The UMKC School of Medicine Community and Family Residency Program has announced that Chadwick Byle, M.D., and Kevin Munger, D.O., M.S., will take on leadership roles as the program’s chief residents for 2017-18.
Byle received his medical degree from the University of Missorui-Columbia. Munger is a graduate of the Des Moines University College of of Osteopathic Medicine.
As chief residents, Byle and Munger will serve as liaisons between program residents and faculty, representing the interests and serving as spokesmen for residents. They also serve as a role model, providing oversight and educational leadership.
Primary care specialties are facing an uphill battle for survival, said John Goodson, M.D., a primary care advocate.
Goodson, an associate professor of medicine at Harvard Medical School and primary care internist at Massachusetts General Hospital, delivered the UMKC School of Medicine’s annual William H. Goodson, Jr., M.D., Lectureship on Oct. 28. John Goodson is the son of William Goodson, who practiced internal medicine in the Kansas City area for more than 45 years.
“I’m really dedicated to the care of my patients,” Goodson said. “That’s what keeps me going in life. The balance of my life is patient care and I will do all that I can to save primary care. That’s why I have become an advocate.”
In 2015, John Goodson established the Cognitive Care Alliance to encourage improved compensation for generalist physicians and to help ensure a highly talented primary care work force for the nation’s future. The alliance has since grown to a force of nearly 109,000 physicians covering the spectrum of primary care specialties, Goodson said.
Goodson said three issues are key to maintaining a strong primary care workforce: training medical students who enter primary care specialties; practice reform, including such things as infrastructure, support, team building and health information technology; and, ultimately, attaining parity of compensation for primary care physicians.
“The healthcare economy is not a free economy by any stretch of the imagination,” Goodson said. “We spend $3 trillion on health care. It’s a huge jobs program and there are many problems. Our job is to ensure that our work is appropriately compensated within this gigantic environment.”
While the complexity of the primary care specialties has increased, he noted that interest in primary care has decreased throughout the years. Goodson said he isn’t sure anyone has the perfect answer, but that the problem is understandable when one compares the compensation for primary care physicians to other specialists who earn much higher salaries.
He called for changes in the way service codes used for billing and reimbursement are defined and valued. Goodson said the playing field is tilted with too few primary care specialists included on the panel of health care professionals that determine those service codes and their values.
“We need to defend the cognitive capabilities of our professions,” Goodson said.
This was the 30th year of the annual lectureship. A group of family, patients, colleagues and friends established the William H. Goodson, Jr., M.D., Lectureship in 1987 to honor his many contributions to the field of medicine in the community. Each year, noted speakers offer scholarly perspectives and information related to internal medicine to current and future practitioners.
The School of Medicine Missouri Delta chapter of Alpha Omega Alpha recently selected 12 new student members who will be inducted into the medical honor society next May.
Selection to the organization is considered an honor recognizing one’s dedication to the profession and art of healing. It is based on character and values such as honesty, honorable conduct, morality, virtue, unselfishness, ethical ideals, dedication to serving others, and leadership. Membership also recognizes excellence in academic scholarship.
Each May, the School of Medicine AOA chapter also welcomes fifth-year students, alumni, residents and faculty inductees who are announced in the spring.
This year’s senior students selected for next May’s induction into the AOA include Himachandana Atluri, Kayla Briggs, Molly Carnahan, Kevin Gibas, Neil Kapil, Susamita Kesh, Deborah Levy, Sean Mark, Luke Nayak, Amina Qayum, Dayne Voelker and Zara Wadood. Two additional sixth-year students will be selected to join the 2017 Class prior to the induction ceremony in the spring.
New members of the organization are invited to participate in an induction celebration that takes place at Diastole.
Orthopedic surgeon Eric Sides initially laughed off Reggie Cook’s idea. Too crazy.
“I don’t understand why you can’t take my left elbow off and put it on my right side,” said the 37-year-old Cook, who lost use of his arms seven years ago after a car accident.
But then Sides thought about the suggestion, and it actually made sense. Cook’s left arm was paralyzed by nerve damage, but the joint was undamaged. The right arm had movement, but the elbow joint had been shattered beyond repair in the accident.
Sides’ thoughts then went to his friend, Lisa Lattanza, considered one of the world’s leading elbow experts. Training together at the University of Missouri-Kansas City School of Medicine led to their close kinship and prominent surgical careers.
Though their orthopedic residencies ended two decades ago and Lattanza is in California and Sides is in Texas, the two remained close. Sides talked to Lattanza about Cook’s unusual request and they came to a conclusion: Why can’t we do this?
They recently joined forces in what’s thought to be the world’s first elbow-to-elbow transplant. The groundbreaking surgery offers a new hope for Cook to live an independent life.
A desperate request
Cook approached Sides, one of the most sought-after orthopedic surgeons in El Paso, Texas, when no other doctor offered options.
In January 2009 after a long night at work, Cook fell asleep at the wheel and crashed. He was in a coma for months. He suffered brain trauma, broke 14 bones in his neck and was left practically a quadriplegic.
Cook’s legs are partially paralyzed and he uses a wheelchair to get around. But his biggest challenge was the loss of mobility in both arms. A nurse came to his house each day to help him change, shower, use the restroom, make him something to eat, brush his teeth. Cook lives with his sister and her family. He credits her, his daughter and dark humor for keeping his spirit lifted.
There have been glimmers of hope before. His left arm is permanently nerve damaged and paralyzed, but an attempt to rebuild his shattered right arm showed promise. In 2013, an artificial joint made of metal and plastic gave him his right arm back —for a few weeks. The delicate joint ripped, a blood clot formed and became infected.
So doctors removed the joint to treat the infection, then reinstalled it. Another infection. Each time the joint was taken out, doctors had to scrape away part of the bone to get rid of the infection, until he had only a few inches of bone in the upper arm, and not much more of the bones in his forearm.
Doctors told him the artificial joint wouldn’t work. They didn’t know what else to do. That’s what led to Cook’s unusual request of Sides that brought in Lattanza, chief of hand, elbow and upper extremity surgery at the University of California, San Francisco.
UMKC School of Medicine Residency
Residents, then and now, divide their time among Children’s Mercy, Saint Luke’s Hospital and Truman Medical Center.
“Through UMKC, the surgeons we worked with were incredible,” said Lattanza, who completed her residency in 1998. “That’s where I learned how to perform surgery. Now I teach residents.”
She and Sides, who was two years ahead of her, were members of a tightknit group. The four-year program had three residents annually.
“We built such a close camaraderie as trainees because it could be so stressful at times,” Lattanza said. “We did battle together.”
“She’s like a sister to me,” said Sides, who completed his residency in 1996. “We would do anything for each other.”
Lattanza and Sides share a similar approach: they love surgery but detest bureaucracy. That the prospect of this surgery was completely out of the ordinary did not deter them.
“We’re doctors and we really want to help other people,” Lattanza said.
Sides accompanied Cook to San Francisco for an array of consultations and for the surgery on April 15 of this year.
A novel surgery
Planning the 12-hour surgery took more than six months. While it might seem like Cook had nothing to lose from the surgery, Lattanza said the surgery actually could have made things even worse for him. He could have lost his right arm. He could have lost the use of his right hand.
On the plus side: a transplant of Cook’s tissue meant no risk of the rejection that might occur with a donor elbow. And actual bone would hold up better than an artificial joint.
On the challenging side: elbows are among the most complicated joints in the body. Knees, shoulders and hips have only one connection where bones meet; elbows have three. And all of the nerves and blood vessels that serve the hand run over the elbow.
Another major complication in this surgery: Moving Cook’s own elbow from the left to right is the mirror image – or reverse – of the one it would replace.
Planning included simulated 3D computer surgery. They then practiced on cadavers to figure out the obstacles when moving the elbow from left to right.
“A big issue was making sure that we did not injure any nerves, which would have altered his hand function and made him worse,” Lattanza said. “Everything was very scarred from his first four surgeries.”
Lattanza compared the surgery and its preparation to choreographing a complex ballet where everyone had precise moves to execute at specific points in time. The troupe was a team of more than a dozen surgeons, nurses and medical technicians. Surgeons performed simultaneously on both sides of Cook.
Due to state licensing restrictions, Sides did not get to scrub in to the surgery, but he participated.
“It was great to be in the operating room again with Eric again,” Lattanza said. “Everyone on the team performed flawlessly and I don’t think I have ever used all my skill and brainpower to this extent. It was exhilarating.”
Although there will have to be a follow-up surgery to reconstruct ligaments, the elbow transplant is so far a success. Cook remains in San Francisco with Lattanza examining him routinely and Sides checks in by phone.
As planned, Cook’s left arm was amputated during the procedure and he nicknamed the stump “Mighty.”
“He’s doing quite well,” Lattanza said. “After 10 days, he bent his arm and he hadn’t done that in seven years. He was quite emotional.”
“We are cautiously optimistic, but he has a long way to go. If the elbow heals and works, he definitely will be better off than when we started.”
Sides, who specializes in adult reconstructive surgery and sports medicine, hopes to team up with Lattanza again.
If Cook’s transplant is successful, it could be a useful example for other patients. Sides said similar procedures could be used on legs or other parts of the body. One application might be a war-wounded veteran.
News of Cook’s unusual surgery has received national media attention. UMKC School of Medicine faculty and their former residency colleagues have celebrated the medical advance.
“It makes me and all of us very proud, because this really is a first,” said Mark Bernhardt, chair of the UMKC School of Medicine Department of Orthopaedic Surgery. “I worked closely with each of them each during their four years, and they were both bright, inquisitive, talented, committed residents.
“Look what teamwork did here. It proved it is a crucial part of patient care.”
Bernhardt announced that Lattanza will be the annual Dr. Rex L. Diveley visiting professor in April 2017 at the UMKC School of Medicine. She will interact and lecture with students and faculty for two days.
In an email, Lattanza wrote to Bernhardt and other UMKC faculty and colleagues.
“Every one of you was there in the operating room with us. We could not have even dreamed or attempted this without the fabulous training and confidence that you all gave us during residency.”
James P. Bagian, M.D., P.E., a physician who developed a program to protect patients from hospital-based harm and a former NASA astronaut who flew two space shuttle missions, presented the keynote address on May 13 at the third annual Vijay Babu Rayudu Quality and Patient Safety Day.
The day-long event gave students, residents, fellows and faculty an opportunity to present their research and learn from experts in the field of patient safety. Following Bagian’s presentation, students and residents gave oral presentations on their work, and presented research posters in the School of Medicine lobby.
Bagian spoke on the need and process for developing and implementing proper procedures to improve patient safety. Currently the director of Center for Healthcare Engineering and Patient Safety at the University of Michigan, Bagian focuses on creating solutions to make health care safer, more effective and more efficient.
Bagian was named one of 50 experts leading the field of patient safety by Becker’s Hospital Review.
He served as the founding director of the Department of Veteran Affairs National Center for Patient Safety and was the first chief patient safety officer for the VA, where he developed numerous patient safety tools that have been adopted nationally and internationally. Bagian received the Innovations in American Government Award in 2001 from the John F. Kennedy School of Government at Harvard for his national program to protect patients from hospital-based harm.
During his 15-year career with NASA, Bagain was the first physician to successfully treat space motion sickness. His approach is now the standard of care for astronauts. He developed a high-altitude pressure suit and other crew survival equipment, and has served as an investigator and medical consultant on two space shuttle accident investigations.
Bagain has led efforts in standardizing pre-hospital combat rescue medical care across all major U.S. Air Force commands and is a founding member of a Department of Defense committee on casualty care that has reduced the mortality rate of service members injured in battle.
Quality and Patient Safety Day is an annual event at the School of Medicine. It it established in memory of Vijay Babu Rayudu, a former student who died in 2007.
The School of Medicine added 21 new members to its Missouri Delta Chapter of the Alpha Omega Alpha Honor Medical Society on May 5 during a celebration at Diastole.
Acceptance into AOA recognizes excellence in academic scholarship and the highest ideals of professionalism in medicine. Members are selected based on their character and values such as honesty, honorable conduct, morality, virtue, unselfishness, ethical ideals, dedication to serving others, and leadership.
Students welcomed into the honor society included four junior members elected this spring: Jasleen Ghuman, Comron Hassanzadeh, Payal Patel and Hima Veeramachaneni. Senior members elected last fall include Vijit Chouhan, Clif Davis, Amanda Fletcher, Katherine Glaser, Amneet Hans, Harika Nalluri, Rehan Nizamuddin, Halee Patel, Loreley Robie, Amit Roy, Chelsea Shapland Hamill, Isadore Tarantino and Keliang Xiao.
Jeffrey Shilt, M.D. ’92, an orthopedic surgeon in Boise, Idaho, was this year’s alumni inductee. Mary Anne Jackson, M.D. ’78, professor of pediatrics and director of infectious diseases at Children’s Mercy, was selected as this year’s faculty inductee. Rebecca Rentea, M.D., pediatric surgery, and Nathan Sanderse, M.D., internal medicine, were the resident inductees.
Four students selected in 2015 as junior inductees served as this year’s AOA student officers. They were Dean Merrill, president; Blake Montgomery, vice-president; Merrill Thomas, secretary; and Setu Patel, treasurer.
Shanta Zimmer, M.D., associate professor of medicine and director of the internal medicine residency program at the University of Pittsburgh was guest speaker at the induction ceremony. Zimmer also delivered this year’s annual AOA Lecture at the School of Medicine.
The School of Medicine chapter of the Gold Humanism Honor Society welcomed the 2016 class of students, residents and faculty members on Jan. 23 during its annual induction ceremony at Diastole.
This is the 13th consecutive year that the UMKC chapter has recognized senior medical students, residents and physician teachers by their selection into the honor society. Those selected are chosen from nominations made by colleagues 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.
Established in 2004, UMKC’s honor society received funding from the Gold Foundation to create a Graduate Medical Education chapter specifically for residents in 2015. Today, the Gold Humanism Honor Society has more than 24,000 members. It recognizes 135 undergraduate medical education and 15 graduate medical education chapters at medical schools throughout the country.
The society was established in 2002 by the Arnold P. Gold Foundation. 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.
Special recognition went to Kim Hartman, M.D., assistant professor of pediatrics, as the 2016 faculty recipient of the Leonard Tow Humanism Award. The award is given annually to one faculty member and one graduating student who demonstrate compassion in the delivery of care, respect for their patients and families, and for their colleages, as well as for demonstrated clinical excellence. The student award will be presented at the School of Medicine commencement ceremony in May.
2016 Gold Humanism Honor Society UMKC School of Medicine Medical Student Inductees Jesal Amin
UMKC School of Medicine Graduate Medical Education Inductees Katie Willet, M.D., Emergency Medicine
Sola Kim, M.D., Internal Medicine
Alexis White, M.D., Obstetrics/Gynecology
Nathan Sanderse, M.D., Internal Medicine
Mohamed Omar, M.D., Internal Medicine
UMKC School of Medicine Faculty Inductees Kim Hartman, M.D., Physical Medicine/Rehabilitation
Rebecca Pauly, M.D., Internal Medicine
Michael Silvers, M.D., Community and Family Medicine
At Mbingo Baptist Hospital, a growing, 310-bed hospital in a rural region of Cameroon, Africa, nearly one in four patients admitted is HIV-positive. Dennis Palmer, D.O., a former UMKC School of Medicine docent, sees it on a regular basis as medical director of HIV/AIDS Care and Treatment at Mbingo.
“It is a very important disease and if you don’t treat it, people die with it,” said Palmer, who presented the 2015 Goodson Lecture at the School of Medicine.
Even in such remote settings, internal medicine physicians such as Palmer have learned how to manage cases of communicable diseases such as HIV and Ebola. But therein lies the rub for health care in underdeveloped regions of the world.
“One of our greatest issues is a shortage of trained physicians of any kind, trained internists, especially, in the developing world,” Palmer said.
To meet the challenge, health care providers in these areas have adopted a concept of task shifting. Lower-level staff takes care of many of the treatment tasks that trained physicians would normally perform.
In Cameroon, as throughout Africa, nurses provide a bulk of the HIV treatment, Palmer said.
Palmer was a docent at the School of Medicine from 1991 to 2004 and also served for a time as deputy assistant dean for years 1 and 2 medicine. In 2004, Palmer left UMKC and the United States to take on the roles of medical director for the Cameroon Project and field director for the North American Baptist Conference in Bamenda, Cameroon.
Nearly 40 percent of today’s health care in Africa comes from missionary medicine, Palmer said.
Eight years ago, he started the Christian Internal Medicine Specialization Program, a four-year internal medicine residency program, at Mbingo Baptist Hospital. Still in a growing stage, the program now has 10 internal medicine residents. Using a case-based curriculum, local faculty and volunteers help with the medical training.
Palmer said recruitment of people into the program has improved, and while he is generally pleased with the progress the program has made, there is still much to be done.
The infrastructure necessary for trained physicians to work at the same level as those in the United States and other developed countries is lacking in Africa. For that reason, Palmer said, many African people leave their country to receive the highest quality of medical training possible, never to return.
“In the end, it won’t be (missionary physicians) who solve the health care problems in Africa,” Palmer said. “It will be the African people who do that.”
The Goodson Lectureship is an annual event that provides perspectives and information related to internal medicine. It was established in honor of William Goodson, Jr., M.D., who served as a docent at the School of Medicine from 1980 through 1982 and practiced medicine in Kansas City for more than 45 years.
School of Medicine residents and students presented 27 posters at the annual Missouri Chapter of the American College of Physicians meetings Sept. 17-20 at Tan Tar A Resort on Lake of the Ozarks. One student and two residents captured the top prizes for their research efforts.
Comron Hassanzadeh, MS 5, received the first prize for student research, and residents Yazan Ghanem, M.D., and Saiprasad Narsingam, M.D., placed first and second respectively with their presentations in the Quality Improvement and Patient Safety division of the resident poster competition.
As winners of the poster contests, Hassanzadeh and Ghanem will be invited to present their posters in competition at the national meeting of the American College of Physicians next May in Washington, D.C.
UMKC School of Medicine Missouri ACP poster contest winners
Student research First prize: Regulation of locomotor activity to amphetamine injection by acid-sensing ion channel 1a and 2 in adult mice, Comron Hassanzadeh, MS 5; Xiangping Chu, MD
Resident research Quality Improvement and Patient Safety division First prize: Improving compliance of guideline-recommended screening measures of health maintenance in TMC-HH Clinics: A QI Project. Sarah Blake, DO; Audrey Bearden, MD; Yazan Ghanem, MD; Amanda Harrell, DO; Rhea Bhargava, MD; Bhaskar Bhardwaj, MD; Reed Cope, MD; Shehabaldin Alqalyoobi, MD; Sood Kisra, MD; Ata Bajwa, MD; John Foxworth, PharmD; Nurry Pirani, MD; David Wooldridge, MD; Reem Mustafa, MBBS/MPH
Second prize: Evaluation of the reporting process of the tests pending at discharge in an academic hospital. Saiprasad Narsingam, MD; Sood Kisra, MD; Samrat Patel, MD; Mihir Brahmbhatt, MD; Asha George, MD; Vritti Gupta, MD; John Foxworth, PharmD
The Hospital Hill Diversity Council will be host to an evening of music, dining and dancing to raise scholarship funds for underrepresented students of color enrolled in the UMKC health sciences schools. The event will take place at 7 p.m. on Sept. 12 at Pierson Auditorium.
This is the third annual Hospital Hill Scholarship Dinner and Dance, and will include a time for networking and a special presention of the Health Care Provider of Color Awards. The awards recognize outstanding commitment and dedication to providing healthcare to underserved populations in the Kansas City metro area.
Last year’s event raised nearly $12,000 for endowed scholarships for students of Africa- American, Hispanic-American, American-Indian, Alaska-Native, Native-Hawaiian, and other Pacific-Islanders heritage.
Music and dancing will follow the awards presentations and dinner.
Space is limited and reservations are required by midnight on Sept. 9. Tickets are $65 per person or $520 for a table of eight. Ticket purchases are tax deductible.