Week 27: Health Equity
The Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion defines health equity as being achieved when no one is disadvantaged from achieving their full health potential because of social position or other socially determined circumstances. Our commitment to health equity continues to be an area of active conversation within the DoM. Many members of our department are national leaders in studying social determinants of health and are also health policy leaders who are making important contributions to the national discourse. However, there is tension and spirited debate regarding what we are practically doing to address health equity within our department and health system. It is a work in progress, and most would agree that there is more that we can practically do to contribute to this goal within the communities that we serve. Advancing health equity and expanding our ability to serve medically underserved communities is a top priority in the DoM. There are active efforts underway to address ways in which our faculty and clinical programs can directly impact communities that are underserved, and I look forward to sharing more as these initiatives are refined and finalized. Here, I will share two recently launched initiatives that illustrate progress, while acknowledging that there is much more that needs to be done.
Last week I was privileged to participate in a “meet and greet” with our community partners for sickle cell care. This meeting was a kick-off for our UCLA Health Sickle Cell Initiative, which is the culmination of efforts from multiple members in the DoM: Dr. Gary Schiller, Dr. Mary Sehl, Dr. Yang Jiang (hematology-oncology fellow), Grace McAuley (research assistant) from hematology-oncology, Dr. Alice Kuo, Blanche Berzamin (MSO), and Samantha Steffin (project manager) from med-peds, Dr. John Ly and Dr. David Li from hospital medicine, Dr. Lynne McCulloughfrom emergency medicine, and our primary care providers: Dr. Daniel Kozman, Dr. Jose Soza, Dr. Gifty-Maria Ntim, Dr. Ana Rivera, and Dr. Lindsay Wells.
We were pleased to welcome Dr. Diane Nugent, chief of pediatric hematology at Children’s Hospital of Orange County, director of the Center for Inherited Blood Disorders and professor of pediatrics at University of California Irvine, a team representing Networking California for Sickle Cell Care, and members from the Sickle Cell Disease Foundation of California that included CEO Mary Brown and community health workers Anthony “AC” Wells and Sharod Johnson. This initiative, with support from the DoM and UCLA Health, will provide comprehensive health care to patients with sickle cell disease in Los Angeles County. The national average for life expectancy for sickle cell is 61 years, and in California it is only 43 years. This nearly 20-year decrease in life expectancy can be attributed almost entirely to access to quality health care. With this initiative, UCLA Health will provide primary care with coordination to specialists, neuropsychological assessments, as well as services specifically targeted to children with sickle cell transitioning to adult health care. Our partnership with the Sickle Cell Disease Foundation will also provide access to their community health workers, who work tirelessly with sickle cell patients to not only make sure they get the health care they need, but also address the social determinants of health. We are in the process of hiring a dedicated Patient Services Representative (PSR) for this initiative, and the job should be posted later this month (please contact Blanche Berzamin for details). The dedicated phone number for patient scheduling is 310-267-1654, and patient appointments are available starting in September for Redondo Beach, downtown Los Angeles and Santa Clarita.
Our hospitalists from downtown Los Angeles, partnered with Martin Luther King Jr. Community Hospital (MLKCH) to begin training the inaugural class of residents in MLKCH’s internal medicine program. The training program officially launched last week. Under the leadership of Dr. Veronica Ramirez, clinical lead of the UCLA Downtown Hospitalist Cohort, seven of our faculty members will participate in the inpatient general medicine teaching service. This new training partnership is an expansion of the teaching services and patient care that the DoM provides throughout our community hospital partners who operate in communities that face significant challenges in accessing quality health care and were disproportionally impacted by the COVID-19 pandemic.
Teaching alongside Dr. Ramirez is a strong academic hospitalist team that includes Dr. Nico Conti, Dr. Lin Deng, Dr. Yao Liu, Dr. Jason Ng, Dr. Margaret Wei. They bring a wealth of teaching experience that will support MLKCH’s residents throughout their training program and their medical careers. New faculty members joining the cohort this year include Dr. David Panek,Dr. Christina Vu, and Dr. Mandy Mohindra.
In Dr. Ramirez’ reflections about leading the downtown hospitalist cohort for the past three years and joining this new MLKCH teaching initiative, she shared:
“I am proud of this group who has strengthened our bond with MLKCH as we worked together to care for vulnerable populations in south LA, which was considered the epicenter of COVID-19 at one point. We are all passionate about working in communities of high need and being able to provide culturally competent care to our patient population. This new training partnership allows us to help train the future medical leaders who will continue to provide the best care for many years to come.”
Leveraging our community resources and broad reach of the DoM to train the next generation of physicians also represents an important priority for the DoM. Let me share an update prepared by Dr. Rachel Brook, co-chair, 4th Year Academic College, DGSOM, director of clinical and career coaching, UCLA Internal Medicine Residency and director of ambulatory medical student education for the department of medicine. You will see in her report, the commitment of faculty within the DoM to enrich the ambulatory clerkship experience for DGSOM medical students.
In the academic year 2020-2021, the Department of Medicine Ambulatory Internal Medicine Clerkship was restructured so that students spent their time working at our DoM Community Clinics. They had primary care and subspecialty themed weeks, where a group of DoM faculty worked together to structure their learning experience. In this manner, students experienced the breadth of the department of medicine’s exposure in our greater southern California communities and learned how various clinic groups functioned and practiced medicine. Even though the transition year coincided with the start of the COVID-19 pandemic, bringing with it many uncertainties and changes to clinical medicine, the DOM Ambulatory clerkship rose to be one of the highest rated 3rd year ambulatory clerkships in the DGSOM. This success strongly reflected the tireless work and commitment of our faculty who then and now continue to embrace our students in their clinic, integrate student learning into their busy clinical practices, while role modeling outstanding patient care delivery. Its success would also not have been possible without the incredible support and time of our physician leads: Dr. Evelyn Curls, Dr. Sheila Naghshineh, Dr. Sun Yoo, Dr. Mina Ma, Dr. Jeff Borenstein, Dr. Eric Curcio, and Dr. Adam Cavallero, as well as Dr. Janet Pregler, Dr. Robert Oye, and our Vice-Chair of Education for the DOM Dr. Jodi Friedman.
In addition, the help and engagement of Farah Elahi, our clinical directors, clinic managers, and all our clinic administrative staff and nurses, were critical for this clerkship’s success, as they have helped make the students feel welcome, orient them to their new ambulatory families, and prepare them for their clinic’s flow and responsibilities. Lastly, without our Internal Medicine Clerkship Executive Coordinator Valecia Sarmento’s incredible organization and oversight, this clerkship structural change would not have been achieved.
Dr. Brook shared a few student evaluations of their experience with our DOM Ambulatory clerkship, which highlights the quality of care, professionalism, and education delivered, despite this challenging time in medicine:
“At my clinic weeks, it honestly felt like I was being co-parented by a team of physicians. They all knew each other very well and seemed like friends and I think this facilitated better continuity of teaching. Also, it was great to show up to the same clinic with the same staff and get greeted by name. It felt so nice not to just be an anonymous medical student who was in the way all the time, where the staff would know which doc I was working with that day.”
“In terms of feedback, I had a wonderful experience! Everyone was a pleasure to work with including the staff and all attendings. I loved the week of specialty clinics and week of general primary care. I only have rave reviews for the attendings who spent a good amount of teaching, gave feedback for improvement day to day, and reviewed my notes with me. This site would be a valuable experience to any MS3.”
These are hard earned and well-deserved evaluations that are representative of the work, effort, and dedication our DoM faculty and staff have put into this clerkship, helping inspire the next generation to pursue careers in internal medicine. Thank you for your leadership, Rachel.
Last week I highlighted graduates of our ACGME accredited subspecialty fellowship training programs. There is a final group of advanced subspecialty training program graduates to congratulate. While technically not fellowships, they represent a critical service that the DoM provides to prepare physicians with highly-specialized skills that provide essential and much-needed clinical expertise to important segments of our community. Meet the graduates of the Advanced Subspecialty Training Programs in the DOM.
- Advanced Clinical Training Program in Transplant Infectious Diseases
- Clinical Nutrition Program
- Extensivist Kennamer Training Program
- Interventional Pulmonology Program
- Kidney and Pancreas Transplant Program
- LGBTQ+ Healthcare Program
- Lung Transplant Program
- Melvin & Bren Simon GI Quality Improvement Program
- National Clinician Scholars Program
- NRSA T32 Primary Care Research Program
- UCLA Digestive Diseases Advanced Endoscopy Program
- UCLA East-West Integrative Medicine Program
You will see that 100% of these graduates will remain in California and 62% are remaining at UCLA, representing important pipelines for expanding our ability to offer a broad suite of expert clinical services to patients within UCLA Health and to advancing the academic and educational mission of DGSOM.
Many of you have asked how we are liking LA and if we are settling in. I have been very busy and am intimately familiar with my short commute to campus. Therefore, this weekend my wife and I decided to do something quintessentially LA. Go to the Hollywood sign. So, we punched “Hollywood Sign” into our GPS and off we went. It turns out that GPS does not mention that the right turn from Derondra Drive to Mulholland Highway (the last mile) is a fire road behind a locked gate! Nevertheless, it was interesting joining hordes of equally confused tourists trying to turn around in a cul-de-sac. The best part was an Italian tourist who decided to direct traffic, with a motive of getting his rental car turned around. Apologies to the long-suffering citizens of this Hollywood Hills neighborhood, who call this road home. Griffith Park down the road was more straightforward.