Instructions: The above is an encoded quote from a famous person. Solve the cypher by substituting letters.

Send your answers to [email protected] answers will be entered into a drawing to win a

$50 gift certifi cate!

THE OFFICE OF GRADUATE MEDICAL EDUCATION Welcomes New Program Directors and Program Coordinators

Program DirectorsKathleen Dori Lu, Critical Care MedicinePamela Flood, Obstetric Anesthesiology

Kevin Thornton, Cardiothoracic AnesthesiologyPaul Blanc, Preventive (Occupational) Medicine

Erik Hung, PsychiatrySandrijn VanSchaik, Pediatric Critical CareSue Rhee, Pediatric Transplant Hepatology

Sharon Poisson, Vascular Neurology

Program CoordinatorsJoanna Times, Otolaryngology

Sharlene Johnson, Obstetric Anesthesiology

Have a Bright Idea to improve the welfare

of our campus community?

Submit it online!

Ideas that have been implemented include:

• Eliminating bottled water from the Medical Center

• Installing sound signals for the visually impaired

on Parnassus crosswalks

• Creating “Mark’s List,” a central depository for

equipment, toner, and supplies

http://brightideas.ucsf.edu

Documents

Residents Report - Summer 2012