1. < Message from the Chair

Three DoM Residents Honored with Teaching Awards from the David Geffen School of Medicine at UCLA

Trainees are at the heart of our department of medicine (DoM) community and although they are learners, they also serve as innovative researchers, compassionate practitioners, and effective teachers. Residents play a particularly important role in teaching medical students to navigate their clinical environments, hone their clinical skills, and provide lessons that shape the expertise and empathy that future physicians will employ in their care. Given the crucial role that our residents play, the David Geffen School of Medicine at UCLA (DGSOM) established The Commendation for Excellence in Medical Student Teaching Award, which is given to residents in recognition of their outstanding teaching of medical students during their inpatient ward rotation. At the end of their rotation at the Los Angeles Veterans Administration Hospital or the Ronald Reagan UCLA Medical Center, 2nd year medicine clerkship students are asked to nominate residents that have stood out as exceptionally great teachers.

We are pleased to spotlight three standout internal medicine residents on their receipt of this award for this rotation: Carolyn Hofley, MD, Jeff Xia, MD, and Dayna Isaacs, MD. 

Below, we highlight each recipient and share their insights on the importance of medical education and the significance of receiving this award.

In fact, it's precisely this emphasis on the holistic human experience that led her to be nominated, as the student who wrote the nomination spoke to Dr. Hofley's keen ability to create a safe environment for emotional processing after a difficult patient experience.

"In medicine, we witness a lot of palliative cases and are regularly a part of end-of-life care," Dr. Hofley explains. "To be able to walk a student through that and embody not just the medical side but the humanism side is really powerful. In medicine we need to compartmentalize in the moment. But at the end of the day, we're humans dealing with difficult situations, and it's okay to feel that emotion and make room for processing."

Dr. Hofley, who is guided in her approach to medicine by her Jesuit, humanistic training from Georgetown University, plans to go into pulmonary and critical care medicine with a palliative focus, and to stay in undergraduate medical education. Congrats, Dr. Hofley!

In line with all good teachers, Dr. Xia shared that his main principle of teaching is to be a good observer, to "be quiet and listen to your learner, and allow your learner enough independence to think through problems and propose their own solutions." He shared that in doing so, you're able to better identify your learner's interests, strengths, and weaknesses, which allows teaching to more naturally flow and better serve the learner. Dr. Xia believes deeply in the power of this model, and teaching in general, sharing that

"The impact of effective teaching is limitless. Effective teaching imbues curiosity and instills confidence in learners." And he offered that while not every teaching moment will be effective, "when the perfect moment does present itself, recognize it and seize it."

For the next step in his career, Dr. Xia is planning to participate in a fellowship in cardiology, where he hopes to continue his path as both a learner and a teacher. Congrats, Dr. Xia!

In line with her fellow awardees, Dr. Isaacs also touched on the impact of learners as instrumental members of the team that enable more effective advocacy for patients. Yes, she's taught them, but offers that she's also "grown exponentially from the medical students and interns" that she's worked with.

And much like she was inspired and energized by her teacher as a medical student, Dr. Isaacs aims to embody the same spirit in her approach to teaching, which she shares is equal parts art and science. This dance between the two, according to Isaacs, is what "makes teaching fun." She elaborated on this approach, sharing the following:

"I aim to empower learners to realize their full potential and foster a culture of curiosity. I guide learners in developing one SMART learning goal and one SMART wellness goal (credited to WashU expert educator, Dr. Abby Spencer). Each day, I challenge them to undertake more autonomy than the previous day. By the end of the rotation, learners are “putting their nickel down” for every clinical decision. Together, we navigate the complexities of medical decision-making by integrating evidence-based practices." Dr. Isaacs also emphasized her commitment to imbuing in learners the importance of life outside of medicine, offering that "we cannot wholeheartedly care for the patient in front of us if we lack the space to care for ourselves."

Dr. Isaacs is thrilled to return to her hometown and alma mater for a hematology/oncology fellowship at UC Davis, where she will continue to merge her passions for cancer care and health policy and advocacy and plans to continue her leadership roles in the American Medical Association, the California Medical Association, and the Committee of Interns & Residents. Congrats, Dr. Isaacs!

We also want to congratulate Ifunanyachukwu Okwuosa, MD, Deborah Yip, MD, Austin Churchill, MD, Rohan Karanth, MD, and Kalei Hosaka, MD on their receipt of The Commendation for Excellence in Medical Student Teaching award in the fall of last year. The DoM benefits immensely from each of you and your leadership.

UCLA Faculty Tackle Geriatric Care From a Community, Patient-Centered Lens

The team, led by President and CEO Jenna Hauss, works towards this mission through a range of programming and resource support for community members including adult daycare, caregiver support programming, senior enrichment and socialization, homeless prevention and intervention, and so much more. Importantly, their organization is built on the evidenced premise that healthcare is holistic and that entire communities benefit when families are cared for across generations, with older adults kept as a priority. 

Dr. Borenstein first heard about ONEgeneration through a board vacancy announcement in search of a physician. Now, he's one of their greatest advocates.

"One thing we deal with in primary care is significant limitations in our ability to help other people with their full spectrum of needs," Dr. Borenstein shared, "especially people with dementia, physical impairments, or both. As a primary care physician, it's frustrating to have a limit to what you can do. ONEgeneration bridges that gap -- I was impressed from the moment I learned about the organization because they're mobilizing around the community and have programs that strongly meet the needs of that community. They are also prolific in terms of grant writing and efficiency. The fact that they write nearly 200 grants a year is an amazing attestation to their productivity and resourcefulness." 

While there is a large breadth of programming that sets ONEgeneration apart, there were a few organizational activities that particularly struck Dr. Borenstein and led him to join the board. First, during the pandemic, community members faced increased barriers to accessing food. ONEgeneration responded quickly and within days were distributing 8,000 pounds of food each day. At a time when many social services came to a standstill, ONEgeneration ramped services up, and are continuing to do so, after securing a grant that allowed them to own a fleet of 14 electric vehicles for bulk food delivery. In addition, they uniquely employ intergenerational programming by bringing together young people and older people for socialization. UCLA researchers have conducted studies on these programs and demonstrated a statistically significant improvement in empathy and positive development outcomes among younger people and improvement in dementia and quality of life among older people. 

"One of the core pillars in our new UCLA DoM strategic plan is community engagement," Dr. Borenstein explained. "Basically, my motivation to join in the efforts of ONEgeneration is that it fits within that pillar and our larger DoM and even UCLA mission."

It's evident that ONEgeneration's work not only aligns with our mission, but also complements our work in medicine through community-oriented programming and social services that tackle the social determinants of health head on.

We are grateful to Dr. Borenstein for his commitment to the LA community. In speaking about his involvement, Dr. Borenstein made clear that his work with the organization is just beginning, and that he hopes other UCLA faculty, trainees, and staff will join him as volunteers. Another way of getting involved is by taking advantage of ONEgeneration’s rich research database, which may help shape future knowledge regarding how intergenerational programming can shape health outcomes across the life course. For more information, and to volunteer, please see here!

David Reuben, MD, chief of the division of geriatrics, who has dedicated his career to older persons, recognizes the significance of physician involvement in community-based organizations like ONEgeneration.

Drs. Catherine Sarkisian and John N. Mafi Publish Recent Paper to Help Clinicians Talk to Patients About the New Alzheimer’s Medications

In the vein of holistic geriatric care, I want to highlight that several DoM faculty and trainees are at the helm of thought leadership regarding how we can provide high quality primary care for aging individuals that is rooted in informed consent and agency. A recent paper co-authored by Catherine Sarkisian, MD, professor in the division of general internal medicine and health services research, and staff physician at the VA Greater Los Angeles Healthcare System, and John N. Mafi, MD, MPH, associate professor in the division of general internal medicine and health services research, is a prime example of this crucial work.

The article, "Talking With Patients About the New Anti-amyloid Alzheimer Disease Medications” and published in the Annals of Internal Medicine, is brief but powerful, and stands to indelibly shape the way that Alzheimer's medications are understood and prescribed. Alzheimer's affects more than 6 million Americans every year, the majority of whom are 65 and older. In recent years, Alzheimer's drugs have been put on the market for the first time with the potential to help patients slow cognitive decline and improve symptoms. This new class of drugs is known as anti–amyloid-β monoclonal antibodies, or mAbs for short, and are given through intravenous infusion. The two mAbs likely to soon be marketed at large scale, are lecanemab and donanemab. And while the development of these drugs reflects a significant scientific breakthrough in the fight against Alzheimer's, the clinical benefits are marginal, and a great deal of confusion persists regarding actual risks and benefits.

In response, Dr. Mafi, Dr. Sarkisian, and their team’s research assistant, Artem Romanov, set out to help clinicians make sense of the competing information about Alzheimer's medications for patients who have Alzheimer's or may be at risk of developing it. Written as an objective and accessible summary of the existing literature with recommendations on how to present key takeaways to patients, the article offers a roadmap for clinicians to navigate the increasingly common patient conversations that often start with general questions about the medications from patients that are hard to answer simply and concisely. Their guide, replete with a graphical aid, is targeted towards primary care physicians -- including but not limited to geriatricians -- who the authors say are "best qualified to help patients decide whether they want mAb treatment." 

This guide is effective in large part due to its reframing of the findings from the clinical trial on lecanemab from a relative scale to an absolute scale of observed average difference that is easier for patients to conceptualize. For instance, instead of framing the benefits as a relative slowing in cognitive decline by 27% as it is typically presented, the authors instead describe the potential benefit of lecanemab as leading to a ~6% decline in cognition (eg., assuming a 100-point scale, the cognitive score declines from 82% to 76% over 18 months) in those receiving lecanemab as opposed to a ~9% decline in cognition (eg., 82% to 73%) in those receiving placebo -- i.e. a ~3% absolute slowing in the rate of cognitive decline -- which paints a more realistic picture of the medication’s potential benefits. The authors offer the same absolute scale for risks, such as brain swelling, by explaining that for every 1000 patients receiving lecanemab, 109 more will have brain swelling on average compared to patients receiving the placebo. Finally, the paper contextualizes the approval of these medications by highlighting its high cost to Medicare and its beneficiaries, and soberly touches on the generalizability of the studies, explaining, for example, that studies conducted on mAbs thus far have mostly included patients who are non-Latino white.

Dr. Mafi and Dr. Sarkisian shared with me that though research is ongoing and the individual benefits and risks of mAbs are clinically nuanced – depending on factors such as age, gender, genotype, and degree of cognitive decline -- they hope this paper serves as an important catalyst for cutting through the noise and improving shared decision making about Alzheimer’s medications with patients and families.

"My ideal," Dr. Sarkisian shared, "is that a patient might say, 'Until I saw this tool, I didn't know how much time was involved or have an actual understanding of the benefits. This tool helped me talk to my doctor who knows me well and make the decision that works for me.' We just need more humility. Doctors can do a better job at saying, ‘I'm not sure,’ and explaining what we do know." Dr. Mafi concurs, expressing, "If the article can, even slightly, help patients understand the expected risks, benefits and efforts of these drugs, then that's a really good thing."

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

Dale

P.S.

I subscribe to the importance of lifelong learning. Writing this piece with its focus on the brain reminded me of something that I learned when visiting an aquarium last year. I did not know that an essential part of the brain, the hippocampus is also a seahorse.

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