Year 3. July 1. The New Residents and Fellows are Here.
Each summer, we welcome new cohorts of talented residents, fellows and faculty to our department. They are all LEADERS who bring unique experiences and perspectives that enrich our community and help us move closer towards achieving our vision to lead in innovation, transform care, and advance health for all.
For those of you, who recently joined the UCLA Department of Medicine (DoM)… WELCOME! You are starting an exciting journey filled with new information, many new faces, and familiarizing yourself with the culture of the DoM. You will quickly find that at the heart of our department is a deep commitment to leadership in patient care, academic development, and the long-term success of our people. We take pride in building a community that values equity, ensuring that every patient receives exceptional care and that we support a diverse and inclusive environment that celebrates and respects everyone. We hold ourselves to the highest standards because we recognize the great privilege, we have in caring for others and serving our community. Together, we seek to make meaningful impact in the lives of those we serve. We are thrilled that you are here and look forward to partnering with you to uphold these principles and continue advancing our missions.
2024 Residency and Fellowship Onboarding
Now, I introduce you to a few of the newest members of our team! Let’s start with the residents and fellows who we met earlier this year when the residency match day and fellowship match day results were announced. We caught up with four residents; Drs. Jennifer Arias, Harini Shah, Hannah Ship, and Sarah Peña, during their final day of residency onboarding and they shared with us what they are most looking forward to as they begin this transformative journey!
These interns are joined by a stellar group of residents who, alongside our senior residents and fellows, will care for more than 50% of inpatient beds across UCLA Health hospitals. I invited Lisa Skinner, MD, program director of the UCLA Internal Medicine Residency Program, to share a few reflections about this incoming class.
"The residency match is a culmination of a monthslong recruitment effort that draws exceptional students from across the country to UCLA. Match Day is not only a cause for celebration, but the beginning of a sprint to welcome and prepare our interns for their first day working as physicians. Our medical education team, led by Ariela Hakim, Bear Waters, Mondo Medina, and Doug Ruiz Carbajal, reaches out to students hours after they receive their match results to gather the raft of information needed to hire and credential 60+ newly minted physicians for three hospital systems and six continuity clinics. Credentialing, parking, pager access, badging — everything must be ready by June 24. Residency schedules are complicated, and the team attends to not only the curricular requirements, but also the varied career plans and life events of residents. By the time the newest DoM members arrive the team has spent hundreds of hours preparing for them.
Our residents come from across the country and many are often still settling into their new homes and orienting to Los Angeles as they embark on this phase of training. The team works hard to make our interns feel welcome. The Chief Residents host an information-packed orientation, a welcome reception and a beach day. Our faculty and chief residents organize a one day “Intern Boot Camp” to refresh their clinical skills. Our department leadership welcomes them to UCLA and articulates our mission.
Despite all the preparation, we know from experience that our interns’ first days practicing as physicians are humbling and indelible. Hours after our class of 2024 graduates hand in their badges and head off to fellowships and jobs, our rising senior residents welcome the newest members of our community. Every year the cycle is renewed. June 24 marks the end of weeks of frenzied preparation by our medical education team and the launch of a new journey for our intern class. A year from now, these same interns, shaped the journey, will welcome their replacements.
We know from experience that many of our residents will stay at UCLA as fellows and faculty. Others will make us proud in their endeavors in other cities and states. They will all make lifelong friends here and fulfill the promise of years of preparation. All of this is possible because our Medical Education Team, APDs, Chief Residents, teaching faculty and senior residents working together to make that first day, June 24, happen."
2024 Department of Medicine Practice Group (DMPG) Faculty Onboarding
Over the coming months, I will also be introducing you to the newest members of our DMPG faculty joining us in 2024. One hundred and eighteen faculty will participate in DMPG onboarding this upcoming year. I invite you to click below to meet 41 of these outstanding physician LEADERS who will be providing healthcare for patients and community members in over 280 sites across California.
I invited Janet Pregler, MD, leader of the DMPG Education Committee, to share her reflections about the onboarding program and this year’s cohort.
“The Department of Medicine Professional Group (DMPG) onboarding program started in 2015 with 40 new faculty. Frankly, we were mainly sitting together in a room looking at slide lectures and, believe it or not, stacks of papers. Over the years, the program has expanded to 70 highly interactive hours with a focus on small group discussion and skills sessions. There is also supplemental specialty specific instruction, a peer mentor program, and, as of last year, three sessions of personalized, one on one coaching developed by our DoM peer coaching program.
Next year, 118 new DoM faculty will participate in the DMPG onboarding program, including, for the first time, faculty from our Section of Hospital Medicine. These include doctors who are assuming their first faculty position after completing training. Onboarders also include mid-career and senior faculty, some of whom have held positions as leaders in education, administration, and community service in other health systems. Over 50 DoM faculty and other leaders in UCLA Health work with the onboarders in 8 in-person sessions held on the UCLA campus and 3 virtual sessions. Onboarders caring for patients in clinical sites stretching from Irvine in the South to San Luis Obispo in the North participate. Overnight accommodations are provided to those traveling from the farthest locations for sessions held in Westwood.
Consistent with our DoM strategic plan vision “Lead in innovation. Transform care. Advance health for all,” our mission is to instill a sense of community among new members of the DMPG, and to provide knowledge, skills, and tools for them to build a thriving clinical practice, effectively educate trainees, engage in creative work, and benefit local communities.
At the end of each academic year, we ask onboarders to evaluate this experience. Consistently, the opportunity to meet and network with colleagues is identified as the most important opportunity onboarding provides. It has been an honor and a privilege to work with our DoM onboarding team, DoM faculty leadership, and UCLA Health to support our new faculty as they begin their careers at UCLA.”
Residents Innovate: Critical Care Unit Handbook Crafted by Trainees for Trainees
Our trainees often have a major impact in advancing medicine before they complete their residency training. I am pleased to highlight two DoM residents who have done so at UCLA Health with the creation of the Cardiac Care Unit House Staff Handbook!
In collaboration with DoM chief residents, co-residents, and faculty members, Daniel Hodson, MD and Revanth Kosaraju, MD led the creation of this comprehensive resource that includes the latest in cardiology and provides valuable insight to residents! Our department is renowned for advanced and innovative cardiacvascular care and we are proud to share the handbook with you which contains our collective expertise and commitment to medical education!
We asked Dr. Hodson and Kosaraju for their reflections about this project.
- What inspired the creation of the cardiac care unit house staff handbook?
Our beloved CCU attending and mentor Dr. Henry Honda approached us to take on the revival and revamping of the CCU handbook. The original CCU handbook had been created many years ago, and since then, there have been many exciting developments in Cardiology and an increase in the medical complexity of the patients we care for in the CCU. Consequently, the breadth and depth of knowledge that residents should know to be effective on the CCU has increased as well. We felt that having a reference document to help one feel more prepared could help all residents not only survive the CCU, but truly thrive and enjoy their time there! After Dr. Honda approached us, we worked with our Chief Residents to recruit a team of co-residents who were passionate about Medical Education and revising the handbook, and worked with Dr. Honda to recruit faculty mentors for the individual sections. UCLA is a special and unique institution with a long history of advancing cardiac care. We hoped to draw on the expertise of our faculty to create a Handbook that could be a reference document for residents across the country (see our Prologue).
- How did you decide on the content that should be included?
We brainstormed fundamental topics, reflected on topics that have come up during our CCU rotations, reviewed similar reference materials and textbooks, and worked collaboratively with our fantastic team of residents and faculty to ensure we touched upon key topics. The broad chapters of the Handbook include Electrophysiology and Arrhythmias, Cardiac Imaging, Vascular Disease, Heart Failure and Transplant, Adult Congenital Heart Disease, Coronary Artery Disease, Advanced Cardiac Life Support, Cardiovascular Clinical Trials, and Cardio-Obstetrics.
- Were there any challenges or interesting discussions during the creation process?
One of the most challenging parts was finding the balance between brevity and detail. We initially conceived of the handbook as a series of one-page summaries and wanted it to be an easy, quick reference about high yield topics, such as those that a resident might encounter overnight. But we found that there were so many topics to cover, and some topics did not fit well into a one-page summary format. Since the full handbook is well over 300 pages, we clearly ended up more on the side of detail, but within this large document, there remain a myriad of one-page summaries. There are simply a lot of topics to cover !
- Did the creation of the handbook involve collaboration with other departments or experts?
We were incredibly grateful to have the mentorship of Dr. Henry Honda throughout this process, and the support of several members of our Cardiology faculty who contributed content and edited chapters of the handbook corresponding to their areas of expertise. In addition, this Handbook would not have been possible without support from our Chief Residents, including Dr. Tara Townes and Dr. Patrick Holman, CCU Director Dr. Marcella Press, and DoM and Internal Medicine Residency leadership.
- What were some valuable insights or lessons learned while working on the handbook?
There have been so many lessons. None of this would have been possible without a fantastic team. Revising the handbook to include and do justice to the many topics above was a collaborative effort with mentors across the many Cardiology subspecialties and with residents who were passionate about medical education. From a content perspective, we explored society guidelines and primary studies, then elicited the words of wisdom of the faculty for each section. From a publishing standpoint, we learned how usability and success depend in large part on accessibility and formatting.
- What outcomes or improvements do you hope to see as a result of this initiative?
Ultimately, we hope that residents can turn to the handbook as a guide both to teach core concepts in Cardiology and facilitate efficient, improved patient care when taking care of our patients in the CCU, many of whom are medically complex and have challenging pathophysiology. We hope that all residents, regardless of their interest level in Cardiology, come to better enjoy their CCU learning experience as a result. If more residents become interested in Cardiology as a result, that’s even better.
There are many places for improvements, and in future iterations, we are excited to include comparisons of guidelines from the US and other countries and to see how the PDF format can be adapted to improve its usability (such as linking to Qualtrics, references, videos, or surveys). We hope the Handbook can be a live, usable resource.
- What feedback have you received from fellow residents or senior staff about the handbook?
The handbook was released at the beginning of June, and the initial feedback from residents has been positive. The incoming co-leaders of the next version (see below) will be establishing mechanisms for feedback, so each version of the handbook can be reflective of resident and faculty needs.
- What advice would you give to new residents or staff members who will use the handbook?
The handbook is meant to be a guide and to complement other resources when making clinical decisions in the CCU. Prior to the rotation, check out the survival guide for some key logistics, then skim the table of contents for each section to get a sense of what content is available. Depending on your comfort, reviewing the sections on ECG interpretation, cardiac imaging, and Swan values are good starting places to feel more comfortable interpreting the wealth of clinical data available in the CCU. After the rotation, give feedback about what was useful, what was less helpful, topics to be added, topics that can be removed, etc. To be successful, the Handbook must be a living document that is constantly adapting to both new developments in Cardiology and also to residents’ needs.
***Lastly, and most importantly, we are pleased to introduce rising Internal Medicine PGY-3 Jay Shah, MD and rising Internal Medicine - Pediatrics PGY-3 Andrew Fahmy, MD, who will be co-leading the development of the next version of the Handbook. We are so excited to see the next iteration under their leadership !
Publication Spotlight: Going with the Flow: Researchers at UCLA discover how blood flow protects against vascular inflammation.
We continue to shine the spotlight on trainee innovations and scholarship with the latest publication from the Mack Lab.
Heart disease remains the leading cause of death worldwide. The cells that line the inside of our blood vessels, called endothelial cells, play an important role in heart disease. Continuous exposure to blood flow keeps endothelial cells healthy and prevents vascular inflammation and disease pathogenesis. This flow also leads to the polarization of some proteins to the downstream end of endothelial cells. But whether this polarity was related to the vascular protection was unclear. New research published in the Journal of Clinical Investigation (JCI) reveals that this polarization is vital for nitric oxide production in endothelial cells. Nitric oxide, in turn, improves blood flow and reduces inflammation.
Soon-Gook Hong, PhD, postdoctoral fellow in the Mack Lab and lead author of the study, discovered that flow establishes polarized signaling domains in arterial endothelial cells. Specifically, endothelial cell body elongation in response to flow induces the asymmetric distribution of Caveolin-1-rich domains to the downstream end of cells. These subcellular domains facilitate focal calcium ion (Ca2+) entry via Transient receptor potential cation channel subfamily V member 4 (TRPV4) channels, and this Ca2+ activates endothelial nitric oxide synthase and the production of nitric oxide. Strikingly, the absence of TRPV4 activity in the presence of flow results in spontaneous inflammation. In contrast, chemical activation of the TRPV4 channels attenuates the vascular response to an inflammatory stimulus.
The work suggests the new concept that blood flow direction establishes signaling domains at one end of the cell, effectively transducing mechanical information from the environment into gene expression. “Intriguingly, not all cells in the monolayer possess this signaling feature, and we believe that cells with these signaling domains function as signaling hubs distributed across the endothelium to enhance blood vessel resilience and suppress inflammation,” said Julia J. Mack, PhD, assistant adjunct professor in the UCLA Division of Cardiology and the corresponding author. “The work holds exciting implications for the vascular biology field and advances our understanding of endothelial flow sensing and signaling mechanisms that promote vascular health.”
Since cardiovascular diseases remain one of the leading killers, and the endothelium is considered a ‘gatekeeper’ of vascular health, the endothelial cell is a critical signaling cell. While many efforts have focused on pathways involved in disease, there has been limited exploration of the mechanisms that prevent disease. “We believe this work is an exciting next step in defining the basic signaling mechanisms in the endothelium that protect against disease.” The Mack Lab continues to investigate this resilience mechanism and its potential for therapeutic targeting to improve cardiovascular health.
Congratulations Graduating Fellows
As we welcome a new group of residents and fellows to our department, we also extend the warmest wishes to our graduating fellows who have completed their training with the DoM and are beginning the next stage of their careers! Please enjoy a few pictures from the recent fellowship graduations which celebrated the accomplishments of this distinguished group.
Dale
P.S.
As you celebrate the 4th of July holiday this week, remember your colleagues who will be working in the hospital over the holiday.
- Be safe on the roads if you are traveling.
- Slather yourself in sunscreen.
- Try not to overeat.
- Do not directly handle fireworks.
- Remember that some dogs are freaked out by fireworks.
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