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In my most recent reflections, I shared with you the overall vision, values, and mission-focused goals of our department’s strategic plan, the specific strategies identified to achieve our mission-specific goals and our vision to lead in innovation, transform care, and advance health for all.

The vision, values, goals, and strategies are what constitute our strategic plan. Now that we have a strategic plan, we must implement it. Strategy implementation is when our strategic plan will come to life, turning the plan into action to achieve our stated goals and vision. Here are the steps we are taking now to implement the strategic plan in 2024.

• Establish a governance structure to provide oversight for the implementation of the strategic plan
• Estimating resources required to implement each strategy
• Prioritizing the strategies within each mission pillar for implementation, based on recommendations from the strategic planning steering committee 
• Developing timelines for implementation

Your commitment and enthusiasm make all the difference as we work together as LEADERS to achieve our shared goals and vision. We look forward to sharing more information and opportunities to participate in the weeks to come.

Yijie Wang, PhD Selected as One of Eight Awardees for the 2023 Chancellor's Award for Postdoctoral Research

When Dr. Yijie Wang started her postdoc at UCLA six years ago to work on cardiovascular health research, she says she didn't see herself as a scientist who stood out. But her mentor Dr. Arjun Deb, had a different perspective, and entrusted her with two complex, high-level projects surrounding a question that had confounded the scientific community for decades. The question was this: do non-excitable heart cells directly affect the excitability of the heart?

Every year in the U.S., sudden cardiac death kills upwards of 350,000 people who have had no previous symptoms of heart disease, and in the majority of cases, the underlying cause is an arrhythmia, which describes an irregular heart rhythm, that could prevent the heart from pumping properly. While there is a strong association between the amount of scar tissue in the heart and the likelihood that an arrhythmia could occur, whether fibroblasts in scar tissue directly communicated with cardiac muscle cells to promote arrhythmias was not known. In a September 2023 study in Science led by Dr. Wang, the question was finally answered, as the paper showed that there is a direct communication between fibroblasts in scar tissue and cardiac muscle cells. The findings have significant clinical implications that may impact how we treat scar tissue related to arrhythmia.

In recognition of her leadership in this groundbreaking discovery, Dr. Wang has been chosen as one of eight recipients of this year's Chancellor's Award for Postdoctoral Research. This award was established in 1998 to recognize the important contributions that postdoctoral scholars make to UCLA's research mission. Each year, awardees receive a plaque and a stipend in the amount of $7,500. She was selected out of 945 total post-docs, and an even smaller selected handful of nominees. Upon accepting the award on the evening of November 8, Dr. Wang shared that

"the journey was not easy, but it was incredibly rewarding."

She also expressed her sincerest gratitude to  Dr. Arjun Deb, who she shared has had a profound impact on her both professionally and personally. She now feels differently than she did when first starting at UCLA six years ago: she believes she is a standout scientist, and that anyone can be, with the right mentorship, persistence and hard work. We are proud to call Dr. Wang one of our own at the DoM and extend our deepest congratulations to her and Dr. Deb.

The Department of Medicine Warmly Welcomes Two New Vice Chairs!

Earlier this summer, I was happy to share the news that Neveen S. El-Farra, MD and Evelyn Curls, MD, MBA were appointed senior leadership roles within the department of medicine. We engaged them in conversation to learn more about their goals and aspirations as they begin these new journeys.

In Conversation with Dr. Evelyn Curls, Vice Chair for Ambulatory Care and Clinical Chief of the Division of General Internal Medicine and Health Services Research

What events in your life led you to pursue a career in medicine? 

I have wanted to be a physician for as long as I can remember. I’m a first gen college graduate, so my path to medicine wasn’t a straightforward one. When I was very young, I looked up to a very popular character on television who portrayed a Black physician. It was inspiring to see a person on TV who was an amazing, funny, and caring doctor, who also happened to look like me. I remember wanting to be the kind of physician who improves the lives of their patients and makes a positive impact on their greater community, just like this character did.

A pivotal event in my life that cemented my commitment to pursue a career in medicine occurred when I became a teenage mother to my amazing daughter, who, by the way, is now a junior in college (said in my proud momma voice). As a single teenage mother, I encountered prejudice and substandard care from healthcare professionals due to my circumstances. This experience fueled my desire to be a physician who provided care that was nothing like the care that I received. Instead, I wanted to be a physician that embodied compassion and empathy, empowering my patients to take an active role in their care.

How have you seen the field of ambulatory care evolve over the course of your career?

Ambulatory care has undergone a considerable shift. Technological strides have allowed for improved chronic disease management and efficient communication through the EMR. This has improved care coordination and patient engagement. But these advancements come with their own set of drawbacks. The administrative load has increased for physicians, leading to clinician burnout due to time-consuming documentation processes. While technology facilitates quicker exchange of information, it can also depersonalize patient interactions and lead to a more transactional feel in care delivery. The landscape of ambulatory care has shifted towards a more efficient model, but it also imposes new demands on physicians to balance technology with the maintenance of a personal and empathetic approach to patient care.

What are some of the challenges that your field is currently facing?

Many people may expect me to cite access issues and in-basket management as the biggest challenges facing our field, but I would contend that the biggest challenge facing ambulatory medicine is a profound feeling of disconnectedness. I find that as a collective, we are detached or disconnected from our purpose and our mission. This detachment puts us at risk of losing connection with our patients, our colleagues, and the wider community we serve. I believe this disconnectedness is an outgrowth of the high rate of burnout that is pervasive in medicine today. Reflecting on Maslow’s hierarchy of needs, the intense and relentless demands we face as clinicians confine us to a state of being in which we are just trying to meet our physiologic needs and psychological needs. Consequently, this traps us in survival mode, preventing us from operating at a higher level where we can tap into the “heart” of medicine and connect back to the purpose of why we ever loved this field to begin with.

What is your vision and/or goals for addressing these challenges in your new leadership role?

To address this disconnectedness, my goal is to have a singular and unwavering focus on fixing the operational issues that prevent the faculty and staff from having the space to connect back to what motivates us to provide care for our patients. My plan is to engage stakeholders and collaborate across the knowledge and expertise silos that currently exist within our department. Together we can redesign the way we practice ambulatory medicine to a model that decreases the burden of providing care by:

• Empowering our staff to work to the full scope of their roles
• Ridding our clinic workflows of redundancies and inefficiencies
• Tailoring access solutions to fit the unique communities we serve
• Employing innovative ideas to address the in-basket problem.

What inspires you to do the work that you do? 

Helping people and enhancing their life experience is my inspiration. I am driven to excel in this role. To me, success is defined as effectively leveraging my skills and experience to make operational and infrastructural changes that improve the care we deliver to our patients. I am inspired by the opportunity to improve the work life experience for our faculty. I respect and am humbled by the opportunity to make changes that positively impact the faculty’s clinic experience.

Is there anything else you'd like to share about yourself, your work, or your field?

A quote by a young Australian poet, Erin Hanson, has really resonated with me and has now become somewhat of a mantra and theme in my life. 

“What if I fall?”
Oh, but my darling,
“What if you fly?”

Ultimately, what I want to share is that I won’t ever stop trying. This drive applies in my personal life and in my professional life. I will never stop trying to improve our systems, our workflows, our patient care, and our physician wellness, because if we keep trying, eventually we fly.

In Conversation with Dr. Neveen S. El-Farra, Vice Chair of Inpatient and Hospitalist Services

What events in your life led you to pursue a career in medicine?

As a child, I was regularly in and out of the hospital for severe asthma; this was my first exposure to medicine as a young, vulnerable child. During that time, I developed a deep admiration for the doctors that cared for me, and that admiration ultimately drove my life's pursuit to become a physician.

The pursuit has always remained a personal one: as a patient myself, with trouble breathing, I could relate to someone who couldn't breathe, or who was scared for their life, and felt called to help them just as I was helped. This desire to support didn't end with the patient, however; rather, it extended to the family and loved ones of patients, which stems from the seared memory of the terrified looks on my parents' faces as their own child struggled to breathe.

Finally, I had a remarkable physician role model in my life through my uncle. He was one of our family patriarchs that came to LA to pursue medicine and ultimately practiced at UCLA, just like his niece would go on to do in his footsteps. Amidst his busy schedule, he always gave to the community through pro bono work, above and beyond care, and consistent kindness. The importance of centering compassion as he did has always stayed with me and continued to propel me further. Despite a range of barriers in my life, I persevered because of this commitment to compassion and my steadfast belief in the mission to serve others to the best of my ability.

How have you seen the field of hospital medicine evolve over the course of your career?

First, I should share a bit about what my career has consisted of and the different roles I've held, which has shaped my shifting view of an ever-shifting field. In aggregate, my career has been dedicated to medical education. Towards this end, I have held the following roles: chief resident, associate program director for the UCLA Internal Medicine Residency Program, site director for the Inpatient Medicine Clerkship at Ronald Reagan UCLA Medical Center, associate dean for Curricular Affairs at the David Geffen School of Medicine at UCLA from 2014 to 2019, medical director for International Services at UCLA Health, and now vice chair of inpatient services.

As you can see, I've been at this for a long time and have worn many different hats. As a result, I've seen the field of hospital medicine shift over time, and from a range of angles. The two main shifts that come to mind are 1) the increase in complexity, acuity, and volume of patients in the wake of the Covid-19 pandemic, and 2) the technological innovations that continue to change how we practice.

With regards to the pandemic, its impacts continue to be felt and serve as a daily challenge. Medicine was forever changed by that unprecedented event, and it feels as though we are still catching up and working to understand the broader implications within the hospital system and treatment. I can't think of a better place in medicine to tackle these challenges.

And with regards to innovation, it's impossible to overstate the evolution of technology and its impact on the hospital system. When I was a resident, we didn't even have phones, we had pocket books! Now, everything is centralized to the phone which you can even use to look up questions about your patients in real time. In addition, with ChatGPT, though there are pros and cons, it's being used as a complementary tool to improve the quality of care for our patients. And finally, we're witnessing unprecedented innovation in our understanding of medicine itself through research, larger data, and technology; these innovations have yielded extreme successes in terms of offering treatments for conditions we never thought would be treatable. At the same time, it has also highlighted gaps in our knowledge of disease processes that weren't clear before.

What are some of the challenges that your field is currently facing? 

Suffice to say that the pandemic changed medicine and medical training in a way that we've never previously witnessed. One of the many resulting challenges has been getting back to the level of bedside care within inpatient services and for medical trainees that we had before the pandemic. It's been a slow process, especially as cases of Covid-19 continue to impact patients and how we care for them. It's crucial that we keep pushing forward to bring back robust, high-quality bedside care for patients and their families.

The second challenge I want to underscore is gaps in bringing medical education innovation learnings into practice; we want to make sure that trainees apply self-directed learnings over their career, which is a commitment we make when joining the field.

The third key challenge we face within inpatient services is the structure of shift work. We are required to operate within shift work in order to preserve our own health and wellbeing and prevent burnout. However, this benefit of shift work is, in some ways, offset by the challenges it brings to continuity and quality of care. We are continually striving to push the boundaries of how we preserve continuity and quality care in shift work and ensure patient safety above all.

Finally, there is the challenge of inequity: under-resourced populations in LA and around the world face significant and disproportionate barriers to accessing care. This challenge is especially acute when it comes to ensuring equitable care outside of the hospital setting where discrepancies in follow-up due to systemic factors worsen inequity. We want to ensure we can provide equitable, quality care to all patients, to set patients up for success and address health disparities as best as possible.

What is your vision and/or goals for addressing these challenges in your new leadership role?

I am interested in learning from a range of UCLA Health hospitals and health centers as well as partnered hospitals and health centers. Inpatient medicine covers a very large scope: we have practices across the state where hospitalists are seeing patients from a range of counties and communities. Each population is different, and each practice has different resources; we need to be learning and sharing lessons learned and best practices across those differing contexts.

One example that comes to mind is MLK hospital -- a safety net hospital servicing South Los Angeles. I recently met with their hospitalist group, and listening to them was deeply inspiring. They raised the issue of not being able to provide inpatient chemotherapy because they're not licensed to do so, and explained how that gap leaves them in a position of trying to get patients even the most basic care. Because they are primarily serving lower-income communities and communities of color, the disparities they are working to mitigate are significant. The MLK hospitalist group's commitment to providing the best care that they're able, in an equitable manner that matches the care of other more resourced institutions is highly admirable. I want to think about how we can support their work and the work of other institutions in their position, as well as learn from them.

What inspires you to do the work that you do?

Our patients: whenever I'm on service, working with our patients always provides me with a fresh and nuanced perspective on life and how our work fits into the life cycle. You meet these patients and have a deeper understanding of the range of life circumstances individuals are under, and that they all deserve the highest quality care.

To say that this job is hard is an understatement. We are working within constraints to try and get patients the care that they need and the hours are long. But at the end of the day, when a patient tells you how much they appreciate your care, or how much of an impact you had on them and their healthcare journey, I become re-grounded in why I do this and why it's worth it.

Patients have thanked me through tears, asked to take pictures with me, hugged me. There was one patient I got close with recently, and I could tell was feeling down; I asked her if we could go for a walk, and we did a lap around the unit -- talking about life, about New York, not about medicine, and I could see her mood improve. These moments of connection and gratitude allow me to feel the impact we have, and that continually inspires. And that inspiration is reinforced by the ability to teach the next generation of physicians and instill in them kindness, compassion, conviction, empathy, and devotion to our patients.

What advice do you have for our aspiring physicians in hospital medicine, and how do you approach teaching medical students and residents?

1 ) Above all else: put the patient at the center. Whatever question or problem we're trying to solve needs to first be grounded in the patient(s) and their needs. When you do that, and when you give your all, know that you've played your part.

2 ) Always maintain compassion and kindness for your patients. I always talk about empathy, because unless you've gone through a patient's specific lived experience before, you can't understand them. As a result, having the empathy and emotional intelligence to realize what's important in a patient's case is crucial.

Is there anything else you'd like to share about yourself, your work, or your field?

What I want to emphasize, now more than ever, is that we have a shared humanity. In medicine, it is our edict to embrace that shared humanity with kindness, compassion, empathy. We must never stray.

Two DoM Faculty Featured in Inaugural UC Population Health Report

Across our health systems in the U.S., entities that pay for health care are increasingly moving from a fee-for-service payment model to a population-based payment model -- a type of prospective value-based payment model that pays for a set of services for an individual's care during a specific period or for a specific condition. The goal of this shift is to create a payment system that structurally promotes preventive and person-based care. In response to this ongoing shift, UC Health formed UC Population Health (UCPH) as a systemwide resource and strategic priority. UCPH, in the words of UC Health Chief Population Health Officer Samuel A. Skootsky, aims to "provide leadership, expertise and project management to academic health centers, with a focus on systemwide initiatives that advance value-based care delivery, improve patient outcomes and optimize resource use and costs."

UCPH released their inaugural report in September of this year, and we are proud to see the UCLA DoM featured heavily. Out of four faculty highlights in the report, two feature UCLA DoM faculty:  Kimberly Narain, MD, MPH, PhD and Carlos Oronce, MD, PhD.

We are proud of the work of both Dr. Narain and Dr. Oronce, and are committed to continuing to pave the way for excellence in population health and value-based care.

Tannaz Moin, MD, MBA Successfully Uses UC System as a Test Case for University-Deployed Diabetes Prevention Program

Dr. Tannaz Moin, associate professor at UCLA and core investigator at the Center for the Study of Healthcare Innovation, Implementation & Policy at VA Greater Los Angeles, has spent most of her tenure in medicine pushing insurers, health systems, and providers to be more proactive. As an endocrinologist and health services researcher who has been studying type 2 diabetes and pre-diabetes prevention before it was ubiquitous in the field, she recognizes the importance of intervening as quickly and early as possible. She also knows that to do so requires not only simply establishing the efficacy of patient interventions, but doing the hard work of establishing the accessibility and successful adoption of such effective interventions.

This drive to translate evidence into real-world practice is what led Dr. Moin to bring the Diabetes Prevention Program (DPP) to The University of California, where she partnered with leaders at UCLA and the University of California Office of the President (UCOP) to roll out the DPP to all 10 UC campuses to address diabetes and obesity risk beginning in 2018. Dr. Moin is the founding director of the UC DPP Coordinating Center based at UCLA and her team recently published the findings of their NIDDK-funded R01 study “12-Month Reach and Effectiveness of a University-Based Diabetes Prevention Initiative.” The goal of the study was to test the reach and effectiveness of DPP -- an intervention already proven to be effective at lowering the risk of type 2 diabetes among individuals with pre-diabetes – when employed by a university and across a diverse range of UC beneficiaries.

The results showed that providing the DPP intervention for free to UC affiliates from their employers was effective for maintaining weight loss at 12-month follow-up, demonstrating that university-based approaches to DPP delivery might improve the reach of DPP among at-risk adults. Alongside this study, Dr. Moin and colleagues also published findings from an RCTexamining the effectiveness of shared decision making for diabetes prevention between patients and providers, which found that patients who participated in shared decision making were more likely to sustain positive life changes that lowered their risk for diabetes such as weight loss. Both studies are poignant examples of how we can remove barriers for individuals at risk of type 2 diabetes to make sustained lifestyle changes. Such programs exemplify "win-wins" as participants benefit from improved health outcomes, health systems save resources, and positive health behaviors are rooted in access and agency.

In the words of Dr. Moin, “We are too often disease-focused and reactive, but efforts to prevent or delay the onset of type 2 diabetes are an opportunity for employers, insurers, providers, and patients to be proactive and take action to sustain health rather than react only after an undesired or negative outcome takes place." We are so grateful that Dr. Moin's work has impacted the UC community in many positive ways and we look forward to supporting this work as it moves forward.

I hope that you are as inspired as I have been in showcasing some of our exceptional colleagues.

Dale

P.S.

Earlier this month, I had the honor of receiving an honorary Doctor of Sciences degree from my alma mater the University of the West Indies, where I also gave the commencement address.

Enjoy the picture of the regalia. My mom, wife, brother, nephew and his wife joined for the festivities.

My mom woke me up the next day to read one article in the newspaper the Jamaica Gleaner that you can read here!

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