Week 43: What Veterans Can Teach Us

The recruiting season for our next class of primary care and categorical residents started this week! If you see Dr. Skinner with tired eyes, it is because she has been carefully reviewing hundreds of applications from some of the most talented medical students in the country. I had the chance to meet with two groups this week to introduce them to UCLA’s Department of Medicine (DoM). I reminded them of our commitment to training the next generation of leaders in internal medicine. I get nostalgic when I think of my own residency interviews more than three decades ago. However, I am always energized when I look at the faces of the next generation, who are seeking to entrust their training to us.

On Wednesday, I also visited the VA Greater Los Angeles (VA GLA) to attend the Rounds of the GLA Teaching Service, which were inspired by one of our legendary faculty Dr. Phyllis Guze.

The case was presented by intern Dr. Victoria Starks (a prelim year intern in anesthesia), under the artful moderation of our clinical reasoning guru Dr. Reza Manesh, with expert input from Dr. Jeffrey Hsu from cardiology, and Dr. Nicholas Stanzione from transfusion medicine and pathology

Dr. Reza Manesh, Dr. Victoria Starks, Dr. Jeff Hsu leading Rounds of the GLA Teaching Service.

It was a challenging case of a patient with a delayed transfusion reaction presenting with “dark” urine, which turned out to be hemoglobinuria in the context of myocardial ischemia. What impressed me was the interactive atmosphere and camaraderie that was clearly conducive to learning.

A shout out to Victoria who presented despite being post-call, and more impressively had made the timely diagnosis that enabled early and lifesaving treatment of this veteran.

Interim Chief of Medicine at VA GLA Dr. Zhaoping Li took me on a tour of the medicine service, and I had the chance to meet with some of our outstanding DoM staff within VA DoM service including UCLA Health Staff Achievement Award winner Mondo Medina, administrative coordinator for the internal medicine residency program.

Recipient of the UCLA Health Staff Achievement Award Armando Medina (left).

I also met Germaine Le, MSO for the VA division and Aida Alvarez fund manager for the VA division.

(Left to right) Aida Alvarez, Dr. Abel, and Germaine Le.

And of course, I met with  our fearless chief residents (left to right): Dr. George TranDr. Cameron HennebergDr. Brandon Smith.

They clearly love the house staff over here, so much so that they probably feed them too much as seen below. They also impressively re-did the floors in all their team rooms! I have always had the opportunity to work in VA hospitals throughout my career and VA GLA is an amazing venue for clinical training.

With such training, it is not unexpected that our house staff receive praise from many of the patients that they care for. This week, I was pleased to receive the following message from a patient’s family member who described the exceptional patient care provided by Dr. Alexander Kokaly. Notes such as these speaks to the training and compassion demonstrated by our trainees every day.


My mother has been hospitalized numerous times in the past few years and we have dealt with many different residents. I wanted to single out Dr. Alexander Kokaly who took care of my mother during her last hospital visit.

Dr. Kokaly really distinguished himself by the way he performed.  He is genuinely friendly, shows that he honestly cares, listens closely, processes what I (as the patient's representative) tell him and responds meaningfully.  He shares with the attending team my concerns, observations, and suggestions when he feels they contribute something that only someone who knows the patient best could add.   He takes time to explain everything that is being done.  He follows through with what he promises to do (something which has never happened before on a consistent basis).   And he updates me EVERY DAY (sometimes in person and sometimes by phone) without my having to chase him, even when there is no dramatic development.   This gives me a chance to ask questions which have occurred to me since the last time we talked.  He tells me about his schedule in advance so I know not to expect his call on his days off.   Overall, I don't know what else one could ask from a person in his position. We are lucky to have had him.”

Alexander Kokaly, MD, MHSA

Our faculty commitments to being prepared to offer the best training to our house staff also came to my attention this week, as summarized in a note from Dr. Wendy Simon, the associate program director of our residency program.

“Last night, I was also part of a group of 54 DOM faculty completing the second of two coaching trainings with Drs. Rachel Brook, Tina Mosaferi and MGH’s Kerry Palamara. Folks really enjoyed coming together to learn positive psychology coaching techniques to benefit our residents. My personal favorite part of the evening was the roulette wheel of 1:1 breakout rooms, that paired me with everyone from a South Bay hospitalist to a Med-Peds physician doing HIV primary care.”

Wendy Simon, MD

The other critical element of our success as a department in training the next generation of physician leaders is our faculty's commitment to teaching medical students across all our clinical sites.

During the week of October 17, the DoM education team hosted the first intersessions block for the rising second year medical students which was highly successful thanks to DoM’s Dr. Antonio Pessegueiro and DGSOM staff Jenny Yoo and Priscilla Nguyen. Dr. Simon shared that during the two internal medicine clerkship preparation days, 16 DoM faculty members taught large- and small-group case-based discussions, anatomy, point-of-care ultrasound and high-fidelity simulation.

This cohort of students then joined the end-year third year medical students on wards and in clinics, where they were precepted by DoM faculty at Ronald Reagan UCLA Medical Center, the VA Greater LA hospitals, and DoM community ambulatory practices. Both Dr. Simon and I extend our gratitude to VA and UCLA site directors Drs. Tyler LarsenAshley SaitoFaizan Malik, Giulia MicheliniRachel BrookJerome GreenbergReece Doughty, and Janette Zara and the DoM education office staff for all their effort to ensure students have an outstanding experience. It has truly been an exceptional year of teaching with faculty going above and beyond to teach twice the usual volume of learners.

I am also reminded that key to remaining on the leading edge of our respective fields is life-long learning. It is impressive to review the offering of continuing medical education programs organized by faculty within the DoM.

One of our signature programs is the Kidney First Program, which promotes early identification of chronic kidney disease (CKD) with the goal of aggressively managing risk factors to slow the decline to end stage renal disease. For those who progress, our dialysis and transplantation programs are some of the best in the world, and our local community recently stepped up to raise philanthropic support to enhance our services including support for patients and support for our teaching and research missions.

On Saturday, October 22nd, Dr. Anjay Rastogi, director of the CORE Kidney Program and clinical chief of nephrology, partnered the family of Nanette Zumwalt, to host the inaugural Power of Hope Gala. The event was organized by the Zumwalt family in recognition of Dr. Rastogi’s patient Nanette Zumwalt, who has a genetic form of kidney disease called autosomal dominant polycystic kidney disease (ADPKD). The gala aims to raise support for kidney care at UCLA Health and the CORE (Clinical Excellence, Outreach, Research, and Education) Kidney Program which is advancing the future of comprehensive kidney care.  

The master of ceremonies was Phillip Palmer, a living kidney donor, patient advocate, and ABC7 News anchor. There were three special performances by multi-award-winning musician Daniel Powter, Oscar and Grammy Songwriter Paul Williams, and C.C. DeVille from the band Poison.  

Three attendees were given special awards for their support, contributions, and influence on the community. Mary Beth Barry, who is a kidney recipient, received the Hope Award for inspiring hope to those around her. Brian Gilliam, who is a living kidney donor, received the Circle of Excellence Award for contributing to the kidney care community and Phillip Palmer received the Angel Award for serving as a donor and advocate.   

The CORE Kidney Health Program was founded by Dr. Rastogi with a vision to create patient-centered kidney care at UCLA Health. In addition to providing comprehensive integrated care and research, the program aims to spread awareness of kidney disease and provide resources for patients, doctors, trainees and the community. It also offers free educational events that provide valuable information to the community about manageable changes patients can make in their daily lives to improve their well-being and prevent future health problems.  Within the program, there is a health club called Bruin Beans Health Club which mentors undergraduate students towards becoming future leaders in health care. The CORE Kidney Program also includes a patient advocacy and support group called the Circle of CORE, comprised of CORE kidney patients. The members serve as ambassadors, empower other kidney patients to become their best advocates and build a community that offers first-hand experience stories and support. Members of the Circle of CORE were present during the event and shared their personal stories to inspire and give hope to kidney patients

(Left to right): Zumwalt family, Dr. Rastogi (center), UCLA President Johnese Spisso & family.
Members of Circle of Core, a patient advocacy and support group.
Members of Bruin Beans Health Club which provides mentorship to undergraduate students.

The event's fundraising goal was to raise $250,000, and this goal was surpassed thanks to generous donors. It was a successful first event for UCLA CORE Kidney Program that resulted in a wonderful night of advocacy, music, and hope.
View additional pictures here.

Finally, let me congratulate Dr. Gregory Brent, our senior academic vice chair and chief of the endocrinology division, who is this year’s recipient of the John B. Stanbury Thyroid Pathophysiology Medal. The American Thyroid Association awards the Stanbury to outstanding researchers in recognition of their contributions, either conceptual or technical, to the understanding of thyroid physiology or the pathophysiology of thyroid disease, as evidenced by having a major impact on research or clinical practice related to thyroid diseases. The award reflects Dr. Brent’s leadership in foundational research in thyroid hormone action, especially actions in metabolic regulation and the brain, and groundbreaking work in the regulation of iodine transport in models of breast and thyroid cancer.

Dr. Brent (left) receiving the Stanbury Medal from the American Thyroid Association.

Congratulations on this award Greg, and also for the legacy that you left behind at the VA GLA.



Came across these during my visit to the VA GLA last week.Guess who? (Hint: Prior chief residents).

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