1. < Message from the Chair

2024 Solomon Scholars Research Day

Forty-three years ago, the UCLA Department of Medicine launched the Solomon Scholars Research Day to highlight resident and physician scholarship, that includes original research (bench, clinical, translational, or health services); clinical vignettes; quality improvement; and medical education innovation. The annual event was created in honor of David H. Solomon, MD, executive chair of the DoM from 1971-1981, and seeks to support career development in research, education, and facilitate exchange among investigators from all UCLA-affiliated internal medicine programs.

Jonathan Le, MD (Cedars-Sinai Internal Medicine): “Comparison of Coronary Artery Calcium Scores Among Different Anti-Cancer Therapies” 

New cancer treatments are increasing the rate of survivorship in the United States with rates projected to reach 22 million by 2030. Immune checkpoint inhibitors (ICIs) have been highly successful at treating specific cancers; however, they are associated with a nearly 5-fold increase in a major cardiovascular event and nearly 6-fold increase in myocardial infarction (heart attack). Many other cancer-directed therapies, frequently combined with ICIs, are also associated with coronary artery disease. Cardiovascular disease has become the leading non-neoplastic cause of morbidity and mortality in cancer survivors, accounting for 56% of noncancer deaths in cancer survivors.

Despite this, few studies have rigorously compared the risk of coronary artery disease (CAD) in patients treated with ICIs versus other cancer-directed therapies. In a retrospective single-center study, using electronic health data from 2010-2023, Dr. Jonathan Le and colleagues at Cedars Sinai compared coronary atherosclerosis between anti-cancer therapies using coronary artery calcium (CAC) scores as a surrogate. Risk factors for coronary artery disease were present in up  to 15% of the 472 patients in the study. There were no differences observed in CAC scores after initiation of ICI versus other cancer directed therapies. Dr. Le noted that further studies will be needed with a bigger sample size examining differences in rates of cardiac events. As he looks to the future, he seeks to identify which specific anti-cancer therapies might be associated with higher CAC burden, and by taking into consideration traditional risk factors, risk stratify patients to identify those who may need modified therapeutics.

Robin Hilder, MBChB MSC (Olive View-UCLA Medical Center): “Safety and Efficacy of Immune Checkpoint Inhibitor Cancer Therapy in Patients with Pre-existing Type 1 Diabetes Mellitus”

At Olive View-UCLA Medical Center, Dr. Robin Hilder studied how immune checkpoint inhibitors (ICI) impacted outcomes among patients with Type 1 diabetes mellitus. Sixty percent of cancer patients develop autoimmunity, known as an immune related adverse event (IRAEs), when undergoing ICI therapy. Patients with a pre-existing autoimmune disease such as type 1 diabetes are excluded from ICI clinical trials resulting in a lack of knowledge about the safety and efficacy in this patient population.

This study detailed outcomes in ICI-treated patients with pre-existing type 1 diabetes. Dr. Hilder and colleagues found that the IRAEs between patients with and without T1DM were comparable when there was routine clinical monitoring and use of continuous glucose monitors and insulin pumps. Dr. Hilder found that patients should be counseled on the risks of IRAEs, and physicians should monitor the need to titrate insulin regimen during the course of cancer treatment. Dr. Hilder notes that larger, prospective studies inclusive of patients with preexisting T1DM are needed to continue defining the patterns of IRAEs during ICI treatment in patients with pre-existing autoimmunity to ensure equitable and evidence-based use of lifesaving cancer therapies.

Janice Loren Chua, MD (Harbor-UCLA Medical Center): “Gender Differences in Authorship of Cardiac Electrophysiology Publications Over the Last Decade”

While there is still much progress to be made, the representation of women in medicine continues to increase each year. In the field of cardiology, the proportion of female cardiology trainees and physicians has also increased over time. However, men continue to represent the majority in both cardiology and academic medicine. Dr. Janice Chua, from Harbor-UCLA Medical Center, shared that according to 2022-2023 AAMC data, 52% of medical school graduates were women, 46% trained in internal medicine, 29% were cardiology fellows, and 20% of electrophysiology fellows were women. While gender disparities in cardiac electrophysiology training have been previously explored, disparities in authorship have not been investigated. Dr. Chua’s research explores whether there are gender disparities in authorship among cardiac EP publications in the past ten years, with the goal of identifying obstacles that impact female representation in cardiology leadership, recruitment, and academic advancement.

The study concludes that gender disparities in EP publications is consistent with findings from prior literature in different fields. It is critical to acknowledge and address these disparities as authorship of scientific publications is an indicator of research productivity which is an important consideration for faculty promotion.

Matthew Newman, MD (Kaiser Permanente LA Medical Center): “Adaptation of a Modified Elixhauser Comorbidity Index to Isolate the Impact of Body Mass Index on Survival Outcomes in Patients with Cancer in a Large Integrated Healthcare System”

Obesity rates in the United States continue to climb with nearly 42% of adults classified as obese in 2020. Obesity, measured by BMI, significantly increases the risk of various types of cancers by modifying hormone and other signaling pathways, leading to dysregulation of growth factors involved in cancer development. Additionally, excess adipose tissue also triggers oxidative stress to activate inflammatory pathways that contribute to the development and progression of cancer. There is ongoing debate about the relationship between BMI and survival outcomes in cancer patients. The “obesity paradox” describes contradictory evidence suggesting that despite a relationship between obesity and the risk of developing certain cancers, a higher BMI may confer better outcomes in some instances. Current research is limited by narrow adjustments for comorbidities, artificial clinical settings, and a lack of diverse patient populations.

I decided to make an editorial comment on this study. I believe that these data might also indicate that body weight loss (cachexia), is a predictor of worse outcomes in patients with cancer, which could contribute to the seemingly paradoxical results.

Rupam Sharma, MD (Kern Medical Internal Medicine): “Addressing Resident Physician Burnout through a Resident Centered Wellness Committee”

Her findings revealed a 13% reduction in burnout rate after residents were involved in organizing resident wellness activities. Dr. Sharma reports that forming the committee provided an outlet for residents to voice their concerns and provided close-looped communication on issues that were addressed and resolved. Dr. Sharma notes, “surpassing our goal of >10% reduction in burnout rates emphasizes an important milestone that provides useful information for our program leadership and the need for further advancing wellness initiatives.”

Elizabeth Dente, MD (on behalf of Allison Reichel, MD) (UCLA Internal Medicine): “Implementation of a Standardized Script to Improve the Efficiency and Effectiveness of Interdisciplinary Rounds on the UCLA Internal Medicine Service”

For each patient that we care for, there is a team of physicians, nurses, case managers, social workers, and other stakeholders who come together during interdisciplinary rounds (IDR) to determine hospital discharges based on the patient’s needs. However, our resident surveys communicated that a lack of formal training on IDR has resulted in experiences that can be taxing, lengthy or unproductive at times. Our nursing colleagues shared that an improvement in IDR would allow nursing staff to attend more often. Through conversations with leadership and other stakeholders, this team of researchers implemented an IDR script to help residents identify the essential information needed to facilitate a safe and effective discharge. Since implementing the intervention, researchers are now collecting data to evaluate whether it is effective.

I hope you will agree that there is remarkable scholarship ongoing among our trainees across and within all of our affiliated training programs. The future of medicine relies on a culture of curiosity and innovation that pushes the boundaries of our knowledge to improve care and outcomes for all. Congratulations to all of these trainees on their work and efforts!

Trainee Authored Publications FY 2023-2024

Another important indicator of our trainees' scholarship is their ability to garner authorship on peer-review publications in the scientific and medical literature. This achievement validates the quality and rigor of their research contributions and indicates that their studies might be more likely to be replicated or stand the test of time.  Our department tracks research productivity through a daily PubMed search query which is shared each day through our department’s blog, DoM Connect. During fiscal year 2023-2024, our search found 284 publications which were co-authored by a DoM affiliated trainee or medical student who collaborated with DoM faculty. One hundred twenty six publications were written by DoM fellows. One hundred sixteen publications were written by DoM residents. Fifty-three publications were authored by DGSOM students, and 25 were from post-doc researchers in the DoM.

Although these statistics represent our best estimates, there could be publications that our search query may have missed. I invite you to take a look at the depth of breadth of scholarship led by trainees in the DoM by visiting HERE.

Special shout out to the following clinical trainee first authors, for primary research publications in high-impact journals. They are residents and subspecialty fellows:

You will also see that our trainees were co-authors in publications that span the entire range of scientific and clinical enquiry. Many of these publications were in some of the most prestigious and competitive journals in their fields including: Advanced Science, American Journal of Respiratory and Critical Care Medicine, Cell Reports Medicine, Circulation Heart Failure, Chest, Clinical Cancer Research, Clinical Gastroenterology, Dermatology, European Heart Journal, Hepatic Medicine, JAAD Case Reports, JAMA, JAMA Dermatology, Journal of American Academy of Dermatology, Journal of Autoimmunity, Journal of Clinical Investigation, Journal of Immunotherapy of Cancer, Lancet Infectious Disease, Mayo Clinic, Molecular Systems Biology, Proceedings, Molecular Therapy, Nano Today, Nature Biotechnology, Nature Cardiovascular Research, Nature Communications, Nature Reviews in Gastroenterology and Hepatology, NEJM Evidence, Proceedings of the National Academy of Science, Progress in Cardiovascular Research, Science, Science Advances.

Congratulations to our trainee scholars! Your achievements at this early stage of your careers convinces me that the future of innovation in medicine is bright!

In Conversation with Jorge D. Flautero Arcos, MD, 2023-2024 LGBTQ+ Healthcare Fellow

During the month June we celebrate Pride Month. Pride Month commemorates the 1969 Stonewall riots, and the ongoing effort to achieve equal justice and equal opportunity for LGBTQ+ community members. I am pleased to highlight one of our distinguished fellows in the LGBTQ+ Healthcare Fellowship Dr. Jorge Danny Flautero Arcos, who shares with us how his fellowship experience has prepared him with the leadership skills and clinical expertise to deliver comprehensive care to sexual and gender minority patient populations.

What were some of the most valuable lessons or skills you gained from the LGBTQ+ Healthcare Fellowship Program?

The most valuable aspect of the fellowship has been working with the LGBTQ+ community, which historically has faced barriers accessing health care, and having patients tell me how happy they are to be paired with a provider from the community. I have gotten a lot of skills in primary and preventative care to meet the needs of the LGBTQ+ community that most doctors don't get training in during medical school or residency, like High Resolution Anoscopy and hormone management for members of the queer and transgender community.

Could you describe a significant project or experience during the program that had a strong impact on you?

As part of the fellowship, I got the opportunity to go to Tijuana, Mexico several times to volunteer as a medical provider in a shelter for LGBTQ+ people seeing refugee status in the US. I think it helped put into perspective the training that I received, including the importance of providing affirming care. As a first-generation Latino doctor, this experience was also meaningful to me as my family also struggled with having access to doctors, let alone doctors that shared our culture and language.

In what ways do you think the fellowship has prepared you for your career? Or how do you envision incorporating your learnings from the fellowship into your professional life?

The UCLA LGBTQ+ Health Fellowship has taught me new skills and sharpened my competencies as a primary care doctor. I will stay on as an attending at UCLA and the LA LGBT Center where I will continue to provide Gender Health services, HIV care, and perform anoscopies for anal cancer screening to my patients.

Are there any specific achievements and milestones from the program that you’re particularly proud of?

The UCLA LGBTQ+ Fellowship was the first fellowship if its kind and this year was the first time that the five current fellowships across the country came together to formulate milestones for this type of training and share our different projects. I was happy to meet the fellows from different parts of the country and share my quality improvement project looking at statin prescription in patients diagnosed with HIV.

What advice would you give to others considering joining the program?

The fellowship can be challenging because we jump in from day one learning and managing topics in medicine that most people don't get training in, such as HIV care and hormone management for gender affirmation. My advice would be to be easy on yourself as you try to master so many things at once.  "Impostor syndrome" is common but you're in the right place and you'll finish the year feeling more confident.

Would you like to share anything else?

It's been an honor to join the UCLA family. I look forward to continuing to learn from, and alongside, my mentors as an attending.

Incredible work, Jorge. We look forward to seeing you grow and lead as a LGBTQ+ healthcare LEADER at UCLA!

Congratulations DoM Fellowship Grads!

On behalf of the department, I extend my congratulations to Dr. Flautero, and all the fellowship graduates this year. We could not be prouder of their accomplishments and look forward to continuing to cheer them on as they move on to the next step of their career. I invite you to view a few pictures of recent graduation celebrations below. We will continue to share these over the coming weeks as programs continue to host their graduation events!

Our DoM faculty share their latest research and perspectives about issues affecting our community at-large. Find out who was in the news recently.

I hope you will agree that our trainees rock!

Dale

P.S.

Looks like June gloom might be over. It was hot this weekend and for those who were out and about, I hope that you applied sunscreen.

Clear skies also mean skywriting. Saw this on Saturday. Is this a So Cal thing??

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