The School of Medicine’s Gold Humanism Honor Society welcomed the 2018 class of inductees during its annual induction ceremony on Jan. 20 at Diastole.
It is the 15th consecutive year that the UMKC chapter has recognized students with induction into the national organization. Three-dozen new members were chosen — 17 students and 19 who are residents, fellows or faculty members.
The students were selected from nominations made by colleagues and faculty based on their excellence in clinical care, leadership, compassion and dedication to service. Members are selected for their exemplary care of patients and their humanistic approach to clinical practice. Dr. R. Stephen Griffith, M.D., and Dr. Glenn E. Talboy Jr., M.D., were this year’s faculty inductees.
With funding support from the Gold Foundation, the School of Medicine established its chapter of the honor society in 2004. A Graduate Medical Education chapter was added in 2014 specifically for School of Medicine/Truman Medical Center residents.
Established in 2002 by the Arnold P. Gold Foundation, the Gold Humanism Honor Society today has 30,000 members nationally in training or practice. It recognizes 149 undergraduate medical education and 14 graduate medical education chapters at medical schools throughout the country.
Members are viewed by their peers as role models for humanistic care within their communities. The society also provides educational events, supports research, promotes professional growth and creates networking opportunities.
2018 Gold Humanism Honor Society
Dr. R. Stephen Griffith, M.D.
Dr. Glenn E. Talboy, Jr., M.D.
Mir Fahad Faisal
Shubha Deep Roy
Waldman’s wealth of textbooks fills needs in practice, education
“HE WROTE THE BOOK ON THAT” usually is a figure of speech. But when it comes to diagnosing, treating and managing pain, Steve Waldman, M.D. ’77, did write the book — dozens, in fact.
His “Interventional Pain Management,” published in 1996, was the first textbook on the new subspecialty of interventional pain management, said Waldman, the School of Medicine’s associate dean of international programs and chair of the Department of Medical Humanities & Bioethics. Other groundbreaking works followed.
Waldman coined the term interventional pain management, for treating pain as the primary focus instead of as a symptom, like fever.
“That was a big shift in pain management,” said Waldman, a clinical professor of anesthesiology at the School of Medicine since 1992. “There were great advances in medical knowledge in the field but the literature really lagged. There was a need and I wrote the book.”
Steven Waldman, M.D. ’77, has published 29 medical textbooks, in addition to hundreds of peer-reviewed articles and book chapters.
For more than 20 years, Waldman has kept seeing such needs and writing books to meet them, on pain management and on his other area of expertise, diagnostic ultrasound. His published writings have grown to 29 leading medical textbooks, chapters in dozens of others, and more than 240 articles, reviews and other contributions to peer-reviewed journals.
Several of his books have gone into multiple editions, a sign that they are filling vital medical needs and that Waldman is committed to keeping them up to date. Besides topping medical-text sales charts, the books have won awards such as the 2016 British Medical Association Book Award for the third edition of “Physical Diagnosis of Pain: An Atlas of Signs and Symptoms.”
How does an author become so prolific, while also teaching and fulfilling two key administrative posts at the School of Medicine? His longtime editor at W.B. Saunders Co., Michael Houston, said Waldman combined practical knowledge with a keen focus on thoroughness and maximum efficiency.
“Dr. Waldman is one of our most productive and dependable authors,” Houston said. “He is very much aware of what the practicing pain management physician needs to know day to day.”
One physician who values Waldman’s deep knowledge and ability to explain and display medical concepts is Commander Ian M. Fowler, M.D., the head of pain medicine and anesthesiology for the U.S. Navy.
“The anatomic illustrations, radiographic and ultrasound images and detailed explanations in Dr. Waldman’s procedural and comprehensive pain management textbooks have improved my care of patients and improved the learning of my trainees,” Fowler said. “He has kept these informative textbooks up to date with frequent new editions and text on emerging technologies such as ultrasound guided procedures.”
On many of his books, Waldman’s productivity has been enhanced with the help of his three sons and daughter. They’ve done everything from acting as a sounding board for ideas and models for photo illustrations to co-writing, editing and proofreading.
Waldman’s efforts are far from finished. His latest project is a textbook on the use of technology in medical education, which he is writing with a professor at Trakya University in Turkey. Several faculty at UMKC also are contributing.
How much Waldman’s texts have helped medical education and practice is impossible to measure. But his books have been translated into a dozen languages, so their reach is global.
“When I was in China last year representing UMKC at the Edgar Snow Symposium, we toured the hospital at Peking University,” Waldman said. “It was gratifying to see a copy of one of my books, in Chinese, being used in a procedure there.”
Two medical students, a man and a woman, are asked why they wanted to study medicine.
“Because doctors can save lives and help heal wounds,” he replies. For her, being a doctor “means I will be able to take care of my family, both financially and physically.” They add that social status and family pride will be nice side benefits, too.
Their answers may be typical. But the students, Zhang Qiming and Gao Yufei, are not — at least not in the halls of the UMKC School of Medicine. They recently wrapped up a month-long exchange visit from the Peking University School of Medicine, seeing how one American school educates the next generation of U.S. physicians.
Some differences between their school and UMKC are obvious. One is the Hospital Hill campus, “which is like a park,” Zhang said, with green space between the med school and the Health Sciences Building, in contrast with the walled area of their university and hospital. Another is UMKC students’ individual offices in their docent unit. Compare that to much tighter, shared study spaces at Peking University.
And then there is UMKC students’ freedom — and much greater expense — to live and eat where they want to.
“At our school, the majority of students live in the dormitories, all eight years,” Zhang said.
“And we take all our meals in the canteen on weekdays,” Gao added.
To do otherwise would simply cost too much, Zhang said, especially in Beijing, where already high rent and other living expenses have risen rapidly in the past 10 years.
But there also are similarities between UMKC and Peking University, including how difficult it is to get into medical school.
Zhang and Gao, both 23 years old, had to be top students to study medicine at Peking University, regarded as “the Harvard of China.” Zhang was in the top 50 of 200,000 high school seniors who took a university placement exam in his province of Fujian, on China’s southeast coast. Gao faced a similar challenge in her province of Yunnan, in southwest China.
Peking University’s medical program is eight years, like most traditional U.S. medical schools that follow four years of undergraduate work to earn a bachelor’s degree. And like UMKC’s six-year B.A./M.D. program, their medical school takes students straight from high school. The last two years are known as a residency, and emphasize patient care. After graduation, Chinese medical students still must get further training, similar to U.S. residency programs.
Zhang and Gao have completed their fifth year. “We have taken many classes to prepare us, including basic sciences and medical sciences,” said Gao. “We have not spent much time yet seeing patients, as students here have, but we will in our final three years.”
In China, Gao and Zhang also have been exposed to various branches of medicine, and each has settled on a specialty — ophthalmology for Gao and urology for Zhang. During their UMKC visit, they have been able to see those specialties taught and practiced at the School of Medicine, Truman Medical Center-Hospital Hill and the Eye Foundation of Kansas City.
“My first years at university were a bit overwhelming; there was so much information to learn,” Gao said. “But when I found ophthalmology, I knew what I wanted to do. I believe interest is the best teacher, and I am very interested in learning everything about how our eyes work. Because I have myopia and must wear glasses, I understand how terrible it is to have bad vision.”
Zhang is similarly excited about his chosen area.
“This is a very strong area at our medical school—urology and urological cancer,” he said. “I also want to be a surgeon, and some of the best cancer surgeons are in urology.”
Zhang and Gao are the first students to visit UMKC under a new cooperation agreement between the School of Medicine and Peking University. The universities hope for further exchanges of students and faculty, along with research collaboration. UMKC’s leadership in bioinformatics and other research was one reason the Chinese school was interested in adding UMKC to its U.S. partners.
The agreement came at the right time for Zhang and Gao, because after their fifth year, students in their program are eligible to do an international rotation.
Their stay, which ran through Dec. 10, began with a welcoming reception at the Diastole Scholars’ Center and a meeting of the board of the Edgar Snow Foundation. The foundation carries on the legacy of Snow, an American journalist who was the first Westerner to report extensively on China under Mao Zedong. Snow and School of Medicine founder E. Grey Dimond were friends, and Gao said one highlight of the trip was seeing Snow’s papers, which are housed at UMKC’s Nichols Library.
Zhang and Gao said they enjoyed meeting faculty and students, and were eager to share what they had learned about the docent system and other aspects of the UMKC School of Medicine.
“I like how each third-year student has one-to-one help from a fifth-year student,” Gao said, “and they continue as fourth-year and sixth-year students. There is so much support.”
On Dec. 5, more than 100 third-year medical students presented research findings at the UMKC School of Medicine as part of their coursework in medical neuroscience.
Students, in teams of four, used data from the Cerner HealthFacts database to try to answer a unique question they identified related to various disease and conditions. Those examined included Alzheimer’s Disease, stroke, obsessive-compulsive disorder, epilepsy and diabetes. After analyzing the data and drawing conclusions, each team made a poster displaying its question and hypothesis, telling how the team members went about testing their hypothesis, explaining their findings, and identifying questions for further study.
The idea behind the exercise was to give students an early research experience, and for many it was their first medical research.
By all accounts, the assignment was a success. Several students said that before the exercise they were worried about how difficult it would be to do research, but now they looked forward to being able to do more.
Shafaa Mansoor, whose team studied possible seasonal effects on strokes, said she is interested in community health and now sees research as a way to further that interest, identify the real effects of medical conditions and test possible treatments.
Her teammates Rebecca Kurian and Tom Matthews agreed that the project was a good, hands-on way to learn how to do research.
“The process was as important as the results,” Matthews said. “Learning how to do this and present our findings was valuable.”
More than 40 faculty members collaborated to make the project a reality, including several who judged the presentations. Each team also had a faculty mentor and a supporting biostatistician from the Department of Biomedical & Health Informatics, Children’s Mercy Hospital or the School of Nursing and Health Studies.
One of the judges, Maria Cole, M.Ed.L., Ph.D., an associate professor in biomedical sciences, very much liked what she saw.
“I had these students in class in January and it’s something to see how far they have come since then,” she said. “Their ability to analyze data and explain their findings, and to link their results to what they learned in class, is impressive.”
The exercise was devised by Jennifer Bickel, M.D. ’01, associate professor of pediatrics and chief of the headache section at Children’s Mercy Hospital; Julie Banderas, Pharm.D., BCPS, professor and interim chair of the Department of Biomedical & Health Informatics, professor and associate dean for graduate studies; and Paula Monaghan-Nichols, Ph.D., professor and chair of the Department of Biomedical Sciences and associate dean for research.
“There was no model for this, so we’re learning as we go,” said Bickel, who talked with the teams about their experiences. “We will make improvements and hope this is something we can eventually share with other programs. It’s exciting to be doing something completely new.”
The teams were judged for poster content, clarity, appearance and organization; their oral presentations; and demonstration of critical thinking.
The top three teams were announced Dec. 6:
First place: Jonathan Jalali, Chidera Okafor, Jacob Perera and Amudha Porchezhian, “Is Patient Sex Linked to Pharmacologic Agents that Induce Acute Dystonic Reaction?”
Second place: Caleb Spencer, Grace Arias, Debolina Kanjilal and Kyla Mahone, “Correlation Between Elevation in Inflammatory Markers of ESR and CRP in Patients Diagnosed with OCD and OCPD and Age.”
Third place: Saniya Ablatt, Vijaya Dasari, Gauri Kaushal and Andrea Pelate, “Stroke Incidence at a Young Age in Rural vs. Urban Populations.”
The UMKC Health Sciences District marked Lung Cancer Awareness Month on Thursday with “Smokin’ Out Lung Cancer,” a midday event that outlined the district’s early lung cancer screening, treatment and prevention efforts, led by Truman Medical Centers.
TMC’s screening program emphasizes early detection and treatment for longtime smokers and ex-smokers. The event Thursday celebrated its patients’ and doctors’ success in committing to healthy living and saving lives. The screening program uses low-dose CT scans and is the only one in the nation to be driven by resident physicians, who are supervised by faculty from the UMKC School of Medicine.
Among the speakers at the event was Dr. Justin Stowell, the radiology resident who started the screening program and who has compiled statistics on its early success. When lung cancer is detected in its early stage, he said, cure rates of 70 to 80 percent are possible.
And besides catching lung cancer early, Stowell said TMC’s program has had success in getting more than one-fifth of the people tested to quit smoking.
Lung cancer is responsible for 155,000 U.S. deaths a year, more than breast, prostate and colon cancer combined, which emphasizes the need for awareness events such as “Smokin’ Out Lung Cancer.” Stowell also noted that Medicare covers the early screening for many longtime smokers, and insurance companies have been adding coverage as the success of the screenings has been demonstrated.
The event, which included a barbecue lunch, was attended by some lung cancer survivors who had benefited from the screenings and subsequent treatment or surgery to remove their cancer. A video was shown that told the survival story of Thaddus Owens, who was at the luncheon.
The event also drew some smokers whose doctors had encouraged them to attend. One of them was 64-year-old Carl Kendall, who said he had tapered off in recent years but still smoked at least half a pack a day.
“I started smoking in 1968,” he said. “I have a doctor’s appointment next week, and I’m going to ask about this screening.”
Charlie Shields, TMC president and CEO, kicked off the presentations. Besides highlighting the screening program’s success, he noted that “Smokin’ Out Lung Cancer” was the first event sponsored by the UMKC Health Sciences District—a newly formed, premier academic health district made up of collaborating health care institutions on Hospital Hill.
“Truman Medical Centers is proud to be part of this exciting partnership,” Shields said. “The UMKC Health Sciences District is proving to do what it was intended, and that is to improve the health of the community in a variety of ways.”
The UMKC Health Sciences District is a cooperative partnership formed by 12 neighboring health care institutions on Hospital Hill: University of Missouri- Kansas City and its School of Medicine, School of Nursing and Health Studies, School of Pharmacy and School of Dentistry; Truman Medical Centers; Children’s Mercy; Kansas City, Missouri, Health Department; Missouri Department of Mental Health Center for Behavioral Medicine; Jackson County Medical Examiner; Diastole Scholars’ Center; and Ronald McDonald House Charities of Kansas City.
In an age of rapidly advancing technology and conflicting economic forces, it is important to guard against overuse of medical treatments and interventions, according to Pieter Cohen, M.D. He was this year’s William Goodson Jr. lecturer.
Cohen, an associate professor of medicine at Harvard Medical School, spoke Nov. 3 about “Slow Medicine,” the approach he and others promote at slowmedupdates.com. Cohen described Slow Medicine as thoughtful practice that involves patients, relies on the best evidence available and is “applied to help decrease excessive and potentially harmful interventions.”
Relatively high use of medical resources and procedures does not produce better results in many areas, Cohen said. For example, research indicates that 30 percent of U.S. knee replacement surgeries are not appropriate. That’s 200,000 major surgeries a year that should have been avoided, he said, resulting in 14,000 people needlessly suffering serious complications and side effects.
Similarly, aggressively ordering lots of CT scans and other tests can result in other overtreatments, not to mention increased anxiety and other side effects, he said, especially when tests produce false positive results.
Cohen cited research in 1973 by John Wennberg, M.D., author of “Tracking Medicine,” who identified the two main drivers of medical overuse. One is supply, so that adding physicians, specialists and hospital beds to an area will increase its use of medicine. The other is the style of medical practice prevalent in an area.
When Wennberg did his research, it was rejected by the Journal of the American Medical Association. But Dartmouth University then financed Wennberg’s work and started the Atlas Project, which examined patterns of medical use and resource intensity in the U.S.
According to Cohen, Wennberg’s conclusions have been proven correct, and Slow Medicine “digs deeper into the style issue to figure out what we can do better.” By involving patients, fully looking at options and not quickly reaching for a specific diagnosis and treatment, he said, Slow Medicine can improve care.
Economic pressures from pharmaceutical companies and medical device makers can promote overuse of some treatments, while cost pressures can curb others than might be beneficial. Slow Medicine tries to put the focus back on what’s best for the patient, which can end up saving money, but for the right reasons. It also keeps physicians from doing things mainly to make themselves feel better, and can prevent extending a treatment that works for some types of patients to others for whom it really wouldn’t be beneficial.
Cohen said Slow Medicine also can take more effort, to fully explain possible risks and rewards of different treatment choices, so that patients have more information and can know that there’s a good case to be made for more than one treatment option. In the end, more thoughtful, appropriate and caring practice can result.
Slow Medicine also is “about letting go of a specific, certain diagnosis” in favor of a more general assessment and then watchful waiting for signs of a particular ailment or for a clearer indication that treatment is needed. The slower approach often provides time for healing without intervention, he said, or provides the data needed to take the best treatment approach possible.
Cohen was the 31st speaker in the William B. Goodson Jr., M.D., Memorial Lectureship, which was established in 1987 by a group of families, patients, colleagues and friends to honor Goodson’s many contributions to medicine.
More than 400 students from the UMKC School of Medicine, School of Pharmacy, School of Dentistry and School of Nursing and Health Studies have taken part this fall in five interprofessional education sessions of the Missouri Community Action Poverty Simulation.
In each simulation, about 80 students act as people living for a month in poverty. Students are assigned to families and receive a description of their role and goals of the simulation. They work to keep their home, pay all bills, keep their jobs, and feed their family each day. Some students serve as teenagers or young children and are asked to behave as their character descriptions.
Participants receive challenges such as an illness in the family, expenses to repair their plumbing, and getting robbed or fired. Students spend four “weeks” living in poverty. Each “week” lasts 15 minutes. There are stations around the room for students to visit to help meet their goals, such as the employer, a “Foodarama” for groceries, a health care center, child care, community action agency, inter-faith services, social services, and a pawn shop and quick cash business.
The simulation is required for students pursuing M.D., D.D.S. B.S.N., Pharm.D. and P.A. degrees. Doctor of Nursing Practice graduate students help run the simulations along with past participants and volunteer faculty and staff.
The final session this semester took place on Nov. 11.
The challenge of finding the right dosage of medicines for young patients is complex and requires fresh thinking, J. Steven Leeder, Pharm.D., Ph.D., told the audience for the latest installment of the Health Sciences Deans’ Seminar Series.
Leeder, a professor of pediatrics and pharmacology at the UMKC School of Medicine, spoke Oct. 25 in the Health Sciences Building on Hospital Hill on “Exploring Inter-Individual Variability in Drug Response: Moving Beyond the Dose-Exposure Relationship.”
Leeder, who leads the pediatric clinical pharmacology group at Children’s Mercy Hospital, noted that many drugs are initially developed for adults and tested on them, making dosage calculations for children more difficult. On top of that, he said, the typical differences in how people respond to a drug can be magnified in children, given great differences in patient weight and in how rapidly different biological mechanisms in children can change during growth and development.
The maturation of the brain, Leeder said, implies that receptors and transporters affecting drugs’ effectiveness may be changing in children and adolescents, but there’s relatively little research knowledge of these changes.
Given those challenges, he said, it makes sense to invert the usual sequence of “dose-exposure-response”: administering a standard dosage of a drug and then seeing how much of that dosage is present in a patient’s body and how much the patient’s condition responded to the drug. Instead, he favors looking at “response-exposure-dose”: identifying the desired response or therapeutic outcome, and determining the amount of drug that needs to be in the body – the “exposure” — to achieve the desired response. Given that knowledge, he said, then a dosage can be tailored to the patient.
Leader, who practices at Children’s Mercy Hospital, noted that many drugs are initially developed for adults and tested on them, making dosage calculations for children more difficult. On top of that, he said, the typical differences in how people respond to a drug can be magnified in children, given great differences in patient weight and in how rapidly different biological mechanisms in children can change.
The maturation of the brain, Leeder said, means receptors and transporters that affect drugs’ effectiveness must be changing in children and adolescents, but there’s relatively little research knowledge of these changes.
Given those challenges, he said, it makes sense to invert the usual sequence of administering a standard dosage of a drug and then seeing how much of that dosage was used by a patient, and how much the patient’s condition responded to the drug. Instead, he favors looking at the response or outcome that’s desired, and then trying to gauge how well an individual patient’s system will use a drug. Given that knowledge, he said, then a dosage can be tailored to the patient.
Such an approach, he said, might best use the “more information on everyone” being provided by the increase in genomics, bioinformatics and population-wide data from electronic health records.
Leeder holds the Marion Merrell Dow Endowed Chair in Pediatric Clinical Pharmacology and is division director for clinical pharmacology and therapeutic innovations. He earned his pharmacy degree at the University of Minnesota and his doctorate at the University of Toronto. He completed a fellowship in clinical pharmacology at the Hospital for Sick Children in Toronto.
Domestic violence deeply touched the life of Carol Stanford, M.D. ’79, when one of her colleagues was murdered many years ago.
At a Sept. 28 lecture at the UMKC School of Medicine, Stanford shared the story of that crime while exploring what physicians can do about the problem of intimate partner violence.
Stanford, delivering the 2017 Marjorie Sirridge Outstanding Women in Medicine Lecture, said such violence causes “tremendous emotional, social and economic dislocations” and crosses all demographic lines.
To illustrate that, Stanford told about reading a newspaper report of a “Johnson County soccer mom” who had been killed, and her businessman husband arrested. She found out a few hours later that the victim was her nurse practitioner.
“This is real and touches each of us,” said Stanford, associate professor at the School of Medicine. Most victims are women in heterosexual relationships, she noted, but men also can be victimized. Abuse also occurs in same-sex relationships and ones involving bisexual or transgender partners.
According to Stanford, 2 million women in the United States suffer intimate partner violence annually. Of those, more than 300,000 are pregnant women. One-third of homicides stem from intimate partner violence, Stanford said.
In their lifetimes, one in four women and one in seven men will experience severe intimate partner violence. By one estimate, the costs of care and economic loss from intimate partner violence are more than $8 billion a year. A victim’s health care needs can be increased for 15 years after such abuse, Stanford said.
She went on to say that it’s important for physicians to be aware and look for a wide range of physical symptoms that can indicate abuse, along with psychological problems, including depression, low self esteem, anxiety and substance abuse.
“I’ve started asking routinely, ‘Have you ever been abused?’ or ‘Do you feel safe in your relationship?’ ”
Prenatal care calls for particular vigilance, she said, given women’s vulnerability during that time. The safety of children in an abusive household also must be considered and physicians must report abuse if there are minor children.
In educating future physicians, Stanford said that it’s important to include clinical experience with victims, and suggested integrating more education about intimate partner violence into the curriculum. Students are becoming more aware of the issue through their community involvement, such as volunteering at such places as the Rose Brooks Center for domestic violence victims.
Stanford also said it was important for physicians to do their part because to raise awareness and battle domestic violence. An abused partner’s situation can be difficult and complicated, so a physician may provide a confidential ear, limited by the need to report child endangerment. The criminal justice system, a victim’s employer and other institutions simply can’t address the problem alone, she said.
Stanford also provided several resources to aid physicians in referring victimized patients for help.
“I think it’s important that we empower patients, because they are the expert on their own situation.”
As violent as the world is, Stanford says she is optimistic. “I think the key to solving this, ultimately, is gender equity. We need a multi-disciplinary educational approach.”
Stanford is a longtime faculty member and docent, known for her dedication to students and involvement with their activities. She has served as faculty adviser or sponsor for many students groups and programs, including the Gold Humanism Honor Society, the UMKC chapter of the American Medical Women’s Association and Camp Cardiac.
At the lecture she thanked her husband, James Stanford, M.D. ’80, and son, Ian Stanford, both in attendance. She also thanked the several members of the Sirridge family present and praised the late Drs. William and Marjorie Sirridge as giants in the success of the School of Medicine and its “humanistic approach to interacting with patients.”
The Marjorie S. Sirridge, M.D., Outstanding Women in Medicine Lectureship was established in 1997 to recognize her dedication, compassion and advancement of patient care and medical education in Kansas City.
Mike Munger, M.D. ’83, a family physician in Overland Park, Kansas, this month became president of the American Academy of Family Physicians at its annual convention. The academy represents 129,000 physicians and medical students nationwide.
As president, Munger advocates on behalf of family physicians and patients nationwide. The organization fosters education and training, provides other extensive resources for its members, and encourages research and best practices in family medicine to promote health and reduce overall health care costs.
Munger became president-elect a year ago and also has served three years as a director on the AAFP Board.
Munger has been a practicing family physician in the Kansas City metropolitan area for 30 years. He is in practice at Saint Luke’s Physicians Group in Overland Park, where he also serves as vice president of medical affairs for primary care. The group has 105 physician members at 14 different sites, three of which maintain Level 3 medical home designation from the National Committee for Quality Assurance, and 11 of which are participants in the Comprehensive Primary Care Plus Initiative. CPC+ is an outcome of the Center for Medicare and Medicaid Services Innovation Center.
After earning his bachelor of arts and medical degrees from UMKC, Munger completed his family medicine residency at what was then the Goppert Family Practice Residency Program at Baptist Medical Center, also in Kansas City. He is board certified by the American Board of Family Medicine and has the AAFP Degree of Fellow, an earned degree awarded to family physicians for distinguished service and continuing medical education.