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WELCOME TO LONG BEACH!

WELCOME TO LONG BEACH!. St. Mary Medical Center UCLA affiliated Internal Medicine Residency. General Overview. “The Best of Academic Medicine in a Community Setting” Residents benefit from real world medicine training during their core rotations at St. Mary Medical Center

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WELCOME TO LONG BEACH!

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  1. WELCOME TO LONG BEACH!

  2. St. Mary Medical CenterUCLA affiliated Internal Medicine Residency

  3. General Overview • “The Best of Academic Medicine in a Community Setting” • Residents benefit from real world medicine training during their core rotations at St. Mary Medical Center • Close teaching relationship with Medicine Attendings and consulting specialists • Ability to tailor experience to individual goals

  4. ST MARY’S PAST & PRESENT

  5. Overview St. Mary Medical Center Founded in 1923 Community Hospital UCLA Teaching Hospital Second-largest in Long Beach Sixth-largest employer in LB Member of CHW Hospital Group

  6. St. Mary Medical Center Milestones 1923—Long Beach Sanitarium 1923—Six Sisters of Charity of the Incarnate Word purchased the Sanitarium and renamed it St. Mary’s Hospital 1933—St. Mary’s Hospital was destroyed by a series of earthquakes in California 1937—A quakeproof and fireproof 100 bed hospital was completed at the site of the original hospital 1940s and 1960s—Various renovations bring hospital capacity to 349 1970’s - St. Mary was the first hemodialysis center in Long Beach; the first trauma center in the harbor area; the first implantation of a nuclear pacemaker and the opening of the Diabetes and Endocrine Center 1990’s—New professional building, surgery center, new ED, and child care center was acquired. St. Mary’s receives national recognition for the HIV/Care program 1996—St. Mary’s became a member of CHW 1998—St. Mary’s expands to include extensive home health care program

  7. St Mary Medical Center • Multi-Subspecialty Tertiary Care Hospital • 400 beds, >450 Associated Physicians • Fully Closed Medical and Surgical ICU • Pacific Shores Oncology Group • West Gastroenterology Group • Bariatric center of Excellence • Orthopedic Center • Level 2 Trauma center • Care Clinic program (HIV)

  8. St. Mary Medical Center: Master Plan Diagram • HOSPITAL FLOORS • 7th: Telemetry • 6th: Medical Surgical • 5E:Rehabilitation • 3rd: Obstetrics/Maternity • 2nd: ICU, OR, Library, Lounge, Lab • 1st: ER, Radiology, Cath lab

  9. Overview – Residency Program 16 Internship positions 7 categorical (+2 Primary care tract) 7 preliminary 32 total residents Medical Education faculty Private Teaching Attendings Harbor-UCLA 1-2 intern ward rotations 7-9 resident consult rotations

  10. FACULTY

  11. Internal Medicine Residency Leadership Team Core Academic Faculty: Jasminka Criley MD, FACP, FHM Acting Residency Program Director Director Medicine Clerkships and Students’ Electives Director, Women Heart Center Chester Choi, MD MACP Academic Chief of Medicine Neill Ramos, MD Academic Staff Physician Director of Coumadin Clinic Sarah Strube, DO Academic Staff Physician Nitin Bhasin, MD Academic Staff Physician  Bettina Kehrle, MD Chief Residents: Nhan Luu, MD Visal Nga, DO Joanna Tan, MD Medical Education Staff: Sylvia Perez Graduate Medical Education and Housestaff Coordinator Eliana Campbell – Continuing Medical Education Coordinator Claudio Villegas Student Coordinator

  12. Internship: Internal Medicine Categorical Primary Care Track Preliminary Residencies: Internal Medicine SMMC TRAINING Students: THIRD YEAR: Internal Medicine Clerkship ER Clerkship Ambulatory Clerkship FOURTH YEAR Internal Medicine subinternship Cardiology, Pulmonary, Gastroenterology Neurology, Nephrology, Radiology Hematology/Oncology, ER PHARMACY STUDENTS NURSING STUDENTS

  13. HARBOR UCLA Medical Center • Categorical Residents will spend approximately 1/3 of time at H-UCLA • 1 to 2 months of Inpatient Medicine during PGY-1 • Subspecialty and many electives options at H-UCLA during PGY 2/3 year • Great teaching and opportunity to make contacts for fellowship • Research opportunities

  14. CURRICULUM

  15. PGY-1 CURRICULUM CATEGORICAL / PRIMARY CARE* 3-4 blocks Medicine Wards SMMC 1-2 blocks Medicine Wards Harbor-UCLA 3 blocks ICU (1-2 Ward HUCLA) 1-2 blocks Continuity Clinic 1-2 months of Night Float (half block of Ward and ICU) 3-4 weeks Neurology 3-4 weeks ER 4 weeks vacation PRELIMINARY 3-4 blocks Medicine Wards SMMC 4-5 blocks ICU 1-2 blocks Continuity Clinic 1-2 months of Night Float (half block of Ward and ICU) 3-4 weeks Selective 3-4 weeks ER 4 weeks vacation * Primary care track curriculum may be subject to change, check website frequently for updates

  16. Intern Year - 14 Rotations Sample Categorical Intern Schedule Sample Preliminary Intern Schedule ROTATIONS TALLY - Rotation blocks vary in length 3 to 4 weeks, most being 4

  17. CATEGORICAL PGY2/3 3 blocks Medicine Wards each year 2-3 blocks ICU distributed during the 2/3rd years 1 block Continuity Clinic each year 1 block of SMMC Cardiology each year 2-4 weeks of Night Float each year 1 block of Ambulatory rotation each year 1 block of Geriatrics during PGY3 year 5-6 blocks Harbor Subspecialty over the 2 years 1 elective block during the 2 years 3 weeks vacation each year

  18. Sample Resident Schedule

  19. Inpatient/Consult Endocrine Infectious Disease Heme-Onc Gastroenterology General Medicine Consult Pulmonary Cardiology Nephrology Geriatrics Elective rotation of your choice (3rd year) Research Inpatient Outpatient Overseas Outpatient Dermatology Rheumatology Endocrine Alternative Medicine Allergy/Immunology Adolescent Medicine Gynecology Sports Medicine-Orthopedics HIV/Care Clinic Ophthalmology Urgent Care Gastroenterology Geriatrics PGY2/3 Rotations

  20. WARDS

  21. WARDS • Teaching Attending or Chief Resident • Current Structure:1 Resident • 1 Intern • 1-2 MSIII and / or 1 MSIV (varies) PRIVATE TEACHING ATTENDINGS: -In addition to faculty, teams may have 2 -3 patients with private attendings while on wards -Experienced, reliable, highly motivated physicians ranging in specialty from ID, Pulmonary, Cardiology, Nephrology, Medicine -Many have been recognized for outstanding contribution to housestaff with awards in teaching

  22. WARD STRUCTURE • Four Ward Teams lettered A, B, C, and D • Each Team rounds with their own Attending MD • Each team consists of 1 ward resident and 1 intern • Intern will be on call every 4 days and will have one day off a week • Currently long call starts at 7am and ends at 8:30pm, with the last admission at 7:30pm • The night-float team will take coverage from 8:30 pm to 7am

  23. WARD - CAPS • Intern CAP – 10 patients maximum • While on call the intern can admit up to 5 new patients and have 2 ICU transfers • Any additional ICU transfer will be considered a new admission • Team CAP is 14 patients • Resident can have up to 4 extra patients on their own

  24. CURRENT INTERN WARD SCHEDULE

  25. Ward/ICU NIGHT FLOAT SCHEDULE 2011-2012

  26. Formal Teaching Morning Report Intern Report Subspecialty Morning Report Board Review Cardiology Conference ECG sessions Teaching Attending Rounds Cardiovascular examination sessions Noon Conference Morbidity and Mortality Journal Club Multimodality Cancer Conference Monthly Trauma/ ER conference Visiting Professor Rounds

  27. Resident Teaching Responsibilities At the bedside Medical Students Noon Conference Morbidity and Mortality Journal Club Ambulatory Topic Cancer Conference Cardiology Conference ICU Conference

  28. NOON CONFERENCE • 12:15 – 1:15 pm • Conference with curriculum based teaching • Case based with focus on IM Board Review • Lead by subspecialty and general internist • No noon conference on Thursdays

  29. NOON CONFERENCE SAMPLE

  30. ICU

  31. Intensive Care Unit - ICU • Closed ICU system (no ward team coverage) • 2 ICU teams named alpha, beta • 4 interns, 2 residents • 1 day off per week Thur/Fr/Sat/Sun

  32. ICU STRUCTURE 2011-2012 • Same call system as wards: • Day call only  7am to 8:30pm • Night Float takes call  8:30pm to 7am • Caps: 5 admissions, maximum census 10 (rare) • Patients admitted on day call stay with intern on call • hand offs from night intern • Intern/Resident do all procedures • Arterial line, Central Lines, Intubation etc.

  33. Subspecialties Support Full range of IM & surgical subspecialties including neurosurgery and CT surgery Full attending radiology support 24hrs/day OB-Gyn Bariatric medicine experience Pathology support

  34. Ancillary Services Extensive nursing assistance, phlebotomy, blood cultures, transportation Case manager assigned to assist with placement/disposition Full range of technologists for echo, XR, ultrasound Excellent PT/OT/Speech In-hospital Rehab facility Nutritionist support & patient education PACS system throughout hospital

  35. Ancillary Services

  36. Outpatient Experience Continuity clinic – one ½ day per week on most services (never on post-call days) Medicine clinic – one-two months per year ER/Urgent Care Specialty Ambulatory months (R2/R3)

  37. ELECTRONIC RESOURCES • OVID, Cochrane, MD Consult • Library – hundreds of full text online journals • PACS – online patient imaging studies • EMPHYSIS/Proaccess—labs/tests/clinic notes • Computerized Labs/Tests- alllabs and testson-line • Digital radiology accessible on any computer monitor • Newly updated, fully integrated website www.stmarymed.com

  38. SMMC is Resident-Friendly • All call rooms have non-hospital beds • Private bathrooms • Nice Resident Lounge • Big screen TV • Refrigerator • Wii • Access to Hospital Physician Lounge

  39. Research Opportunities Harbor-UCLA UCLA Oncology Research Network Site Care Clinic Pacific Shore Hematology Oncology Group ICU Elective month (UCI, Cedars, USC, other) UCLA Solomon Scholars Program

  40. Research Opportunities Recent publications: in Clinical Cardiology, Chest, Hospital Medicine …. Vukanovic-Criley, J.M., Hovanesyan, A., Criley S. R., Plotnick, G., Mankowitz, K., Ryan, T., Conti R and Criley, J. M.  Remote Testing of Cardiac Examination Competency. ClinCardiol 2010; 33, 12, 738-745. DOI:10.1002/clc.20851 Darwish, O. and Criley, J. Hydrochlorothiazide-Induced Noncardiogenic Pulmonary Edema: BAL Fluid Analysis doi: 10.1378/chest.10-0944 CHEST January 2011 vol. 139 no. 1 193-194 Ramanathan, V.S., Vukanovic-Criley, J.M., Choi, C. and Burg, A. Apple Core Lesion. Consultant, Vol 51 No 3, March 11, 2011.

  41. Research Opportunities Recent presentations: AFMR (American Federation for Medical Research) SGIM (Society of General Internal Medicine) SHM (Society of Hospital Medicine) ACP (American College of Physicians) WGEA (Western Group of Ed. Affairs, AAMC) APDIM (Association of Program Directors of IM)

  42. SOLOMON’S SCHOLARS Annual research presentation at UCLA with all UCLA affiliated IM Residency training programs Case presentation or Individual research Oral platform presentation (one resident each year) Mandatory by the end of the 3rd year, may be done at any year of training (preliminary interns welcome!)

  43. Southern California ACP Indian Wells, October 2008

  44. Southern California ACP Indian Wells, October 2009 Residents Posters: 1. Atrial Fibrillation as a Complication of AtrialSeptal Imperfection with Anomalous Pulmonary Venous Connection AshkanAmooee MD; Omar Darwish, DO; Alexander Stein, MD; Ravi Menghani, MD; Jasminka Criley, MD, FACP, FHM 2. A water pill that almost killed: Hydrochlorothiazide-Induced Acute Non-cardiogenic Pulmonary Edema Omar Darwish, DO and Jasminka Criley, MD* 3. Intra-Hepatic Cholestasis: A Rare Case Report. Gary Hensley, MD and BimPhan, MD 4. “Gurgling In The Chest: An Unexpected Finding of Bochdalek Hernia”VisalNga DO, James Keefe, MD, Ann Marie Levan, MD, Patrick Cahill, MD, Jasminka Criley MD FACP FHM 5. HaNDL with CareSanthi Raja MD, FJFICM, Jasminka Criley MD, FACP, FHM, Ali Khoiny MD and Chester Choi MD, MACP* 6. Bizarre Behavior and Bezoar - a Thought to Chew On. Joanna Tan, MD; Jasminka Criley, MD, FACP, FHM 7. THE GREAT ESCAPE:  AN UNEXPECTED DIAGNOSIS FROM ENTRAPED LUNG Ana Cecilia Uribe MD, VisalNga DO, HemalKadakia MD, Alexander Stein MD, JoytiDatta MD, Jasminka Criley MD 8. “Pandora’s Box: HIV, Disseminated KS, MDS and Gangrene-Complication on Complication.”Howard Van Gelder MD, VisalNga DO , Benjamin Montoya MD, James Keefe MD, HemalKadakia MD, Chester Choi MD, MACP and Jasminka Criley MD FACP FHM * Region I subdivision winners

  45. ACP 2010

  46. WGEA, Stanford 2011 • Criley, J., MD, FACP, Yang, A., BS, and Kreger, C., MD. Using Virtual Patient Examinations to Improve Cardiac Examination Competency of Medical Faculty and Residents: The Positive Effect of a One-Time Skill Development Workshop. AWARD FOR BEST RESEARCH POSTER • Criley, J., MD, FACP, Brown, E., MA, Yang, A., BS, Reyes, J., MS, Pham, J., BA, Wan, L., BA, Burg, A., MD, Fair, P., RN, and Villaruz, A., MT, CPHQ, MHA. Who is Your Doctor? Assessing the Level of Patients’ Knowledge of Who is Their Physician on Inpatient Teaching Service. • Luu, N., MD, Mantie, J., Cummins, K., BS, and Criley, J., MD, FACP, FHM. Clinical Reasoning in Cardiac Examination. • Darwish, O., DO, Van Gelder, H., MD, Bhasin, N., MD, Arciaga, P., MD, and Criley, J., MD, FACP, FHM. Simulation Training Makes a Mark on Delayed Posttest Results.

  47. GRADUATES Since 2001, we have had many graduates accepted into fellowship positions Class of 2011 (10 residents) 2 fellowships (Nephrology, Kennamer fellow) 1 appointed Full time faculty at SMMC 4 Full time Hospitalists 3 Chief Residents Majority of graduates of the Internal Medicine Program are now working in Southern California area

  48. GRADUATES Most graduates practice in Southern California 25% - 50% per year proceed to Fellowships Pulmonary – Harbor-UCLA Hem-Onc – Harbor-UCLA, City of Hope Infectious Disease – Cedars Sinai, University of Washington, UCI, West LA VA, Harbor-UCLA Rheumatology – Olive View UCLA, University of Iowa – Nephrology – Harbor-UCLA Gen Medicine – Westwood VA, Harbor-UCLA Endocrinology – King-Drew, City of Hope, INNSZ Palliative Care – West LA VA Medical Center

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