Year 3. November 18. New and Old Ways of Sharing Knowledge and Learning.
This week, I will focus primarily on providing more in-depth perspectives on an important shift in our department's approach to faculty scholarship that moves us into the digital age, while reflecting on tried-and-true approaches to clinical teaching that should be preserved.
In Conversation With…Proceedings Editor-in-Chief Michael Lazarus, MD
Early this fall we announced the appointment of Michael E. Lazarus, MD as editor-in-chief of Proceedings of the UCLA Department of Medicine. For this special celebration of Proceedings, I share a conversation with Dr. Lazarus, who took some questions about the journal’s goals, the benefits it offers to faculty and what the future holds.
What is your vision for Proceedings of the UCLA Department of Medicine?
Our vision is to emphasize our wide geographic diversity. Each of our associate editors will focus on contributions from community sites and our affiliate hospitals, including UCLA-Olive View Medical Center, Harbor UCLA, the Greater Los Angeles VA, and Kern Medical Center in Bakersfield. We aspire to foster close collaboration in publishing between all our sites, bridging primary care and sub-specialty authors on manuscripts. As the editorial team, our overall goal is to demystify the publication process, provide prompt editorial support, and move our faculty members manuscripts through the system as efficiently as we can. As fellow faculty at UCLA, we recognize the importance of documenting creativity at every step of our University of California academic promotion process.
With regards to the journal, what are your goals for the next year?
We have successfully helped our faculty publish five manuscripts in the two weeks since our Cureus channel came online. Our ultimate goal is to increase this pace to roughly five manuscripts per week. To achieve this, our editorial team is advertising the new journal widely within our department and more broadly to our affiliate institutions. Many faculty work in community sites and we were fortunate to recruit two fantastic associate editors: Dr. Ramya Malchira from our north valley region and Dr. Dianne Cheung from the South Bay region. We have created a list of frequently asked questions that are available on our channel site to help guide the submission process. We will also be attending multiple main campus and community clinical site meetings to engage primary care, hospitalist and sub-specialty faculty in the collaborative vision of jointly creating and submitting manuscripts in the coming months.
Why was it important to add a peer review process to Proceedings publications?
We are partnering with the Cureus Journal of Medical Science, a California based journal with a global authorship and readership, and over 60,000 peer reviewers worldwide. External peer review elevates the content and credibility of our creative work and allows it to be indexed on PubMed, a free online repository of biomedical literature.
How does moving Proceedings to Cureus benefit both faculty and the DoM?
Our faculty will now have access to an internal, peer-reviewed, free, faculty-edited, exclusively online journal with access to thousands of external peer reviewers. We will accept up to five authors per manuscript and ensure a timely editorial process. Accepted publications will then be PubMed indexed. This process elevates our faculty clinicians’ academic output and provides a global platform to showcase the DoM’s scope and breadth of talent.
What advice do you have for faculty who are submitting for the first time?
Create a free Cureus account by visiting our channel here. Review the FAQs on the channel site, then review the information for authors. Go to the “submit manuscript” link in the bottom right corner, read the easy-to-follow instructions on the screen… provide a list of five internal peer reviewers and their contact email address.
One of two things may follow: the manuscript is sent for invited peer review and Cureus invites 11 external peer reviewers automatically. Alternatively, you will receive an email from editorial staff providing clear and specific requested additions or clarifications to your manuscript. Once you respond to these requests and resubmit your paper to their satisfaction, the manuscript will enter peer review.
Within three days you will get constructive feedback in writing from anonymized reviewers. Once two full reviews are completed and responded to, the manuscript moves to a secondary review by our editors and if all issues are addressed the paper is forwarded to the main Cureus site for final review and copy editing. Finally, it is published on our Cureus channel and in time, PubMed indexed.
The editorial team is always available for assistance.
Dr. Lazarus encourages those who have additional questions to reach out to him directly via email at mlazarus@mednet.ucla.edu. As a reminder, the last day manuscripts for the legacy Proceedings of UCLA Health will be Friday, November 22nd. Thereafter all submissions will be accepted through the Proceedings of the UCLA Department of Medicine channel on Cureus.
Please join me in thanking him for his steadfast dedication to moving the DoM into a new era of scholarship excellence, and be sure to watch the video below to learn more about the future of Proceedings.
Satya Patel, MD Shares Experience with Proceedings Submission
Important insights are already making their way to Proceedings, with five submissions published so far. In late September, internal medicine trainee Esther Kim, MD, UCLA internist Priyanka Moolchandani, MD and VA hospitalist and assistant clinical professor Satya Patel, MD became the first to publish a submission in the new format. The article described the case of a 61-year-old male patient who developed pericardial effusion and subsequent cardiac tamponade following the insertion of a tunnel hemodialysis catheter — a common procedure — for the treatment of end-stage renal disease.
“In a health system where countless life-saving procedures occur on a regular basis, it is critical to understand the potential consequences of these procedures,” Dr. Patel, corresponding author, said. “When physicians are considering post-procedure complications of tunneled hemodialysis catheter placement, pericardial effusions should be on the list.”
Dr. Patel views Proceedings as a valuable tool for collaboratively disseminating knowledge that can influence clinical reasoning on cases physicians are likely to see. It also gives residents experience in writing case reports, with benefits for everyone involved. Dr. Patel and Dr. Moolchandani “were able to help guide Dr. Esther Kim refine her skills in writing an effective case report and produced valuable scholarship for everyone's academic career advancement,” Dr. Patel said.
To those who are considering submitting to Proceedings, Dr. Patel suggests identifying cases where there are defined points of improvement in the diagnostic and management space, especially if they involve atypical presentations of common diseases.
“Partner with medical students and house staff on the care team to write up these cases so that everyone’s skills at teaching effectively through scholarship can develop,” he said.
I encourage you to read Drs. Kim, Moolchandani and Patel’s report in full and second Dr. Patel’s suggestion to work with students and residents on writing case reports and submitting them to Proceedings. We are fortunate to launch this great resource to both document faculty creativity and teach the next generation of physicians here in the DoM!
Teaching the Art of the Bedside Exam
When Robert K. Oye, MD launched the publication that would become Proceedings of the UCLA Department of Medicine, he viewed it as a teaching tool as much as he did a venue for documenting faculty creativity. Education is central to our mission in the DoM and the broader UCLA Health system. All of our hospitals are teaching hospitals, meaning that they serve as training grounds for future physicians.
Another tool in our training toolbox is what is informally known as DoM Chair Bedside Rounds, or “chair rounds” for short. Once a week, I join one of our teams of residents, medical students and attendings during their rounds in the wards of the Ronald Reagan Medical Center and meet with pre-selected patients. My goal is to help our trainees become adept in the art of the bedside exam, a ritual that has been described by Stanford physician and author Abraham Verghese, MD as “transformative, transcendent, and at the heart of the patient-physician relationship.” Dr. Verghese views the patient as the best teacher.
I share this philosophy and see it as my duty as chair to model it to the next generation of physicians, especially as electronic health records replace patients as our main source of information about them. Some have argued that technology has advanced to the point that we can eliminate the bedside exam in our medical school and residency curriculums. In my view, this focus on the digital patient instead of the real one right in front of us risks us missing vital information that could inform a life-saving diagnosis.
So, what are our residents learning in chair rounds? First and foremost, they are learning to listen to the patient. The EHR contains patients’ medical history as documented by the medical “biographers” they have met along the way to our hospital, but this is not an autobiography. It is crucial to get the narrative of the patient from the patient themselves, not only so the clinician can ensure that previous diagnoses were correct and learn what will happen to them after they leave the hospital — an important factor that may influence your treatment decisions — but so that the physician may recognize symptoms if a similar case crosses their path.
The bedside exam also establishes a bond that is invaluable to both the patient and the physician. Our patients have thanked us for listening to them and touching them. While technologies like point-of-care-ultrasound (POCUS) have improved our ability to quickly make diagnoses, they are no replacement for the ear, the stethoscope, and the hand.
I rounded with now third-year resident Arun Burra, MD during his very first day of service. In what I consider to be a thoughtful gesture, he and his team selected patients with endocrinology-related pathologies to take full advantage of what they might be able to learn from me. One patient had cystic fibrosis and type 1 diabetes; according to Dr. Burra, he learned quite a bit from my way of talking with the patient and subtle points about physiology, including how the patient’s medications would affect his blood sugars. Importantly, although Dr. Burra and the rest of the team had already spent time discussing the patient and learning their chart, they found there was much more to uncover through conversation.
“I think to be a good doctor, you do need to spend a lot of time reading the chart,” Dr. Burra said. “But I think chair rounds inspired me to go talk to the patient a little bit sooner — I don’t need to go over every single aspect of their chart and read every single note before I go talk to them, because things might have changed, and their understanding is equally important, if not more important, than their doctor’s understanding of their disease.”
Some of you may find yourself wondering, “Who has time for all this in 2024?” It is true that our healthcare system is designed so that physicians are incentivized to move from one patient to the next as quickly as possible. But it seems there is something fundamentally broken about this system: Among developed countries, our nation performs worst on several metrics of health outcomes — despite spending far more on healthcare. What’s more, a lack of face-to-face interaction with patients is thought to be linked to burnout among residents, a problem that could lead to attrition and worsen an already-severe shortage of doctors. Thus, it is critical that bedside exam skills are taught, even if we do not always have time to use them all in every interaction. As Dr. Verghese has written, this ritual is “cathartic to the physician and necessary for patients.”
On a personal level, chair rounds is a chance for me to engage with what I love most about medicine: education and patient care. Passing the art of the bedside exam on to our trainees reminds me why I became a doctor in the first place, and I am very grateful to our residents and patients who have been so eager to learn and to teach. For trainees, please note that the cases you learn from on chair rounds would make for excellent submissions to Proceedings!
L to R: DGSOM MS4 Samuel Woldeyohannes; Arun Burra, MD; Dr. Abel; Lindsay Schlichte, MD; Daniel Kahn, MD; and dental resident Yumeto Shigihara, DDS.
Dennis Slamon, MD, PhD, Awarded Szent-Györgyi Prize
I will round out this week’s newsletter with some exciting news: Dennis J. Slamon, MD, PhD — chief of the UCLA Division of Hematology-Oncology, director of Clinical/Translational Research and director of the Revlon/UCLA Women’s Cancer Research Program at UCLA Jonsson Comprehensive Cancer Center — was honored with the Szent-Györgyi Prize for Progress in Cancer Research on Oct. 18 at the National Cancer Foundation Research Global Summit in Washington, D.C. The Szent-Györgyi Prize recognizes scientists whose pioneering discoveries have shaped cancer prevention, diagnosis or treatment, and have transformed our understanding of cancer biology. Dr. Slamon’s work goes well beyond those criteria.
In the mid-1980s, Dr. Slamon dramatically altered the course of oncology when he and his lab discovered that mutations in the gene HER2 make cancer cells more aggressive and are found in as many as 30% of breast cancer cases. Though their work was initially met with skepticism, it ultimately led to the development of the drug trastuzumab (Herceptin), a monoclonal antibody that targets the HER2 receptor on breast and stomach cancer cells. This therapy is directly responsible for saving the lives of millions of cancer patients around the world; the discovery of HER2’s role in cancer progression has saved millions more by changing the way we think about cancer biology and launching an era of therapies that target cancer cells based on their genes.
Dr. Slamon has continued to advance our knowledge of cancer medicine ever since, such as with the discovery that cancers that are estrogen-receptor positive, but HER2-negative are susceptible to drugs that target enzymes involved in cell division. These findings led to the development of a drug called palbociclib (Ibrance), which has improved the prognosis for patients with one of the deadliest subtypes of breast cancer.
Dr. Slamon’s research epitomizes the DoM’s mission to Transform Patient Care, Lead in Innovation, and Advance Health for All. Here is a link to watch the full awards ceremony, including Dr. Slamon giving a fascinating lecture about his discoveries. Congratulations Dennis!
Dale
P.S.
There are many videos in today’s piece. I will add another one to your playlist. If you would like to hear my perspectives and philosophy on mentorship of physician scientists please see the interview, recently released by the American Society for Clinical Investigation. Thanks to Utibe Essien for serving as the interviewer!
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