Carilion MedicineSPRING/SUMMER 2019 In partnership with the Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute at VTC

As medical knowledge and technologies grow at exponential rates, education must keep pace. contents CARILION MEDICINE SPRING/SUMMER 2019 Departments 2 FROM THE CMO 3 IN BRIEF A hospital with a new expansion, a medical school with a new leader, a health sciences college with a new name 9 GRAND ROUNDS Education initiatives both classic and with a twist 44 THE ART OF MEDICINE: BEAUTY OF THE BLUE RIDGE  A recent art show celebrated Virginia’s storied mountainous region. 46 CHEERS FOR PEERS 26 Carilion clinicians achieve recognition SKELETON KEY: Artist Jennifer Anderson Printz took the opportunity 48 BACKSTORY: ADVANCING to learn about the human form during “Anatomy for Artists and Other Curious HEALTH IN AMERICA Sorts,” the first Mini Medical School the Leading the American Hospital Association proved Virginia Tech Carilion School of Medicine an unprecedented opportunity to help effect change. offered to community members. BY NANCY HOWELL AGEE

SPECIAL REPORT Building a Better Doctor Features 12 20 26 30 36 40 AMERICA’S NEXT SPECIAL LIFELONG MEDICINE IN HANDLE THERE’S TOP MODEL EFFECTS LEARNING MINIATURE WITH CARE NO PLACE In designing the Virginia Tech Carilion Clinic’s graduate Carilion Clinic’s Continuing Carilion Clinic and its Carilion Women’s new Carilion School of Medicine medical education program Medical Education program collaborators administer office-based treatment LIKE HOME from scratch, leaders were has grown with the region’s is keeping more and more doses of fun, informative program meets pregnant, Family medicine physician able to choose the best ele- needs—and attracted medical professionals at the medical education for opioid-dependent Edwin Polverino thrives in ments of medical education. top physician talent. top of their game. community members. patients where they are. the “medical home” model. BY CHARLES SLACK BY ANITA SLOMSKI BY VERONICA MEADE-KELLY BY MARYA JONES BARLOW BY JESSICA CERRETANI BY LINDA STALEY

COVER ILLUSTRATION: OLIVER BURSTON/DEBUT ART LTD; PHOTOS, THIS SPREAD: DAVID HUNGATE (ABOVE), JARED LADIA (RIGHT) when i was in medical school, the pockets of my short white coat bulged with every manual Carilion Medicine imaginable. Although my neck sometimes ached, President and Chief Executive Officer carrying around what felt like an extra 20 pounds Nancy Howell Agee On the pulse of the was worth it, as the quick access to information Chief Medical Officer and Carilion Clinic community compensated for my lack of knowledge. Over the Executive Vice President years, my coat lightened, but even as a chief resident, Patrice M. Weiss, M.D. my pockets sagged. Editorial Advisory Panel in brief Today, students have plenty of information at Joel Bashore, P.A.-C., Nathaniel L. Bishop, D.Min.; Cesar Bravo, M.D.; John Burton, M.D.; Kimberly their fingertips—but it fits into a small, rectangular Carter, Ph.D., R.N.; Kimberly Dunsmore, M.D.; computer that weighs only a few ounces and can also Daniel Harrington, M.D.; Cynda Johnson, M.D., Carilion Roanoke be used to make phone calls. M.B.A.; Donald Kees, M.D.; Sam Nakat, M.D.; Michael Nussbaum, M.D.; John Pastor; Edwin Memorial Hospital Medical students today don’t have to worry about learning from CD-ROMs Polverino, D.O.; Paul Skolnik, M.D.; Robert or walking home from the library late at night. They don’t have to go to medical Trestman, M.D., Ph.D.; Fidel Valea, M.D. to Expand records to sign off on carts full of charts or to radiology to review an image. Now, Chief Administrative Officer electronic medical records make all the details accessible from anywhere. Jeanne Armentrout Carilion Clinic has announced plans to enlarge the footprint of Carilion Roa- Access to information isn’t all that’s changed about medical education. Four- Vice President Mike Dame noke Memorial Hospital. hour lectures in a large auditorium are a thing of the past. Many lectures are now “This is an exciting day, not just for Executive Editor online, and professors often find themselves addressing sparsely filled halls. And Carilion, but for our entire region,” said Linda Staley with a more case-based curriculum, students begin learning clinical skills from Nancy Howell Agee, president and chief day one, so the facts they’re learning are more immediately applicable. Editor executive officer of Carilion. “After several Paula Byron We didn’t start learning clinical skills until the second semester of our second years of careful planning, we are embark- Editorial Assistant ing on a major expansion that will address year. Our instructor would give us a patient’s name, then we’d pair up with a Tiffany Holland the growing needs of the one million pa- buddy to take a history, perform a physical, write up our findings, and present the Art Director tients we serve and continue the great case. Working with actual patients was so exciting that even when I went home on Laura McFadden momentum happening in the Roanoke weekends, I’d take my stethoscope and otoscope so I could listen to my parents’ Innovation Corridor.” Special Thanks The Roanoke Innovation Corridor is THE FUTURE SERVED UP: A rendering shows the Carilion Roanoke Memorial Hospital hearts and peer into their eyes and ears. My poor parents! Catherine Doss, Mark Lambert, Alison expansion at the location of aging tennis courts no longer in use. Still, I didn’t truly understand the information until I met patients who Matthiessen, Anne Shaver an initiative to build on the partnership between Virginia Tech and Carilion, the were suffering from the conditions I’d been studying. Take sickle cell crisis. I’d CARILION CLINIC merger of Jefferson College of Health and cost more than $300 million. The en floors that will make up Carilion’s memorized facts: I knew, for example, to administer oxygen rather than iron. 1 Riverside Circle P.O. Box 13727 Sciences with Radford University, and project is part of Carilion’s long-term Cardiovascular Institute, enabling all Although I knew the protocols, none of it really made sense to me until I was an Roanoke, VA 24036 Carilion’s investments to accelerate Roa- capital plan to invest at least $1 billion of Carilion’s Roanoke-based heart and OB/GYN resident admitting a pregnant woman in sickle cell crisis. CarilionClinic.org | 800-422-4842 noke’s development as a center for inno- in the region. vascular services to be consolidated into Much has changed over the past three decades when it comes to medical vation and a multimillion-dollar biomed- A new tower, to be built to the south one location. An additional building will education. You’ll read about some of that evolution in this issue, as we explore the ical and technology hub. of the hospital, will consist of two or house the Department of Psychiatry Construction, slated to begin later three floors of parking, an expanded and Behavioral Medicine. innovative ways the Virginia Tech Carilion School of Medicine is incorporating Carilion Medicine is published twice a year at: this year, is expected to take five years Emergency Department, and six or sev- The expansion project will add approx- collaboration, technology, and emotional intelligence into its curriculum. 213 McClanahan Street, Suite 200 imately 400,000 square feet to the med- How do today’s medical students differ from those of my generation? They are Roanoke, VA 24014 ical center. Once completed, the hospital adept with tools we couldn’t have imagined 30 years ago. Many have advanced Phone: 540-266-6586 Fax: 540-266-6608 will have 2.4 million square feet, making Email: [email protected] Medical School Approved Long Term it one of the largest in Virginia. degrees and extensive research experience. Yet the reasons they decided to Web: CarilionClinic.org/carilionmedicine become physicians are the same as those of the students of my day: the The Liaison Committee on Medical for American Medical Colleges and the “We are making real, definitive prog- ress,” Agee said. “New buildings are excit- desire to help others and be part of the healing process. Carilion Clinic is a nationally ranked integrated health Education (LCME) will continue full American Medical Association. care system headquartered in Roanoke, Virginia. Its accreditation for the Virginia Tech Carilion LCME visited the school in Octo- ing; they are a physical representation of flagship, Carilion Roanoke Memorial Hospital, is the the growth and innovation in our region. clinical affiliate of the Virginia Tech Carilion School of School of Medicine for a period of eight ber 2018 to evaluate the educational Medicine and Radford University Carilion (formerly years, the longest term possible. program and any changes made because What happens inside the buildings— Jefferson College of Health Sciences). The LCME, the nationally recog- of the medical school’s integration into the clinical care, the education, the re- © Copyright 2019 by Carilion Clinic. No part of this nized accrediting authority for medical Virginia Tech on July 1, 2018. The LCME search—is even more exciting to me. It’s publication may be reproduced or transmitted Patrice M. Weiss, M.D. education programs leading to the M.D., granted the Virginia Tech Carilion School the work of talented medical, health sci- Chief Medical Officer and Executive Vice President in any form or by any means without written permission from Carilion Clinic. All editorial rights is jointly sponsored by the Association of Medicine full accreditation in 2014. ences, and technology professionals that Carilion Clinic reserved. Opinions expressed herein may or may not is carrying our community forward.” reflect the views of Carilion Clinic. CarilionClinic.org/carilionmedicine

2 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: JARED LADIA RENDERING: COURTESY OF EARL SWENSSON ASSOCIATES CARILION MEDICINE | SPRING/SUMMER 2019 3 leadership

Lee Learman Named Dean Merger Completed Translational Health Grant briefings In Times of Crisis Carilion Clinic and its long-time teaching he integrated Translational Health try that are recognized as elite clinical and of the Medical School Carilion Roanoke Memorial Hospital has arm, Jefferson College of Health Sciences, Research Institute of Virginia translational research institutions. earned national verification from the critical part of the Virginia Tech Carilion finalized their partnership with Radford (iTHRIV) has received a five-year “This grant is an indication of the in- T American College of Surgeons as a Lev- Academic Health Center and the uni- University in July, resulting in the success- grant of nearly $23 million from the Na- novative research happening right here el 1 Pediatric Trauma Center. The desig- versity’s overall vision to improve the ful merger of Jefferson College into Rad- tional Institutes of Health to advance in- in Virginia,” said Nancy Howell Agee, nation reflects the hospital’s expanded quality of life in the communities we ford University. The college’s name is now novative ideas from the point of discov- Carilion’s president and chief executive care for children and the critical nature serve and solve the complex problems Radford University Carilion. ery to implementation in clinical practice officer. “It is an investment that will im- of traumatic injury, the leading cause of of the future.” “Our partnership with Radford Uni- and population health. prove lives across the commonwealth, death for children one year and older. From 2008 to 2015, Dr. Learman versity is not new; it goes back decades, in ITHRIV includes the University of and we are excited to join our partners The center is one of only three Level 1 served as the Clarence E. Ehrlich Professor fact,” said Nancy Howell Agee, Carilion’s Virginia, Inova Health System, Virgin- and peers in discovery.” programs in the state and the only one and Chair of the Department of Obstetrics president and chief executive officer. “Hav- ia Tech, and Carilion Clinic as partners, As individual institutions, the partners in western Virginia. The hospital has and Gynecology at Indiana Universi- ing a name, however, is an important sym- with the Center for Open Science and each have established strengths in bio- been a Virginia-designated adult Level 1 ty. He joined Indiana after serving 14 bol of our work together. It’s a nod to the the University of Virginia’s Licensing & medical and health-related research. Al- Trauma Center since 1983. years on the faculty at the University of future and of more good things to come.” Ventures Group as affiliates. The focus of though individual programs have invested On July 1, Lee Learman, M.D., Ph.D., joined California, San Francisco, where he held a “To mark our growing partnership iTHRIV is to use data to improve health in maximizing research success, iTHRIV the Virginia Tech Carilion School of Medi- joint appointment in the Department of and enhanced opportunities for current among rural and urban populations and is the first cross-state effort in Virginia to Leadership Recognized cine as its second dean. He has also been Epidemiology and Biostatistics. and future students, we chose a strong to leverage data science expertise across integrate broad clinical and translational Modern Healthcare has named Nancy named professor in the school’s Depart- Dr. Learman has authored more name that showcases our critical focus the state. research resources and processes. Howell Agee, president and chief ment of Obstetrics and Gynecology. than 75 peer-reviewed publications and and allows important The NIH Clinical and Translational “We’re delighted to be part of this executive officer of Carilion Clinic, “We’re excited to welcome Dr. Lear- serves as a peer reviewer to more than work to grow in the Science Awards program, which provided transformative initiative in translation- No. 9 on its list of 50 Most Influential man to the Virginia Tech Carilion family,” 15 journals. His own research focuses future,” said Radford the support, enables research teams— al and clinical research,” said Timothy Clinical Executives, an honor that said Nancy Howell Agee, president and on gynecology, obstetrics, and medical University President including scientists, patient advocacy Sands, Ph.D., president of Virginia Tech. recognizes national leaders who are chief executive officer of Carilion Clinic. education. In his medical practice, he Brian O. Hemphill, organizations, and community mem- “This partnership advances our biomed- driving innovation and transformation “His extensive experience makes him focuses on diagnosing and treating Ph.D. “The Radford bers—to tackle significant scientific ical health and sciences enterprise, ex- in health care. For the second time, a great match for us, and I’m confident chronic pelvic pain. family looks forward and operational problems in clinical and pands our ongoing collaboration with the magazine also named Agee to its he’ll continue the momentum we be- Dr. Learman received his bachelor’s to officially welcoming Jefferson College translational research that no one team Carilion Clinic, and strengthens our con- list of Top 25 Women Leaders. “Agee gan with Dean Cynda Johnson.” degree from the University of Califor- of Health Sciences students, faculty, staff, can overcome. nections with colleagues across the com- had a front row seat in 2018 for some Dr. Learman has 25 years of leader- nia, Los Angeles; his M.D. from Harvard alumni, and friends as Highlanders in pre- The national Clinical and Translational monwealth at the University of Virginia of health care’s biggest policy battles,” ship experience in medical education Medical School; and a doctorate in social paring to open Radford University Caril- Science Awards network includes approx- and Inova in a way that will benefit the the description for that honor read. and health care, most recently as the psychology from Harvard University in ion for the upcoming academic year.” imately 60 institutions around the coun- health of all Virginians.” “Not only did she serve as chair of the senior associate dean for academic a program supported by the MacArthur It was in January 2018 that Carilion, American Hospital Association’s board affairs and the senior associate dean Foundation. He completed his residen- Jefferson College of Health Sciences, and of trustees, but she was a leading for graduate medical education at the cy in obstetrics and gynecology at the Radford University jointly announced the voice in her home state of Virginia for Florida Atlantic University’s Charles E. University of California, Los Angeles. intention to merge the college into Rad- expanding Medicaid. Agee has been Schmidt College of Medicine, where he “I’m honored by the opportunity to ford University. The merging institutions a long-time mentor of women leaders was also a tenured professor of obstet- serve as dean of the Virginia Tech Car- came from positions of strength and be- inside and outside of Carilion, where rics and gynecology. Florida Atlantic ilion School of Medicine,” Dr. Learman lieved that by joining forces, they could half the leadership team is female.” University is a newer medical school, said. “In its first decade of existence, it build something even stronger. having opened for its first class in 2011, has built a solid foundation drawing “Even though we are closing a chapter Lasting Tribute one year after the Virginia Tech Carilion on the strengths of both an outstand- on Jefferson College of Health Sciences,” Within just five months of the retire- School of Medicine. ing public research university and an said the college’s president, Dr. Nathaniel L. ment of Cynda Johnson, M.D., M.B.A., a “With his experience as a physician, outstanding private health system. Bishop, “we’re ready to open another that Virginia Tech Carilion School of Medi- researcher, and academic leader, This unique public-private partnership will expand opportunities for those seeking cine fund in her name reached the Dr. Learman is an ideal choice to lead makes the Virginia Tech Carilion School a career in the health sciences.” $1 million mark in gift commitments. VTCSOM, and we look forward to of Medicine uniquely positioned to pre- When Jefferson College of Health Sci- The milestone was met in part with welcoming him to Virginia Tech,” said pare future physicians for the changing ences hosted its final commencement in a finishing gift from Carilion Clinic, Timothy Sands, Ph.D., president of the health care landscape and to become a May, it was a celebration of both its talent- in addition to nearly 150 gifts from university. “The medical school is a national leader in medical education.” ed graduates and the school itself, which individuals. The school created the fund has prepared thousands of health care pro- FROM DISCOVERY TO IMPLEMENTATION: Members of the iTHRIV team gather for an as a permanent tribute to Dr. Johnson’s viders in the community and beyond. organizational meeting in Charlottesville, Virginia. legacy as founding dean.

4 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: RYAN ANDERSON PHOTO: COE SWEET CARILION MEDICINE | SPRING/SUMMER 2019 5 a moment in history

IAMSE Conference Held in Roanoke

n June, the Virginia Tech Carilion ing Across Borders conference, which Making School of Medicine hosted the 23rd attracted nearly 700 health-care pro- IAnnual Meeting of the International fessionals from across North America It Count Association of Medical Science Educators to Roanoke, and felt confident we could (IAMSE), which drew nearly 700 basic accommodate this annual meeting,” Carilion Clinic will participate in science and clinical educators from Dr. Vari said. “I enjoyed bringing my a statewide pilot to reduce the across the globe to Roanoke. peers to the place I’ve called home for the provision of low-value health IAMSE, a nonprofit professional de- last decade and giving them greater expo- care in Virginia. The initiative ACCENT ON velopment society for health professions sure to the Virginia Tech Carilion School will be led by the Virginia Center HEALING: An education, seeks to promote “excellence of Medicine and our key partners.” for Health Innovation, which ambulance delivers and innovation in teaching, student as- IAMSE represents more than 1,000 a young patient to received a $2.2-million grant sessment, program evaluation, instruc- medical scientist educators, both basic Burrell Memorial from Arnold Ventures to launch tional technology, human simulation, scientists and physicians, in almost 50 Hospital in the 1930s; the pilot. Dr. Isaac David Burrell and learner-centered education.” countries. The organization offers pro- Low-value health care in- (below). The IAMSE president for 2018 and gramming to advance health sciences cludes medical tests and proce- 2019—Richard Vari, Ph.D.—also serves education as well as an online peer-re- dures that research has proved as senior dean for academic affairs at the viewed journal. add no value in particular clini- Virginia Tech Carilion School of Medi- “The IAMSE conference was a re- cal circumstances and can lead cine. The school had put in a bid to host sounding success, thanks in part to our to potential patient harm and a the conference in 2020, but IAMSE asked partners, sponsors, and volunteers who higher total cost of care. whether a year earlier might work for the put in countless hours to make it hap- A national dialogue around school instead. pen,” Dr. Vari said. “We broke the IAMSE low-value care has been “The event organizers saw that we record for number of participants, and growing since 2012, when the successfully hosted a large conference the event was another feather in the cap American Board for Internal a few years ago, the 2015 Collaborat- for Roanoke as a conference destination.” Medicine identified more The Legacy of Isaac David Burrell than 550 tests and procedures A doctor helps create a new hospital for African Americans, that should be questioned by but not in time to survive his own medical emergency. providers and patients. Carilion is one of six Virginia health systems and three n the early 20th century, African American ented, well-respected physician needed medical utive officer of Carilion Clinic, recalled a story clinically integrated networks doctors in Roanoke struggled to find suitable help. But he knew he wouldn’t find it in Roanoke. about a critically injured woman who was being participating. Together, these Ifacilities to care for their patients. Talented Instead, he was loaded onto a cot in the transferred from Lexington to Roanoke. groups represent more than 900 physicians like Isaac David Burrell would often back of an unheated boxcar to make the jolting, “The trip was long, and her health was failing practice sites that will join to practice in cramped rooms in houses, with limited 240-mile journey to the Freedman’s Hospital in fast,“ Agee noted in a Roanoke Times op-ed fol- form a large-scale health system access to surgical tools, sterilization equipment, Washington, D.C., where he underwent surgery lowing the city’s declaration of Dr. Isaac D. Burrell learning community targeting and adequate lighting. African American patients for gallstones. Shortly thereafter, he died. Day more than a century after his death. “Fearing the reduction of seven low-val- needing hospital care would be shuttled to Dr. Burrell’s preventable death served as a the worst, the ambulance took her to the closest ue care measures. Charlottesville, Virginia, or Washington, D.C., on catalyst for the opening of a hospital in Roanoke hospital—Burrell Memorial. She wasn’t supposed “Making sensible reforms to lengthy and uncomfortable train rides. for African Americans. In March 1915—a year, to go there; she was white, after all.” our health system that reduce Dr. Burrell and a group of other African Amer- almost to the day, after his death—Burrell Memo- Doctors at Burrell Memorial saved the wom- costs and improve patient care ican physicians recognized the need to provide a rial Hospital opened in a two-story building that an’s life and, when she was stable, they began has been a long-time priority higher level of medical care for the 11,000 African had served as a preparatory school for boys. The arranging her transfer to Roanoke Memorial. for me,” said U.S. Senator Mark R. Americans living in Roanoke at that time. Togeth- hospital, which grew from an initial ten beds and “She didn’t want to leave—everyone at Warner of Virginia. “All eyes er, they set out to create a hospital. two operating rooms, provided care and comfort Burrell Memorial had been so kind and com- are now on Virginia because, if Tragically, Dr. Burrell would never see the to many through the 1970s. passionate toward her,” Agee wrote. ”She was successful, we could serve as a hospital’s completion. One frigid day in the winter In a tribute to Dr. Burrell this past spring, allowed to stay.” national model for improved of 1914, on the eve of his 49th birthday, this tal- Nancy Howell Agee, president and chief exec- (photos continued on next page) value in health care spending.” WELCOME TO ROANOKE: Dr. Richard Vari, president of the International Association of Medical Science Educators, addresses conference participants.

6 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: ALISON MATTHIESSEN PHOTOS: COURTESY OF THE HARRISON MUSEUM OF AFRICAN AMERICAN CULTURE (TOP); CARILION CLINIC ARCHIVES CARILION MEDICINE | SPRING/SUMMER 2019 7 a moment in history grand rounds Education at Carilion Clinic and its affiliates A HOSPITAL TO CALL ONE'S OWN: In 1915, Burrell Memorial Hospital BENCH RESEARCH: Dr. Lamvy Le worked (left, as it appeared in with her mentor, Dr. Zhi Sheng, to investi- the 1920s) took over the gate a promising therapy for patients with building of the Alleghany glioblastoma. Institute, a preparatory school for boys.

structive surgeon, to evaluate the outcomes of patients who had undergone elective car- pal tunnel syndrome surgery. Dr. Le gave two clinical and five poster presentations on her research and was an author on three publications. She was also a recipient of the St. Baldrick’s Foundation Summer Fellowship. In addition to her academic achieve- ments, Dr. Le served as a student leader for various groups, including the Surgery Student Interest Group and the Group on AT THE READY: Ronnell Johnson (left) and Jacquelyn Clark Women in Medicine and Science. She also pose with an infant incubator at Burrell Memorial Hospital in served as president of the Alpha Omega Al- the early 1960s. Before the hospital’s launch decades earlier, African American babies requiring intensive care had to be pha Medical Honor Society. transported to Richmond, Virginia, or Washington, D.C. Dr. Le was an active participant in com- Lamvy Le Named Outstanding Graduating Student munity service activities as a volunteer at Below, Dr. James H. Roberts joins the nursing staff on the the Bradley Free Clinic and the Boys and front steps of Burrell Memorial Hospital, circa 1920. amvy Le, M.D., was named the A first-generation American, Dr. Le Girls Club of Virginia. She was also a leader Virginia Tech Carilion School of Med- spent six weeks on a visiting student mi- in the establishment of the Carilion Cranio- Licine’s 2019 Outstanding Graduating crosurgery fellowship in Taiwan, where she facial Clinic’s Cleft Carnival. Student in recognition of exceptional aca- studied traditional Chinese medicine. “Lamvy has been an exceptional stu- demic achievement, leadership, and service. During her four years of medical school, dent, an outspoken ambassador for the Dr. Le received her medical degree Dr. Le conducted research under the men- school, and an active member of the VTC during the school’s graduation in May. torship of Zhi Sheng, Ph.D., an assistant School of Medicine and Roanoke communi- The tragedy of Upon arriving at the medical school in professor at the Fralin Biomedical Research ties,” said Aubrey Knight, M.D., the school’s 2015, Dr. Le quickly established herself as Institute at VTC. There, Dr. Le helped iden- senior dean for student affairs. “She has a Dr. Burrell’s early an academically gifted student with con- tify and investigate a promising therapy for bright future ahead of her.” death served as siderable leadership potential. She excelled patients with glioblastoma, a common and Dr. Le, a graduate of the University of in the school’s problem-based, patient-cen- aggressive form of brain cancer in adults. Virginia, begins her residency in plastic sur- a catalyst for tered curriculum and earned 11 Letters of In addition, Dr. Le conducted two re- gery at the University of Minnesota Medi- the opening of Distinction, the highest in her class. In ad- search projects in Carilion Clinic’s plastic cal School in Minneapolis this summer. She dition, she was one of two junior inductees surgery section. Along with mentor James looks forward to continuing to be part of a hospital for into the Alpha Omega Alpha Medical Hon- Thompson, M.D., an associate professor of the Virginia Tech Carilion community. African Americans. or Society, a recognition reserved for only surgery and a plastic reconstructive sur- “I cannot imagine going to medical 15 percent of a medical school class. She geon, she identified barriers to care for cleft school anywhere else,” she said. “The fac- was also inducted into the prestigious Gold lip and palate patients and their families in ulty and staff are passionate about craft- Humanism Honor Society, a recognition southwestern Virginia. Dr. Le also worked ing the most innovative and progressive for students who best exemplify humanism with Anthony Capito, M.D., an assistant medical education curriculum and help- and empathy in their medical endeavors. professor of surgery and a plastic recon- ing students achieve their goals.”

PHOTOS: COURTESY OF THE VIRGINIA ROOM DIGITAL COLLECTION, ROANOKE PUBLIC 8 CARILION MEDICINE | SPRING/SUMMER 2019 LIBRARIES (BUILDING) AND THE HARRISON MUSEUM OF AFRICAN AMERICAN CULTURE PHOTO: DAVID HUNGATE CARILION MEDICINE | SPRING/SUMMER 2019 9 future leaders

Combining Medicine with Business ‘Ides of March’ MATCH DAY BY THE NUMBERS No ‘Match’ for the n 2018, Mercedes Robinson, a third-year marketing. An organizational development student at the Virginia Tech Carilion class early in the program gave students in- Class of 2019 MATCH RATE FOR TOTAL NUMBER OF ALL SIX CLASSES STUDENTS MATCHED ISchool of Medicine, set her white coat sight into their own group behavior. The soothsayer’s warning, “Beware aside and picked up a briefcase in order to “Learning my own strengths and the ides of March,” spelled doom for OVER SIX CLASSES pursue a master of business administration weaknesses allowed me to understand Julius Caesar and shook up the Roman through Virginia Tech’s Pamplin College of not only how I can function better within Empire, but it sealed a much different Business. She was the first of her classmates a group but also how I can manage a team fate for the Virginia Tech Carilion 100 to take advantage of this relatively new effectively and potentially an organization School of Medicine’s class of 2019. PERCENT program, developed by both schools, to down the line,” Robinson said. DOUBLE EXPOSURE: Through a combined Continuing the streak from the five 240 give future physicians a set of skills that will Her class of approximately 20 consisted M.D.-M.B.A. program, Mercedes Robinson classes before them, all 37 members was able to take a year off to earn a gradu- allow them to navigate many challenges in of professionals from a wide range of of the class successfully matched to a health care management. careers. Normally a two-year curriculum, ate degree through Virginia Tech’s Pamplin NUMBER OF TOP 5 MOST POPULAR SPECIALTIES College of Business and then pick right up residency program to continue their “Earning an M.B.A. really opened up the combined program for medical where she left off in medical school. education, making their Match Day SPECIALTIES an entire new world for me,” Robinson students allows them to use some of their theme, “Ides of Match,” celebratory REPRESENTED said. “I knew I wanted to go into medical medical school experience to earn credits instead of ominous. leadership and administration. I came and complete the degree in one year. into the rhythm of medical school once I Medical schools across the country away with more foundational business But being a pioneer is bound to have started my clinical rotations.” commemorate Match Day. At the exact skills and a better understanding of how its drawbacks. Although she’s uncertain what same moment, students in the National 36 29 25 23 21 organizations operate.” “The most challenging part for me path she will pursue in medicine after Resident Matching Program open 24 The combined program enabled her to was being the first medical student to graduation, Robinson says she is well envelopes that reveal where they will INTERNAL EMERGENCY PEDIATRICS GENERAL RADIOLOGY MEDICINE MEDICINE SURGERY earn her degree in one year, including a do it,” Robinson said. “There was no one equipped for the future. pursue their residency. This year, more few courses she took the summer prior to to give me insights about the process, “Earning my M.B.A. was not a year than 43,000 medical student applicants starting the fall semester. The curriculum especially with navigating coming back that was wasted,” she said. “I really came vied for only 33,000 positions. NUMBER OF TOP 5 MOST POPULAR STATES AND DISTRICTS included courses in accounting and infor- after taking a year off. It felt like a risk away with gaining so many new skills, “This is the most successful match STATES mation systems, business information at the time, but absolutely one worth a fresh perspective, and a well-rounded in Virginia Tech Carilion School of REPRESENTED technology, finance, management, and taking. Plus, I found that I got right back experience.” Medicine history,” said Aubrey Knight, M.D., senior dean for student affairs, who dressed for the occasion in Roman headdress and toga, in Physician Assistant Student of the Year addition to his signature tuxedo. 34 “Students in this class opened doors For Heidi Rossow, the 2019 recipient of “Within my cohort of just 42 students, for themselves and this school by the Physician Assistant Student of the Year backgrounds range from dietitian to para- matching into world-class residencies, 44 26 17 17 16 Award, a career in medicine is about peo- medic to submarine officer,” said Rossow of particularly programs that are noted VIRGINIA NORTH MARYLAND WASHINGTON, TEXAS ple—their stories and their lives. her program, now part of Radford University as the leaders in their specialty.” CAROLINA D.C. “Not only does medicine allow you Carilion. “Having each other’s experiences CarilionClinic.org/carilionmedicine to genuinely connect with other human to learn from beyond the PowerPoints and beings,” she said, “it also gives you the textbooks has made PA school an even FARTHEST FLUNG RESIDENCY SITE TOTAL NUMBER OF opportunity to make an impact on someone more rewarding experience as a whole.” Seattle, Washington STUDENTS WHO OPT else’s ‘story’ for the better.” Since joining the American Academy of FOR PART OR ALL OF The award—presented by the American PAs, Rossow has served as a reference com- THEIR RESIDENCY Academy of PAs, the national professional mittee scribe for its House of Delegates and 32 AT CARILION society for physician assistants—honors one as a member on four committees. student a year who has demonstrated exem- “While I’m very proud of what I’ve 2,250 NUMBER plary service and leadership. accomplished thus far personally, I’m even MILES OF STUDENT Rossow graduated from the University more proud to have such a large network PAIRS of Florida with a bachelor’s in pre-profes- of inspiring colleagues across the country,” PARTICIPATING IN sional biology in 2015. Two years later, she Rossow said. “These superstar professionals COUPLES MATCHING PEOPLE FIRST: Heidi Rossow finds patient Dr. Aubrey Knight interactions to be the most rewarding part of enrolled in the physician assistant program and students alike inspire me to do better 13 clinical care. at Jefferson College of Health Sciences. every single day for my future patients.”

10 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTOS: RYAN ANDERSON (TOP); AUSTIN RUSSELL PHOTOGRAPHY (LEFT) PHOTO: NATALEE WATERS; INFOGRAPHIC: COMPLEX STORIES CARILION MEDICINE | SPRING/SUMMER 2019 11 In designing the Virginia Tech Carilion School of Medicine from the ground up, the school’s leaders were able to cherry pick the best elements of medical education. BY CHARLES SLACK

12 CARILION MEDICINE | SPRING/SUMMER 2019 ILLUSTRATION: OLIVER BURSTON/DEBUT ART LTD CARILION MEDICINE | SPRING/SUMMER 2019 13 Multiple Mini Interviews The Virginia Tech Carilion School of Medicine uses multiple interviewers to identify candidates who commu- HE VIRGINIA TECH CARILION “WHEN YOU’RE academic affairs at Carilion Clinic. “You’re able to At a time when doctors must stay current with nicate well and can thrive in teams. School of Medicine is one of the nation’s smallest STARTING FROM create something that is different.” dizzying technological and biomedical breakthroughs, medical schools, with an average of 42 students per SCRATCH, YOU HAVE And it’s that word—different—rather than small the need has never been greater for clinicians to be year, andT among its youngest. A BIG ADVANTAGE. or young, that perhaps best describes the school. In sensitive to the human side of medicine. The product Problem-Based, But these facts haven’t stopped the school’s ad- YOU’RE ABLE TO less than a decade since it welcomed its first class of a partnership between Virginia Tech, a renowned Patient-Centered ministrators from taking on a big mission: creating a in 2010, Virginia Tech Carilion has earned national research institution, and Carilion Clinic, a health care CREATE SOMETHING Curriculum new kind of doctor for a new world of medicine. If any- recognition for innovation. The medical school has system with a long tradition of community-based med- The school’s patient-centered THAT IS DIFFERENT.” thing, fledgling status has proved to be a distinct asset. reached for bold, new approaches to every aspect of icine, the Virginia Tech Carilion School of Medicine learning approach promotes “When you’re starting from scratch, you have a —Daniel Harrington, creating new clinicians, from how it admits appli- seems almost uniquely qualified to produce doctors empathy and understanding. M.D., Vice Dean, big advantage,” says Daniel Harrington, M.D., vice Virginia Tech Carilion cants to how it instructs them to how they interact with abundant skills on both sides of that equation. dean of the medical school and vice president for School of Medicine with the community around them. The process begins with the application. Standardized Patient Program Finding the Best Candidates Community members are trained to From the start, the school’s leaders believed that tra- give medical students the practice ditional admissions benchmarks such as academic and coaching they need. grades, standardized test results, and formal inter- views—while important—failed to reveal key char- acteristics about which candidates have not just the Medical Student work ethic and technical skills, but also the human Research Program skills required to be effective clinicians. Across the four-year curriculum, To help admissions officers gauge those vital medical students devote more than qualities, applicants—who now average more than 1,200 hours to research. 4,000 for those 42 annual spots—undergo a “multi- ple mini interview” process, originally developed at Oral Health Program McMaster University in Hamilton, Ontario. Virginia The medical school is one of a hand- Tech Carilion was among the first U.S. schools to rec- ful of schools nationally to incorpo- ognize its advantages. rate oral health into its curriculum. Applicants arrive in Roanoke over a weekend, where they have the opportunity to meet and mingle with faculty members, administrators, and current Interprofessionalism students and learn about the school’s patient-centered Doctors, nurses, physician assistants, curriculum. But the heart of the weekend is a full Sat- and other team members who learn urday of one traditional interview and nine decidedly together work better together. nontraditional interviews. For the nontraditional sessions, applicants rotate through interview stations. At each one, the appli- Ultrasound Technology cants read a brief scenario that evokes a medical or in the Classroom ethical question. They then enter a room to have an The medical school was one of the eight-minute conversation with a member of the com- first nationally to dedicate part of its THE FIRST CUT: The munity to share their thoughts about the scenario. curriculum to ultrasonography. medical school’s shared disaster drills often “The interviewer might be a faculty member, a include practice on minister, a retired physician, a teacher, or a shopkeep- surgical teams. er,” says Dr. Harrington. “That person won’t have seen the student’s CV or background.” All interviewers have

14 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: RYAN ANDERSON CARILION MEDICINE | SPRING/SUMMER 2019 15 an interest in the medical school and are trained in the “WE TEACH CLINICAL begin their journey through the medical school’s interview process. Otherwise, though, the conversa- SKILLS AND CLIN- four “value domains”—basic science, clinical sci- tions are unscripted, without right or wrong answers. ence, research, and interprofessionalism. These ICAL REASONING HANDS-ON LEARNING: Virginia Tech Carilion School of According to Richard Vari, Ph.D., senior dean for form the basis of the school’s approach to medical Medicine students follow a patient-centered, problem-based academic affairs, “This process gives the interview- FROM THE VERY knowledge and clinical skills, woven throughout all curriculum that provides a fully dimensional educational er an inside look into the student’s ability to think FIRST DAY OF four years. experience, with such opportunities as disaster drills (left), quickly, reason through a problem, and perform un- MEDICAL SCHOOL. A central tenet of Virginia Tech Carilion’s edu- practice with standardized patients (below), and work with dental patients (below left). der stress.” IT’S NOT SAVED FOR cational philosophy is developing compassionate Questions and follow-ups can help determine YEARS THREE AND and scientifically minded future physicians, and how, for example, a student responds to being put on one way this happens is through problem-based, pa- FOUR, AS IN SOME the spot—with equanimity, or by becoming combat- tient-centered learning. “We teach clinical skills and ive. All of this amounts to much more than a feel-good SCHOOLS.” clinical reasoning from the very first day of medical exercise in community relations. Applicants who ex- —Richard Vari, Ph.D., school,” says Dr. Vari. “It’s not saved for years three Senior Dean for Aca- cel across the multiple mini interviews can rise to the demic Affairs, Virginia and four, as in some schools.” top of the pool, in some cases ahead of those whose Tech Carilion School Working in groups of seven, students meet three college grades and board scores are better. of Medicine times a week to learn about actual patient cases. The focus at first is on science and clinical diagnosis. When the students are studying the cardiovascular The Human Side of Medicine system, for example, they may be presented with a Once the interviews and the application process case study of a patient dealing with a cardiac or sys- have yielded a carefully chosen class, the students temic vascular condition.

“One of the most important of Medicine, which opened its doors “By examining the case, the students uncover all “COMMUNITY Vital Community Connections aspects of my first year will be to think in 2011. they know about the cardiovascular system—the anat- MEMBERS REALLY Members of the community play an important role in deeply about the strategic planning “I’ve always been attracted by sev- omy, the physiology, the pharmacology,” says Dr. Vari. FEEL LIKE A PART helping students learn how to interact with patients, process for the school of medicine eral elements I see as high priorities “More important, they uncover what they don’t know.” ask questions, and diagnose conditions. The medical OF THE SCHOOL. with broad stakeholder input,” the at the Virginia Tech Carilion School of Over the course of the week, the students re- school’s 10 exam rooms serve as home for the stan- new dean says. He’s looking at how Medicine,” Dr. Learman says. “These in- search the condition on their own, then present back THEY’RE HELPING dardized patient program, where students, starting the school might expand while clude humanism and professionalism to the group, offering one another constructive feed- EDUCATE THE in their first year, examine “patients” simulating con- keeping in place what makes it spe- in medicine, as well as the scientific back on the strengths and weaknesses of their rea- STUDENTS TO ditions the students are currently studying. cial—the individualized attention for basis of medical practice.” soning. After a final team discussion on Friday, next BE BETTER While the standardized patients undergo sig- students, the focus on research and Dr. Learman adds that he appre- comes a crucial step—the chance to meet the actual CAREGIVERS, AS nificant training in order to represent various con- patient-centered learning, and the ciates the school’s emphasis on its patient who has been the subject of the week’s study. ditions, they do not necessarily have medical back- PHYSICIANS, WHEN strong connections to the community. connections with the community. According to Dr. Vari, it’s a chance to drive home to grounds, says Tracey Criss, M.D., associate dean for With 25 years as a leader in medical “A top priority will be deepening my medical students that the enzymes, blood type, heart THEY GRADUATE.” clinical science, years 3 and 4. education, Dr. Learman is no stranger understanding of our community,” he rate, biochemistry, and pharmacology they’ve been —Tracey Criss, M.D., “The program brings a sense to the community to helping young medical schools says, “and by that I mean not only the Associate Dean for analyzing all week add up to someone with a life, a Clinical Science, Years that our standardized patients are part of educating When Lee Learman, M.D., Ph.D., took succeed. He most recently served as Roanoke community, but the larger job, a family, and emotions. 3 and 4, Virginia Tech our students,” Dr. Criss says. “Community members over the helm of the Virginia Tech Car- senior associate dean for graduate community of people who care about Carilion School of “What they’re now exploring is the human side Medicine really feel like a part of the school. They’re helping ilion School of Medicine this summer, he medical education at Florida Atlantic this medical school and want to see it of this patient who happens to have this disease,” educate the students to be better caregivers, as physi- began with the intention of listening. University’s Charles E. Schmidt College grow and succeed.” says Dr. Vari, who adds that less than 5 percent of cians, when they graduate.” medical schools are able to offer patient wrap-ups. As the students proceed through their years, the “It puts the learning of their basic science, clinical simulated situations become more complex, testing reasoning, clinical skills, research, and interprofes- both their medical acumen and their ability to han- sionalism in the construct of a real human being.” dle delicate and often emotional situations, includ- “It’s a wonderful way to learn,” Dr. Harrington ing issues involving quality and safety. Dr. Criss de- says. “Our students have thrived with this model.” scribes one scenario in which a student must inform

16 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: RYAN ANDERSON PHOTOS: RYAN ANDERSON (LEFT TOP AND BOTTOM); JARED LADIA CARILION MEDICINE | SPRING/SUMMER 2019 17 a patient and a family member that, due to medical “WE THINK WE’RE “Medical education was not keeping up with error, a chest tube has been inserted on the wrong PUTTING OUT SOME- the scientific revolution in the biomedical science side of the body. In the tenseness of the moment, the space,” he recalls. “There has been a revolution in THING THE COUNTRY fact that the patient and family member are playing molecular biology, molecular genetics, neuroscience, roles seems not to matter. BADLY NEEDS. EVEN computational bioscience, and other areas. Even as “Our students don’t know, when they walk in the WITH ALL THE NEW advances were profoundly influencing how medical room, how that simulated patient and family mem- ALGORITHMS AND conditions are diagnosed, medical schools were still ber are going to react,” Dr. Criss says. “Sometimes ELECTRONIC MED- teaching medical students the same old way.” they respond with calmness and sometimes with ICINE, ELECTRONIC Dr. Friedlander saw the opportunity to help forge fear, anxiety, and anger. Students have to sponta- new approaches to teaching at the foundational level HEALTH RECORDS, neously react to the emotions of that patient.” of the nascent school. AND COMPUTATIONAL “From day one, students are exposed to pos- CAPABILITIES, WE sibilities for doing research,” he says. “They meet Research as a Core Requirement NEED PEOPLE WHO researchers from the Fralin Biomedical Research Research, something not always prioritized at other UNDERSTAND THE Institute and the main Virginia Tech campus in THE HEART OF THE MATTER: schools, plays an integral role at the medical school. SCIENCE OF MEDI- Blacksburg, research–oriented physicians from Car- Regardless of the medical specialties they hope to ilion Clinic, and leading scientist physicians who As a medical student, Dr. Vu CINE AND ARE READY Phan spent countless hours in pursue, all students must become “scientist physi- visit from across the country to present the latest FOR THE NEXT BIG a Fralin Biomedical Research cians”—a term coined by Michael Friedlander, Ph.D., advances while aligning with the students’ current Institute laboratory studying senior dean for research at the medical school, to de- CHANGES.” classes and patient case presentations.” the mechanisms of how viruses scribe both the primacy of the doctor’s calling and —Michael Friedlander, The results have been impressive, with students cause the heart tissue inflam- the essential role that research plays in it. Ph.D., Senior Dean involved in nearly 60 published papers and more mation known as myocarditis. for Research, Virginia He is now pursuing a psychiatry Research is central to all four years of training, to- Tech Carilion School than 250 presentations at regional, national, and residency at Hahnemann Uni- of Medicine taling more than 1,200 curriculum hours. In years 2 even international medical meetings. versity Hospital in Philadelphia. through 4, each student is allotted $1,000 a year for “We think we’re putting out something the coun- supplies, and each is expected to produce an original try badly needs,” Dr. Friedlander says. “Even with all research project starting in the first year, culminating the new algorithms and electronic medicine, elec- with a final manuscript of publishable quality in the tronic health records, and computational capabilities, lessons in teamwork and empathy move beyond the “THEY’RE PAYING A The school is also one of the few in the country to fourth year. we need people who understand the science of medi- confines of medicine. As one part of the program, for LOT OF ATTENTION make oral health part of the curriculum, thanks to phil- The need for that emphasis may seem obvious for cine and are ready for the next big changes.” example, students work together to prepare nutritious TO THE PATIENT, AND anthropic gifts and a partnership with Delta Dental of someone bound for a career at a major teaching hospi- meals for needy members of the Roanoke community. Virginia, amid growing awareness of the key role that AT THE SAME TIME tal. But why so for someone hoping to serve as, say, a In one of the most intensive exercises, the medical oral health plays in a patient’s overall well-being. primary care physician in rural Virginia? As Dr. Fried- Learning Across Professions students work with students in other health profes- THEY’RE GATHER- The drive to innovate is sure to continue under lander sees it, training students in a scientifically rigor- Even as Virginia Tech Carilion strives to create supe- sions on disaster drills. Administrators may simulate ING INFORMATION Virginia Tech Carilion’s new dean, Lee Learman, M.D., ous context aims to create a more complete clinician. rior individual clinicians, a key driver of the school’s the aftermath of a serious interstate accident, a terror- FROM OTHER TEAM Ph.D., who sees the school’s size and youth as major ad- “You approach all your patients and all medical educational philosophy is that no doctor is an island. ist attack, or a natural disaster. Students, given pieces MEMBERS. WHAT YOU vantages in advancing the mission of innovation guid- situations from a human perspective, but also from Studies have shown that flawed communication of information, must respond in real time, assess the SEE IS STUDENTS ed by its goals to create new doctors for a new world. a rigorous scientific perspective,” says Dr. Fried- among health care professionals accounts for some condition of trained “patients,” and, most of all, work Where will this grand new experiment in medi- RECOGNIZING THE lander, who also serves as executive director of the 70 percent of medical errors. together to solve problems and save lives. cal education ultimately lead? Ever the researcher, Fralin Biomedical Research Institute at VTC. “You With that in mind, the school became the first in “They’re paying a lot of attention to the patient, and VALUE OF THE TEAM Dr. Friedlander says, “We don’t have enough data are versed in the most contemporary scientific un- the country to integrate interprofessionalism across at the same time they’re gathering information from APPROACH.” yet.” It may take 15 or 20 years to determine whether derstanding of the patient’s condition, and you have its entire, four-year curriculum. In conjunction with other team members,” says Dr. Criss. “What you see is —Tracey Criss, M.D., Virginia Tech Carilion’s innovations are truly helping actually done biomedical research. Moreover, when another pioneer in adopting shared learning—Jeffer- students recognizing the value of the team approach.” Associate Dean for to produce better clinicians. But what he does hear Clinical Science, Years you don’t know the most scientifically validated ap- son College of Health Sciences, now known as Radford 3 and 4, Virginia Tech are stories—and they’re great. proach to a particular issue, you have the skills, con- University Carilion—future doctors study with tomor- Carilion School of “We hear wonderful, wonderful things,” Dr. Fried- Medicine fidence, and knowledge to find that information and row’s nurses, physician assistants, and allied health Innovation Across the Board lander says. “Our graduates are star residents in their deploy it on your patient’s behalf.” professionals. “They’re learning roles and scopes, con- These creative approaches to medical education fos- programs, highly regarded by the physicians mento- Dr. Harrington adds, “By the time students grad- flict resolution, and team-oriented best practices,” says ter a spirit of innovation that permeates the school. ring them. And residents from other medical schools uate, they understand how to ask questions and are Dr. Vari. Teamwork, he notes, increasingly personifies In 2010, for example, Virginia Tech Carilion, with are wowed not only by their knowledge, but also their skilled in finding the answers.” “the art of medicine and the practice of medicine.” the support of Sonosite, Inc., integrated advanced ability to move facilely between scientific discovery and That idea dates back a decade or more, when The students examine ethical dilemmas in health portable ultrasound machines into the curriculum, the delivery of quality clinical care.” Dr. Friedlander, then a faculty member at the Baylor care, approaches to leadership, and strategies for enabling students to master an evolving technology Dr. Learman agrees. “I anticipate that, over the College of Medicine, served on a national task force overcoming personal biases and other issues. that will be essential to their ability to offer patients next decade, we will go from being one of the most of the Association of American Medical Colleges and “It’s preparing them for the real world of health care the best care. In 2018, the school purchased newer, outstanding new medical schools,” he says, “to one the Howard Hughes Medical Institute dedicated to where they’re going to have to work with colleagues state-of-the-art portable ultrasound equipment to of the most outstanding medical schools in the the scientific foundations of future physicians. who aren’t physicians,” Dr. Vari says. In some cases, enhance the students’ mastery of the skill. country, period.” CM

18 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: RYAN ANDERSON CARILION MEDICINE | SPRING/SUMMER 2019 19 As its graduate medical education program grew and adapted to meet the region’s needs, Carilion Clinic became a magnet for top physician talent. BY ANITA SLOMSKI

IN 1971, WHEN ROANOKE MEMORIAL HOSPITAL established one of the nation’s first family practice residencies, it was embracing the need for a new kind of physician who could help alleviate a dire shortage of primary care doctors while providing better, more holistic care. At the time, Roanoke had far too few general practitioners to go around, and many people in the community had little choice but to go to the hospital’s emergency room for routine medical care. MAKING THE ROUNDS: Family medicine, recognized as a specialty just At the same time that two years earlier, seemed like just what the doc- residents at Carilion Roanoke Memorial tor ordered. Family physicians would serve as the Hospital learn from their hub of a patient’s care, providing most of it them- attendings, they challenge selves, emphasizing prevention, and coordinating them to become even better teachers.

20 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: JARED LADIA CARILION MEDICINE | SPRING/SUMMER 2019 21 referrals to other specialists. But to train this new “THE RESIDENT AND patients the welcome news that they could be part a specialty, part of that training called for family kind of doctor in outpatient medicine as well as in the I SEWED LACERA- of the new practice. Making appointments would be practice residents to take shifts in the ER. If they business side of running a medical practice, Roanoke TIONS ALL NIGHT, much more convenient, waits would be shorter, and needed help, they would call their faculty mentors, Memorial needed to create something entirely new. SPLINTED BROKEN they would be able to establish relationships with and Dr. Amos remembers a July 4 boating accident It established the Family Practice Center, a medical BONES, AND ADMIT- their own personal doctors rather than seeing what- that landed eight people in the ER. office carved out of the hospital’s warehouse. TED THOSE WITH ever physician happened to be on duty in the emer- “The resident and I sewed lacerations all night, “The heart and soul of the family practice res- INTERNAL INJURIES.” gency room or in the hospital’s outpatient clinic. splinted broken bones, and admitted those with in- idency was this model unit, which was only the —Francis Amos, M.D., Yet family medicine was so new a specialty that ternal injuries,” he says. “Working in the ER was an First Graduate of second such family medicine practice in the state,” the Family Practice Dr. Amos and directors of the handful of other fam- incredible learning experience for our family prac- recalls Francis Amos, M.D. The first graduate of the Residency, Carilion ily practice residency programs nationwide had few tice residents.” hospital’s family practice residency, Dr. Amos be- Clinic guidelines to follow. Often they would gather at the came associate director of the program. American Academy of Family Practice’s headquar- To jumpstart the Family Practice Center, Dr. Amos ters in Kansas City to swap ideas on how best to A Magnet for New Physicians combed the hospital’s outpatient records and gave train residents. With emergency medicine not yet But Carilion Roanoke Memorial’s pioneering work in family medicine was just one of many efforts, be- gun in the 1930s, to give new doctors the skills they needed to provide high-quality care to the communi- ty. Continuing that tradition, last summer Carilion Clinic, which now includes Roanoke Memorial as well as six other hospitals, welcomed 300 physician trainees to 26 residency and fellowship programs. During their training, these new residents and fel- lows will play an essential role in serving the health system’s one million patients in southwestern Virgin- ia and southern West Virginia. They’ll also be trained least a hundred interactions with center was doing anything like it,” says according to standards set forth by the Accreditation patients who were seriously ill or Dr. Simonds. Council for Graduate Medical Education. dying. Conflicts with coworkers were Soon, other Carilion residency “Training requirements for accreditation are now common, and the residents rarely programs were consulting with big documents, not the few pages that existed when I heard a word of praise. Dr. Simonds and Dr. Sotile, and in was a resident in the mid-1980s,” says Donald W. Kees, The survey responses confirmed 2015 the two published a guidebook M.D., vice chair of pediatrics and designated institu- Dr. Simonds’ suspicion that residency of their techniques, which mostly tional official for graduate medical education at Caril- was taking an unnecessarily heavy toll involve small adjustments in attitude ion. “All programs now have common training require- on these doctors’ lives. and outlook. Yet the changes seem to ments that govern such issues as the number of hours “Rather than assume that resi- make a big difference in how residents a resident can work, patient safety standards, and how Nine years ago, neurosurgeon Gary dents just needed to toughen up,” perceive their training. residents, faculty, and programs are evaluated.” Simonds, M.D., was worried about the Dr. Simonds says, “I wanted to change “Physicians are so focused on Many residents and fellows who have trained at seven residents in the neurosurgery our approach and arm them with taking care of patients that they fail to the health system’s hospitals stay on after they com- training program at Carilion Clinic. techniques to mitigate the burden.” recognize when they’re overstressed plete their training, joining Carilion’s medical staff Dr. Simonds, who established the So, in partnership with clinical and fatigued,” says Dr. Simonds. and establishing practices in underserved areas. residency program in 2006 and psychologist Wayne Sotile, Ph.D., an Today, thanks to this training, “Every year, about 30 percent of our trainees ran it until his retirement this year, expert on resiliency and physician Carilion’s neurosurgery residents remain with Carilion when they finish residency or knew these young physicians were work/life balance, Dr. Simonds seem happier and less stressed. fellowship,” says Dr. Kees. “Compared with other under constant stress, and when he instituted monthly meetings with the Once subject to complaints from rural areas, we have a large number of primary care asked them to keep a tally of what residents and the entire neurosurgery coworkers and patients for being doctors and specialists available to our patients.” happened to them in a typical day, the team to develop and practice short-tempered and abrupt, now they Over the past several years some difficult-to-re- results were eye-opening. techniques for coping with stress. get compliments, and they’ve been cruit specialists—including, for example, two child During each night on call, a “That Carilion supported and recognized as the best consultants in psychiatrists and an addiction medicine psychia- resident might need to handle scores encouraged this intensive effort to the emergency room. trist—have stayed to practice in the region after of urgent phone calls, and a week improve resident well-being was “They are light-years from where training at Carilion. The neurosurgery residency has in the hospital often included at unprecedented; no other medical they once were,” says Dr. Simonds. brought four additional neurosurgeons to the com- munity. Several graduates of the emergency medi- cine residency, a comparatively new addition to the PIONEERS IN FAMILY MEDICINE: The Family Practice Center hospital’s offerings, have chosen to practice at Caril- (above), within view of Roanoke Memorial Hospital, opened its doors in ion, eliminating the need for locum tenens emergen- the 1970s. Dr. Francis Amos (pictured in 2015), the first graduate of the cy physicians in some of the system’s hospitals. family practice residency, became associate director of the program.

22 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: JARED LADIA PHOTOS: CARILION CLINIC ARCHIVES (TOP RIGHT); COPYRIGHT, THE ROANOKE TIMES, REPRINTED BY PERMISSION 23 At the same time, the residency programs have “IF WE DIDN’T and 1961. In 1968, the hospital created a one-year “Training those additional physicians affects our well-prepared to practice medicine when they join drawn many accomplished practicing physicians to HAVE RESIDENTS general practice residency and the general surgery bottom line,” says Dr. Kees. “But Carilion is commit- clinical settings.” the Roanoke area. They come expressly for the op- AT CARILION, WE residency program expanded to four years. ted to providing the region with high-quality prima- And just as trainees emerge from their time at Car- portunity to train young physicians. Then came the family practice residency. The ry and specialty care.” ilion’s hospitals as better doctors, having been educat- WOULDN’T HAVE THE “If we didn’t have residents at Carilion, we wouldn’t hospital, as a leader in the new specialty, had no And the residents and fellows continue to repay ed by a multitude of specialists and subspecialists, the have the quality of faculty that we have,” says Daniel QUALITY OF FACULTY trouble recruiting physicians. that investment handsomely. faculty benefit as well, with residents and fellows chal- Harrington, M.D., vice president for academic af- THAT WE HAVE.” “We were in demand from the very beginning, “I’m so impressed with the caliber of physicians lenging them to become better teachers and commu- fairs at Carilion and vice dean of the Virginia Tech —Daniel Harrington, because there were so few family practice residency entering residency and fellowship programs to- nicators, adds Dr. Harrington. And most important, Carilion School of Medicine. Dr. Harrington, who M.D., Vice President programs,” says Dr. Amos. “And even though family day,” says Dr. Harrington. “As U.S. medical schools patients benefit from better and safer care when all of for Academic Affairs established a psychiatry residency at Roanoke at Carilion Clinic and practice residency programs at university medical have increased the standards required for grad- their physicians are at the top of their game. CM Memorial in 1990, led graduate medical education Vice Dean of the centers had prestige, many young doctors preferred uation, these doctors have become increasingly CarilionClinic.org/carilionmedicine Virginia Tech Carilion at the hospital for many years before taking his cur- School of Medicine to come to Roanoke Memorial because community rent position. hospitals were a better fit for the medical experience Residents and fellows also affect the quality of and type of patients they wanted to care for.” care for Carilion patients through the research they Another drawing card for Roanoke Memorial was conduct as part of their training. Most residents par- that the hospital’s specialists eagerly participated in ticipate in quality and patient safety research projects teaching family medicine residents, and generalists with a faculty mentor. In recent years, those projects practicing in the community routinely volunteered have resulted in quality improvements such as put- days off to train the young doctors in the Family ting alerts in electronic health records to prevent the Practice Center. ordering of MRIs for patients with pacemakers and “Those senior physicians had invaluable experi- standardizing the placement of inferior vena cava fil- ence and guided the residents, seeing patients right ters in patients at risk of blood clots. alongside them,” says Dr. Amos, who continued to Some residency programs and all fellowship pro- supervise residents once a week after he established grams at Carilion also require research in the physi- his own practice in Rocky Mount, 30 miles south of Virginia,” recalls Dr. Berry, who retired 36 residents completed the program: cians’ medical specialties. Joshua Eikenberg, M.D., for Roanoke. In anticipation of Dr. Amos’ retirement in in 1992 as the longest serving director two in plastic surgery, two in thoracic example, recently received national recognition for a 2014, a Carilion family medicine resident joined the of a residency program at the hospital. surgery, and the rest in general study he conducted of patients who had undergone practice to help smooth the transition. The program also trained the first surgery. In addition, two physicians Mohs surgery for their skin cancer. The dermatology woman in a Carilion general surgery finished vascular fellowships. resident found that physicians’ perceptions of their residency; she completed her training Established as a tribute to Dr. Berry’s patients’ pain influenced their opioid-prescribing prac- A Continuing Commitment in 1978. dedication to training the surgeons tices and that patients who received opioids were no The creation of the Virginia Tech Carilion School Dr. Berry was recruited to launch of tomorrow, the Dr. Robert Berry more satisfied with their pain treatment than those of Medicine, started in 2007 and opened in 2010, the hospital’s new surgical residency Resident Education Fund recognizes who did not receive the addictive painkillers. solidified Carilion’s path toward becoming a major program in 1971. Previously he had outstanding residents for their academic medical center. The system’s hospitals have served as director of medical education contributions and participation in the continued to add faculty and have expanded into at Methodist Hospital in Philadelphia, surgical residency program. Supported A History of Education and Service new areas of subspecialty care. and he had been a medical missionary by faculty members and surgical The first interns at Roanoke Memorial Hospital -ar “Between 2006 and 2007,” says Dr. Harrington, in Nepal for four years. He recalls residency graduates, the fund supplies rived in 1933, but it wasn’t until 1946 that the Ameri- “we had phenomenal growth in the number of resi- performing that country’s first heart books and curriculum materials to can Medical Association, then the accrediting body for dency and fellowship programs we offered.” surgery and tending to climbers who residents and makes a $2,500 award graduate medical education, put its stamp of approv- Yet Carilion’s continued development of residency were injured on Mount Everest. each year to enable a resident to al on the hospital’s internship program. At the time, and fellowship programs has required an exceptional During his 20-year tenure as director At Carilion Roanoke Memorial attend a national medical conference. general practitioners could hang a shingle for their commitment to the mission of educating physicians. of Carilion Roanoke Memorial Hospital, every resident who Dr. Berry’s insistence on clinical own practices after a one-year hospital internship. The primary funders of graduate medical education— Hospital’s surgical residency program, completed surgical training under his excellence and compassionate World War II had emptied medical schools, and the Centers for Medicare & Medicaid Services and the Robert E. Berry, M.D., oversaw many tutelage achieved board certification, patient care remains a hallmark of practicing physicians were called to active duty, Veterans Administration—subsidize residents’ salaries surgical firsts. and at the time of Dr. Berry’s the surgical training program he leaving Roanoke Memorial with just nine staff doc- and pay hospitals to train young physicians. In 1997, “We did the first arterial pressure retirement in 1992, the residency established. It’s part of his lasting tors and interns during the war. By the late 1940s, though, CMS capped the number of residency positions measurement, the first shunts for renal program had become so well-known legacy, carried on at Carilion Roanoke the hospital had four interns who were paid $90 to it would support at each hospital, leaving the institu- dialysis, the first duplex scans, the first and respected that it was receiving Memorial Hospital and by the $150 a month, plus room, board, and laundry. tions to cover the cost of any additional residencies. dual-chambered cardiac pacemaker, 300 applications annually from young hundreds of surgeons he helped In the 1950s, as medicine became more so- Carilion stepped into the breach, and today, and the first parathyroid transplant in doctors around the country. That year, train over two decades. phisticated and specialized, hospitals created resi- when those 300 new trainees start working at Car- dencies to extend and deepen the training of new ilion this summer, the government will fund the doctors. Roanoke Memorial established residency training of only 190 of the residents and fellows. programs in surgery, pathology, internal medicine, Carilion will pay the remaining 110 physicians’ sala- and “crippled children’s orthopedics” between 1956 ries and training costs.

24 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: CARILION CLINIC ARCHIVES CARILION MEDICINE | SPRING/SUMMER 2019 25 Traditionally designed to keep physicians at the top of their game, Carilion Clinic’s Continuing Medical Education program is reaching more medical professionals than ever. BY VERONICA MEADE-KELLY

A DOZEN YEARS AGO, A COLLEAGUE womb during pregnancy. Yet its use in approached Apostolos (Paul) Dallas, medical practice is far-reaching. Since M.D., Carilion Clinic’s long-tenured its introduction in the United States in director of Continuing Medical Educa- the 1960s, ultrasonography has been tion, and made what was, to Dr. Dallas, adopted by fields as disparate as cardio- an intriguing observation. vascular medicine, urology, emergen- “You know, nobody’s teaching por- cy medicine, and dermatology to help table ultrasonography in the United make diagnoses and guide treatment. States,” Dr. Dallas recalls the colleague And, by ditching cumbersome ma- saying. “I think we can be the first peo- chinery for more mobile, handheld de- STEPS IN THE RIGHT ple to teach it.” vices, portable ultrasonography has DIRECTION: Continuing medical Ultrasonography, a technique that opened up more applications for this education courses ensure that uses the echoes of soundwaves to cre- providers receive training on the powerful tool. The portable devices can latest assistive devices, such as ate images of what’s inside the body, is be dispatched in the field quickly— ReWalk, a wearable robotic exo- perhaps best known for helping obste- inside or outside the hospital—making skeleton that helps people with spinal cord injuries stand, walk, tricians track what’s happening in the them especially useful in critical care and climb and descend stairs.

26 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: JOE CASTIGLIONI CARILION MEDICINE | SPRING/SUMMER 2019 27 and emergency medicine, where cases are delicate or “While it may be imperceptible to them, CME zational support, opportunities for networking and life-threatening and time is of the essence. matters to patients,” Dr. Whicker says. “They expect collaboration, and recognition for medical experts Apostolos (Paul) Dallas, M.D. The notion that portable ultrasonography devic- the level of expertise that CME helps provide. When whose educational roles are too often overlooked. es, which were widely available by the late 1990s, they come in, they expect their physicians and health It’s hoped that some additional CME program- were not being used to their full potential because care team to have answers. While providers are nev- ming might continue to come out of the collabora- of a lack of training was disconcerting. And it’s ex- er going to be all-knowing, it’s absolutely critical for tions and training provided by the academy. Still actly the type of gap that CME, which is designed them to stay up with the latest technologies and in- more stems from existing trainings offered by indi- to keep physicians updated on the latest technologies formation so they can provide the best possible care.” vidual departments. and practices, was meant to address. To Dr. Dallas, it “One would hope that if you’re educating a physi- “Almost every department has a requirement to was a perfect opportunity for Carilion doctors to fill cian on a new technique or practice,” Dr. Dallas adds, teach residents and fellows. If their trainees can ben- an unmet need in medical education. “then on the very next opportunity the physician has efit from it,” Dr. Dallas says, “then we ask: why not “It’s one thing to do something that everyone to see a patient with a relevant condition, there’s the make it so other physicians can benefit from it also else is doing and try to do it incrementally better,” potential that the patient will benefit.” and get CME credit?” Dr. Dallas says. “It’s another thing to do something He offers the emergence of new medications Additionally, Carilion’s CME program offers various no one else has done. It was exciting.” as an example. If a physician learns during a CME conferences and symposia, including a spring sympo- course that a new anticoagulant has come onto the sium that has, for the past 70 years, offered a concen- market that causes less bleeding and is better at pre- trated mix of interdisciplinary training for interested There’s Always More to Learn venting clots than older therapies, then that doctor Carilion physicians. Mandatory CME programs began to pop up across can immediately switch patients to the better agent. “We conduct regular needs assessments to see the United States back in the 1930s, once it was rec- Similarly, if physicians learn that a new antibiotic is where our gaps are and what our faculty and profes- ognized that the initial training of physicians wasn’t available, they’ll know they can prescribe it if other sionals need to learn more about,” Dr. Whicker says. enough to sustain them through their long careers. treatments fail. “Once we establish what those needs are, we seek ex- “ALMOST EVERY Carilion faculty also teach courses nationally Patients would be better served, it was thought, if Carilion’s portable ultrasonography course pro- perts who can provide that training internally and, if DEPARTMENT HAS that weren’t developed through the CME program, their doctors continued to learn over the years. vides additional instances. Dr. Dallas notes that one necessary, we’ll bring in outside experts to fill those A REQUIREMENT TO yet depend on a faculty member’s unique expertise. That philosophy has proven ever more relevant as student used the tool days after taking the course to gaps. This is true when it comes to teaching, as well as TEACH RESIDENTS Joseph Moskal, M.D., chair of Orthopaedics, for ex- the responsibilities of modern physicians have mount- “WHILE IT MAY BE identify the location of a dangerous clot. Another a variety of other developmental needs that reach our AND FELLOWS. IF ample, teaches courses on an anterior approach for ed. Physicians today not only care for the sick and IMPERCEPTIBLE TO diagnosed fluid buildup around the heart of a woman physicians and other health care providers.” THEIR TRAINEES CAN total hip replacement surgery that he helped pioneer. injured, but also find themselves with additional re- THEM, CME MAT- who was suffering from low blood pressure. Dr. Whicker adds that topics include basic re- BENEFIT FROM IT, Surgeons from across the globe have visited Carilion sponsibilities, most often as teachers, administrators, TERS TO PATIENTS. “There have been cases,” he says, “where a physi- search, quality improvement, communication skills, THEN WE ASK: WHY to learn the procedure, which allows access to the hip researchers, and advocates. Learning all these skills— WHEN THEY COME cian has been able to help a patient in a significant team-building, well-being, and anything else that NOT MAKE IT SO socket without cutting through major muscle groups, on top of those needed to treat patients—would be IN, THEY EXPECT way by having attended one of our CME courses.” will improve the patient and learning experiences OTHER PHYSICIANS potentially speeding recovery. Dr. Moskal has also impossible during the relatively short term of medical THEIR PHYSICIANS throughout the organization. CAN BENEFIT FROM taught the technique in Europe. training. And new information and procedures always AND HEALTH CARE IT ALSO AND GET Similarly, Carilion’s chief of Otolaryngology, arise. Without CME, it would be difficult for physicians TEAM TO HAVE TEACH to Learn CME CREDIT?” Benjamin Cable, M.D., is one of only three experts to keep fresh and updated. ANSWERS.” With physicians’ responsibilities increasing, and Crossing Borders nationally who teach surgeons how to perform —Apostolos (Paul) Shari Whicker, Ed.D., director of the Office of —Shari Whicker, Ed.D., with medical and scientific knowledge growing In Virginia, physicians are required to accrue 60 hours Dallas, M.D., sialoendoscopies in children. The minimally invasive Continuing Professional Development, of which Director of the Office at exponential rates, CME has had to keep pace. of CME every two years. Although requirements vary Director of surgery has been shown to be a safe and effective of Continuing Profes- Continuing Medical CME is a part, looks at the issue from the perspective sional Development, Dr. Dallas reports that, in his time as CME director, by state, it’s safe to say that demand for training na- Education, Carilion treatment for obstructive salivary gland disorders. of health care delivery. Carilion Clinic Carilion has gone from offering 7,000 credit hours tionally is high. Clinic And the reach of Carilion’s program extends even each year to more than 80,000 hours—an increase Carilion is doing its part. While most of its offerings further. Classically, CME has been defined as “by phy- of about 20 percent each year. cater to physicians within the Carilion system, many sicians, for physicians.” Yet the Carilion program has, Some of that increase can be traced to the growth courses allow physicians from all over Virginia, neigh- over the past several years, committed to extending of the Virginia Tech Carilion School of Medicine, boring states, and the country to train as well. Past con- offerings to other health care professionals, such as which has brought more students, residents, and fel- ferences have even attracted doctors from abroad. nurses, physical therapists, and physician assistants. lows into the system, creating an even greater demand And Carilion has projected outward. Some cours- “So many of the courses we offer are valuable for for instruction. In tandem, and through collaboration es—particularly those that are unique or in high de- other health care professionals, and we don’t see a with the Virginia Tech Carilion School of Medicine mand—are taught outside of Carilion’s walls. reason we should ever limit it,” Dr. Whicker says. She WATCH AND LEARN: and Jefferson College of Health Sciences (now Rad- The portable ultrasonography course that Carilion emphasizes that, as health care professionals increas- Continuing ford University Carilion), Carilion has recognized the designed—a detailed, hands-on, CME program first ingly work together on teams, it’s essential that they medical education importance of support for quality teaching. offered to critical care physicians at Carilion—proved work from a shared knowledge base. programs at That commitment is exemplified by the Teach- so popular that it gained national attention. In addi- “As health care evolves, interprofessionalism Carilion teach a ing Excellence Academy for Collaborative Healthcare tion to extending the program to primary care physi- becomes even more critical to patient care, and if range of topics, including portable (TEACH). The program, which Dr. Whicker directs, cians and others, the experts who taught it were ul- we’re not learning in the same way we’re practicing, ultrasound brings together faculty and other professionals at Car- timately asked to design a portable ultrasonography we’re losing a lot,” she says. “It’s important to tear technology. ilion united by the common thread of teaching within course for the Society of Critical Care Medicine and, down the walls, engage in conversation together, and the health professions. The academy provides organi- later, the American College of Physicians. learn from one another.” CM

28 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: JARED LADIA PHOTO: STEPHANIE KLEIN-DAVIS/COPYRIGHT, THE ROANOKE TIMES, REPUBLISHED BY PERMISSION CARILION MEDICINE | SPRING/SUMMER 2019 29 Through fun, informative programs aimed at all ages, Carilion Clinic and its collaborators administer a therapeutic dose of community medical education, with far-reaching benefits. BY MARYA JONES BARLOW

WHEN SUSAN TOLLIVER AND COLLEAGUES AT JEFFERSON COLLEGE of Health Sciences hosted the first “Senses and ScienceAbility”—a free day of art and science immersion for area schoolchil- dren—they weren’t sure what the response would be. “With relatively little promotion and a small program, we had over 300 people,” says Tolliver, an instructor in laboratory management and biomedical sciences. “Many came when the doors opened and didn’t leave until we closed. We learned that they wanted us to do it again. We learned they wanted more.”

Since that first event in 2017, Senses and ScienceAbility has SCRUBBING IN: grown to include new community partners, multiple down- A young partici- town Roanoke venues, schools and homeschoolers through- pant in Senses and ScienceAbility—a out southwestern Virginia, approximately 40 hands-on activi- medical education ties and exhibits, at least 140 volunteers, and crowds of more program for commu- nity members—gets than 700 eager participants. ready to step into an operating room.

30 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: MARK LAMBERT CARILION MEDICINE | SPRING/SUMMER 2019 31 learn about the health care field, anatomy and physi- “WE PROVIDE AN see the kids’ excitement, it renews my own excitement ology, medical terminology, patient rights, health in- INSIDE VIEW ON for my work.” formation privacy, safety, and more, while also practic- HOW WE TAKE CARE Last year’s STEAM Day drew more than 500 chil- ing CNA skills in laboratory and clinical settings. They dren from throughout Virginia and West Virginia. OF PEOPLE, WHAT leave well-prepared for the CNA exam and to pursue They met dogs and handlers in Carilion’s Pet Pals degrees in nursing and other health care fields. THERAPIES WE therapy program, stepped aboard the Life-Guard air The course is a partnership of Roanoke County USE, AND HOW WE ambulance, learned to pack wounds and place tour- Public Schools, Carilion, and Medical Facilities of MONITOR THEIR niquets with paramedics, and “scrubbed in” to per- America, a Roanoke-based company that operates PROGRESS. HEALTH form simulated surgery with the hospital’s OR team, long-term care facilities, with support from the CARE CAREERS among other experiences. Claude Moore Scholars Program. Together they de- The event, held each fall, partners Carilion with IN OUR AREA ARE veloped a curriculum that would meet requirements the Science Museum of Western Virginia, the Virgin- of the Virginia Board of Nursing, as well as the needs THRIVING AND ia Museum of Transportation, the Taubman Museum of the region’s population and health care employers. GROWING, AND WE of Art, and Virginia Tech to enable children to expe- “I was heartened to witness the affection, caring, NEED GOOD PEOPLE rience a variety of locations and activities spanning DEM BONES: Artist Jennifer and empathy demonstrated by the young men and TO DO THESE JOBS.” every step of their academic careers. Anderson Printz sketches a women in this course toward the elderly population,” Jennings also coordinates Carilion’s participation skeleton during the Virginia —Cathy Jennings, R.N., Tech Carilion School of Medi- says Karen Zimmerman, R.N., a Carilion instructor Lead Organizer for in the Virginia Tech Science Festival, held each fall who leads the course. “They give of themselves from STEAM Day, Carilion in Blacksburg. At last year’s event, Carilion hosted cine’s first Mini Medical School, Clinic “Anatomy for Artists and Other the heart—not just to meet a course requirement. seven activities, including a virtual teddy bear clin- Curious Sorts.” On their own, for example, the students wrote and ic, DermaScan screenings that illustrate skin damage delivered 250 Christmas cards to the patients at the from the sun, and demonstrations of the da Vinci ro- Salem Health & Rehabilitation Center, where we do botic surgical system. “We have kids who cry at the end of the day be- “FOUR YEARS OF Dr. Trinkle says the objective is to put an engaging, our clinical rotations.” cause they don’t want to go home,” Tolliver says. “We MEDICAL SCHOOL interactive spin on the world-class research and learn- A second introductory course is planned next year have parents who write to tell us their children are ea- CONDENSED INTO ing going on inside the decade-old medical school. for returning students who want to delve deeper into Time for Hissing Cockroaches ger to come back—or that they’ve decided to pursue a Over the course of several two-hour evening sessions, such areas as diabetes management, mental health, FOUR NIGHTS” IS career in health care because they attended.” participants might play with the school’s virtual anat- EKG technology, and phlebotomy. At Senses and ScienceAbility—the More than the glowing reviews, Tolliver says the WHAT EACH MINI omy table, dive into simulated patient treatment The program is one of two that offer medical-relat- annual partnering of Jefferson College real reward is “that look in their eyes when you know MEDICAL SCHOOL scenarios, or participate in hands-on workshops on ed instruction to area high schoolers. In 2017, Roanoke of Health Sciences with the Taubman that they are curious, intrigued, and stimulated.” OFFERS. moulage—the art of fabricating mock injuries for the County Public Schools partnered with Jefferson Col- Museum of Art and Roanoke Public It’s an observation echoed for Carilion Clinic and —David Trinkle, M.D., purpose of training emergency response teams. lege of Health Sciences and Roanoke County Fire and Libraries—children of all ages can its many collaborators: Offer medical education pro- Associate Dean for The Mini Medical School is one of the many ways Rescue on a program that prepares students to earn choose from dozens of hands-on activities that pres- Community and grams, and the local community will embrace them Culture, Virginia the medical school extends itself into the community Level 1 emergency medical technician certification. ent science as play. with enthusiasm, revealing the region as an eager Tech Carilion with creative and broadly appealing programs, includ- At this year’s event, more than 700 participants partner in building a healthier population. School of Medicine ing art shows, service-learning projects, and multicul- conducted virtual dissections of the human body, tural events. “From the start, we wanted to make our Gathering Steam donned scrubs and experienced the operating room, school as welcoming as possible to members of the Each year, hundreds of students—from held Madagascar hissing cockroaches, explored Medical School, Abbreviated community and thank them for their enthusiasm,” kindergartners to high school seniors— the properties of water, or simply burned off some The Virginia Tech Carilion School of Dr. Trinkle says. “Through their engagement and the eagerly arrive by bus and car for STEAM steam on an obstacle course. Medicine offers the public aMini Med- connections we make at these events, we’re able to Day in downtown Roanoke. After en- As the free Saturday event has grown each year, so ical School that David Trinkle, M.D., serve the community even better.” gaging in dozens of free hands-on activ- has the enthusiasm from organizers and the public. the school’s associate dean for com- ities promoting science, technology, engineering, art, “I say often that I have the best job in the col- munity and culture, playfully describes and math, they return home wearing surgical scrubs lege,” Tolliver says. “This arts and sciences festival as “four years of medical school condensed into four Nursing a Passion and excited about health care careers. is a big reason for that. The organizing committee nights.” While the program doesn’t confer a medical Through a course called“Introduc - That’s the reward for lead organizer Cathy Jennings, is composed of scientists who work long and hard degree, it does allow participants to explore the school, tion to Nursing Careers,” juniors R.N., and the 54 Carilion employee and student volun- to ensure that the event is spectacular, and we’re along with timely topics in medicine and public health. and seniors at all five of Roanoke teers who put in 12 months of planning and 300 hours joined by nearly 200 faculty, staff, and student vol- The premier installment, “Anatomy for Artists and County’s public high schools have the of volunteer time each year on the event. unteers who engage with the visitors. Our commu- Other Curious Sorts,” gave painters, sculptors, and opportunity to train and complete re- “All of my team looks forward to this. It’s one of our nity partners add a dimension we could not have other interested community members glimpses into quirements to become certified nursing assistants. favorite days of the year,” says Jennings, a cardiac sur- without them.” the human body. Other Mini Medical Schools have Launched last fall, the program graduated its first gery clinical nurse specialist at Carilion. “We provide Tolliver says she expects next spring’s Senses tackled what it’s like to be a medical student, mental 27 CNAs this spring and has a full roster of 50 stu- an inside view on how we take care of people, what and ScienceAbility celebration to be even larger and health issues and treatment, global health and inter- dents scheduled to start this fall. therapies we use, and how we monitor their progress. with amplified impact, now that Jefferson College national medicine, genetics and population health, Offered at the Burton Center for Arts and Technol- Health care careers in our area are thriving and grow- of Health Sciences has completed its recent merger and military medicine and healing for veterans. ogy, the class meets every other morning. Students ing, and we need good people to do these jobs. When I to become Radford University Carilion.

32 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: DAVID HUNGATE CARILION MEDICINE | SPRING/SUMMER 2019 33 transport program operates a three-helicopter fleet “BRAIN SCHOOL GIVES cal Research Institute, and hear from our physician col- that reaches patients throughout Virginia, parts of COMMUNITY MEM- leagues at Carilion who are providing high-quality care West Virginia, North Carolina, and Tennessee. for patients with brain disorders,” Dr. Friedlander says. BERS THE CHANCE Carilion curated, produced, and donated the “This is an opportunity for our scientists and the public exhibit to offer a glimpse of how pilots and first re- TO LEARN ABOUT to have a dialogue on some of the most fascinating top- sponders help save lives when time is short and dis- THE BRAIN, HEAR ics in the science of brain and mind.” tances are long. Highlights include an interactive look FROM SCIENTISTS While the subject matter is undoubtedly cerebral, at the history of the rescue program, behind-the- ON THE LEADING it’s also fun and accessible for people of all ages. Interac- scenes rescue videos, and a review of safety features. EDGE OF DISCOVERY, tive presentations by leading Virginia Tech researchers “We really hope to be able to inspire some future and Carilion physicians are paired with hands-on activ- AND HEAR FROM aviators, whether they want to become a pilot or a ities, such as holding an actual brain. flight nurse, flight paramedic, aviation mechanic, OUR PHYSICIAN Past Brain Schools have delved into such topics as or dispatcher,” says Susan Rivers, Life-Guard pro- COLLEAGUES WHO aging and dementia, sleep and circadian rhythms, pain, gram director at Carilion. “Unfortunately for our ARE PROVIDING addiction, traumatic brain injury, animal brains, and patients, when we are called to transport them, it’s HIGH-QUALITY CARE the impact of digital technology. often the worst day of their lives. They are not able FOR PATIENTS.” “We want residents to learn more about the rapidly to take it all in during their short flight. This exhibit changing understanding of the capacity, function, and —Michael Friedlander, gives the community an opportunity to take a peek Ph.D., Executive resilience of the brain,” says Dr. Friedlander. “We’re behind the curtain to learn more about Life-Guard’s Director, Fralin proud that these changes include some of the discov- Biomedical Research very special mission—what it looks like from start Institute at VTC eries being made daily here at the research institute by THE PLAY’S THE to finish and how the team gets the job done safely, our students, fellows, and faculty.” CM THING: When quickly, and with the best clinical care possible.” Jefferson College of Health Sciences— now Radford Univer- sity Carilion—intro- Brain Teasers duced its first Senses One of Carilion’s principal academic and ScienceAbility partners, Virginia Tech, delivers a series event, the children of highly attended annual programs didn’t want to leave. that inform the community about the frontiers of medicine and science. One example includes the Maury Strauss Distinguished “THE ORGANIZING scholarship that funds my education to be a better per- Public Lecture Series, a Fralin Biomedical Research Launching Teens into Health Care COMMITTEE IS son is extremely motivating.” Institute at VTC program that brings leading experts Jeremy Slater, a Roanoke native en- COMPOSED OF Since 2010, Carilion has awarded almost $63,000 in research, health care, and policy to Roanoke. Also tering his junior year at Emory Uni- in scholarships to 37 student volunteers, says Shanna popular is the institute’s Brain School, in which re- SCIENTISTS WHO versity, says Carilion Roanoke Memo- Flowers, manager of volunteer services at Carilion. searchers and physicians share contemporary advanc- rial Hospital always “felt like home.” WORK LONG AND Volunteers raise the money through donations to es in brain science with community members. He spent many hours of his childhood HARD TO ENSURE the hospitality snack carts that they wheel into hos- “Right here in Roanoke, remarkable discoveries are there, accompanying his father to treatments for a THAT THE EVENT pital waiting rooms, offering beverages and food to being made that influence the worldview of neurosci- rare blood disorder and his mother to her job as a IS SPECTACULAR, patients’ family members. ence and implementation of brain health across the respiratory therapist. AND WE’RE JOINED Slater is spending the summer in Tajikistan on lifespan,” says Michael Friedlander, Ph.D., executive di- When Slater was old enough to join the hospital’s a Fulbright scholarship to study Persian. His prin- rector of the research institute and Virginia Tech’s vice BY NEARLY 200 summer teen volunteer program, he didn’t hes- cipal interest is international sustainability and de- president for health sciences and technology. “With the itate. He spent three summers during high school FACULTY, STAFF, AND velopment, with a major focus on health. He hopes help of groundbreaking neuroscience research taking tending to patients and families and helping staff. STUDENT VOLUN- to work at the World Health Organization, United place at our institute, Roanoke has transformed from COOL FOR SCHOOL: “It meant a lot to be able to contribute to the hos- TEERS WHO ENGAGE Nations, or another organization with global reach. a ‘train city’ to a ‘brain city.’” Faculty members in pital community and provide some happiness and For the past seven years, Dr. Friedlander and his the Fralin Biomedical WITH THE VISITORS.” Research Institute support for patients in a stressful situation,” he says. colleagues have invited the public to attend Brain —Susan Tolliver, sometimes comple- “It was a full, enriching experience that taught me a Instructor in Labo- Taking to the Skies School, a celebration of the brain held each March ment the annual Brain lot about listening and communicating with people.” ratory Management An interactive exhibit at the Virgin- in conjunction with Brain Awareness Week, which School with other and Biomedical Brain Awareness Week The icing on the cake was a $1,500 Teen Volun- Sciences, Radford ia Museum of Transportation invites is spearheaded internationally by the Dana Alliance teer Scholarship toward Slater’s college education University Carilion visitors to experience the history of Vir- for Brain Initiatives, a private philanthropic organi- outreach. Here, a second-grader enjoys as an interdisciplinary studies major, minoring in ginia’s first air ambulance, Life-Guard. zation that supports brain research. wearing a cerebral Hindi and Persian. “I feel very blessed,” Slater says. Opened in 2018, the permanent ex- “Brain School gives community members the chance cap while learning “Volunteering at Carilion allowed me to help make hibit showcases the evolution of Life-Guard since it to learn about the brain, hear from scientists working more about the brain. the community a healthier, happier place. To receive a first took to the skies in 1981. Today, Carilion’s air on the leading edge of discovery at the Fralin Biomedi-

34 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: MARK LAMBERT PHOTO: AMANDA LOMAN CARILION MEDICINE | SPRING/SUMMER 2019 35 By Jessica Cerretani with

CARILION WOMEN’S NEW OFFICE-BASED TREATMENT PROGRAM MEETS PREGNANT, OPIOID-DEPENDENT PATIENTS WHERE THEY ARE.

SHE’S STRUGGLED WITH OPIOID ADDICTION on and off for what seems like forever. She tried to stop using when she was pregnant with her son—and she did for a little while, until the disease reeled her back in. Now she’s expecting again, and reluctant to ask for help. Along with the fear of losing custody of her young son and new baby, she has a deep-seated feeling of humiliation. The only thing more shame- ful than being an addict, she thinks, is being a pregnant one. Despite the stigma, opioid use in pregnancy is on the rise, with dev- astating effects. According to the Centers for Disease Control and Pre- vention, the number of women with an opioid-use disorder at the time of labor and delivery more than quadrupled between 1999 and 2014, re- flecting the same pattern of prevalence in the general population. For Virginians, those statistics hit close to home: Here, the number of infants born with neonatal abstinence syn- drome—the withdrawal symptoms that result after a baby has been exposed to opioids in the womb—increased by 11 percent just from 2016 to 2017.

36 CARILION MEDICINE | SPRING/SUMMER 2019 ILLUSTRATION: SHONAGH RAE CARILION MEDICINE | SPRING/SUMMER 2019 37 The risks of opioid use are clear in new mothers, too. One of care, where the clinicians understand both substance use THIS IDEA THAT MAT IS A CRUTCH, THAT YOU’RE NOT REALLY recent study found that even though opioid overdoses decrease and pregnancy,” says Sarah Dooley, R.N., the program’s oper- during pregnancy, they rise again during the postpartum peri- ations manager. IN RECOVERY IF YOU’RE ON SUBOXONE OR ANOTHER od, particularly in the second six months after delivery. Women MEDICATION,” SAYS DR. WELLS. “THAT’S PRIMARILY A PROBLEM OF NOT who do overdose tend to be younger, single, unemployed, less educated, and less likely to have received adequate prenatal care. MoreThe OBOT than model Medicationoffers medication-assisted therapy (MAT), UNDERSTANDING THE BRAIN PROCESSES BEHIND ADDICTION.” Indeed, the judgment surrounding substance-use disorders on-site behavioral health services, and care coordination. This and pregnancy is especially strong, leading many women with treatment involves behavioral therapy combined with the use of opioid dependency to forgo prenatal care altogether. FDA-approved drugs such as buprenorphine, methadone, and ications, for example, doesn’t mean just swapping one drug for “We talk about how they can console their babies and use skin- “Opioid-use disorder is a chronic disease that’s really put naltrexone to address the withdrawal symptoms and cravings another. In fact, the American College of Obstetricians and Gyne- to-skin contact, which is the best medicine for newborns,” into focus during pregnancy, when you now have two lives at that accompany opioids. When administered appropriately, the cologists recommends MAT as the preferred treatment for preg- says Dr. Wells. “We try to educate women as early as possible, so risk,” says Jennifer Wells, M.D., a physician in Carilion Clinic’s treatment can help opioid users safely sustain recovery. nant women. Compared with MAT, medically supervised opioid they know what to expect.” Department of Psychiatry. “But because of the stigma, women OBOT clinics integrate MAT into a comprehensive outpa- withdrawal in expectant mothers is associated with higher relapse Because the months following childbirth can be particular- often feel ashamed and unworthy of help.” tient treatment plan that views opioid-use disorder as a chronic rates and worse outcomes, such as preterm birth and miscarriage. ly dangerous for moms, the OBOT program continues to offer To address this crisis, Dr. Wells and her colleague Kimberly medical condition. It’s an approach that aims to provide collab- “There’s this idea that MAT is a crutch, that you’re not really in support and resources for at least six weeks after delivery. “Opi- Simcox, D.O., a physician in Carilion’s Department of Obstet- orative care without the stigma associated with addiction, while recovery if you’re on Suboxone or another medication,” says oid-dependent women are typically abandoned in the post-preg- rics and Gynecology, have established one of Virginia’s first of- giving patients the tools they need to manage their disease. Dr. Wells. “That’s primarily a problem of not understanding the nancy period, and most cases of overdose occur during this time,” fice-based opioid treatment (OBOT) programs specifically for “We should be thinking of opioid-use disorder as we do diabe- brain processes behind addiction. We try to educate women and explains Dr. Simcox. “We try to follow patients closely after deliv- pregnant women. The Roanoke-based program—which opened tes or hypertension,” says Dr. Simcox. “It should be viewed like any their families about how critical MAT is for the safety of the fetus ery before transitioning them to long-term addiction care.” its doors in February through Carilion Women’s—offers med- other long-term chronic condition that requires treatment.” and for having a healthier baby—and that’s everyone’s goal.” ications, counseling, and psychosocial and pregnancy-related Obstetrics-specific OBOT clinics tailor this model to the needs To that end, the Carilion Women’s OBOT goes beyond med- support to expectant mothers. of opioid-dependent pregnant women. Like traditional OBOT pro- ication and counseling to include a spate of services focused on GrowingThe Carilion Women’s by Leaps OBOT program and Boundshas grown quickly since “What makes us unique is that we allow women with an opi- grams, they offer MAT, but they also include information aimed at pregnancy and the postpartum period. “We’re not just seeing its inception. Within two months, the program was already oid-use disorder to come to a place that provides coordination breaking down misconceptions about its use—reliance on med- women coming in for medication and therapy, and it’s not your serving about 15 patients at weekly appointments. “We’re typical quick clinic visit,” says Leanna Stone, the center’s care coor- growing every week, and we expect to expand even more with- dinator, who also provides patients with psychotherapy services. in the next six months,” says Dooley, who adds that the plan is “It’s helping women apply for Medicaid if they need insurance and to offer prenatal care as well. helping them find food banks if they lack access to good nutrition. Some patients come from other local programs, seeking We’re looking at each patient as a whole person, not just a preg- consults. Others arrive through word of mouth. But phy- nant woman or a woman with substance-use disorder.” sicians play a crucial role in helping pregnant patients find OBOT clinics, too. “Some women come to their OB/GYN terrified that they’ll BirthThat support and continues Beyond beyond labor and delivery. Although the lose custody of their baby or be judged, so they try to hide program doesn’t yet offer obstetric care, its clinicians work closely their opioid-use disorder,” says Dr. Wells. “But with sensitive with patients’ obstetricians to ensure a safe and seamless expe- questioning and an open dialogue, they may feel comfortable rience. “Our hope is to bring prenatal care to the program in the enough to reveal their disease.” near future,” says Dr. Wells. “For now, our responsibility is to pro- Indeed, the American College of Obstetricians and Gynecol- vide medication, psychological care, and overall support.” ogists recommends early universal screening for substance use The unique experience of the staff—Dr. Wells and Dr. Simcox as part of comprehensive obstetric care, beginning at a woman’s are among a handful of physicians in the country both trained in first prenatal visit. “We should be asking every patient, ‘Can I obstetrics and board certified in addiction medicine—presents a ask if you’re struggling with substance use?’—and then be ask- significant opportunity to address all aspects of support. ing again,” says Dr. Simcox. “The advantage is that we’re knowledgeable about both In the past, physicians were hesitant to question their pregnant pregnancy and opioid use, so we can talk to patients and their patients, mainly because they felt they couldn’t provide guidance physicians about pain at delivery, neonatal withdrawal, and or treatment. Now, the establishment of the Carilion Women’s other concerns,” says Dr. Simcox. “We’re coordinating with OBOT program gives clinicians the confidence to discuss opioid obstetricians throughout the process so there are no surprises dependency with their patients. and everyone is aware of the care plan.” “Providers used to be afraid to ask patients, ‘How can I help?’ DOUBLE EXPOSURE: They also work closely with Carilion pediatrician Jacinda because they didn’t have the answer,” says Dr. Wells. “Now they Dr. Jennifer Wells (left) Hays, D.O., to help prepare mothers for the withdrawal symptoms know that there’s a place for women to get treatment and sup- and Dr. Kimberly Simcox of neonatal abstinence syndrome—common in infants born to port, so they feel more comfortable bringing up the issue.” are among a handful of opioid-dependent women. These babies are not born addicted to The program, which is only expected to grow over time, physicians nationally who are both trained in obstet- opioids, but do experience the uncomfortable withdrawal process already serves as a model that Dr. Simcox and her colleagues rics and board certified in after birth. Babies diagnosed with neonatal abstinence syndrome hope will be implemented in other areas as well. “We’ll be add- addiction medicine. are seen by Dr. Hays in a new transitional, low-stimulation nurs- ing more resources as our patient population increases,” she ery housed in Carilion’s Mother/Baby Unit. says. “It’s such a unique opportunity for care.” CM

38 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTO: JARED LADIA CARILION MEDICINE | SPRING/SUMMER 2019 39 photo essay

There’s No Place Like

CAREFUL LISTENING: During a four-month follow-up appointment, Dr. Edwin Polverino checks the lungs of Louise Wolfe, a longtime patient with hypertension. HOME Carilion Clinic’s primary care practices are structured as “medical homes,” a delivery model that uses a team approach to care. TEXT BY LINDA STALEY | PHOTOS BY JARED LADIA

DWIN “TED” POLVERINO, D.O., HAD BEEN a primary care physi- cian in private practice for 22 years before joining, in 2015, one of Carilion Clinic’s patient-centered medical homes. “I wanted to bring evidence-based medicine to the communi- ty,” he says. “Yet keeping up with all the data and latest studies is virtually impossible as a solo practitioner.” EAs a physician at one of Carilion’s 47 medical homes, Dr. Polverino now has a full team to help bring all resources to bear on patient care. He has the support of teams both at his practice and off-site, so he can focus his time on direct care. “The provider doesn’t need to own it all,” he says. Although his office staff resembles that of a typical physician prac- tice, behind the scenes, off-site teams are proactively identifying gaps in care, such as an overdue mammogram, and preparing orders for his signature. Care coordinators connect with patients who need educa- tion and coaching between appointments. They also tap community resources to eliminate barriers to care, such as a lack of food, housing, or transportation. Beyond his own practice, Dr. Polverino serves as a regional medical director with responsibility for clinical and quality oversight for several practices. Such intense management is integral to Carilion’s operation as an accountable care organization that focuses on realigning care delivery from fee-for-service to fee-for-value. It’s especially beneficial for patients suffering from chronic condi- tions—such as diabetes, hypertension, and heart failure—that can be further complicated by behavioral health issues. In one case, for exam- ple, care coordinators arranged psychotherapy when they discovered that a patient with heart failure had stopped taking her medication after her husband died. “With the full team,” says Dr. Polverino, “I’m confident that each visit has follow up, referrals are made, and nothing falls through the cracks.”

40 CARILION MEDICINE | SPRING/SUMMER 2019 CARILION MEDICINE | SPRING/SUMMER 2019 41 A TEAM EFFORT Clockwise from right: Clinical team lead Gary Bilbro, R.N., checks expiration dates on medications in the practice inventory. Off-site, Summer Baker, the accountable care strategies manager, reviews information from Carilion’s electronic data warehouse, which captures millions of terabytes of patient data from multiple sources to identify gaps in care. Dr. Polverino meets with patient Parker Marshall. Colette Carver, F.N.P., senior director of ambulatory nursing practice, and Jamie Wagner, R.N., clinical educator, review the refrigerator’s temperature log to ensure the safety of vaccines stored at the practice. Emily Woodie, a care coordinator, searches a customized database of community resources to prepare for a call with a patient.

CHECKING IN Dr. Polverino walks to his office between appointments with patients.

42 CARILION MEDICINE | SPRING/SUMMER 2019 CARILION MEDICINE | SPRING/SUMMER 2019 43 the art of medicine

THE UNFOLDING LANDSCAPE A range of local artists offered their takes on the Blue Ridge Mountains in “Virginia’s Blue Ridge, a Metro-Mountain Adventure”: A. Blue Ridge Farm, by Whitney Brock B. Determination, by Edwina Dickson C. James from Springwood, BEAUTY OF by Hazel Bowers D. Making Tracks Through the Blue Ridge, by Whitney Brock THE BLUE RIDGE E. Untitled, by Denise Swayne The Virginia Tech Carilion School of Medicine’s most recent art show celebrated the state’s mountainous region. BY CATHERINE DOSS A B

HE DISTINCTIVENESS OF THE BLUE Ridge Region recently came to life in the hallways of the Virginia Tech Carilion School of Medicine, as the school’s latest art show captured the stories of the Blue Ridge Mountains through acrylic, oil, and water- Tcolor painting, as well as photography and sculpture. The theme, “Virginia’s Blue Ridge, a Metro-Moun- tain Adventure” set the stage for art that featured the splendor and uniqueness of the region. “We chose the theme of the art show with the sheer beauty and diversity of the Blue Ridge Region in mind,” said David Trinkle, M.D., associate dean for community and culture at the medical school. “From scenic overlooks and recreational activities to wineries, art, culture, and the Blue Ridge Park- C way, the 42 local artists exhibiting in the show had a wide open canvas.” The region, whose population tops 300,000 peo- ple, is a vibrant destination. “A big piece of our medical school’s success is in its ability to attract top-caliber students, faculty, and re- searchers to the Roanoke Valley,” said Dr. Trinkle. “The beauty of our surrounding area, our outdoor amenities, and the promotion of our region by Visit Virginia’s Blue Ridge go a long way in making this happen.” Sponsored by the school’s Creativity in Healthcare Education Program, the exhibition was one of three held annually for local artists—and sometimes med- ical students—to showcase their work to the school community as well as the local one. “We launched the program to expand the social, cultural, and humanistic awareness of the school’s students, faculty, and staff by integrating the arts into their daily routines,” Dr. Trinkle said. “The pro- gram also serves as a way to involve community E D members in the life of our school.” CM

44 CARILION MEDICINE | SPRING/SUMMER 2019 CARILION MEDICINE | SPRING/SUMMER 2019 45 cheers for peers

Committee beginning in January. Virginia Tech Carilion School of Surgery Dr. Dehmer also served as Rating Medicine graduate—published Panel Moderator for the American “Safe Placement of Intramedullary CHARLES BISSELL, M.D., chief spotlight on International Contributions College of Cardiology’s Appropri- Nail and Inter-Physician Variabil- of Surgery for Carilion New ate Use Criteria Task Force. ity in Guidewire Placement in River Valley Medical Center, PAUL DAVENPORT, R.N., vice president of Emergency Retrograde Tibiotalocalcaneal and BECKY FRITZ, director of Services, spoke at the Health Service Journal Provider RAHUL SHARMA, Fusions,” in The Journal of Foot & Surgical Services, presented Summit in Nottingham, England. His talk was titled “An M.D., interven- Ankle Surgery. at the Press Ganey National International Perspective: The Role of Command Centres tional cardiologist, Client Conference in Orlando. to Tackle Operational Variation and Integrate Large Not- coauthored the THOMAS K. MILLER, M.D., chief Their topic was “Using Shared for-Profit Health Systems.” National Cardio- of Sports Medicine, received the Decision Making to Improve the genic Shock Virginia Career Award from the Patient Experience.” DAVID HARTMAN, M.D., chief of Adult Outpatient Psychi- Initiative (National CSI) study and Virginia Orthopedic Society. He atry, and CHERI HARTMAN, Ph.D., Psychiatry, presented presented the findings at the was also appointed to a second BRYAN COLLIER, their quality improvement study titled “A Retrospective Society for Coronary Angiogra- year as a principal reviewer for D.O., chief of Review of Retention of Opioid-Dependent Adults in an Emergency Medicine orative. He spoke at the Virginia MICHAEL JEREMIAH, M.D., chair phy and Interventions 2019 the American Journal of Sports trauma surgery, Outpatient Buprenorphine/Naloxone Clinic” at the Global Neonatal Perinatal Collaborative’s of Family and Community Med- Scientific Sessions in Las Vegas. Medicine. was chosen by Addiction Psychiatry 2018 Conference in Madrid. Study JOEL BASHORE, P.A., presented First Maternity Mortality Summit icine, was invited to extend his Dr. Sharma was also named a the Association coauthors also included ANITA KABLINGER, M.D., clinical “It Won’t Stop Bleeding!: Epistaxis in January and was lead author of board role for the Association of 2018 Rick Nishimura, MD, MACC, DR. MILLER and of Women trials research director for Psychiatry. Management in the ED and Ur- “The Pregnant Patient: Managing Departments of Family Medicine and Patrick T. O’Gara, MD, MACC, JOSEPH MOSKAL, Surgeons as the 2019 recipient gent Care” to the annual continu- Common Acute Medical Prob- and continue his role as chair of Emerging Faculty Leader by the M.D., chair of of the AWS Past Presidents’ JOSEPH MOSKAL, M.D., chair of Orthopaedics, helped de- ing medical education conference lems,” which appeared in American the association’s Healthcare Deliv- American College of Cardiology. Orthopaedics, Honorary Member Award. The velop and gave more than a half dozen presentations at the of the Arizona State Association of Family Physician in November. ery Transformation Committee. coauthored with prestigious award is given first European meeting of the International Congress of Joint Physician Assistants in Prescott. Virginia Tech annually to a nonmember Replacement Direct Anterior Approach in Innsbruck, Austria. MARK GREENAWALD, M.D., vice Orthopaedics Carilion School of Medicine leader in surgery who inspires, Dr. Moskal helped pioneer the anterior approach for total SARAH KLEMENCIC, M.D., was ap- chair of Academic Affairs and Internal Medicine students MALEK BOUZAHER encourages, and enables hip replacement surgery in the United States in 2004. Now pointed to a three-year term on the Professional Development and Coauthors J. RANDOLPH and SUSAN GIAMPALMO a cover women to realize their profes- more than a quarter of all hip replacements in the United Board of Directors of the Virginia vice chair of Family and Com- GREGORY DEHMER, M.D., director CLEMENTS, D.P.M., chief of article in AAOS Now, the news sional and personal goals. States are performed that way. The meeting, which attracted College of Emergency Physicians. munity Medicine, served as the of quality and outcomes at the Podiatry; KELLEY WHITMER, magazine of the American surgeons from around the world interested in learning the closing keynote speaker for the Cardiovascular Institute, was M.D., Diagnostic Radiology; HOA Association of Orthopaedic Carilion’s Bariatric program, new technique, included live surgeries and hands-on ca- third annual Bounce Back Project reappointed to a two-year term to NGUYEN, M.D., a medical resident Surgeons, on the disposal of led by A. DAVID SALZBERG, daver workshops. Dr. Moskal has also been invited to serve Family Medicine Resilience Conference 2018 in the Medicare Evidence Devel- in Obstetrics and Gynecology; unused opioid medications. M.D., and TANANCHAI A. as a visiting professor at the University of Belgium Medical Minneapolis in December. opment and Coverage Advisory and MATTHEW RICH, M.D., a 2018 LUCKTONG, M.D., received Center and join the European Hip Society. As a member of the U.S. Preven- reaccreditation in April for the tive Services Task Force, JOHN Psychiatry three-year maximum as a Com- EPLING, M.D., coauthored recom- prehensive Center of Excellence mendations about interventions Provider Excellence MICHAEL GREENAGE, D.O., resi- by the Metabolic and Bariatric to prevent perinatal depression dency director for Psychiatry, and Surgery Accreditation and Translating Human Factors that were published in the Journal CLIFFORD NOTTINGHAM, M.D., received the 2019 ROBERT TRESTMAN, M.D., PH.D., Quality Improvement Program of the American Medical Associa- Dr. Robert L.A. Keeley Award for exceptional service chair of Psychiatry and Behavioral of the American College of into Safety tion. Dr. Epling was also appoint- to patients and to the community. The honor is Medicine, wrote a chapter, “Legal Surgeons/American Society Carilion Clinic received the Next Generation ed as an associate editor of given annually to a physician who embodies the and Forensic Aspects of Aggres- of Metabolic and Bariatric Innovator Award from the National Quality Peer-Reviewed Reports in Medical values of Dr. Keeley, who was a beloved thoracic sion,” in a book, Aggression: Clinical Surgeons. Forum in the category of Operational Education Research (PRiMER), the surgeon. Dr. Nottingham completed medical school Features and Treatment Across the Efficiency and Design. Carilion is one of the journal of the Society of Teachers at the Medical College of Virginia in 1978 and a Diagnostic Spectrum, published in The Cleft and Craniofacial first health care systems in the United States to fully im- of Family Medicine. residency in family medicine at Roanoke Memorial January by the American Psychiat- Center, led by JAMES T. plement the latest evidence-based guidelines from the HONORED: Dr. Clifford Nottingham Hospital in 1981. He retired in 2018 after 40 years of ric Association. THOMPSON, M.D., was fully National Patient Safety Foundation: Root Cause Analysis is flanked by Dr. Patrice M. Weiss (left), DAVID GREGORY, M.D., is serving practice, including 27 at Carilion. Beginning in 1997, approved by the American Cleft 2 Carilion’s chief medical officer, and and Action (RCA ). The National Quality Forum recognized on the Board of the Virginia Acad- Nancy Howell Agee, president and he had been recognized as a “Top Doc” in Roanoke DR. TRESTMAN was also named Palate-Craniofacial Association’s Carilion’s Clinical Advancement and Patient Safety team emy of Family Physicians and on chief executive officer. every year. to the Psychiatric and Substance Commission on Approval of for implementing RCA2 with human factors integration. the Executive Committee of the Abuse Services Council of the Teams as a Cleft Palate Team for Virginia Neonatal Perinatal Collab- American Hospital Association. a period of five years.

46 CARILION MEDICINE | SPRING/SUMMER 2019 PHOTOS: DARRYLE ARNOLD (TOP LEFT AND DR. COLLIER); JARED LADIA (ALL OTHERS) CARILION MEDICINE | SPRING/SUMMER 2019 47 backstory

ADVANCING HEALTH IN AMERICA Leading the American Hospital Association was the opportunity of a lifetime to help transform a field ripe for change. BY NANCY HOWELL AGEE

HAIRING THE BOARD OF TRUSTEES OF THE Underlying all this travel has been the hard work of American Hospital Association was one of helping shape public policy and providing leadership to the most memorable and humbling experi- advance the field during a time of tumultuous change. ences of my career. Working with colleagues across the country from The actual “swearing in” took place in a hospitals large and small, I’ve focused on two things: hotel conference room at a board meeting improving quality and addressing access and affordabil- Cin January 2018, a modest affair compared with the ity. I’m passionate about the association’s initiatives to ceremonial investiture five months later at the associ- innovate and transform health care. The Value Initia- ation’s annual meeting. tive, through which the association provides thought Before a crowd of hundreds, including the governor leadership on access and affordability, is something I of Virginia, I accepted the mantle from an outstanding initiated. The program wasn’t on the radar three years leader, Gene Woods, pres- ago, and now it’s a formal ident and chief executive part of the organization, officer of Atrium Health. I with a design studio and was deeply moved by the fund to foster innovation ceremony and grateful that in health care. close family and friends— My year as chair was including Carilion Clinic an exciting one for Caril- board members and col- ion, too. We worked hard leagues—could share the to get Medicaid Expansion experience with me. passed and finally it did. Serving as chair is actu- It’s been a game changer REMEMBER WHAT IT WAS LIKE TO BE ally a three-year commit- for us and thousands of ment, beginning with chair-elect and continuing as previously uninsured patients. We also improved our immediate past chair, so my responsibility doesn’t end financial position, planned a major expansion, and until December. grew our partnership with Virginia Tech. Since taking office, I’ve logged enough miles to cir- Holding down basically two jobs has meant a signif- cle the globe twice. While New York, Chicago, Washing- icant time commitment. I’ve been blessed with a great ton, D.C., Phoenix, and San Diego have been frequent team—both at Carilion and at the American Hospital CURIOUS? destinations, I was also among a small delegation that Association. I can’t think of anything more exciting ensured U.S. representation at the International Hos- than advancing health in Virginia and in America. CM pital Federation annual meetings in Brisbane, Austra- WE REMEMBER. lia, and Taipei, Taiwan. Nancy Howell Agee is president and chief executive officer Highlights also included attendance at a Rose Gar- of Carilion Clinic and immediate past chair of the American At Carilion Clinic, we know the answer to a mystery could be den ceremony with the president, speaking at the Na- Hospital Association, which represents more than 5,000 tional Press Club, and meetings with the secretary of hospitals and health care systems across the country. She just over the next hill. That’s why we take those extra steps every day. health and human services, the senate majority leader, began her career as a nurse at Carilion Roanoke Memorial and dozens of other legislators. Hospital, which is part of the system she now leads. Our mission, and your health, depend on it.

48 CARILION MEDICINE | SPRING/SUMMER 2019 ILLUSTRATION: HARRY CAMPBELL Curiosity.CarilionClinic.org

G255531 Curiosity Our Health - Sarabia.indd 1 6/3/19 11:28 AM CARILION CLINIC P.O. BOX 13727 NON-PROFIT ORG. ROANOKE, VA 24036-3727 U.S. POSTAGE PAID ROANOKE, VA PERMIT NO. 247

9 | OUTSTANDING GRADUATE Dr. Lamvy Le, who was named the Virginia Tech Carilion School of Medicine’s Outstanding Gradu- ating Student, will undertake her residency in plastic surgery at the University of Minnesota Medical School in Minneapolis.

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Preparation Meets Practice Building for the Future Conversation Pieces Carilion Clinic’s more than two dozen Carilion Roanoke Memorial Hospital’s The Virginia Tech Carilion School of residencies and fellowships provide $300-million expansion will add Medicine uses multiple mini interviews doctors with vital training. 400,000 square feet of space. to help identify the best future doctors.

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