Friday, March 31, 2017 Volume 3. Issue 3.

The Pulse

The Department of Community Health and Family Medicine
Quarterly Newsletter

“Without continual growth and progress, such words as improvement,
achievement, and success have no meaning.” -Benjamin Franklin

CHAIR'S MESSAGE

Fellow CHFM Members,

Welcome to another edition of The Pulse, the newsletter of the Department of Community Health and Family Medicine. I trust you will find this newsletter informative and take great pride in the activities and accomplishments of our department members. If you have any suggestions on how we can improve The Pulse, please let us know.

In this edition, we are providing information about the latest activities and accomplishments in our core mission areas. In particular, the achievements of several individual faculty members and staff are presented and highlighted.

After reading the information contained in this newsletter, I am sure you will share in my pride as our department continues to be a very active and productive member of the Gator Nation.

Best regards,

Peter J. Carek, MD, MS
C. Sue and Louis C. Murray, MD Professor and Chair

ACHIEVEMENTS

Several achievements have been recognized by award or appointment for CHFM faculty and staff since the last edition of The Pulse. Please join in congratulating the following on their accomplishments!

Young Leader Award
Dr. Tanya Anim received the Young Leader Award from the Florida Academy of Family Physicians in recognition of her outstanding service. Here is the link to the Gainesville Sun article: http://achievers.blogs.gainesville.com/652/two-local-entities-join-forces-provide-critical-home-repairs-local-homeowner/

Superior Accomplishment Awards
The Superior Accomplishment Award winners from the department have been announced. Congratulations to these superior employees!

Karen Fournier – UF Student Health Care Center
Dottie Howard – UF Student Health Care Center
Lou Lebron – UF Student Health Care Center
Art Watson – CHFM Administrative Office

Appointments
In January, Dr. Jay Clugston was awarded an appointment in the Department of Neurology as a Joint Associate Professor.

Dr. John Malaty was appointed to the National Board of Medical Examiners (NBME) - USMLE Ambulatory Care Test Material Development Committee (TMDC) for a 2-year term.

In April 2016, Dr. David Quillen was elected to chair of the Faculty Senate for the University of Florida. During this spring, as part of his chair-elect year, Dr. Quillen has been meeting with college deans and senior vice presidents of the University of Florida. His term as chair starts June 1, during which he will serve as one of the 13 members on the Board of Trustees for the University of Florida.

Dr. Quillen’s goals for his year as senate chair and UF trustee are as follows:
1. Maintain and expand collaborative communication with faculty and university leadership following the principles of shared governance.
2. Be the faculty voice with senior UF leadership and with the Board of Trustees.
3. Raise the important issues of faculty welfare like benefits, tenure and promotion, academic freedom, and a just work environment with the Board of Trustees, senior UF leadership, and faculty.

Invitation to Participate
Dr. Jay Clugston was invited by Florida Alliance of Sports Medicine (FASMed) to participate in the Collaborative Solutions for Safety in Florida High School Sports group to develop and submit safety policy recommendations to the Florida High School Athletic Association for adoption. The meeting was held in Gainesville on March 9-10, 2017.

Thank you, Dr. Hall!
In July 2017, Dr. Karen Hall, MD will be stepping down from her current position as Program Director of the Family Medicine Residency Program. She became program director in 1996 and has enriched the program with her energy and leadership for over 20 years. Dr. Hall is the fourth program director in the history of the program and boasts the longest tenure by far of any of the previous directors. Most program directors across the country maintain this position for less than half this time, so this in itself represents an amazing accomplishment and commitment to the residency program.

Remarkable growth within the program has occurred under her tutelage. The residency class size expanded from six per year to 10 per year and two areas of concentration were added within the curriculum. Excluding the current class of residents, 172 physicians have completed their training and 98 percent of those graduates passed their family medicine boards on their first attempt. In addition to her routine program director duties, teaching duties, scholarly work, clinical work, and administrative duties, she participated in research and grant acquisitions which totaled nearly $13,500,000 for the department.

In September 2011, one of her most tangible accomplishments occurred with the groundbreaking of a new Family Medicine Residency Center and its opening approximately nine months later. This was no small task and required months of meetings, planning, and persistence. Dr. Hall cannot be thanked enough for this opportunity to expand, modernize, and now work in an environment much more appealing to staff and patients.

Thank you, Dr. Hall, for your years of service and dedication to the department!

EDUCATION & SCHOLARSHIP

EDUCATION

MEDICAL STUDENT EDUCATION:
It pays off to directly observe students! Starting May 2017, all clinics will be directly observing medical students perform at least one focused history and physical. To prepare for these direct observations, pilot testing was conducted. The following are observations from Dr. Robert Hatch during pilot testing:

“I saw some VERY interesting things come to light. For instance, I watched as a patient repeatedly ignored a student’s attempts to direct the history. Had I not seen it myself, I would have blamed the student for the missing information, but he clearly had done his best to get it. In another instance, I saw the most surprising “straight leg raise” I have ever seen. I couldn’t even tell what the student was doing until he announced that the straight leg test was normal! Needless to say, it did not get close to testing for nerve root impingement. Again, had I not seen it myself, I never would have known that the technique was so far off. I am more and more convinced that direct observation will be beneficial for our students, and I appreciate everyone’s efforts to get this done!”

RESIDENCY PROGRAM:
The department is delighted to welcome the incoming resident class of 2020. Mark your calendar for July 12 so you do not miss the opportunity to meet the new residents at the Welcome Reception. CHFM faculty and staff look forward to working with this excellent internship class and meet them on July 12! More details about the reception are listed in the Upcoming Events section of this newsletter.

SPORTS MEDICINE FELLOWSHIP:
January was an exciting time for the Sports Medicine Fellowship. On January 2, the fellows traveled to Tampa, Florida to attend the Outback Bowl where the Florida Gators won against Iowa. Then on January 4, at noon, the 2017-18 fellowship matches were confirmed. The department is excited to welcome Dr. Stephen Carek and Dr. Timothy Durkin to the fellowship program starting July 1.

During the month of January, the current fellows covered multiple sporting events and even had the chance to travel with the men’s basketball team.

The first full week of February, Drs. Langley and Starnes headed to Salt Lake City, Utah to work with world-renowned Dr. Massimo Testa at the Intermountain Medical Group LiVe Well Center. They received outstanding sports performance training from Dr. Testa. (picture below)

Once the fellows returned, they had to prepare for the Five Points of Life Marathon under the direction of Dr. Katie Edenfield and Dr. Seth Smith. The FPOL Marathon was held on February 26.

March did not mean quiet time...Dr. Langley and Dr. Starnes have been assisting with lacrosse, softball, baseball, basketball, track & field, and tennis event coverage. Starting March 30, they will cover the FL Relays, a 3-day premier track and field event with many participants from all over the world.

Drs. Langley and Starnes pictured with Dr. Massimo Testa at the
Intermountain Medical Group LiVe Well Center in Salt Lake City, Utah.

BIOETHICS, LAW AND MEDICAL PROFESSIONALISM:

Education

Bioethics lies at the intersection of medicine, law and philosophy. With the prominence of biomedical research and patient-centered healthcare, formal ethics instruction is the bedrock of scientific advancement and quality care.

This quarter, BLMP faculty have been hard at work to promote ethical and professional medical decision-making throughout the local healthcare community. The program faculty have interacted with medical students during lectures, CLGs, and clerkships, residents during workshops, and UF graduate and undergraduate students during classes. With topics ranging from decisional capacity to organ transplantation to reproductive issues, BLMP faculty are laying the foundation for humanistic care.

The following courses are directed and offered by BLMP faculty this spring semester:

• CM E 21: Advanced Issues in Medical Ethics and Law

• CM E 29: Financial, Business and Health Systems Aspects of Medicine

• CM E 30: Religion, Culture and Medicine

• GMS 6221: Ethics in Genetics

• GMS 6931: Ethical/Policy Issues in Clinical Research

• IDH 3931: Medical Ethics and Professionalism in The House of God

Service

BLMP faculty are committed to serving their community. By offering their expertise through a variety of channels, program faculty are able to instill ethical and professional values in the people with whom they come in contact.

This year, BLMP faculty have volunteered their time to staff the on-demand ethics consult service and to meet regularly with the UF Health Ethics Committee, the Pediatric Ethics Subcommittee, and the Subcommittee on Social Worker Proxy Policy. Moreover, program faculty also served on the UF Health planning committee for National Healthcare Decisions Day activities, which will take place over the course of March and April 2017. During this month-long celebration, faculty will participate in panel discussions and assist patients with completion of their advance directives..

FACULTY DEVELOPMENT:
The next two Faculty Development sessions are “The Hidden Curriculum,” presented by Dr. Robert Hatch on April 20, and "How to Make Teaching Sessions Interactive - Teaching with Cutting Edge Audience Response Systems - Poll Everywhere" on May 18. Faculty Development sessions are scheduled on the third Thursday of every month starting at noon. You may attend these sessions in person at UF Health Family Medicine - Main or via Jabber by dialing 75003.

SCHOLARSHIP

QUALITY:
Highlights for CHFM quality projects for the past quarter:

Readmission Trends in Family Medicine – The CHFM Readmission Rate is consistently hovering around 19 percent. Inpatient faculty, residents and ancillary staff continue to meet each Thursday morning to examine trends in readmissions and possible alternatives to patient care to improve patient health outcomes. The UF Health enterprise has announced a new initiative to attribute patients to the plurality of their care, allowing specialties to better focus on patients who are readmitted due to complex diseases and provide more comprehensive care. New CHFM initiatives are being discussed and will incorporate the new health coaches for the west Gainesville clinics and UF Health Family Medicine - Main.

ED Utilization – The Eastside ED Utilization pilot project wrapped up at the end of January. The rate of high utilizers who presented to the ED showed a downward trend, as shown in the graph below. A new list of high utilizers has been generated and given to the Eastside health coach, Reathea Felder, who will continue using interventions to reduce the number of patients presenting to the ED.

Sickle Cell Disease – The Sickle Cell Project, a collaboration with the CDC to look at the impact of ferritin testing on sickle cell patients who have had a transfusion, has wrapped up Phase 1. The impact of the alert in Epic has resulted in a 100 percent rate of ferritin tests ordered on sickle cell patients who have had office visits during Phase 1. Data from Phase 1 is being analyzed and Phase 2, the clinical application based on the ferritin levels recorded, will be implemented this quarter.

Advance Directives – Training of clinics was wrapped up last quarter. BLMP faculty, led by Professor Solberg, are working on data analysis to examine if the training was effective in the increase of advance directives being completed and scanned into Epic.

PRESENTATIONS:

International

Malaty J. Postviral olfactory loss. Presented at: SmellTaste2017; February 25-26, 2017; Gainesville, FL.

Malaty J. Smell and taste disorders in primary care. Presented at: SmellTaste2017; February 25-26, 2017; Gainesville, FL.

Local

Clugston J. Clinical perspectives on concussion management. Presented at: North Central Florida Chapter of the Society for Neuroscience Annual Conference; March 17, 2017; Gainesville, FL.

Chacko L, Bielick L. A population health approach to managing high-risk patients. Presented at: Primary Care Innovations Conference; March 10, 2017; Gainesville, FL.

Felder R, Mercado E. ED utilization reduction initiative. Presented at: Primary Care Innovations Conference; March 10, 2017; Gainesville, FL.

Nelson D. Transitional care management in the outpatient setting. Presented at: Primary Care Innovations Conference; March 10, 2017; Gainesville, FL.

Porter M. Primary care tracks in medical schools. Presented at: Primary Care Innovations Conference; March 10, 2017; Gainesville, FL.

Powell J. Clinical pharmacist in primary care. Presented at: Primary Care Innovations Conference; March 10, 2017; Gainesville, FL.

Sando K, Cowart K, Harrell JG, Konopack J, Westwood G. Incorporating pharmacist services into modified open access scheduling in a rural family medicine practice. Presented at: Primary Care Innovations Conference; March 10, 2017; Gainesville, FL.

Sando K, Cowart K, Harrell JG, Konopack J, Westwood G. Pharmacist-physician collaboration to improve diabetes care. Presented at: Primary Care Innovations Conference; March 10, 2017; Gainesville, FL.

Striley C, Dewar M, Cottler L, Carek P, Mercado E. Implementing a community health worker intervention in primary care. Presented at: Primary Care Innovations Conference; March 10, 2017; Gainesville, FL.

PUBLICATIONS:

Asken BM (g), Clugston JR, Snyder AR (g), Bauer RM. Baseline neurocognitive performance and clearance for athletes to return to contact. Journal of Athletic Training. 2017 Jan; 52(1):51-57. PMID: 27905859.

Asken BM (g), DeKosky ST, Clugston JR, Jaffee MS, Bauer RM. Diffusion tensor imaging (DTI) findings in adult civilian, military, and sport-related mild traumatic brain injury (mTBI): A Critical Review. Brain Imaging and Behavior. Published online ahead of print March 24, 2017.

Asken B (g), Snyder A (g), Clugston J, Gaynor L (g), Sullan M (g), Bauer R. Concussion-like symptom reporting in non-concussed collegiate athletes. Archives of Clinical Neuropsychology. Published online ahead of print March 10, 2017.

Collins MW, Kontos AP, Okonkwo DO, Almquist J, Bailes J, Barisa M, Bazarian J, Bloom OJ, Brody D, Cantu R, Cardenas J, Clugston J, Cohen R, Echemendia R, Elbin RJ, Ellenbogen R, Fonseca J, Gioia G, Guskiewicz K, Heyer R, Hotz G, Iverson GL, Jordan B, Manley G, Maroon J, McAllister T, McCrea M, Mucha A, Pieroth E, Podell K, Pombo M, Shetty T, Sills A, Solomon G, Thomas DG, Valovich McLeod TC, Yates T, Zafonte R. Statements of agreement from the Targeted Evaluation and Active Management (TEAM) approaches to treating concussion meeting held in Pittsburgh, October 15-16, 2015. Neurosurgery. 2016 Dec; 79(6):912-929. PMID: 27741219.

Dubose DF (g), Herman DC, Jones DL, Tillman SM, Clugston JR, Pass A, Hernandez JA, Vasilopoulos T, Horodyski MB, Chmielewski TL. Lower extremity stiffness changes following concussion in collegiate football players. Medicine & Science in Sports and Exercise. 2017 Jan; 49(1):167-172. PMID: 27501359.

Marlow NH, Malaty J, Jo A, Tanner RJ, Beau de Rochars VM, Carek PJ, Mainous AG. Hearing impairment and undiagnosed disease: The potential role of clinical recommendations. J Speech Lang Hear Res. 2017 Jan; 60(1):231-237; doi:10.1044/2016_JSLHR-H-15-0373. (Peer reviewed)

Mims LD, Porter M, Simpson KN, Carek PJ. The “July Effect”: A look at July medical admissions in teaching hospitals. J Am Board Fam Med. 2017;30(2):189-95.

Solberg LB, Shniderman AB. Legal language of health care consent forms: Complexity, comprehension, and impact on patient decision-making. American Journal of Bioethics Neuroscience. 2017; 8(1):47-49.

CHFM EVENTS

UPCOMING EVENTS

GRAND ROUNDS – APRIL 4, 2017
Presenter: Jeannette South-Paul, MD
Andrew W. Mathieson UPMC Professor and Chair
Department of Family Medicine, University of Pittsburgh School of Medicine

Title: The Road to Leadership in Academic Family Medicine: Challenges and
Reward

Location: Communicore building – room C1-15

Time: 12:15pm - 1:15pm

CHFM RESEARCH NIGHT – JUNE 1, 2017
Please join us for Research Night on Thursday, June 1, 4:00pm to 6:00pm at Evans Champions Club at Ben Hill Griffin Stadium.

Parking is available in the O’Connell Center parking lot. Enter at the Bull Gator entrance near the Heisman winner statutes. Take elevators to the 5th floor.

Please R.S.V.P. by April 1 to chfm-rsvp@chfm.ufl.edu or 352-273-5103. Clinical faculty interested in attending should contact their ACU manager.

SUMMER PICNIC – JUNE 3, 2017
The 3rd annual summer picnic will be held on Saturday, June 3, from 11:00am to 3:00pm at Poe Springs. This year, the Poe Springs Lodge is reserved, which will provide a cool environment to enjoy your lunch away from the heat and bugs. After lunch, you can enjoy the springs, which are a cool 72 degrees year round. For little ones, there is a great playground, and there is a volleyball court for the big kids (and young at heart). Cornhole, frisbee, and other fun outdoor activities are planned. Lunch will be served at 11:30am., but you are welcome to come anytime between 11:00am to 3:00pm. Please RSVP to your clinic manager or to Ali Trucluck at a.truluck@ufl.edu by May 5 so we have plenty of barbeque for everyone.

RESIDENT GRADUATION BANQUET - JUNE 23, 2017
The Resident Graduation Banquet will be held at the Wyndam Garden Hotel & Conference Center, 2900 SW 13th Street, on Friday, June 23. Tentative start time is 6:30pm.

WELCOME RECEPTION – JULY 12, 2017
We cordially invite all CHFM faculty, residents, administrative staff, ACU managers, and clinic staff to join us after work on Wednesday, July 12, from 5:30pm to 7:30pm, in the resident lounge at Family Medicine – Main to welcome new faculty and the incoming resident class of 2020. Invitations have already been sent out. Please check you inbox and mark your calendars.

FACULTY & CONFERENCE SPOTLIGHT

Arch (Chip) Mainous, PhD

Dr. Mainous recently took on the role of Vice-Chair for Research in the department. In addition to this role, he is the Florida Blue Endowed Professor and Chair of the Department of Health Services Research, Management and Policy in the College of Public Health and Health Professions. He came to UF almost four years ago from the Medical University of South Carolina, where he was a Professor and Director of Research in the Department of Family Medicine. Additionally, he was the Associate Dean for Assessment and Evaluation in the College of Medicine at MUSC. He is an active researcher and is currently collaborating with CHFM faculty members on trials funded by the NIH and the CDC. He is currently the Deputy Editor of the journal Family Medicine. In 2016, he was awarded the Innovative Program Award from the Society of Teachers of Family Medicine and the Distinguished Research Mentor Award from the North American Primary Care Research Group.

Inaugural Primary Care Innovations Conference

The inaugural Primary Care Innovations Conference was held on March 10, 2017 in a perfect venue: the highly innovative Harrell Medical Education building located on the University of Florida campus. The conference brought 139 primary care professionals together to share innovations, energize each other, and stimulate collaboration across professions as well as institutions. The conference began with an inspirational keynote address from Dr. Andrew Morris-Singer, founder of Primary Care Progress. His address focused on relational leadership and pointed out that primary care professionals are the cavalry and no outside force will come to the rescue. The conference included 36 different presentations and many participants had difficulty deciding which eight or 10 presentations to attend. The theme for the inaugural conference was “Building a Community of Innovators.” The day comprised of a networking/problem solving lunch with the goal of launching several initiatives to keep attendees in contact and engaged during the coming year and building momentum for next year’s conference. The conference was a team effort among the H. James Free Center for Primary Care Education and Innovation, the Department of Community Health and Family Medicine, and generalist physicians from the Departments of Medicine, Pediatrics, and Family Medicine. Key to the success of the conference was the leadership of the conference chair, Ryan Nall, MD, and the expertise of the UF Continuing Medical Education office.

Click here for additional pictures of the conference.

LINK TO 2015-2016 ANNUAL REPORT

The 2015-2016 Annual Report has been published and added to the CHFM webpage. Here is the link to the report: 2015-16 Annual Report

GRAND ROUNDS PRESENTATIONS

In case you missed any of the latest sessions:

March 14, 2017
Shireen Madani Sims, MD
Coaching for Resilience to Foster Wellness in Faculty and Learners
March 2017 Grand Rounds Presentation - Mediasite

February 7, 2017
Brian Berryman
COM Faculty Benefits and Retirement
February 2017 Grand Rounds Presentation - Mediasite

January 2017
Cancelled

December 2016
Cancelled

November 1, 2016
Marvin Dewar, MD, JD
We’re modern, but are we contemporary?
November 2016 Grand Rounds Presentation - Mediasite

October 4, 2016
Peter Carek, MD, MS
Residency Training in Family Medicine: Looking at Our History and into Our Future
October 2016 Grand Rounds Presentation - Mediasite

PCP LIVE PRESENTATIONS

PCP Live sessions have been cancelled. The last session was held in November 2016.

In case you missed any of the latest sessions:

PCP Live #33
November 16, 2016
Ki Park, MD
Cardiovascular Risk Stratification in Women- Where are we in 2016?
November 2016 PCP Live Presentation - Mediasite

PCP Live #32
October 19, 2016
Alice Rhoton-Vlasak, MD
Oncofertility and Infertility – What is the Difference and Why does it Matter?
October 2016 PCP Live Presentation - Mediasite

PCP Live #31
September 21, 2016
Siddhartha A. Wayangankar, MD, MPH
Demystifying the Screening and Diagnosis of Peripheral Arterial Disease
September 2016 PCP Live Presentation - Mediasite

If you missed any of the latest issues of The Pulse, here's where you can find them!

(Clicking on the picture will take you to the website)

If you would like to add something to this newsletter or have any suggestions, questions, comments or concerns, please email Misty Gray at mistygray@ufl.edu with subject “CHFM Newsletter”