March 2013 Newsletter

eNewsletter from the Department of Medicine This e-mail address is being protected from spambots. You need JavaScript enabled to view it >

Department of Medicine eNewsletter
March 2013
:: Interview
:: Department News
:: Department Events
:: Leadership Council Minutes
Website's New Features

Resident International Travel Blog


Master of Science Program in Clinical Research


Updated Research Seminars and Workshop Schedule

Recent Grand Rounds Recordings

"Resistant Hypertension: Contemporary and Promising Strategies" by Jackson Wright, MD, and Sahil Parikh, MD


"Neurocognitive Aspects of Cardiovascular Disease" by John Gunstad, PhD

Leadership Council
March 2013

Chair ::

R. Walsh


Present ::

B. Arafah

K. Armitage

A. Askari

R. Chandra

M. Cooney

F. Creighton

C. Hoppel
T. Hostetter
D. Hricik
G. Isenberg
F. Jacono
M. Jain
N. Meropol
R. Salata
D. Simon
R. Walsh
J. Wright



Recorded by ::
A. Staruch
Stay connected
and up-to-date
with department
conferences and events
by signing up for the following tools:

Department of Medicine YouTubeDepartment of Medicine LinkedinDepartment of Medicine Facebook
Welcoem to the Department of Medicine Agre Society
department interview

Keith Armitage, MD, Vice Chair for Education and Internal Medicine Residency Program Director discusses the impact the flu epidemic had on residents, shares his thoughts on match results in the current graduate medical education funding climate and gives insight into future residency trends.


The 2013 flu epidemic is cited to be the worst seasonal flu outbreak in 10 years, according to the Centers for Disease Control and Prevention (CDC). What impact did the outbreak have on the residents?

The residents are the backbone of health care delivery at University Hospitals Case Medical Center. During the peak flu outbreak, we had a historically high census and a number of residents worked incredibly hard, taking on additional patients. I was proud of the way our residents came through. The DACRs that month - Chrystal Lantz, MD, Claire Sullivan, MD, and Raksha Indokar, MD - in particular, took on additional patients, at one point following an additional 18 flex patients. Our chief residents and a number of other residents also pitched in.



The Internal Medicine Residency Program has interviewed a record number of applicants this year. Do you foresee the number of applicants to remain high in the coming years? How has the matching process changed this year?

We interviewed over 600 applicants for Internal Medicine, Medicine/Pediatrics and Preliminary program this year. Just for Categorical Medicine alone we interviewed over 450 people. One of the biggest improvements of the program this year was a new website that has novel content and served as a great platform for applicants to get a feel for the program. We need to recruit aggressively as Cleveland does not always sound like an appealing location to applicants. We have done well in the match in the last few years, attracting strong applicants regionally and nationally, and will concentrate on continuing this trend.

There was one additional change this year - the National Resident Matching Program (NRMP) required that all positions must be filled via the match; in the past we were allowed to take some non-LCME grads out of the match, but that option has ended as of this year. As for the high number of applicants, this trend will most likely be sustained over the next few years as the net number of graduates from U.S. medical schools increases and interest in Internal Medicine appears to be high. There is a strong job market in internal medicine as the demand for general internists and hospitalists grows.

Currently U.S. medical schools are graduating more students, while the number of training positions remain frozen, which ultimately leads to more competition for residency training positions. The bottleneck for producing more physicians is at the graduate medical education (GME) level. Since GME funding is a complicated political issue, the prospect of increasing the number of residents nationally does not look promising.


The NRMP match results were announced last week. Our program demonstrated excellent results, matching at 162 out of a match list of 442. In analyzing the detailed results, our competition for students in the match comes from the University of Michigan, University of Pittsburgh Medical Center and Barnes-Jewish (Washington University). Nationally the number of U.S. students in the match increased from roughly 15,000 in 2009 to 17,000 this year; this is a result of new medical schools and increased medical school size. The number of U.S. students applying to internal medicine increased by 500 since 2009. The number of internal medicine positions in the match increased by 1000 due to the "all in" rule. The fill rate for internal medicine in the match was 96%, with about 49% of positions filled by U.S. grads.



Can you tell us about the new chief residents that are being selected for the academic year 2013-2014? What skills will they be bringing to the program? Are there any special projects the new chief residents will be concentrating on?

The roles of chief residents are unique to internal medicine and pediatrics, where the chief year is an additional year of training. Chief residents are an essential element of our resident training program. This coming year the new chief residents will be Claire Sullivan, MD, Crystal Lantz, MD, Kamal Shemisa, MD, Sumit Bose, MD, and Navin Vij, MD. This group brings outstanding leadership and clinical skills to the program, I am very much looking forward to working with them.

One of the primary objectives our program has concentrated on in the past years is engaging residents in patient safety and quality improvement, and we hope to continue this trend. In addition, there is a considerable change coming in our training program next year as the Accreditation Council for General Medical Education (ACGME) is rolling out a new system of accreditation that relies more heavily on direct observation and more stringent reporting of individual residents' specific competencies to the ACGME.


There has been considerable debate over the size and scope of federal subsidies to support residency training of the nation's physicians. What is your take on Obama administration cutting back on graduate medical education (GME) funding? Do you believe our nation is training enough doctors, and, if so, of the types that are needed?

For the last 30 years GME funding was set up so that having residents was seen as a financial benefit to hospitals. Proposed cuts to GME funding may change the formula and having residents may not have as positive a contribution to a hospital's financial health as it once did. Currently there are not enough residency positions in U.S. to meet our work force needs for physicians. The funding for new residency positions is problematic in light of the deficit reduction efforts and the need to cut the federal budget. With the number of positions being frozen, as the number of U.S. medical graduates increase, the opportunities for international graduates diminish.

The greatest need in our society right now is for physicians who provide frontline care; on the other hand, our health care system had put the greatest incentives for professionals who provide specialty care, therefore, devaluing primary care. This is slowly changing. We are involved in an innovative program at VA focused on training residents in multidisciplinary teams with a focus on chronic disease management. We have also begun an initiative to send residents to do their continuity clinic in community-based primary care practices. As a result of a very positive experience in this setting, some of our residents are now looking to accept jobs in the community clinics. Overall, we are currently experiencing a shift toward a more balanced mix of primary care and specialized training in medicine; hopefully this will allow us to meet society's needs and, in particular, the needs of health care systems in Cleveland more effectively.


What changes do you see in the residency in the next few years?

The ACGME is rolling out a new accreditation model called the "Milestones Project." The new system will require a six month reporting of resident achievements within 21 competencies. We will need to review our evaluation system and faculty will need to be engaged in more direct observation of the residents.

Learn more about Internal Medicine Residency Program

department news report

Division of Cardiovascular Medicine

Rebecca Boxer, MD, MS, published an article entitled "A Randomized Control Trial of High Dose Vitamin D3 in Patients with Heart Failure" in the Journal of American College of Cardiology. Dr. Boxer's findings show that high doses of vitamin D and calcium failed to improve the physical performance in older patients with heart failure. Dr. Boxer hypothesizes that a trial where vitamin D intake would be combined with physical exercises may yield a higher benefit from vitamin D.

Sahil Parikh, MD, was selected to receive Emerging Leader Mentorship award from the Society for Cardiovascular Angiography and Interventions (SCAI). Dr. Parikh was chosen for his leadership potential and motivation to excel both regionally and nationally in the areas of clinical care, scholarship, education and advocacy.

As a result, Dr. Parikh will be participating in 2013-2015 Emerging Leader Mentorship (ELM) Program. This is a collaborative program developed by SCAI in partnership with the American College of Cardiology (ACC) and Cardiovascular Research Foundation (CRF). This hands-on, two-year mentorship program concentrates on improving leadership and presentation skills, fostering relationships, keeping up-to-date on emerging trends and developing a professional niche for participants.


Aaron Proweller, MD, PhD, recently published his work entitled "Notch Transcriptional Control of Vascular Smooth Muscle Regulatory Gene Expression and Function" in the Journal of Biological Chemistry. Dr. Proweller found that Notch signaling through the transcriptional control of key regulatory proteins is required for contractile responses of mature VSM.

Schedule a clinical appointment with Cardiovascular Medicine physicians





Divison of Gastroenterology & Liver Disease

Richard Wong, MD, received the 2013 Distinguished Endoscopic Mentoring Award from the American Society for Gastrointestinal Endoscopy. Dr. Wong was recognized for his substantial commitment and devotion to the nurturing of the next generation of endoscopic investigators.






Schedule a clinical appointment with Gastroenterology & Liver Disease physicians





Division of Hematology & Oncology

Basem William, MD, made a presentation entitled "Impact of Bone Marrow Neuropathy on the Outcome of Autologous Stem Cell Transplantation for Lymphoma" at Bone Marrow Transplantation tandem meeting.






Schedule a clinical appointment with Hematology & Oncology physicians





Division of General Internal Medicine & Geriatrics

Hiloni Bhavsar, MD, Chief Resident of the Internal Medicine Residency Program, was nominated for Sally Ann Shipley Award. The award celebrates individuals who have excelled in continuous quality improvement efforts. Dr. Bhavsar's nomination was a recognition of her exceptional practice in the areas of patient safety and quality, including her project on improving MD-RN communication, and the discharge process.
Attila Nemeth, MD, was appointed to the Society of Hospital Medicine's Veteran's Administration Task Force Committee. Dr. Nemeth will serve as a liaison between the SHM and the VA.
Brook Watts, MD, MS, and Todd Smith, MD, were awarded $20,000 grant from the Diabetes Quality Enhancement Research Initiative for the project entitled "Validation of Automated Methods for Diabetes Case Identification from EMR-Derived Data."

Division of Pulmonary, Critical Care & Sleep Medicine


Elliott Daisenbrook, MDElliott Dasenbrook, MD, became a member of Savara Pharmaceutical's Clinical Advisory Board. Dr. Dasenbrook will provide clinical knowledge and strategic guidance to the company as it advances the development of its lead product, AeroVanc, for the treatment of methicillin-resistant staphylococcus aureus (MRSA) lung infection in patients with cystic fibrosis. Dr. Dasenbrook was previously an investigator of a study that showed that cystic fibrosis patients with MRSA infection have a shorter life expectancy. Dr. Dasenbrook will be a lead investigator for Savar's upcoming Phase II trial.



Kingman Strohl, MD, was an invited speaker on Gene Discovery for Sleep Apnea at the Southern Sleep Society.









Schedule a clinical appointment with Pulmonary, Critical Care & Sleep Medicine physicians





Division of Rheumatology

Ali Askari, MD, Charles Malemud, MD, Ansul Rao, MD,
and Elham Talherian, MD, published an article entitled "The Biological and Clinical Activity of Anti-Malarial Drugs in Autoimmune Diseases" in the Current Rheumatology Review.






Schedule a clinical appointment with Rheumatology physicians

department conferences & events

Medicine Grand Rounds

Location: Lakeside, 5th Floor, Kulas Auditorium

Time: Tuesday, 12:00 - 1:00 p.m.

  • April 2 - "History of Mechanical Ventilation" by Arthur Slutsky, MD
  • April 9 - "Emerging Issues in Resistance in Staphylococcus Aureus" by Usha Stiefel, MD
  • April 16 - "Duty Hour Reform: Is the Beef There?" by Michael Bronze, MD
  • April 23 - "Rationale and Impact of Health care Reform on the Nation, State and University Hospitals" by Thomas Zenty (Wolstein Auditorium)
  • April 30 - "Is Hepatitis C Birth Cohort Screening a Cancer Prevention Strategy?" by Yngve Falck-Ytter, MD

Morbidity and Mortality Conference Series

Location: Lakeside, 5th Floor, Kulas Auditorium

Time: Friday, 12:00 - 1:00 p.m.

  • March 29 - A case of a 28-year-old male with thrombotic thrombocytopenic purpura ultimately diagnosed with atypical hemolytic uremic syndrome treated with eculizumab
  • April 5 - A case of a 37-year-old female with a history of venous thromboembolism diagnosed with heparin induced thrombocytopenia bilateral adrenal hemorrhage
  • April 12 - A case study of a 59-year-old female with a history of cardiac transplant complicated by antibody mediated cardiac allograft rejection.
  • April 19 - Two cases of delayed diagnosis of subacute Staphylococcus Aureus endocarditis and multi-organ failure with discussion for cardiac valve replacement.


Research Day 2013

Research Day showcases the wide range of basic, clinical and translational research performed in the Department of Medicine. The event concentrates on stimulating meaningful discussion and creating new opportunities for collaboration among the trainees.

Date: Friday, May 3, 2013

Time: 12:00 - 5:00 p.m.

Location: Wolstein Research Building Auditorium and Lobby


Submit Abstract



Spring Dinner 2013

Spring Dinner celebrates the high level of education and training in the Department of Medicine. We will be honoring our graduating class of 2013 and presenting annual awards to fellows, post-docs and faculty for exemplary work.

Date: Thursday, May 23, 2013

Time: 6:00 - 9:30 p.m.

Location: Thwing Ballroom




Cleveland Play House Outing

Our residents went to a unique series of workshops at Cleveland Play House. The activities incorporated a series of games and exercises drawn from the world of theatre and improvisation designed to cultivate creativity, compassion, honest communication and collaboration. Click here for more photos.


Cleveland Museum of Art Visit

The Cleveland Museum of Art utilized its collection as laboratories for residents to develop observational and communication skills, build empathy and cultural awareness. Our residents opened new insights into the process of medical practice by spending time in the galleries, handling objects of art, and making art themselves. Click here for more photos.


Medicine and Art

Medicine and Art is an event hosted by the Case Western Reserve University Gold Humanities Honor Society and the Association of Residents and Fellows. The event started with a reception at University Hospitals Seidman Cancer Center, followed by scavenger hunts, workshops and tours at the Cleveland Museum of Art. The activities included talks on art and observation, personal perception and preferences, and anatomy in art. Click here for more photos.

department leadership council minutes

Leadership Council

Dr. Walsh updated Council members on the current recruitments for the Chairs of Genetics and Ophthalmology at Case Western Reserve University/University Hospitals Case Medical Center. Dr. Walsh announced that a search firm has been selected to assist with the search for a Director of the University Hospitals Respiratory Health Institute. Dr. Guilherme Oliveira has been recruited by Dr. Simon in the Division of Cardiovascular Medicine to direct the section of Heart Failure Transplantation.

Leadership Council

Dr. Walsh reported on the University Hospitals Strategic Plan Parent Committee to the council.


Leadership Council

Dr. Walsh led a discussion of the potential impact of sequestration on GME funding.



Leadership CouncilDr. Armitage reported on the Internal Medicine Residency Match. He noted that a survey has been sent to the residency applicants who were ranked by the Department of Medicine.



Dr. Walsh discussed the School of Medicine budget process for 2013-2014 including how sequestration may impact NIH and Department of Defense budgets and research funding. Regarding the School of Medicine budget, Mr. Creighton distributed information on grants that will be ending next year. He noted that budget meetings with Division Chiefs are being scheduled for the first week of May.


Leadership Council

Mr. Creighton discussed YTD UHMG Net Margins (through February); YTD 2012 Actual Charges and YTD 2013 Actual Charges.



Leadership Council

Mr. Creighton updated the council on the system conversion from IDX to Athena and the paper record to Allscripts.