Year 2. April 17. Hail to the Chiefs – Part 2.

My year as a chief resident has been incredibly rewarding and has allowed me to grow both personally and professionally. I will be forever grateful for the opportunity to join such an inspiring team of program leaders, administrators, co-chiefs, and most importantly, residents. From the very beginning of the year, I was welcomed into the primary care family with open arms and have had the distinct privilege of working with and learning from our current and future leaders in primary care. Among the many highlights of the year have been developing the primary care didactics curriculum, organizing networking and mentorship events for those interested in primary care careers, leading narrative medicine workshops, and precepting residents in clinics all throughout Los Angeles. I know that the leadership, educational, and administrative skills I have gained this year will serve me well throughout my career, and I look forward to remaining connected to this wonderful residency community – fortunately, as a UCLA NCSP fellow next year, I’m not going very far!

As the chief resident for quality and patient safety, I have had the opportunity to teach quality improvement curricula to trainees and be involved with resident-led QI projects. It has been rewarding and inspiring to connect with residents on self-initiated projects that address issues with clinical processes. I have also worked with VA QI chiefs on a national level and built connections across the country to learn about each other’s hospital systems. As a chief resident based at the VA, I am involved with the VA Sepulveda Ambulatory Care Center, which is one of our primary care rotations. I have greatly enjoyed building a noon conference didactic series there and strengthening the community on-site. Finally, this year has been especially unique and remarkable for me as I have had the privilege of leading morning reports, collaborating with my co-chiefs on diverse projects, connecting with faculty and staff across different sites, and providing support to residents.

Residency showed me how humbling it is to be a clinician; my chief year showed me how humbling it is to support clinicians. It has been a privilege to learn from my peers who invest so much of their energy and time into being outstanding physicians for their patients, across hospital systems, clinics, and teams. I was inspired by the personal resolve residents show to surmount the challenging learning curve of residency and support one another. Working with residents at Venice Family Clinic and via our Equity, Diversity, and Inclusion curriculum have been the most rewarding parts of my year!

It has been a privilege to serve as chief resident this past year. This job is quite diverse and has granted me the opportunity to develop countless skills as a clinician, an educator, and a leader. As one of our mentorship and coaching leads, I have valued the ability to connect with and support our residents during this critical part of their early careers. I also have loved the ability to grow as an educator through completing the UCLA Medical Education Fellowship, direct teaching opportunities, and various curricular innovations. A few important curricular projects include leading the residency ultrasound curriculum, championing simulation education, re-designing our pre-operative rotation, bringing back UCLA undergraduate shadowing, and partnering with palliative care to bring a debriefing space to our MICU rotation. This year will forever shape my career as an academician, clinician educator, and leader.

Serving as chief resident has been a uniquely meaningful experience. It has been particularly rewarding to help revitalize our noon conference curriculum at Ronald Reagan. With the help of our enthusiastic faculty and fellows, we have built several new series ranging from diagnostic schemas to engaging specialty talks to clinical reasoning cases. Across our clinical sites, I am immensely proud of how our chief class has reinvigorated in-person resident learning with a renewed commitment to creative teaching and interactive didactics across diverse topics. It has been a joy to collaborate with faculty and learn with and from our inspiring residents. The chief year opportunities for teaching and curricular innovation have shaped my growth as an educator.

Chief year has been one of the most incredible experiences of my personal and professional life. As chiefs, we wear countless different hats in order to serve our program - mentor, educator, advocate, administrator, project manager, and of course, physician - and I have deeply enjoyed diving into and balancing between each of these roles. I am proud to have served as a Mentorship Chief, spearheading both program-wide initiatives such as our Hospitalist Mentorship program, multiple events designed to expose our residents to different paths in medicine, and connecting each of our residents with faculty mentors, along with deeply fulfilling one-on-one mentorship between myself and the residents. As the Fall Retreat Chief Lead, I helped design and execute our retreat, which fortunately was able to be in-person (complete with ropes course team-building games!) after the virtual COVID years. Ever-thirsty for innovative, hands-on, in-person learning, I loved co-leading the POCUS Training Program, where we helped train over 90 of our residents in bedside ultrasound. For 4 years, I have called UCLA my home and family in medicine; it has been a great honor to have given back to the program as a chief. I will forever cherish the invaluable lessons I've learned and relationships I've fostered this year and can't wait to bring them with me as I embark on the next step of my career and life.

Serving as a chief resident has been a true pleasure and privilege. This year has given me so many unique opportunities to grow as an educator and leader, from overseeing our ambulatory medicine curriculum to recruiting an incredible group of talented and passionate incoming interns. The most rewarding moments, however, have been the opportunities to deliver patient care alongside our medical students and residents -- the moments of teaching when the role of a chief resident truly lives up to the etymology of the word "doctor." As an attending on the inpatient medicine wards, I've taught learners of all stages about differential diagnoses and treatments; I've helped medical students develop their physical exam and clinical reasoning skills; and (perhaps most valuably) while precepting in continuity clinics, I've empowered residents to take ownership of their panel, to engage and motivate their primary care patients, to have tough conversations, and to grow into the physicians they want to become. I look forward to drawing on my experiences as a chief resident throughout the rest of my medical career, and I'm so grateful to have worked with my fellow chiefs, as well as all of our students, residents, and faculty.

It has been an honor and a privilege to serve as a chief resident for our department at UCLA. The role has been fun, engaging, and challenging. As one of the VA-based chiefs, I particularly enjoyed and took pride in the culture and spirit of educational inquiry and development at the VA, much of which is embodied in the numerous weekly case discussion conferences with residents and medical students focused on developing clinical reasoning skills. I also had the benefit of serving as one of the Equity, Diversity, & Inclusion chiefs and enjoyed working with our residents and faculty within our department and across the health system to continue building on our EDI efforts and initiatives. Seeing the positive impact of our efforts as chief residents on both our residents individually and the program as a whole has been incredibly rewarding and I am positive I will carry lessons from this year with me throughout my career.

It's been a great privilege and joy to serve as one of the VA-based chief residents. It was incredibly rewarding to work with and learn from the residents and various faculty who make UCLA a phenomenal place to train. In particular, I've enjoyed being able to facilitate the case-based clinical discussions with the residents during morning report and noon conference. I'll definitely miss being a part of the IM residency family!

Elizabeth Tarling, PhD Awarded American Heart Association’s Established Investigator Award

Elizabeth Tarling, PhD, associate professor in the division of cardiology, has been having an impressive month with news that she has been awarded the American Heart Association’s (AHA) Established Investigator Award. The award grants $400,000 over a duration of five years to support established investigators who are in a rapid growth phase of their career, have established records of accomplishments, continue to show extraordinary promise, and are leading innovative/novel research that challenges existing paradigms and employs novel concepts, approaches, or technologies. The AHA funds less than 50 of these awards nationally each year. Dr. Tarling shares the following summary about her research:

“When cells in the lung don't work properly patients have trouble breathing. This happens in conditions like asthma or fibrosis, the latter of which is a devastating and debilitating disease with high morbidity and limited options for treatment. This can also happen in people with heart disease, and people with lung disease often have increased risk of coronary artery disease (CAD). High levels of fat and cholesterol are found in the lungs of people with lung disease, but it is not known why the levels are increased or how lipid levels are regulated at the genetic level. The drugs currently used to treat lung fibrosis do not work well in a lot of patients.

The interplay between cellular lipid homeostasis as it contributes to the progression of specific lung diseases or how this is linked to increased CAD is not well defined. Lipids are also absolutely essential for maintaining the biophysical properties of surfactant which is necessary for efficient gas exchange. So, it is important to understand how lipid levels in the lung may affect the risk of heart disease and lung fibrosis so that we can find new drugs which are more effective. In this study, we are testing how levels of different lipids are controlled in the lung using mice. By studying these pathways, we hope to find new drugs that can be used to treat either lung disease, heart disease, or both.”

In addition to the AHA Established Investigator Award, Dr. Tarling recently published “RNF130 Regulates LDLR Availability and Plasma LDL Cholesterol Levels,” in Circulation Research. Her article made the cover of the journal!

In this latest piece, Dr. Tarling and colleagues describe how RNF130 (ring finger containing protein 130) may serve as a posttranslational regulator of the receptor for low-density lipoprotein cholesterol (LDL-C). LDL is sometimes called “bad cholesterol”, and one way that circulating levels of LDL is regulated, is by altering the levels of the LDL receptor (LDLR) on the surface of the liver cells. High surface LDLR levels, results in more efficient removal of cholesterol from the circulation, leading to lower LDL cholesterol. Conversely, if there is increased degradation or internalization of LDLR in cells, then levels of LDL cholesterol will rise. LDL receptors are recycled by a process known as endocytosis and intracellular vesicle trafficking. Dr. Tarling discovered that RNF-130 is an E3 ubiquitin ligase, an enzyme that modifies the LDLR by tagging it with another molecule known as ubiquitin, a process known as ubiquitination. Increased ubiquitination of LDLR increases its endocytosis, thereby reducing the amount of LDLRs on the surface of liver cells. This in turn leads to elevation of cholesterol. Conversely, when she lowered or reduced the activity of RNF-130, more LDLRs remained on the surface of liver cells, resulting in lowering of circulating LDL cholesterol. This discovery reveals a new way to regulate levels of LDLR, which could lead to new approaches that could be used therapeutically to treat patients with high levels of cholesterol, that is distinct from the modes of action of currently approved cholesterol lowering drugs. Read the publication HERE.

Congratulations Liz!