Boosting medical students’ understanding of genetics and molecular diagnostics, improving communication among members of hospital rapid-response teams, and exploring the benefits of having a hospital clinical coordinator are among the project proposals awarded a 2015 Frymoyer scholarship.
The scholars, who include five UVM College of Medicine professors and a staff nurse at UVM Medical Center, gathered for a luncheon at the University of Vermont College of Medicine on September 16.
The John W. and Nan P. Frymoyer Fund for Medical Education – which is celebrating its 15th anniversary this year – aims to provide financial support for physicians and nurses who seek to enhance the UVM medical learning experience and who exemplify the ideal clinician teacher with a focus on patient care.
A basic understanding of genomic medicine could help practicing physicians personalize and improve treatment for patients with a range of illnesses, from cancer to diabetes, says Rebecca Wilcox, M.D., UVM assistant professor of pathology. She and colleagues Leah Burke, M.D., a UVM professor of pediatrics and medicine, and Tamara Williams, Ph.D., an assistant professor of pathology, have proposed building curriculum during the first two years of medical school that teaches such fundamentals of genetics and molecular diagnostics. Wilcox is a pathologist and expert in colon cancer who knows that genetics play a valuable role in patient care. “It’s important to know the mutation of the cancer,” she says. “And that will dictate what treatment they can use and how well the patient will do, the prognosis.”
Genetic and molecular information can help doctors decide which tests to order and how to interpret those tests, Wilcox says. And these tools are easily accessible to most physicians today.
“If you look at 10 years ago, the amount of time and the money it would take to look at these genes, it was prohibitive,” she says. “Now, we can look at the entire genome … and you can know the results in 24 hours.”
The goal is for medical students to learn enough basic information to know what genomic data is available, how to find it and how to communicate with patients about the specifics of their illnesses. The “Fry girls” – as Wilcox, Burke and Williams now call themselves, after receiving their scholarship – not only have the expertise in genetic research but the educational skills to “really teach them the language, the technology,” Wilcox says. Williams teaches a number of undergraduate genetics courses and Burke directs the clinical genetics program at UVM Medical Center.
Jason Bartsch, M.D., UVM assistant professor of medicine, and Rachel McEntee, M.D.’12, a chief resident in internal medicine at UVM Medical Center, hope to improve communication for the rapid-response team that’s called when a patient on a general medical or surgical floor experiences a decline in status. The floor nurse might page the team for a change that ranges from somewhat vague – “the patient doesn’t look right” or has chest pain – to very specific, such as a drop in oxygen or heart rate, Bartsch says.
When a group of medical professionals show up at the patient’s bed, it’s often unclear what exactly is needed or who is in charge, Bartsch says. “The response gets to be quite variable.”
At UVM Medical Center, this multidisciplinary team is called CATS, for Critical Access to Treatment. The CATS team includes internal medicine physicians, critical care nurses, respiratory therapists, phlebotomists, EKG technicians and usually medical residents.
In some cases, not every CATS member is needed, Bartsch says. In others, a particularly assertive nurse or physician might take over the decision-making, while another team member has a different but valuable opinion.
“I want the medical resident and the whole team to work together to come up with a plan,” Bartsch says.
Additional training could help medical residents and all team members overcome this confusion, Bartsch and McEntee suggest. They plan to attend an upcoming simulation training conference in Boston to learn the best ways to implement this kind of training, he says.
They have proposed role-playing scenarios of common CATS calls – perhaps a patient has “altered mental status” – and an assessment of the steps to take in those situations. CATS members also will participate in follow-up briefings as part of Bartsch and McEntee’s plan for their Frymoyer award.
“It’s really important in these scenarios to talk about what went right and what went wrong,” Bartsch says.
Stephen Leffler, M.D., UVM professor of surgery and chief medical officer for the University of Vermont Medical Center, and Jason T. Garbarino, R.N., M.S.N., a staff nurse at the medical center, proposed creating and evaluating the role of a clinical nurse leader (CNL) to improve coordination of care, particularly for patients with complex medical and behavioral problems. Better care coordination is crucial to helping patients leave the hospital sooner, manage their problems at home and experience longterm health improvement, Leffler says.
The CNL would oversee a patient’s transition from the hospital to home, coordinate various providers and arrange for at-home needs and wraparound services. The position is “focused on the overall patient experience and outcome,” Leffler explains. “It’s almost like having a patient concierge.”
Doing this at UVMMC will involve figuring out how to shift the work of the various individuals who now handle parts of that role. The medical center now uses a more traditional case management structure.
“A lot of people now are doing that work in little pieces,” Leffler says. “We’re not doing it in a fully focused, patient-coordinated way.”
Leffler and Garbarino plan to track whether patients have fewer complications in the hospital (urinary tract infections, bed sores), leave the hospital sooner, get readmitted less frequently and generally have a smoother experience with their follow-up visits, medications and ongoing treatment.
“Data from health care organizations that have implemented the CNL role have demonstrated clear improvements in the delivery of care, patient safety, and decreased hospital costs,” Garbarino and Leffler wrote in their Frymoyer proposal.
John Frymoyer was dean of the UVM College of Medicine from 1991 to 1999 and CEO of the former Fletcher Allen Health Care, now UVM Medical Center, from 1995 to 1997. His late wife Nan Frymoyer worked as a community health nurse and served on the UVM College of Nursing and Health Sciences advisory board. She helped launch the Frymoyer Community Health Resource Center at the UVM Medical Center.
In addition to the recently-announced 2015 Scholars, 43 UVM and UVM Medical Center clinicians have been named Frymoyer Scholars over the past 15 years. They include:
2014
Hirak Der-Torossian, M.D., M.P.H. – “Curriculum Design and Creation of a free online course for Medical and Nursing Students: Writing Research Protocols Suitable for Submission to the UVM Institutional Review Board
Anne Dougherty, M.D.’09 – “Development of a Global Women’s Health Curriculum for Medical Students and Residents”
2013
Charlotte Reback, M.D. – “Building Bedside Competence in Medical Students through ‘Active Learning’”
2012
Laurie Leclair, M.D. – “Simulation Training for Multidisciplinary Intensive Care Unit Teams: Active Learning to Promote Best Practice”
Patricia King, M.D., Ph.D. – “Teaching Professionalism through Lessons from the Board of Medical Practice”
Ursula A. McVeigh, M.D., and Jean Coffey, Ph.D., A.P.R.N., C.P.N.P. – “Palliative Care Education
Marie Sandoval, M.D., and Mary Val Palumbo, DNP, APRN – “Developing Best Practices in Communication when using the Electronic Health Record for Nurse Practitioner and Medical Students and their Preceptors”
2011
Ted James, M.D. and Celia Cohen, R.N. – “Teaching and assessing health communication skills, professionalism, and inter-professional communication through a series of simulated clinical management scenarios”
2010
Mark Gorman, M.D. – “Web-based, Interactive Stroke Teaching”
Paula Duncan, M.D. – “Shared Decision-making and Strength Based Approaches”
Laura McCray, M.D. – “Preventing Burnout: The Development of a Medical Student and Resident Physician Wellness Curriculum”
Jan Carney, M.D., and Susan Greenfield, Ph.D., R.N., and Hendrika Maltby, Ph.D., R.N. – “Second Life: Simulating Public Health for Medical and Nursing Students”
2009
Richard Pinckney, M.D., M.P.H. – “The Art of Compassion: A Workshop Series for Medical Professionals”
2008
Robert Karp, M.D. – “Improving Basic Medical Student Competencies in Clinical Geriatrics”
Nancy Morris, Ph.D., A.P.R.N., and Peter Igneri, PA-C, M.M.Sc. – “Communication and Psycho-Motor Skills for Minor Office Procedures to Improve Access and Enhance Quality Care”
2007
Chuck Mercier, M.D., and Catherine Muskus, R.N. – “Communication and Team Work: The Key to Quality Health Care an Interdisciplinary Workshop Using High Fidelity Simulation”
Judith Lewis, M.D. – “Development of Web-based Educational Material for Education in Psychiatry”
2006
Beth Kirkpatrick, M.D., Louis Polish, M.D., Hendrika Maltby, Ph.D., R.N., Chris Huston, M.D., and Burton Wilcke, Ph.D. – “Global Health Education and Training for Health Care Professionals at the University of Vermont”
William Raszka, M.D., Jill Jemison and Cate Nicholas, Ed.D. – “Using Computer Assisted Instruction (CAI) to Improve Medical Student Patient Care Skills and Knowledge”
2005
Charles Hulse, M.D. – “Vermont Program on Ecology and Health”
Mario Trabulsy, M.D. – “Innovations in an Emergency Medicine Rotation”
2004
Terry Rabinowitz, M.D. – “Development and Implementation of a Telepsychiatry Consultation Teaching Program”
Susan Goetschius, R.N. – “Building Nursing Expertise in Geriatrics: An Acute Care Clinical Model”
2003
Virginia Hood, M.D. – “Studies Show: Interpreting the Results of Medical Studies for Patient”
Robert Shapiro, M.D. – “Pharmaceutical Development and Prescriber Decision-Making”
2002
Christopher Grace, M.D. – “Bioterrorism Education for Physicians, Nurses and Students”
James Rathmell, M.D., and Todd Maughans, M.D. – “Developing Electronic Case Tutorials for the Neural Sciences course”
2001
David Little, M.D. – “Enhanced Teaching of Musculoskeletal Concepts”
William Raszka, M.D., and Ann Wittpenn, M.D. – “Improving Medical Student Competency: A Proposal to Return to Bedside Teaching”
