Year 2. November 6. More Strategy.
In last week’s reflection, I shared with you the overall vision, goals, and mission pillars of our department’s strategic plan. The plan is ambitious and will require the members of our community to serve as LEADERS in our four mission pillars of research, education, patient care and community engagement and investment. During the strategic planning process, we invited the department of medicine (DoM) community to participate in various roles which included design teams who led the development of each mission pillars goals and their respective strategies. This week, I will share with you the strategies that the four design teams identified as key priorities for achieving our vision to lead in innovation, transform care, and advance health for all.
Let’s begin with our research mission pillar where our goal is to accelerate the growth and impact of our research and discoveries.
What strategies will we use to achieve this goal?
- We will invest in strengthening the research infrastructure and ensure that our faculty, staff and trainees have the adequate space, training, and support needed to help us continue to lead groundbreaking, innovative research.
- We will develop, retain, and recruit researchers and research staff that are not only pushing the boundaries of medicine but also embody our core values as LEADERS.
- We will Implement a DoM-wide approach for identifying targeted, multidisciplinary research areas.
- We will foster a department-wide research community that encourages collaborative, innovative, high-impact research across all areas.
- We will raise the profile of the DoM research portfolio, internally and externally.
Next, let’s examine our education mission pillar which has set the goal of developing leaders who will drive the future of medicine and health sciences.
How will we do that?
- We will train leaders who provide holistic, patient-centered care and drive scientific discovery to create a better future for our community.
- We will champion diversity in our trainees, faculty, staff, and patient population.
- We will develop and recognize outstanding faculty educators.
- We will promote the DoM as a nationally recognized leader in education.
- We will create a culture of learning that encourages all DoM faculty, staff, and trainees to reach their full potential.
Our department is known for providing compassionate and cutting-edge patient care, and our patient care design team identified that our department goal in this mission pillar is to provide the highest, quality patient-centered, innovative, integrated healthcare for all.
What steps will we take to ensure that we achieve this goal?
- We will increase access to high quality, patient-friendly inpatient and ambulatory care.
- We will strengthen clinical infrastructure and operational efficiencies.
- We will create strategic alignment to optimize patient care in collaboration with the DGSOM clinical departments, UCLA Health, our academic affiliates, and community-based partners.
- We will cultivate a culture and environment in the clinical setting that supports provider and staff well-being and retention.
- We will expand external visibility and strategically differentiate the DoM clinical enterprise as a key component of an academic health system.
As part of a public serving university, our department has set a goal to advance health and improve outcomes for our diverse communities. We will achieve this goal for the communities throughout Southern California through the following strategies:
- We will increase access to care and health resources for historically and contemporarily under-resourced communities.
- We will strengthen engagement and collaboration with organizations caring for historically and contemporarily under-resourced communities.
- We will provide high-quality health equity training for all in the DoM.
- We will advance health disparities research and policy to improve health equity, in collaboration with health systems and community partners.
- We will promote healthier, thriving neighborhoods through health education and disease prevention.
We believe these ambitious goals and thoughtful strategies are key towards helping us accomplish our strategic plan and achieve our vision. I am confident that every member of the DoM community will identify how they can contribute towards advancing these strategies to get us one step closer to the finish line. Each one of us has the capacity to contribute to these missions in various ways and I am pleased to highlight below a few of the ways that members of the DoM are already doing so.
JAM Award Recipients Fight for Health Equity
In addition to providing high-quality patient care, our faculty are leading critical research projects focused on addressing health inequities faced by members in our communities and diversifying the field of medicine. This week, we celebrate three additional faculty who recently received a JAM Seed Grant Award from the Justice, Equity, Diversity and Inclusion (JAM) Council of the David Geffen School of Medicine (DGSOM). We spoke with Dr. Veronica Ramirez, Dr. Gifty-Maria Ntim, and Dr. Adrian Mayo about their recent awards.
Dr. Veronica Ramirez is an internal medicine physician and hospitalist focused on addressing complex medical challenges and patient advocacy in internal medicine. She shares that she chose to become a hospitalist because there was a need for more Latinos in medicine, particularly in hospital medicine. Being a patient in the hospital is one of the most vulnerable times for a person and Dr. Ramirez is committed to helping patients navigate their in-patient care during this critical moment by providing culturally and linguistically competent care.
Dr. Ramirez was inspired to explore the potential benefits of integrating more robust social medicine training in residencies from her years of working with individuals marginalized in the in-patient setting, as well through her personal experiences as a member of a historically unrepresented group in medicine. Through the JAM award, she will be able to bring that exploration to light. Following up on her participation in the inaugural JAM mentorship class in 2022, Dr. Ramirez is working on creating a social medicine curriculum for internal medical residents at Martin Luther King Jr. Hospital. The mission of this curriculum is to explicitly train internal medicine physicians who have an interest in working with medically vulnerable populations. This is particularly crucial given that the hospital is located in one of the most underserved areas of LA.
While the curriculum is still being fleshed out, the general framing is a lecture series delivered throughout the year on topics such as social determinants of health, government insurance programs, street medicine, refugee health, and incarceration and health. Thus far, Dr. Ramirez has been spending much of her efforts on the project establishing relationships with potential speakers and partners. Ultimately, one of the goals of the program is to provide a practicum opportunity for residents where they can shadow or work closely with a relevant partner or entity such as a case manager, social worker, or a refugee health clinic, to see their lessons applied in practice. The JAM Award funding will be used primarily to compensate lecturers and community organizations for their time -- a crucial component of incorporating equity directly into the project.
Dr. Adrian Mayo, a faculty member of the UCLA Internal Medicine Residency Global Health Pathway, is part of the hospitalist sections EDI committee, and volunteers to bring care to people experiencing homelessness. He is committed to excellence and equity in medicine.
It is the combination of these efforts that led Dr. Mayo to design an intervention to provide people experiencing homelessness with cell phones, which he will now be able to carry out with the support of the JAM Award.
The goal of this intervention is to improve the continuity of care for individuals experiencing homelessness, who are at higher risk of adverse chronic health conditions, readmission, and longer rates of inpatient stay. In doing so, Dr. Mayo is approaching this issue through a broad public health lens by targeting an important social lever for change. He shares that he designed this specific intervention because
"many of our follow up programs are targeted through cell phones, and if you don't have access to a cell phone, you may not be able to even receive necessary, continued care."
While Dr. Mayo is still scoping the project, the current plan is to purchase a set of cell phones for a number of identified individuals who are experiencing homelessness and assess if the rate of follow up improves among this group. Analysis of this nature can be difficult because we don't have clear metrics for a base rate of follow up for this population on a national scale, and because a good amount of follow up for this population takes place in other care settings. Nonetheless, Dr. Mayo is continuing to push forward on this project in the hopes that it can incite change. He shares,
"it brings me a deep satisfaction to work with this population and bring quality care to people who otherwise wouldn't be getting the same care as others based on factors out of their control."
Dr. Gifty-Maria Ntim, MD, MPH, is a primary care physician certified in both internal medicine and pediatrics who has spent her tenure in medicine working to promote health equity for patients of all ages, from newborns to elders. She takes this commitment further, however, by viewing her role dually as a clinician and an educator with a mission to provide excellent care that promotes justice for all and to teach the next generation of med-peds clinicians to do so. While Dr. Ntim has always been committed to this dual role in her work, Dr. Ntim solidified this commitment following her appointment as the Med-Peds residency program director in 2022.
Since taking on this role, Dr. Ntim has been steadfast in ramping up efforts to both 1) recruit and retain a diverse, inclusive, accessible, and just Med-Peds residency class, and 2) prioritize educating Med-Peds residents on issues of diversity, inclusivity, accessibility, and justice. One way in which Dr. Ntim has already initiated this work is by supporting her residents to create an EDI committee specific to the Med-Peds residency program, appropriately named mEDI-pEDI. Her plan is to use funds from the JAM Award to strengthen the existing efforts of mEDI-pEDI through efforts such as improved recruitment efforts aimed at increasing resident diversity, the establishment of meaningful relationships with community partners, and providing Med-Peds residents with a variety of educational experiences aligned with their program’s revamped mission and vision.
When speaking about why she is building out this program, Dr. Ntim shares,
"residents can feel tension sometimes between what we say we're about and how we show what we're about."
And when discussing what this program will entail, she goes on to explain that
"Our program should make the most of the unique cultural and socioeconomic tapestry that Los Angeles provides by intentionally providing residents with an understanding of the structural barriers patients face that have led to some of the disparities in health we see."
Dr. Ntim is personally familiar with these issues as well, which are driving factors for her. She shared that
"medicine is not about looking like one type of person. Because I come from medicine as a Black woman from West Africa, with an accent, this is my life. In terms of trying to link it to some of my interests in medicine and justice, my purpose comes from being able to create spaces for future generations of physicians where they feel they belong."
She is grateful to the JAM Program for providing her such a space, and the JAM Award funding for allowing her to make these spaces possible for future Med-Peds residents.
Jason E. Bahk, MD Awarded The Service Excellence of the Quarter Award
As we celebrate our JAM Award recipients for embarking on meaningful, community-based work, I want to simultaneously extend my sincere congratulations to Dr. Jason Bahk, a hospitalist in our Henry Mayo Hospital, Olive View – UCLA Medical Center and Burbank cohort, who has been given the Service Excellence of the Quarter Award in recognition of his high-quality patient care. This award couldn't be more deserved, as Dr. Bahk embodies CICARE in the way he treats each patient with respect, care, and humility.
Unlike other awards, the Service Excellence of the Quarter awardee is selected based on patient feedback and endorsements from patients and their loved ones. While many patients have spoken highly of Dr. Bahk, this specific award can primarily be traced back to one patient that Dr. Bahk cared for nine months ago; after discharge, she wrote a letter to Henry Mayo to share how thankful she was that Dr. Bahk took the time to listen to her, and how he was the first care provider to do so in earnest. In discussing his experience with the patient, Dr. Bahk explained that she had a condition that many physicians dismiss because it's psychosomatic. He says,
"I don't feel like I did anything that spectacular, but what I did do was listen to her. We are in a human profession."
While active listening can improve a patient's experience regardless of their condition, the kicker in this story is that the patient ultimately did have a physical underlying condition that is often dismissed as psychosomatic. When asked about how he stays motivated to take this human-centered approach with every patient, Dr. Bahk shares that he was enlightened by the personal experience of helping his mother navigate her breast cancer diagnosis and treatment when he was a fourth-year medical student; though she unfortunately passed away, Dr. Bahk explains that he tries to honor her legacy by treating all patients like he would a family member and with human connection. His multilingual abilities in English, Korean, and Spanish, in addition to his work in medical advocacy, has helped him in this endeavor.
"Being an internist means understanding people," Dr. Bahk states. "If you sit with a patient long enough, they'll tell you what's going on."
Iris Cantor - UCLA Women’s Health Center Tackles Reproductive Harms of Environmental Toxins in Impacted Communities
Continuing our celebration of excellent events, I want to take a moment to congratulate Dr. Janet Pregler, Julie Friedman, MPH and the entire team at Iris Cantor - UCLA Women’s Health Center for putting on the successful conference “La Salud De La Mujer y El Medio Ambiente." Hosted in collaboration with a range of women's and environmental health groups at the California Endowment. The October 4th event carried on a ten-year long tradition of bringing stakeholders together to discuss the intersection of environmental and women's health.
This year's full-day conference was centered specifically around addressing racial and ethnic disparities in relation to environmental toxin exposures that are linked to breast cancer, poor birth outcomes, and other reproductive health harms in Los Angeles. Because the Latina community is at disproportionate risk of experiencing adverse reproductive health outcomes due to environmental toxins, the event was conducted entirely in Spanish. This allowed a range of residents, community members, and stakeholders to fully participate in a conversation that most impacts them.
With around 170 attendees, 20 speakers, 24 featured organizations with resource tables, and an all-female mariachi band, the conference was replete with enthusiasm. Moisés Moreno-Rivera, Deputy Secretary for Environmental Justice, Tribal Affairs and Border Relations, California Environmental Protection Agency, the primary funder of the conference, gave the keynote. Speakers promoted affordable and realistic modifiable behaviors that can help attendees reduce exposures to toxins. A major focus was the need for collective advocacy to address structural causes of environmental disparities, including the location of toxic industries in communities of color.
According to Dr. Pregler,
“The Iris Cantor-UCLA Women’s Health Center remains committed to supporting education and research on the threat to women’s health posed by environmental toxins. The burden of environmental toxins on the health of women of color living in urban areas is often overlooked. It was a privilege to spend a day learning from so many community leaders, educators, promotoras, and other activists.”
Palliative Care Research Symposium Takes Palliative Care to New Heights
Finally, November is Hospice and Palliative Care Month and I am proud to highlight the work of Dr. Anne Walling, the UCLA Palliative Care Program, and the VA, which together hosted its first Palliative Care Research Symposium the evening of last Monday, 10/30.
As physicians, our edict is to do no harm. Often, we interpret this oath as doing everything we can to save a life, such as pushing for organ transplants or encouraging potential curative surgeries. A growing body of research, however, suggests that palliative care, when aligned with a patient's wishes, can yield better quality of life at end of life, improve end of life health outcomes, and promote a smoother grieving process for loved ones. This is where the UCLA Palliative Care Program and VA come in as not only leaders in the provision of palliative care, but as leaders in researchers studying ways to improve palliative care and goals of care decision making.
Dr. Walling brought together some of the leading minds in this field -- both from UCLA and across the country -- to present on their cutting-edge research on palliative care. This year's event boasted a packed three-hour agenda that included ten expert speakers, two expert moderators, and around 60 attendees.
I was honored to be able to kick off this seminal event by reflecting on how far we have come in the U.S. when it comes to palliative care, and yet how much further we have to go. Dr. Walling followed up with her own introductory remarks, sharing that
"if the secret of quality is love, then palliative care is the heart of a learning health system."
Each speaker embodied this sentiment, beginning with four lightning talk presentations moderated by Drs. Emily Martin and Jessica Kaltman. Dr. Thanh Neville spoke about the 3 Wishes Program at UCLA, sharing her team's data on how the program is evidenced to have improved emotional and spiritual support at the end of life; Dr. Neil Wenger presented on the implementation of a recent large-scale study that included 50 primary care clinics across UCLA, UCI and UCSF; Kirsten Buen, RN, MA, MS, and PhD candidate discussed the importance of building stronger relational infrastructure among palliative care providers as well as acknowledging and strengthening ways to manage discordance in palliative care (eg. the tension between wanting to sedate someone for comfort and keeping them alert to be with loved ones); and Dr. Arpan Patel demonstrated the evidence of integrating principles of palliative care for patients with end-stage liver disease in order to ensure the integration of palliative care concepts such as quality of life and patients’ goals and values along with pursuing disease directed treatments, including transplant as appropriate.
Finally, Dr. Charlotta Lindvall, based at Dana-Farber Cancer Institute, keynoted the symposium with a talk on the use of NLP for advancing palliative care. One tool she and her team developed, called Clinical Regex, has significant research applications for health services research, and particularly for palliative care research. For instance, it can allow researchers to find the "needle in the haystack" in a timely fashion when searching for data elements only available in unstructured data in the electronic health record. She also discussed how advanced NLP methods can help identify documented patient symptoms otherwise buried in free-text clinical notes, which can be crucial for clinicians making decisions about treatment. Dr. Lindvall finished her talk with the recommendations that we 1) make better use of validated measures and conceptual frameworks, 2) prioritize measurement, 3) advance our use of NLP in palliative care, and 4) work better together across departments and health systems.
I believe this symposium was a crucial step towards fulfilling all four of those recommendations. The UCLA/VA Palliative Care Research Program is poised to establish a long tradition of excellence in palliative care research and innovation at UCLA. We would like to extend our thanks to Drs. Anne Walling, Carol Mangione, Paul Shekelle, and Zhoaping Li, who all provided opening remarks and without whom this event would not have been possible.
I look forward to continuing to highlight the exemplary work of our faculty and staff in the palliative clinical care in an upcoming communication.
Residency Recruitment is Underway!
These past few weeks, I have been welcoming prospective residents before their interviews with UCLA DoM faculty. I have had great pleasure meeting with these talented and bright aspiring leaders in medicine to share with them the wonderful work that you lead each day, and our commitment to developing our trainees as future leaders. While I can share about why our program is the best, I invited residents in the medicine-pediatrics and physical medicine and rehabilitation residency programs to share why THEY chose the DoM. Enjoy a few of their reflections:
MED - PEDS
Andrew Y. Chang, MD
"I chose UCLA for the diversity of training sites - having the opportunity to practice both in a quaternary level academic center and a community hospital on a regular basis ensures that I have the breadth of training experiences to become a well-rounded physician. So far, my intern year has been an even more positive experience than I anticipated, with a welcoming culture that focuses on both supporting each other as well as helping each other push to grow clinically."
Lindsay Olson, MD
"I chose UCLA Med-Peds for the diversity of training sites and patient populations, the seemingly unlimited opportunities/resources, the fun and genuinely kind residents and faculty, and of course...the amazing weather and vibrant culture in Los Angeles! Since starting residency, I have been shocked by the commitment of our program leaders to continuously adapt and mold our training to fit the needs of us residents and our patients. Also, I could not believe how quickly I felt connected to my co-residents. Who knew that the family feeling people described was actually real?? I love my job!"
Phoebe (Kathleen) Hung, MD
"I chose UCLA because I wanted to train at a place that had diverse training sites and become an excellent clinician. Now that I'm here, I'm blown away by both the quality of teaching and the kindness of the providers that I interact with every day. UCLA has also truly supported me in making my career goals come true - and the benefits don't hurt either."
Sahana Shankar, MD
"I feel immense gratitude to have the opportunity to train at UCLA. I was drawn to the Medicine-Pediatrics program here for many reasons including the clear dedication to each resident and an active effort to tailor their experience to their interests, the LEND clinic (my dream clinic), and the diversity of clinical training sites. All of those things exceeded my expectations and there is infinitely more here that makes our program so special. I’m grateful for the incredibly supportive culture, co-residents by whom I’m constantly inspired, and the endless opportunities no matter your interest. I truly believe that this program fosters a community and a culture that allows you to become the best version of yourself and the best physician you can be."
Rachel To, MD
"In all the best ways, my training thus far at UCLA has been an incredibly humbling and challenging experience. From medically complex patients in the MICU to visits to the women’s shelter during my primary care block, UCLA is preparing me to be an excellent clinician, thoughtful advocate, and forward-thinking leader. I chose UCLA for its well-rounded training, and I continue to be blown away by the amount of support and genuine care that faculty, staff and co-residents have for each other."
Katherine Tran, MD
"I was drawn to UCLA Med-Peds for the opportunity to train at a variety of different clinical sites, including two different combined continuity clinic settings; strong categorical programs; abundant academic resources and supportive faculty; and multiple opportunities to get involved with advocacy work. I was also drawn to LA as a city for its cultural vibrance, diversity, and endless nature and activities. I felt immediately at home in a wonderful and welcoming community that shares my values, and I’ve loved my time at UCLA so far, both inside and outside of the hospital."
PHYSICAL MEDICINE AND REHABILITATION
Kristen Clark, MD
“I chose UCLA because of the diverse learning opportunities, complex patient populations and collaborative and supportive environment. Since starting residency, I have been impressed by the education we receive from not only our amazing program director but all of the faculty and co-residents. Through the UCLA PM&R residency, I have had ample opportunities to grow as a resident through hands on learning and challenging cases.”
Jennifer Tram, MD
"I chose to train at UCLA because of the diversity of clinical experiences at multiple clinical sites and its strong sense of community. We have the opportunity to train at the West LA VA hospital, UCLA medical center, California Rehabilitation Institute, Children’s Hospital, Long Beach VA hospital and Rancho Los Amigos! Besides the strong clinical training, our program is incredibly friendly and tight-knit. We support each other in the clinic, and we have a great time exploring LA’s beaches, restaurants and amusement parks outside of work. I feel so very fortunate to be able to train at UCLA PM&R."
Recruiters, take note and share these testimonials with prospective applicants.
Last Tuesday, it seemed like a lot of costumes were worn across the department. The administrative staff conducted a pumpkin carving competition, and I was summoned to officiate the judging of the pumpkin carving contest. After serious deliberations regarding the 12 entries, I declared a championship tie.
The winners were: Genevieve Aguirre, Bryan Alvarenga, Hilda Zamora, Gilma Rodriguez for creations depicting what I can best describe as "Sleeping Beauty" and “Dios de la Muerte.”
Then Daisy Cazares won the award for the best costume. Aiming for the stars apparently!
Meanwhile across the road at Ronald Reagan UCLA Medical Center, the chief residents decided to become body doubles for their Program Director Dr. Lisa Skinner.