Week 12: We Work in a Medical School After All

I went to New York to teach a class over the weekend. For the past decade I have been leading an NIH funded program that is developing the next generation of researchers in endocrinology, diabetes and obesity. The program focuses on empowering groups that have been under-represented in science, and medicine.

We have trained and mentored 177 fellows ranging from graduate students, post-docs, subspecialty fellows and junior faculty, many of whom are now making their mark and mentoring others. It was good to get back home, early Sunday morning at 1:00 am. The flight home got me thinking about an important facet of our education mission within the department of medicine (DoM), which is teaching medical students. They represent the future of our profession and a job well done now, ensures that we will be comfortable having them take care of us 20 years from now. Sometimes, given the multifaceted complexity of our many missions and the necessary attention that we give to our primary areas of focus, it is possible to overlook the tremendous impact of the DoM on medical student training at the David Geffen School of Medicine (DGSOM).  The impact is tangible. Dr. Jason Napolitano a professor in our department and associate dean for curricular affairs shared the following with me:

This year, 20% of DGSOM grads (30 students) chose Internal Medicine residencies. These numbers are for those matching into categorical rather than preliminary positions. Our grads are bringing their UCLA training with them across the country with 4 students heading to UCSF, 4 to NYU, 2 to Stanford, 2 to U Michigan, and 1 each to Brigham and Women’s, MGH, U Washington and Northwestern. Fortunately, 8 students are staying here at UCLA for at least the next three years. Internal Medicine has been the most popular specialty for our graduates for many years in a row, with 21% of MS4s choosing our specialty in 2019, 35% in 2020 and 26% in 2021.

2020 was a high-water mark. I hope that this recent trend does not represent a waning of interest. It is my hope that we will be able to mirror to our students, the multiple professional possibilities that Internal Medicine holds. In a recent meeting with Jason and Dr. Ed Ha, I underscored the critical impact of the experiences that medical students obtain in our core medicine clerkship that will give them critical skills that will be essential for their professional lives no matter what specialty they ultimately choose.

As such, it was a great pleasure to see that one of our best, Dr. Holly Middlekauff was this year’s recipient of the 2022 Lucien B. Guze Golden Apple Award for excellence in teaching. This is an award given out each year by medical students at the DGSOM. I understand that Holly has been a recipient of this award in prior years (2017, 2019, 2020) and the warm testimonials from many current and former medical students speak to her generosity and the profound impact that her teaching and mentorship has made on their professional lives. Holly stopped and greeted me on my first day at UCLA as I wandered through the lobby of Reagan Hospital and reminded me that she had spent some time in Iowa with a mutual mentor Dr. Allyn Mark. There is a phenomenon known as “Iowa Nice.” I wonder if some of what Holly has brought to UCLA over the years, may reflect some lessons learned in Iowa?   

I was also pleased to be copied on letters of thanks to members of our faculty for their service on the medical school admissions committee. Those specifically recognized were Dr. Olujimi Ajijola, Division of Cardiology, Dr. Tara Vijayan, Division of Infectious Diseases, Dr. Kathryn Melamed, Division of Pulmonary Medicine and Dr. Adriana Izquierdo in the Division of General Internal Medicine and the VA Hospitalist Program. Thank you for the many hours that you devoted to identifying members of the next incoming medical school class. I also received a note from Dr. Chris Cooper thanking faculty who led the respiratory theme of the Scientific Foundations of Medicine. Of 39 faculty in this course, 23 (59%) were from the DoM across 5 divisions. I applaud and recognize all our faculty, including many not listed here who have and continue to make important contributions to the training of our medical students. 

Dr. Carlos Irwin Oronce a member of our UCLA National Clinician Scholars Program received the Best Published Research Paper of the Year Award from the Society for General Internal Medicine.  His manuscript: https://bit.ly/3tNpJ42 demonstrated that the use of low value care (that offer no net benefit in specific clinical scenarios as defined by the US Preventive Services Task Force (USPSTF), with a Grade D recommendation), cost nearly $480 million dollars in Medicare costs in the 10-years between 2007 and 2016.

Three services—screening for asymptomatic bacteriuria, vitamin D supplements for fracture prevention, and colorectal cancer screening for adults over 85 years—comprised $322,382,772, or two-thirds of the annual costs of the Grade D services measured in this study.

Congratulations Carlos on this national recognition. Thanks to Dr. John Mafi for your mentorship. I am proud to see how work in our department is being recognized for its contribution to rigorously shaping the conversations around high-value care. It is also noteworthy that Carlos’ paper, which focused on USPSTF guidelines came out just as his Division Chief Dr. Carol Mangione is taking the helm as Chair of the USPSTF.

In prior posts, I acknowledged the outstanding contribution of our Pulmonary, Med-Peds faculty, Infectious Diseases faculty, House staff and our primary care physicians and hospitalists in leading our COVID response during some of the longest and darkest days of the pandemic. Things are easing now, and we are gathering feedback not only on the toll that the pandemic left on our frontline providers, but on issues that predate the pandemic that are contributing to burnout. These findings are being analyzed and more information regarding our plans to address this critical issue will be forthcoming soon. Meanwhile, we were also busy competing for extramural funding to advance our understanding of COVID-19 and its sequelae. Join me in congratulating Drs. Jeffrey Hsu and Reza Ardehali in the Division of Cardiology for their receipt of a $1M grant from the American Heart Association to study: Mechanisms Underlying Cardiovascular Consequences Associated with COVID-19 and Long COVID.

Our department has provided impressive leadership during this pandemic in research, education and clinical care. This distinguishes us as being among the best.



Our 7-month-old granddaughter (our first and only one!) and her parents are visiting us from Chicago this week along with her uncle who came over from Salt Lake City, as he has not seen her for a while. So, we have a full house. If you see me walking around, I will be smiling under my mask. Stop me, and I will show you her picture on my phone.

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