1. < Message from the Chair

Last week was a busy one in the UCLA Department of Medicine (DoM), with many holiday celebrations, the State of the Department address and a steady stream of accolades for our amazing faculty. This week I will also touch on an important project that is bridging our department with the fledgling health care system in Malawi.

Advancing Bidirectional Global Health Partnerships: Colleagues from Malawi Visit UCLA

For the past two decades, the UCLA Department of Medicine Global Health Pathway (DoM GHP) has provided support for internal medicine and med-peds residents to rotate with Partners in Hope Medical Center (PIH) in Lilongwe, Malawi. PIH is a beloved site among DoM faculty, trainees, and students. Participants in these global health electives have described them as paradigm-shifting experiences that instill a sense of cultural humility and a deep appreciation for the creativity and enterprise required to practice medicine in low-resource settings.

Last month, two PIH colleagues made the long journey to UCLA for clinical observerships. Physician Isaac Yiwombe, MBBS and radiology technician Khumbo Gama spent a packed two weeks with DoM LEADERS who shared their expertise in critical care, dialysis, echocardiography, and more.

The endeavor was truly a team effort. DoM GHP Associate Directors Daniel Kahn, MD and Faysal Saab, MD developed individualized two-week schedules for Dr. Yiwombe and Mr. Gama to ensure their learning objectives were met. Dr. Yiwombe spent most mornings rounding in the medical intensive care unit, attended noon conferences, and spent the afternoons with renal and pulmonology teams. Mr. Gama spent most mornings with echocardiography technicians, attended noon conferences, and passed the afternoons with cardiology teams or practicing with DoM GHP faculty. They also attended an evening case conference hosted by internist Rachel Brook, MD.

One particularly special item on Dr. Yiwombe’s and Mr. Gama’s agenda was a special simulation case session led by Dr. Kahn, Dr. Saab and Dr. Brook in which Dr. Yiwombe and Mr. Gama worked through a series of cases side by side. Dr. Kahn selected multiple simulation cases suited to their complementary roles; as Dr. Yiwombe worked through the case on the mannequin, there would be an opportunity for an echocardiography by Mr. Gama, who would perform the scan on ultrasound simulation equipment that Dr. Kahn had programmed to portray the exact pathology of the patient in the case.

“This simulation session is an example of ingenuity emerging from bilateral exchange,” Dr. Hodson said. “To our knowledge, this is the first time clinical and ultrasound simulation have been integrated in this way, and Dr. Kahn engineered this new type of simulation specifically for their visit.”

Dr. Yiwombe hopes to establish a program in which faculty and staff at PIH can take part in the same type of case conferences and skills “drills” in which he participated during his visit. He also would like to replicate the DoM’s supportive, education-centric culture, and the visit further increased his interest in upgrading the electronic medical record system at PIH.

“When you foster a learning environment, people are able to work with each other pretty well,” he observed.

Meanwhile, Mr. Gama would like to replicate the way information is transferred between radiology technicians and providers.

“Of course, there are some things that maybe we will not be able to implement right away. Maybe we need strategic changes in terms of advancement of skills and machinery,” Mr. Gama said. “But there are some things, like the system of handling information, that we need. We plan to recommend that to our leaders at home.”

As for what UCLA could learn from medicine in Malawi, Dr. Yiwombe noted that unnecessary testing might be one factor that drives up the sky-high cost of U.S. healthcare.

“I think where we’re from, we’ve learned to work in a low-resource setting, and you are able to use very few test results to come up with a diagnosis and treatment plan,” he said.

Under the leadership of former DGSOM Global Health Program Director Risa Hoffman, MD, MPH, as well as DoM GHP faculty, Dr. Hodson applied for two grants to help fund Dr. Yiwombe’s and Mr. Gama’s visit, and the DoM GHP contributed additional funds. These grants included a Rapid Response Award from the UCLA-Charles Drew University Center for AIDS Research and a Global Health Collaboration Award from the David Geffen School of Medicine Global Health Program.

Other faculty who helped “the stars align” to make the trip possible, as Dr. Hodson put it, included Medicine Global Health Pathway Director Christopher Tymchuk, MD, PhD, Cardiologist Timothy Canan, MD and the many residents, fellows, attending physicians and staff who helped with the simulations, offered one-on-one teaching and organized activities, such as tours of L.A. and an epic afternoon at Six Flags.

While Dr. Hodson has spent several years living and working in sub-Saharan Africa, he has had much less opportunity to play the role of host.

“Equitable bidirectional exchange requires the sharing of ideas and movement of bodies in both directions. To be adept at fostering such relationships, one must become comfortable and competent in both the role of guest and the role of host,” he said. “While related experiences, it takes different skills to travel to a different setting than it does to host colleagues at your own institution.”

From a professional standpoint, Dr. Hodson believes his time hosting Mr. Gama and Dr. Yiwombe will be invaluable to his goal of building more equitable bilateral exchange. Their trip taught him a wide range of lessons about what’s necessary to successfully host colleagues from abroad in the hospital, “from big picture planning to minuscule details I never would have thought of without the first-hand experience,” he said.

On a personal level, “being part of Issac’s and Khumbo’s visit was a manifestation of gratitude for all the friends, colleagues and even strangers who have hosted me over the years,” Dr. Hodson said. “While it will never be possible to pay it all back, I hope to pay it forward to current and future collaborators, and these two weeks were but a humble start. For all the friends who joked about visiting me in the United States one day, this was a very deliberate attempt to curate such an experience for Isaac and Khumbo. And the time was both so much fun and imbued with meaning!”

Momentum is high to find opportunities to bring additional colleagues from PIH and other global health partners to UCLA.

“I think it was a really successful visit,” Dr. Hodson said. “Everyone’s on board to make it happen again.” He encourages interested residents to consider using global health elective time to help host colleagues from abroad.

A huge THANK YOU to Drs. Hodson, Tymchuk, Hoffman, Saab, Kahn and the many, many others who made Mr. Gama’s and Dr. Yiwombe’s trip possible! The DoM Global Health Pathway is an integral part of our mission to Advance Health for All. This is an essential step towards a bidirectional global health training pathway, and I look forward to more cross-cultural exchange.

A Year of Cheers for Mina Sedrak, MD, MS

2024 has been a big year for Mina Sedrak, MD, MS, associate professor of medicine and director of the cancer and aging program at DGSOM. In August, he received an $800,000 grant from the Rising Tide Foundation for Clinical Cancer Research to support his lab’s phase II Prevention of Frailty with Fisetin and Exercise (PROFFi) trial. In September, he received a $100,000 grant from Kure It Cancer Research, was named an associate editor of the Journal of the National Cancer Institute and received the Diana Gordon Jonsson Award for Clinical Excellence from UCLA Health Jonsson Comprehensive Cancer Center. In November, he was selected as a National Cancer Institute Division of Cancer Prevention Early Career Scientist.

To cap it all off, last week, on Dec. 11, he was honored during a special ceremony in San Antonio, Texas with a Susan G. Koman Rising Star Researcher Award, a prestigious recognition of midcareer scientists with the potential to significantly impact the breast cancer field as researchers and leaders.

“People want to live as long as they can after their diagnosis of cancer, but they also want to make sure that the time they have is as high quality of a life as it can be, and they value their independence and cognition,” Dr. Sedrak said. “What we’re finding is that these things really do matter, and my job as an oncologist doesn’t end when cure or control of the disease is achieved.”

Dr. Sedrak and his lab are trying to combat accelerated aging post cancer treatment with senolytics, a new class of drugs that triggers senescent cells to self-destruct. They are focused specifically on fisetin, a compound found in strawberries that seems to have potent senolytic activity in mice and human tissue. The Sedrak lab is currently running two clinical trials to test its effectiveness, the first of which — called TROFFi — investigates whether fisetin supplements can improve frailty in postmenopausal women who have undergone treatment for breast cancer. The second trial, PROFFi, assesses its ability to prevent frailty when combined with exercise, also in postmenopausal women who have been treated for breast cancer.

PROFFi builds on the first study, Dr. Sedrak explained. “We weren’t sure that a pill was going to solve a complex, multi-system aging problem like frailty,” Dr. Sedrak said. “We know that exercise works, but we also know that it doesn’t seem to work for everyone, and after you finish treatment that your initial response to exercise can sometimes be blunted. We had a hypothesis that in women who aren’t frail but are pre-frail — meaning they are vulnerable or at increased risk of becoming frail — we might be able to jumpstart the benefits of exercise by giving them fisetin.” 

In some ways, Dr. Sedrak is picking up a baton passed to him by his late mentor, City of Hope geriatric oncologist Arti Hurria, MD. She was passionate about improving the lives of older adults with cancer, a population that is often excluded from clinical trials. After Dr. Hurria passed away in a car accident in 2018, Dr. Sedrak resolved to continue her legacy. 

“To me, my job is really not about the next grant or the next paper or the next protocol or the next experiment — it’s about making a real difference in the lives of the millions of patients who are being cured of their cancer but are living with accelerated aging,” he said.

What a year, Mina! Join me in congratulating Dr. Sedrak on his many achievements this year! I am proud that the DoM is home to his transformative research and clinical work, and I look forward to celebrating its progress.

A POCUS Debate

Since starting this newsletter nearly three years ago, it has always been my hope that it would be a source of inspiration, community, and, at times, a forum for thoughtful exchange of ideas and even debate on important issues. The Nov. 18 edition proved to be one of those times: My thoughts on DoM Chief Bedside Rounds, technology and the dying art of the bedside exam sparked some wonderful discussion, and I could not be more delighted!

In response to my comment on how technologies like point-of-care ultrasound (POCUS) are no replacement for a physical exam despite their usefulness in making diagnoses, Reece Doughty, MD, associate director of bedside ultrasound, responded with a cogent argument for POCUS as an essential tool for physicians. He noted that Abraham Verghese, MD himself — a prominent proponent of the bedside exam whose work I cited in my reflection on this issue— is an advocate for POCUS, and believes that a pocket ultrasound machine should be part of the new doctor’s bag. Here is an excerpt from Dr. Doughty’s email, reprinted here with his permission:

In my reply to their email, I noted that going to the bedside highlighted opportunities for sharpening physical diagnosis skills and also to obtain nuances in the history that are not always evident in the electronic medical record. I also invited Reece to describe their POCUS training program and to provide a response to my thoughts.

Kahn and Doughty also view POCUS as an excellent training tool, especially for speeding up the time it takes to master challenging skills. As an example they pointed to jugular venous pressure (JVP), a method of indirectly measuring pressure in the right atrium of the heart by observing the right side of the patient’s neck. Though this is one of the most important skills that physicians learn, many young doctors struggle with it, Dr. Doughty noted.

“I certainly did not feel proficient at JVP when I finished residency,” Dr. Doughty said. POCUS helped.

“It’s only when I started evaluating the JVP with ultrasound that I actually became really good at it without an ultrasound, because you can identify what you’re looking for much better,” he explained. “As opposed to having someone tell you, ‘This is what you’re looking for,’ you can actually see it.”

Dr. Kahn had a similar experience himself and noted that he has witnessed the same patterns among the trainees he works with. Recently his team admitted a patient whose JVP they needed to assess. Initially, they struggled.

“They couldn’t really find it. I had them ultrasound it,” Dr. Kahn said. The next day, he had them perform this skill again, this time without an ultrasound. Their performance improved dramatically.

“Because they got a sense of how the jugular vein runs in their neck and what it looks like, they could do it,” he said. “As a doctor, we use all of our tools — observation, touch and auscultation — and when you add visualization, whether it’s the jugular vein or a heart murmur, it adds a whole other dimension to learning.”

Dr. Doughty and Dr. Kahn note that the idea that ultrasound runs contrary to the physical exam is a common misconception. To them, it is the opposite.

“It’s like the stethoscope. It’s like the reflex hammer,” Dr. Kahn said. “It helps you be a better diagnostician, a better doctor, a better educator.” In Dr. Doughty’s email to Dr. Abel, he quoted Dr. Verghese: “’The waning of the bedside exam,’ he said last year, might ‘find new life through ultrasound.’”

I want to thank Drs. Doughty and Kahn for this thoughtful response. A funny thing happened two weeks ago when I was on Chair’s rounds. As serendipity would have it, I rounded with Dr. Kahn’s team. One of the patients that we saw together had a left sided pleural effusion and the team and I went over the physical examination, where I demonstrated physical findings consistent with the pleural effusion and underlying atelectasis or consolidation. Afterwards we looked at the POCUS results and saw the same thing. So, let’s shake hands and spend more time at the bedside!

2024 State of the Department

It is hard to believe that we are at the end of 2024, but what a tremendous 12 months it has been! Your tenacity and dedication to our mission has led the UCLA Department of Medicine (DoM) through another phenomenal year, and all the information I am about to share with you reflects your hard work. Let us look at where we stand as the year draws to a close.

I would like to start with the most important part of the DoM: Our people. Ours remains one of the largest departments of medicine in the country, and our ranks continue to grow. We added a net of 114 new faculty this year, bringing our total to 1,819. That includes new division chiefs in infectious diseases, geriatrics and cardiology, as well as new Dermatology Clinical Chief Iris Ahronowitz, MD and Rheumatology Clinical Chief Yaqoot Khan, DO. To the many LEADERS who stepped into new appointments in 2024, congratulations! I look forward to working together to carry the department forward.

The success and wellbeing of our people is at the heart of our department, and we are committed to supporting you. To that end we have implemented wellness initiatives designed to combat burnout. The figures for physician and physician-scientist burnout that you see below are early signs that this undertaking is paying off, but there is still much more work to be done. For an in-depth discussion on our progress, including our strategies to address the persistent gap in burnout rates between male and female physician scientists, please revisit the blog post about our Wellness Town Hall series.

From a financial standpoint the department continues to be in a good position, with about six months of cash on hand. As UCLA has grown as a health system, it has become clear that we have to function in an integrated way. There is a process underway called clinical integration that will see the clinical operations fully integrate into the health system and away from departments and DGSOM, so revenues now accrue in one place. This is a phased approach that will take a couple years to complete. The first wave of this endeavor saw the transfer of the hematology/oncology operations, as we maintained the identity of the division within the DoM. The next phase will see the transition of the remaining DoM clinics into the health system and is expected to be completed sometime in the spring of 2025. Note that this will not change administration or staffing levels; faculty will remain in their departments. We are working closely with the health system on this process.

We will continue to build on our success as a department by following our roadmap, the Strategic Plan. This plan outlines our vision to Lead in Innovation, Transform Care and Advance Health for All, which will be carried out by embracing our core values and focusing on our mission pillars of patient care, research, education and community engagement.

Let us start by looking at our progress on patient care. Our patient encounters continue to rise. The community is knocking on our door, seeking the world-class care that we continue to provide. To accommodate this demand, we are both in the planning and active phases of expanding our ambulatory clinic footprint across the region; bringing our nationally ranked specialty services such as oncology, cardiology and more to our sites including the Central Coast; and building out our inpatient and outpatient clinic capacity at the UCLA West Valley Medical Center. We are also in the planning stages of adding more capacity to Ronald Reagan Medical Center following the Resnik Neuropsychiatric Hospital’s relocation to mid-Wilshire.

Turning to our research mission. 2024 has been an incredible year for research in the DoM. The department published nearly 2,400 publications, over 1,400 of which were in high-impact journals and more than 10% of which were co-authored by our trainees. We re-branded and launched Proceedings of the UCLA Department of Medicine on Cureus, a peer-reviewed platform that will greatly broaden the visibility of our faculty’s creativity. We also held several very successful events that celebrate and bring together our research community, including Research Day and Solomon Scholars Research Day.

For several years now, we have been one of the top-funded departments of medicine in the country, a superlative owed in large part to a multi-million-dollar grant secured several years ago by Judith Currier, MD. That grant is set to sunset in 2026. To maintain the caliber, depth and breadth of research that has established our reputation as one of the top academic medical institutions in the world, we need to diversify our funding base both within and outside our NIH portfolio. We have seen our applications for grant funding increase over the past year, and we aim to continue to grow them in 2025.

The DoM Research Committee has been listening closely to our research faculty over the past year to learn what we need to do to ensure that the DoM is optimized as a venue to conduct research. Personnel, training and resources were at the top of the list. You can learn more about the survey that led us to this data in the blog post about our recent Research Town Hall. We plan to continue to strengthen this communication with all of you, as well as to share the successes of our department’s research more broadly, through our forthcoming research website and monthly newsletter. Both of these will launch in 2025.

With regards to education, our goal is to develop leaders who will drive that future of medicine and health sciences. This year we focused on training leaders who provide holistic, patient-centered care and drive scientific discoveries; developing and recognizing outstanding faculty educators; and creating a culture of learning that encourages all DoM faculty, staff and trainees to reach their full potential.

We have made significant progress in all of these realms. We launched a trainee mentorship and career development best practices workgroup that will deliver recommendations next year, bolstered staff support for the STAR program and integrated PSTP as a residency pathway within the STAR program. We similarly launched workgroups to provide recommendations for faculty educator development and for the mentorship and career development of staff, both of which will also provide recommendations in 2025. Additionally, the DoM Office of EDI launched an educational series for staff titled “Leaning Into New Knowledge” that focus on personal and professional development. We will continue to expand on these initiatives next year.

Our residents and fellows are the lifeblood of the DoM, and our 2024 match results for both were nothing short of spectacular. The same can be said for 2025’s fellowship match results, which we shared earlier this month. The quality of trainees that we bring into the DoM is a testament to our department’s ability to attract, train and retain the best of the best in medicine.

With regards to community engagement and investment, our goal on this front is to advance health and improve outcomes in our diverse communities. One component of our focus this year was strengthening collaborations with organizations that are dedicated to under-resourced communities, such as federally qualified health centers and safety net facilities. Under the leadership of Daniel Kozman, MD, MPH, the new director of health equity partnerships in the DoM Office of Equity, Diversity and Inclusion, we completed a process improvement partnership that will streamline the process to facilitate clinical service agreements (CSAs) with safety net partners on behalf of the DoM. This will make setting up CSAs easier in the future, allowing us to act on our community engagement goals more quickly.

We also celebrated many successes with our partners at the Veterans Affairs of Greater Los Angeles Health Services (VA GLAHS). Our robust patient care, research and education collaborations with the VA GLAHS are moving medicine forward in significant ways. For 2023-2024, the DoM VA Division managed $7.3 million in federal research grants and supported 116 residents and 65 fellows, figures that represent just how important this partnership is to our research and education missions.

We are working on modeling our relationship with the VA at our affiliate partners as well. This year saw several milestones in this effort, such as the expansion of joint faculty recruitments and research opportunities at Olive View-UCLA Medical Center and exploratory talks to address a severe shortage of oncology care for the safety net population who are cared for at Kern Medical in Bakersfield. These collaborations continue to expand our reach to more patients, foster innovation and educate our trainees.

I would also like to give a shoutout to our EDI Office for helping us excel at the second community engagement goal we set for ourselves this year: providing high-quality health equity training for all in the DoM. Program Manager Patrick Frierson led a robust, thought-provoking “Lunch & Learn” educational series for staff that helped develop a foundational understanding of EDI topics and built community. 

As we look to 2025, I am motivated to continue our ongoing work with the health system on financial integration and clinical expansion to ensure that we put in place a system that supports all our missions. I also aim to broaden our departmental focus on philanthropy, which I anticipate could have significant implications for potential challenges with extramural funding. We will continue moving forward with our DoM strategy implementation and are in the process of establishing our 2025 priorities. With regards to wellness, we will implement tailored wellness initiatives at the division level. We will also work on intentional DoM staff engagement and recognition in alignment with the DGSOM people strategy.

I would like to close by thanking our many LEADERS who are the backbone of the many things we do here within our department. There is much more that I could have shared in the allotted time. We are actively posting and writing about this, and as such, I encourage you to stay in touch with DoM developments on our blog, Instagram account, X and Bluesky. Finally, I hope you all will agree that the state of the department is strong — and that the future is bright. 

Dale,

P.S.

During this holiday season, the chief residents put out a call for a decorating competition in our executive suite at Reagan Hospital. My assistant Gilma disappeared one afternoon to ensure that her area was competitive. When I saw it for the first time, including the makeover of my office door, I was impressed and understood why she dubbed her workstation “Candy Lane.” I have no say in who will win the contest, but for those who will be voting….

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