Notes from the Chair
Tom E. Norris, MD
Colleagues and Friends: The UW Department of Family Medicine has had a busy summer—much has happened since my last message to you in our June Newsletter. A new academic and resident year has now started for all of us. This is always an exciting time for medical students, whether they are beginning their journey, making the big leap from the classroom to the clinical setting, or pondering specialty and graduate medical education choices. In the residency, this gives us the opportunity to assess how well we really did in the match and allow us to extend increased responsibilities to the residents with whom we have worked for one or two years. So far, we are delighted with our new residents and with the progress being made by those who have been with us for one or two years. Overall, our Department continues to do well and to make progress in a number of areas. I will update you on several of them in this report.
Faculty Retreat—Scholarship:In June we held our annual faculty retreat. The focus of this year’s session was the promotion of scholarly activities by faculty members. The University and the Department require regular scholarly contributions from all faculty members as a fundamental part of their job. While this opportunity is a great joy for many, it can be a significant challenge for others. At the retreat we worked on the value and importance of mentorship for successful scholarship. Both mentees and mentors have clear responsibilities to each other in these relationships. All of our faculty members have opportunities and responsibilities in both areas. Bill Phillips has been leading a committee to expand our understanding of this area, and he played a key role in the retreat. At the regular meeting of the Residency Network Program Directors earlier this month, we also discussed scholarship. In addition to the University, it is now required of all residency faculty in all programs and also for their residents. I am very impressed with the quality of work that is being done in this area—clearly it is a key factor in our success.
New Sports Medicine Section: One area of news for the Department this summer is the creation of a new Sports Medicine Section. For many years the Department and the departmentally based faculty have been administratively divided into sections, usually based on function. For example, we have long had sections focused on medical student education, resident education, research, and the residency network. Last summer the MEDEX program joined us and we created a section for them. Sports Medicine joined the group this summer. Our three sports medicine trained family physicians are Kim Harmon, Jon Drezner, and Ashwin Rao. They currently base their clinical practice at Hall Health Student Health Center but will be moving much of their clinical effort to the new Husky Stadium Sports Medicine Clinic when it opens in a year. Kim serves as Program Director for our sports medicine fellowship, which trains one fellow each year. She also serves as one of the team physicians for Husky Football. Kim will serve as section head for the new Sports Medicine Section. Jon and Ashwin provide teaching for our residents, serve as team physicians for some Husky sports, and also serve as team physicians for the Seattle Seahawks. All three of them have been heavily involved in research, with areas of focus that include cardiac events in athletes and the use of musculoskeletal ultrasound. A research paper from this team was selected as the best article by family physicians at the STFM meeting in Seattle this spring.
Residency and Clinical Care: We continue to grow and develop our new residency and clinical practice site at Northgate. As I noted in my last report to you, we moved into this new clinic in March, after having our clinical site in the UW area since the inception of the Department. The Northgate site is allowing us to expand the size of our practice, adding more pediatric patients, and adding more continuity obstetrical patients. The clinic is a joint effort of the Department and the UW Neighborhood Clinics (UWNC). The merging of our educational culture with their practice oriented culture has been challenging at times, but is good for both of us and for our patients. UWNC has been in the forefront of developing a patient-centered medical home (PCMH) practice. They have been recognized as an NCQA Level 1 PCMH for several years, and we are working with them to advance to become an NCQA Level 3 PCMH. The new clinic utilizes an On Stage/Off Stage design that, we hope, improves the patient experience and promotes better team functions. The challenges that we are facing were well described by Margolius and Bodenheimer in their often cited 2010 Health Affairs article (Margolius D, Bodenheimer T. Transforming primary care: from past practice to the practice of the future. Health Aff (Millwood). 2010 May; 29(5):779-84). I will endeavor to keep you informed of our experiences with the new clinic, our new partner, and the journey toward PCMH.
Our other residency site is at Harborview Medical Center (HMC). In early May we applied to expand the Family Medicine Residency at HMC from 2-2-2 to 6-6-6. The purpose for the request was to provide us with the workforce to allow us to develop a Family Medicine in-patient service at HMC. This would not only allow our residents and faculty to care for patients hospitalized from our clinic, but would also allow us to assist HMC by caring for other patients admitted from the emergency department. In addition, it would allow us to train more family physicians with a focus on underserved care. Due to financial considerations our request was not approved this year, but we plan to re-apply next spring.
Research Section: I have previously reported to you on our strategic efforts to expand the Research Section in our Department. I am pleased to report that Emily Godfrey, MD, MPH will join us as a new faculty member in October. Emily has been an Associate Professor at the University of Illinois College of Medicine in Chicago. She received her BS from the University of Wisconsin, followed by an MD from the Medical College of Wisconsin. After completing her family medicine residency at West Suburban Hospital in Oak Brook, IL, she completed a fellowship in family planning and an MPH at the University of Rochester. She then returned to Chicago for a yearlong faculty development fellowship. For the past two years she has been “on loan” to the CDC where she has served as a Reproductive Health Research Officer. At UW Emily will practice full-spectrum family medicine and will focus her research efforts on women’s health and reproductive questions. We are looking forward to welcoming Emily to our faculty.
We have just received word that the WWAMI Rural Health Research Center (RHRC) competitive renewal grant has been approved four more years and funded. As one of only four federally funded RHRC’s, this is a very important program for our regions.
In early September we held a Research Section retreat. The session began with presentations on thirteen projects that are currently underway. The breadth, complexity, and quality of these research endeavors are impressive. We then spent time discussing the strategic importance to the Department of the Research Section and our plans for the next year. Laura-Mae Baldwin, the section head, announced that she plans to step down from section leadership next year. Laura-Mae has done an outstanding job leading our research efforts for the past several years. As a result, the Department has initiated a national search for a new Research Section Head and Vice Chair for Research. We hope to have this new faculty member in place by next summer.
Medical Student Education: As noted earlier, school is just beginning for the new medical students. This summer over 120 students who had just completed their first year participated in the Rural Underserved Opportunities Program (RUOP). This program, allowing students to spend four weeks with a rural or urban underserved primary care physician, has grown steadily in popularity and is very highly regarded. Early reports indicate that there is strong student interest in the Family Medicine Interest Group this year. Finally, a large group of 4th year students has indicated that they are applying to Family Medicine programs for their residencies—we are hoping for another strong year in the Match.
UW/WWAMI Residency Network: The network continues to thrive. At the Program Directors’ quarterly meeting earlier this month solid reports were received from the 18 member programs. A number of new programs are in various stages of development. If the RRC approves, the new Missoula program will accept new residents in the summer of 2013, with the Coeur D’Alene program planning for the summer of 2014. Programs are also under development in Puyallup, Tacoma, Tri-Cities, and several other sites.
Parting Thoughts: Since my last report, the Supreme Court has allowed most of the Patient Protection and Affordable Care Act to stand. It is not clear yet what this will mean to Family Medicine practice, education, and research. Much depends on the outcome of presidential and congressional elections this fall—we will all need to wait and see. Based on Massachusetts’ experience with a similar program, the demand for family physicians will continue to increase. One thing that does seem clear is that a steadily expanding proportion of the family physician workforce is now employed by hospitals and large group practices. Will this trend improve the care that we provide for our patients? Will it change the training that we provide for our residents? I am unsure of the answers to these questions, but I enjoyed Atul Gawande’s thoughts on this topic. I encourage you to read “Big Med” from the 8/13 New Yorker: http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande
Finally, I want to thank you for your support of Family Medicine at the University of Washington. Without your help, we could not do our job.
Tom E. Norris, MD
The Department of Family Medicine is proud to announce the establishment of a Sports Medicine Section. Our sports medicine program has a rich tradition in the training and mentoring of students, residents, and fellows, and is nationally and internationally recognized for research related to the cardiovascular health and safety of athletes. Dr. Kimberly Harmon, Professor in the Departments of Family Medicine and Orthopedics & Sports Medicine, has been appointed section Chief to lead its clinical and academic programs. Other Sports Medicine faculty members are Dr. Jonathan Drezner, Professor and current President of the American Medical Society for Sports Medicine, and Dr. Ashwin Rao, Clinical Associate Professor.
Sports Medicine Publications
- Casa DJ, Anderson SA, Baker L, Bennett S, Bergeron MF, Connolly D, Courson R, Drezner JA, Eichner ER, Epley B, Fleck S, Franks R, Guskiewicz KM, Harmon KG, et al.
- The Inter-Association Task Force for Preventing Sudden Death in Collegiate Conditioning Sessions: Best Practices Recommendations. J Athl Train. 2012;47(4):477-80.
- Connes P, Harmon KG, Bergeron M.
- Pathophysiology of exertional death associated with sickle cell trait: can we make a parallel with vaso-occlusion mechanisms in sickle cell disease? Br J Sports Med. 2012 May 19. [Epub ahead of print]
- Drezner J, Fudge J, Harmon K, Berger S, Campbell R, Vetter V.
- Warning Symptoms and Family History in Children and Young Adults with Sudden Cardiac Arrest. J Am Board Fam Med. 2012; 25(4):408-15.
- Francis G. O’Connor, Bergeron M, Cantrell J, Connes P, Eichner R, Harmon KG, Ivy E, Kark J, Klossner D, Lisman P, Meyers BK, O’Brien K, Ohene-Frempong K, Thompson AA, Whitehead J, Deuster PA.
- ACSM and CHAMP Summit on SCT: Mitigating Risks for Warfighters and Athletes. Med Sci Sports Exer. 2012 July 17. [Epub ahead of print]
- Harmon KG, Drezner JA, Klossner D, Asif IM.
- Sickle cell trait associated with a RR of death of 37 times in national collegiate athletic association football athletes: a database with 2 million athlete-years as the denominator. Br J Sports Med. 2012; 46:325-330.
- Kramer E, Botha M, Drezner J, Hosny-Adbelrahman Y, Dvorak J.
- Practical Management of Sudden Cardiac Arrest on the Football Field. Br J Sports Med. 2012 Aug 3. [Epub ahead of print]
- Meyer L, Stubbs B, Fahrenbruch C, Maeda C, Harmon K, Eisenberg M, Drezner J.
- Incidence, Etiology, and Survival Trends from Cardiovascular-related Sudden Cardiac Arrest in Children and Young Adults Age 0-35 in King County, Washington: A 30-Year Review. Circulation. 2012 August 13. [Epub ahead of print]
- Weiler R, Goldstein M, Beasley I, Drezner J, Dvorak J.
- What can we do to reduce the number of tragic cardiac events in sport? Br J Sports Med. 2012 May 6. [Epub ahead of print]
- Webner D, Duprey KM, Drezner JA, Cronholm P, Roberts WO.
- Sudden Cardiac Arrest and Death in United States Marathons. Med Sci Sports Exerc. 2012 Apr 19. [Epub ahead of print]
- Williams ES, Owens DS, Drezner JA, Prutkin JM.
- Electrocardiogram Interpretation in the Athlete. Herzschrittmacherther Elektrophysiol. 2012; 23(2):65-71.
News from the Research Section
Rural Health Research Center/Center for Health Workforce Studies
RHRC is Re-funded!
The WWAMI Rural Health Research Center (RHRC) just successfully competed for four more years of support. The WWAMI RHRC is one of seven rural health research centers funded by the Health Resources and Services Administration’s (HRSA’s) Federal Office of Rural Health Policy (FORHP) to perform policy-oriented research on issues related to rural health care. This $2.64 million cooperative agreement supports the WWAMI RHRC to conduct rural health studies, most focusing on health workforce issues. Eric Larson, the Center’s Director, and Sue Skillman, Deputy Director, will work with a team of department faculty and staff to conduct studies determined each year through a collaborative process involving FORHP.
Center for Health Workforce Studies (CHWS)
The UW CHWS will provide evaluation assistance to the Washington Center for Nursing (WCN), which just received a Robert Wood Johnson Foundation “Academic Progression in Nursing” grant. The WCN-led statewide grant, one of 9 funded across the US, is designed to "advance state and regional strategies aimed at creating a more highly educated, diverse nursing workforce." The UW CHWS will subcontract with the WCN (Funding $20,000 for each of two grant years) for evaluation-related activities.
In a contract with the Washington State Office of Financial Management (OFM), the UW CHWS is carrying out analyses of a statewide survey of primary care physicians, nurse practitioners and physician assistants to assess their numbers, distribution, and capacity to serve patients covered by Medicaid. Findings from the survey have been analyzed by Meredith Fordyce and Sue Skillman along with OFM staff, and the results of focus groups of physicians were analyzed by Barb Matthews. Findings will soon be released. (Funding - $53,697.)
Community paramedicine is an emerging professional model that extends paramedics’ traditional emergency response role to include public health and community healthcare delivery. Davis Patterson and Sue Skillman will facilitate a discussion of emergency medical services research at the National Consensus Conference on Community Paramedicine, in Atlanta in October 2012. Based on this discussion, they will draft a National Community Paramedicine Research Agenda to establish an evidence base for this model. The UW CHWS will be funded via a subcontract from the North Central Emergency Medical Services Institute; the conference is funded by the Agency for Healthcare Research and Quality (AHRQ). (Funding - $10,022.)
RHRC and CHWS in the News
The RHRC and CHWS were featured in an interview with Deputy Director Sue Skillman, released by the Health Workforce Information Center on their website. The interview highlights current research related activities of the CHWS and RHRC. To view the interview with Sue Skillman please visit "Health Workforce News."
WWAMI region Practice and Research Network
The Department of Family Medicine collaborates with the UW Institute of Translational Health Sciences (ITHS) in supporting the WWAMI region Practice and Research Network (WPRN), a growing network of now 27 primary care practices committed to research and practice improvement. We are delighted to announce that the ITHS and its work have been funded for another five years, from June 2012 through May 2017!
The WPRN is also excited to announce that three papers (cited below) were published in August and September 2012 from its first project, the "ACE-Is, ARBs, Statins and Contraception" study. This study looked at women of childbearing age taking medications with potential adverse fetal effects, and explored how contraception and medication risks had been addressed with these patients. All three manuscripts are a collaborative effort between the WPRN Coordinating Center at the UW, and WPRN practice champions from Central WA Family Medicine (Yakima, WA), Family Medicine of Southwest WA (Vancouver, WA), Pocatello Family Medicine (Pocatello, ID), Swedish Family Medicine First Hill (Seattle, WA), Tacoma Family Medicine (Tacoma, WA), UW Family Medicine (Seattle, WA), and U. of Wyoming Family Medicine-Cheyenne (Cheyenne, WY).
- Baldwin LM, Keppel GA, Davis A, Guirguis-Blake J, Force RW, Berg AO.
- Developing a Practice-Based Research Network by Integrating Quality Improvement: Challenges and Ingredients For Success. Clinical and Translational Science. 2012 Aug;5(4):351-5. Epub 2012 Mar 27. PubMed PMID: 22883614.
- Force RW, Keppel GA, Guirguis-Blake J, Gould DA, Vincent C, Chunchu K, Monger RM, Holmes JT, Cauffield J, Baldwin LM.
- Contraceptive Methods and Informed Consent among Women Receiving Medications with Potential for Adverse Fetal Effects: A Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) Region Study. Journal of the American Board of Family Medicine. 2012 Sep; 25(5):661-668. PubMed PMID: 22956701.
- Guirguis-Blake J, Keppel GA, Force RW, Cauffield J, Monger RM, Baldwin LM.
- Variation in Refill Protocols and Procedures in a Family Medicine Residency Network. Family Medicine. 2012 Sep; 44(8):564-8. PubMed PMID: 22930121.
Project ROAM sponsors Summer Research with Medical Students
This summer, Project ROAM collaborated with two medical students in the Medical Student Research and Training Program (MSRTP). Eliza Hutchinson worked with Roger Rosenblatt, interviewing physicians trained by Project ROAM to identify the barriers that kept waivered physicians from prescribing buprenorphine/naloxone. Kelly Shannon worked with psychiatrist Joseph Merrill, reviewing data from patients on chronic opioid therapy at Harborview Medical Center to determine whether the Washington state Prescription Monitoring Program identified prescriptions of controlled substances not known to the primary care provider. Both students are working with their mentors to submit a paper for publication.
Upcoming Opioid Safety Conference:
On Oct 31 and Nov 1, Group Health Cooperative and Project ROAM are hosting a National Summit on Opioid Safety at Cedarbrook Lodge in SeaTac. The goal is to offer strategies and tools to health care facilities that wish to promote safe and compassionate use of opioid therapy. Register on-line at www.eventbrite.com/event/3628531034.
The Tobacco Studies Program is now entering its 10th year, and offers two courses (HSERV 558: Tobacco & Public Health, and HSERV 556: Tobacco Related Health Disparities) open to both undergraduate and graduate public health and other health and social sciences students, a tobacco scholarship program for those pursuing a concentration in tobacco studies, practicum opportunities, mentorship and thesis advising, a journal club, listserv and website with podcasts of prior lectures and seminars plus other resources. More information can be found at http://depts.washington.edu/tobacco/.
A Tobacco Studies Program graduate published an important paper in the Pediatric Infectious Disease Journal: Metzger MJ, Halperin AC, Manhart LE, Hawes SE. Association of Maternal Smoking with Infant Hospitalization and Mortality Due to Infectious Diseases. Pediatr Infect Dis J. 2012 Aug 27. [Epub ahead of print] This research shows for the first time that there is an increased risk of morbidity and mortality due to almost all types of infectious diseases (not just respiratory infections) among infants born to mothers who smoke during their pregnancy. This suggests there may be a broader immune effect of tobacco exposure on infants than has been described previously.
Additionally, as a newly appointed member of the AAFP Tobacco Cessation Advisory Committee this year, Dr. Abigail Halperin has been assisting the Academy in updating their Office Champions program, which provides resources to family medicine practices to implement systematic identification and evidence based treatment of all tobacco users seen in primary care clinics through an integrated, team approach, including EMR-based technology.
Family Medicine Research Fellowship seeks applications
The UW Primary Care Research Fellowship is now recruiting applicants to begin in June or July of 2013. This two-year NRSA fellowship is offered jointly by Family Medicine, General Internal Medicine, and Primary Care Pediatrics at the University of Washington in Seattle. It is an opportunity for graduating residents or physicians with practice experience to gain formal research training for careers as academic investigators and professional leaders. The program includes a MPH degree and provides training in research methods, experience working with an established investigators, and mentorship for career success.
Contact William R. Phillips, MD, MPH, at email@example.com.
For more information, see: http://depts.washington.edu/fammed/research/training/nrsa.
- Doescher M., Skillman SM, Andrilla CHA.
- The contributions of generalist physicians, nurse practitioners, and physician assistants to rural primary care. Presented at AcademyHealth Annual Research Meeting, Orlando, Florida, 6/24/12.
- Patterson DG, Keppel G, Skillman SM, Doescher MP, Berry C, Daniel C.
- The influence of state policies and practices on J-1 visa waiver physicians' service in rural and underserved areas. Poster presented at AcademyHealth Annual Research Meeting, Orlando, Florida, 6/24/12.
- Skillman SM.
- Data needed to understand health workforce supply. Presented to Washington State Health Care Personnel Shortage Task Force, Puyallup, Washington, 6/6/12.
- Skillman SM, Phippen E.
- Washington's health workforce: challenges and promising practices. Presented at St. Francis Hospital Leadership Retreat, Lakewold Gardens, Gravelly Lake, Washington, 7/11/12.
- Calmbach WL, Ryan JG, Baldwin LM, Knox L.
- Practice-based Research Networks (PBRNs): Meeting the Challenges of the Future. J Am Board Fam Med. 2012 Sep;25(5):572-6.
- Kadivar H, Goff BA, Phillips WR, Andrilla CH, Berg AO, Baldwin LM.
- Nonrecommended breast and colorectal cancer screening for young women: a vignette-based survey. Am J Prev Med. 2012 Sep;43(3):231-9.
- Kwamme E, Catlin M, Banta-Green C, Roll J, and Rosenblatt R.
- Who Prescribes Buprenorphine for Rural Patients? The Impact of Specialty, Location and Practice Type in Washington State. In press. Journal of Substance Abuse Treatment (2012) http://dx.doi.org/10.1016/j.jsat2012.07.006
- Robins L, Green B, Jackson JE, Force R, Baldwin LM. PS1-62:
- Assessing Readiness for Team Care in Community-based Clinics: Barriers and Facilitators to Implementing an Evidence-based Intervention to Improve BP Control. Clin Med Res. 2012 Aug; 10(3):169.
- Rosenblatt RA, and Mary Catlin.
- Opioids for Chronic Pain: First, Do no Harm. Ann Fam Med 2012; 10:300-301. Doi:10.1370/afm.1421
- Quest TL, Merrill JO, Roll J, Saxon AJ, and Rosenblatt RA.
- Buprenorphine therapy for opioid addiction in rural Washington: The experience of the early adopters. Journal of Opioid Management. January/February 2012. 2012; (8)1: 29-38.
- Scott JD, Unruh K, Catlin M, Merrill J, Tauben, D, Rosenblatt, R, Buchwald D, Ramers C, and Spach D.
- Project ECHO: A Model of Complex Chronic Care in the Pacific Northwest United States. Submitted to Journal of Telehealth and Telemedicine.
Research Section in the News
In a recent article entitled "Ovarian Cancer Screenings Are Not Effective," the New York Times cited research published in the Annals of Internal Medicine by the research section's Laura-Mae Baldwin, Barbara Matthews, Holly Andrilla, and Denise Lishner: "Vignette-based study of ovarian cancer screening: do U.S. physicians report adhering to evidence-based recommendations?" This study's survey found that 1 in 3 physicians believed that ovarian cancer screening was effective, despite evidence to the contrary, and that substantial proportions of physicians reported routinely offering or ordering ovarian cancer screening, thereby exposing women to the documented risks of these tests.
The NYT article can be found at http://www.nytimes.com/2012/09/11/health/research/ovarian-cancer-tests-a....
Medical Student Education
Underserved Pathway Update
Congratulations go out to the 2012 Underserved Pathway graduates! Twenty-seven graduates successfully completed an interactive web-based curriculum, community service, and underserved focused preclinical and clinical courses. Students also enjoyed a longitudinal mentorship with practitioners from throughout the WWAMI region. One recent graduate described her UP experience: "Having a formalized guideline through medical school to focus elective time around underserved topics really helped me determine my career path. The underserved focused preceptorships were also very meaningful."
The Underserved Pathway continues to gain student interest! If you work in a rural community, a community health center, or with underserved or vulnerable populations, please consider becoming a mentor. Mentoring provides students the opportunity to learn from an experienced role model who can field questions, discuss residency and career plans, support them in their education, and encourage them to maintain their commitment to the underserved. Not only do mentors have the opportunity to influence a medical student’s career trajectory, many also experience a sense of renewed enjoyment and commitment to their own career. To become a mentor, simply contact UP Program Coordinator, Toby Keys, at firstname.lastname@example.org.
Dobie, S. Lessons. Fam Med 2012; 44 (8): 582-3
Congratulations to the UW Family Medicine Interest Group! UW FMIG is one of sixteen FMIG programs nationwide that won the Program of Excellence Award from the American Academy of Family Physicians for 2012. Find more information at http://fmignet.aafp.org/online/fmig/index/fmig-on-campus/fmigresources/f....
Please join us for the next session of the Family Medicine Grand Rounds lecture series on Wednesday, October 3, from 12:30pm – 1:30pm. The presentation will be in the Roosevelt Commons Building, Room 416 (4311 - 11th Avenue NE, Seattle, WA 98105). The presenter is to be announced.
Following this, Kim Harmon of Sports Medicine will present on November 7, and Amanda Kost of Medical Student Education will present on December 5. More information on FM Grand Rounds can be found on the Grand Rounds web page. (hyperlink 7)
Works in Progress
The Department of Family Medicine announces the next Works in Progress presentation, to be held on Monday, October 8, at 12:30pm (Roosevelt 1 Conference Room: 4225 Roosevelt NE, Ste 308). The presenters are yet to be announced. The following presentation will be Monday, December 10, at 12:30pm.
Last month we held the second annual Department of Family Medicine Picnic at Gasworks Park. The table-decorating contest was to the theme of the 1962 Seattle World’s Fair; it was a fun and creative competition.
It was a beautiful day.
The King himself was there and everyone had an opportunity to get his or her photo taken with him.
There were drinks…
…and food of all kinds!
This year Renton Technical Culinary School joined us with food at four workstations. The variety included pasta dishes, salads, burgers, homemade chips, and more. For dessert the crowd favorite returned. We lined up at the Molly Moon Ice Cream truck anxiously waiting for delicious scoops and ice cream sammies.
There were games for the kids (and those of us adult enough to admit we’re still kids at heart).
Credit to these photos goes to Tina McCain. Thanks, Tina!