Gas Pipeline Summer 2016

A Message from the Chairman

The evolution of the Perioperative Surgical Home at Stanford

Five years ago, partly in response to the development of the medical home for patients with chronic diseases, the Perioperative Surgical Home (PSH) was developed by the American Society of Anesthesiologists. Although we have embraced the goals of the PSH, our approach has reflected the unique collaborative environment of Stanford.

The PSH was designed to promote coordinated care across the three phases of the perioperative continuum (preoperative, intraoperative, and postoperative), in order to achieve the triple aim of improving patient satisfaction, improving the delivery of healthcare, and reducing the cost of care. In addition to these benefits to patient and society, the PSH was promoted as an anesthesiologist-led initiative and was viewed as defining a role for the anesthesiologist in an evolving health care system.

The initial PSH models developed in settings that shared several common factors that prompted the need for change. For example, the surgical care was often disjointed in these places, and the anesthesia departments previously had limited roles in preoperative and postoperative care. The postoperative management was by surgeons who had limited experience in complex medical management. Patient outcomes were recognized as poor. Finally, there were underutilized anesthesiologists who could devote time to the PSH. Although the anesthesiologist-led PSH has been successful in other institutions, that success has often depended upon many of these factors.

The evolution of the PSH at Stanford has been different. Our department already had a long history of preoperative assessment and optimization, plus involvement in postoperative care by our critical care, acute pain, and regional anesthesia teams. We have collaborated with surgeons and other specialties to coordinate the care of our complex surgical patients. The majority of postoperative surgical patients at Stanford are managed by hospitalists who provide excellent care.  Despite high acuity and complexity, surgical patient outcomes are excellent. Finally, our anesthesiologists are fully utilized in clinical activities.

The PSH version that has developed at Stanford is based on the long history of collaboration among different departments and our shared goal of improving patient experience and outcomes. The underlying concept is that individual physicians and services should be responsible for those areas in which they add the greatest value. The Stanford PSH also includes contributions from other healthcare providers, such as nurses, nurse practitioners, physician assistants, pharmacists, physical therapists, dietitians, respiratory therapists, and discharge planners. In many respects, the PSH is similar to the clinical care pathways we have used in the past, but now there is an emphasis on care coordination among providers, application of evidence-based interventions, and the use of outcome metrics to assess what works. The process is an iterative one with continuous improvement as the goal. Our approach overlaps with the early recovery after surgery (ERAS) programs, which were initially developed for colorectal surgery, but the PSH is broader in scope. Finally, our approach is applicable to patients undergoing non-surgical procedures such as endoscopy or interventional radiology, leading to the concept of the interventional home. The approach at Stanford has already demonstrated improved outcomes, decreased length of stay, and increased patient satisfaction, and it is being expanded to all interventional services.

Although one goal of the anesthesiologist-led PSH was to create a broader role for the anesthesiologist in the future, this broader role already exists in our collaborative model. We are responsible for perioperative evaluation and optimization, and we incorporate technology to be more patient-centric. We are collaborating with other departments in areas such as prehabilitation, anemia management, and smoking cessation. Intraoperative management increasingly uses regional anesthesia to decrease the adverse effects of opioids and anesthetic protocols based on subspecialty expertise to provide the best care to every patient. Our increasing faculty subspecialization promotes the development of perioperative teamwork and has the added benefit of improving the residency educational curriculum.  For patients requiring critical care management after surgery, our department is involved in all five critical care teams and has led the expansion of the cardiothoracic critical care service. We are actively involved in pain management following surgery, including patients with regional anesthesia or epidural catheters, patients with chronic pain, and patients with difficult pain problems. Our collaborative approach has been effective in patients undergoing colorectal surgery, joint replacement, cardiac surgery, and liver transplantation, as well as in patients with complex problems such as pulmonary hypertension.

Anesthesia residents must obtain the skills required for such PSH models. This year I chaired a joint ASA-ABA committee that was charged with recommending such training. Although it will be several years before our recommendations are incorporated into training requirements, at Stanford we are already implementing these changes. We are expanding the use of transthoracic echocardiography, including an echo rotation and applications in the preop clinic, PACU, ICU, and on the floors. We are teaching skills such as leadership, quality improvement, and conflict resolution. Finally, we are developing rotations where anesthesia residents and attendings will co-manage postoperative patients, working with surgeons and hospitalists to improve outcomes.

I believe our approach to the PSH at Stanford has achieved the goals that were developed by the ASA five years ago. I am grateful for the dedicated commitment of many of our faculty, as well as the contributions of hospital administration, surgeons, and other departments and healthcare providers. We still have significant opportunities for improvement, but I am proud that we are helping lead the implementation of this model for future health care.  

Three Funding Opportunities

NIH Lasker Clinical Research Scholars program

The NIH Lasker Clinical Research Scholars Program provides 5+ years of fully funded research in the NIH intramural program for tenure-track level clinical investigators, followed by 3 years of NIH funding at an academic medical center/research institute or by continuation in the NIH intramural program. NIH Lasker Scholars may be able to maintain an affiliation with their previous academic institution during their time at the NIH.   The deadline for applications is August 26, 2016. The general start date for the positions is summer 2017, but this is flexible.  More information can be found at this website or by emailing LaskerScholar@nih.gov.  

2016 Spectrum Pilot Grants 

Deadline

Amount of Funding

Typical grants range between $15,000 and $50,000 per year and depend on the specific program and the individual proposal. This year Spectrum is offering double the number of awards for pilot grants accelerating clinical and translational research.

Eligibility

  • Stanford faculty including Clinical Educators (CE). 
  • Graduate students and postdoctoral scholars (clinical and non-clinical) are required to include a PI eligible faculty member as co-PI on the application. 
  • CE faculty members' applications should be focused on clinical research. CE faculty PI waivers are not needed for internal funding opportunities (see RMG waiver website for further details).

Pilot Grants

In keeping with its core mission, Spectrum offers pilot grants for accelerating clinical and translational research (CTR) in these areas:

Program Goals

The Stanford CTSA/Spectrum Pilot Grant Program has two major goals: 

  • To stimulate innovative clinical and translational research 
  • To encourage collaborative, transdisciplinary work
  • The primary expectation is that these early-stage translational projects will lead to additional research, external support, information dissemination and most important, will develop into longer-term, comprehensive projects. 

Previously funded projects

Questions?

or 650-497-7032.

Funding opportunities in Child and Maternal Health

The Stanford Child Health Research Institute (SCHRI) Grant and Postdoctoral Support program aims to develop and support the best child and maternal health-focused and innovative clinical and translational research. All projects must be significantly related to child health. The applicant must be a pediatrician, obstetrician, a child health subspecialist or scientist who has a focus on or plans on focusing on child health research. The SCHRI Grant and Postdoctoral Support program offers child and maternal health research grants for Instructors, Assistant, Associate, Professors, and Postdoctoral Fellows in 4 categories:

  • Category I: Pilot Early Career ($35K)
  • Category II: New Ideas for Mid/Senior Investigators ($35K)
  • Category III: Bridge Funding ($35K)
  • Category IV:  Postdoctoral Fellows ($55K)

Clinical fellows (MD or equivalent) training in a clinical fellowship program should not apply through this mechanism.

Complete application and guidelines

http://spectrumchildhealth.stanford.edu/

Submit your proposals here, per the application instructions. You do not need to submit your applications via your RPM. 

Deadline

Monday, October 3, 2016 at 5:00 pm  

Timeline

Awards will be announced in December 2016.  Earliest award start date is January 1, 2017.  The performance period is 12 months.

General Eligibilty

  • All applicants must have or plan on having a focus on child health or obstetrics research, or wish to expand their interest in child health research
  • All applicants must be a SCHRI Member (except postdoctoral fellows), or his/her primary research mentor must be a SCHRI Member.  Membership Application at: http://chri.stanford.edu/how-to-apply.edu/
  • A Primary Research Mentor must be identified for instructors, assistant professors, and postdoctoral fellows.
  • All applicants must have legal residence in the United States. (Applicants with H or J visas are eligible).
  • The following are not eligible:
    • Clinician Educators (CEs). 
    • Visiting scholars to Stanford
    • Senior Research Scientists, Research Associates/Assistants
    • Former recipients of SCHRI awards who have not complied with award/reporting requirements. Mentors or applicants who have overdraft(s) in previous SCHRI awards that are not cleared prior to applying are not eligible.

Types of Research

Research must be primarily related to child health. Child refers to the expectant mothers, oocyte, zygote, embryo, fetus, infant, child, and/or adolescent.  All areas of research are eligible: basic, translational, clinical research, epidemiology/statistics, informatics, health services, or health policy. 

 I.  Pilot Early Career Investigators

Eligibility: Instructors and Assistant Professors only.
The Pilot Early Career category provides both PI salary and non-salary support for hypothesis-driven or hypothesis-seeking research that could lead to research that is externally fundable as a result of the proposed study. The study must be a pilot, concept, development, or feasibility proposal. This category is intended to help early-career applicants become independent researchers by facilitating projects that will produce the data needed for applications to external funding agencies. 

II. New Ideas for Mid/Senior Investigators

Eligibility: Associate Professors and Professors only.
The New Ideas category provides non-PI-salary support for high-impact, high-risk projects proposed by mid to senior investigators.  Projects must be novel to the field (i.e., not previously described in literature) and not a continuation or expansion of the investigator’s currently funded or unfunded research. The grant is intended to facilitate projects which are highly innovative and, if successful, will facilitate novel directions in research that is fundable by external funding agencies.

III. Bridge Funding

Eligibility:  Assistant, Associate, and Professors only.
The Bridge category provides both PI salary and non-salary support that helps to (1) bridge investigators between two awarded funding periods from either federal or non-federal sources (i.e. applicant has already won two awards and seeks Bridge Funding before a second award begins) or (2) enable applicants to re-submit an NIH-scored or non-triaged grant proposal – awardee is required to document the subsequent resubmission including the resubmitted proposal.  Only one bridge funding award is allowed (no two consecutive bridge awards). Applicants must justify how the SCHRI award will enable them to the NIH resubmission (e.g. maintain animal colony, produce preliminary data, etc.)

IV. Postdoctoral Fellows 

Eligibility: Postdoctoral Fellows Only. This category provides salary-only support for postdoctoral fellows requesting support in association with a specific project related to child health.  Medical fellows (MD or equivalent) training in a clinical fellowship program should not apply through this mechanism.  Applicants who completed a first post-doctoral fellowship at an institution not affiliated with Stanford University and wish to pursue a second post-doctoral fellowship at Stanford University in a scientific area different from their first post-doctoral fellowship are eligible.

  • Preference will be given to first and second year postdoctoral fellows.
  • Eligibility is limited to first through third year postdoctoral fellows.
  • Third year postdocs must justify how this funding will help his/her career, i.e. facilitate a change into a new field, etc. in the Career Development section of the application.
  • Fourth year postdocs and above are not eligible.
  • The postdoc’s primary research mentor must be a SCHRI Member and one of the following:
  • MD, MD/PhD, or PhD whose primary focus is maternal and child health research.
  • MD, MD/PhD, or PhD who wishes to expand his/her interest in maternal and child health research.

Questions?

 

Picturing Pain

Kids express their pain — and healing— in photos through a LPCH program

If you’ve ever been in extreme or extended pain, you know how difficult it can be to put the experience in words. How then do doctors and pain psychologists understand what their patients are going through? And how do patients get the self-understanding and connection that comes from articulating their experience? These were questions Anya Griffin, Ph.D., a pediatric psychologist and clinical director of the Pediatric Rehabilitation Program (PReP) at Lucille Packard Children’s Hospital, asked herself. “Pain is one of those things you can’t see, so how can we understand the lived experience of children with chronic pain? And how can we know how effective the program is?” she said recently.

Dr. Griffin explained PReP as “an intensive day treatment program for kids who are compromised by chronic pain. They’re not going to school, not getting out of bed. Typical outpatient care is no longer effective.” About three children and teens participate in the program at a time, doing physical therapy, occupational therapy, aquatic therapy, mindfulness and Dance/Movement Therapy groups, pain psychology, family therapy, and going to a school based at the hospital.  

The PReP patients were asked to take a picture that showed how they felt about their pain at the beginning of the program, which lasts anywhere from 3 weeks to 3 months, depending on the diagnosis and treatment needs. Then the patients were asked to take another picture that described how they felt at the end. “A lot of them said this is the one way they could tell people what their pain is like,” Dr. Griffin said. “My opinion is that it was very therapeutic for them.” She will be applying for another grant to expand the project to include the caregivers of the children, so they can capture and express the experiences of how having a child with chronic pain affects them. 

The pairs of photos and their captions are hung in a display case in the basement hallway of the Children’s Hospital. One pair shows tacks laid out on the floor in the shape of a body, with a stuffed bunny toy laying on its back, near the head of the tack-body. The caption explains that the pain of the anonymous artist feels sharp, like pokes from tacks, and at the beginning of the program, it left her immobile, like the toy. A viewer might also note the juxtaposition of the childish toy with the tacks, which symbolize pain that most people don’t experience until adulthood, if ever. The post-program photo? It shows a blurry-faced female sitting cross-legged, eyes closed, hands in a meditative pose. The caption explains that it is meant to show how peaceful the artist felt when swimming, something she was doing easily by the end of the program and hadn’t been able to do before PReP.

Another pair—this one displayed a bit larger and in the center of the exhibit—shows pieces of blue, broken glass laid out on a table in the “before” picture, and, in the “after” photo, those same pieces of glass contained in a glass jar. The caption explains that the broken glass symbolizes both that the pain felt by the photographer was sharp, and that she felt broken as a person at that point. Then, at the end of the program, she had learned how to both contain her pain and how to take those broken pieces and make them into something better.

That artist, a teenager whom we’ll refer to as “Jane,” spoke at the opening of the PhotoVoice exhibition. She said that when she first entered the program, she didn’t take the photography assignment very seriously or feel very motivated to do it—or much else. “I was in a very low state,” she recalled. “I didn’t want to think about my pain or any way to express it. But when I started to understand that my pain is connected to my physical and emotional state, I understood why we were doing the project, and I saw that I could turn my pain into new opportunities,“ Jane said to the group gathered for the opening, which consisted mostly of patients currently in the program, their families, program facilitators, and Jane’s family.

She also described the vast difference in her appearance from beginning to end of the program. At the opening, a beautiful, energetic blond teen dressed in a maroon cocktail dress and heels stood before the room. But Jane said that when she first started PReP, she was in a wheelchair and had braces on various parts of her body because of the severe pain; her mother added that her hair was dyed a cherry red “as if her anger were coming out her hair.”

 Now, Jane keeps a copy of the pictures she took on her nightstand at home. She said that, “when I wake up and see it, they remind me that today is going to be a good day. And even if something goes wrong that day, I know how to fix it.”  Jane is now a happy, active student who is back playing the sports she once loved. 

Moving forward, Dr. Griffin and her research team, Dr. Amanda Feinstein and Ashley Dunn, are looking to further educate the larger Stanford University and LPCH community about the impact of pediatric chronic pain through this continued project effort. They hope to bring to light the inner struggles of families dealing with pain and the beauty of these young voices getting back into life through the interventions of the PReP program.

Congratulations to the Class of ’16 Residents!

On June 18 th , the Class of 2016 residents and their families celebrated their graduation. Best of luck as you move on to the next chapter of your careers!

Dr. Alex Macario congratulating graduate Lindsay Borg.

Incoming and outgoing Chief Residents Drs. Anna Harter (class of ’17), Chris Clave (’16), Quentin Baca (’16), Amanda Kumar (’16), Meghana Yajnik (’17), and Austin Schwab (’17).

Dr. Pedro Tanaka congratulating graduate Jed Cohn.

Anesthesia's Got Talent

It can be easy to assume that your co-workers’ talents don’t extend much past what they display in the office or the operating room—especially when their careers take up the majority of their waking hours. But in the case of the Stanford Anesthesia Department at least, that assumption would be entirely off base. On June 2nd, Anesthesia staff, residents, faculty, and family members of these employees gathered in the Li Ka Shing Center to show off their artistic sides at the 4th Annual Arts and Anesthesia Soiree. And there was a lot to see. Paintings, drawings, ceramics, a quilt, hand-crafted furniture, and even an anesthesia-inspired cake lined the room. A slide show of travel photographs played on a projector. Throughout the evening, dancers, singers, musicians, and poets took to the stage.  

One of Anesthesia Department’s poets and the organizer of the event, Dr. Audrey Shafer, said that the event is “meant to be fun and supportive—a way to explore other areas of our lives that don’t get discussed in the OR or the lecture hall.” That supportive environment was clear from the rapt attention of the audience and the way children’s crafts were intermingled with the art of adults who had clearly devoted time to mastering their crafts. That environment also allowed performers to take certain risks: Musician Dr. Jennifer Basarab-Tung performed a number of songs throughout the night—some on piano and some as a singer, some accompanying others and some solo. The last piece she did, a very challenging vocal piece called Laudamus Te, where she was accompanied by Anesthesia Resident and violinist Lynn Ngai Wu, was something she had wanted to perform in public as a solo for a long time. “…but the thought of singing a solo gives me panic attacks.  Somehow, solo singing just seems more intimate and personal to me.  Each time I muster up the courage to do it, I feel that I've overcome a little more of that stage fright, and maybe some day it will be a thing of the past,” she said.

Despite the long hours of work as anesthesiologist, Dr. Basarab-Tung finds time to devote to music just about every week. “Because of the schedule demands of a medical career, I've typically joined choirs that have mixed skill levels and will look the other way if I miss rehearsals here and there.  My current choir rehearses only once a week, so it's usually easy to make time,” she said. Sometimes, it’s the hospital that is accommodating—Dr. Basarab-Tung had a leading role in a Gilbert and Sullivan operetta during her first year as an attending, and she managed to tailor her work schedule around it. In general, though, part of the appeal of singing is that she can do it anywhere. “I do my best singing in the car! If I didn't make time for music in some way, I would lose a major part of my identity and well-being, so it has never even been a question for me,” she said.

Dr. Shafer, who conducts research on art and medicine as well as organizing art events for the anesthesia department, said that even after four years of hosting the Art and Anesthesia Gala, there’s still a lot of energy behind it. “Every year, something surprises me…There’s the surprise of finding out that someone you know has these hidden talents,” she said.

From left to right: Yi-Bing Ouyang, Ph.D., Senior Research Scientist in the Gifford Lab; Lili Yang, Data Control Specialist in Metadata Department (SUL), Stanford; Cen Gao, a lab manager in Department of Biology, Stanford; Xin Li, an art teacher in Ai Xin Learning Center, Fremont, CA. All of the dancers take Chinese Dancing through the Health Improvement Program (HIP). Here they are doing a Tibetan folk dance.

Susan Lim, Executive Administrative Specialist; Araseli Hernadez, Administrative Associate; and Janine Roberts, Anesthesia Education and Training Manager take a break from watching the acts to pose for a photo. 

Publications

Interviews with the Anesthesia Chief Residents

An Interview With… Chief Resident Anna Harter  

  • Gas Pipeline: Tell us a bit about yourself.
    Anna Harter: I grew up in the Bay Area and went to a small liberal arts college in North Carolina. I went straight from college to medical school at UCSD, and then I had a really hard time deciding what specialty to go into. I took a year off between the third and fourth year of med school to do a masters in clinical research. I worked on a great project involving anesthetic neurotoxicity which helped me to decide on Anesthesiology, and pediatric anesthesia specifically. Now I still like peds anesthesia and I want it to be part of my practice, but I’ve decided not to pursue a fellowship or subspecialize further. I’m hoping to find a job next year at a practice where I can do a little bit of everything— including regional anesthesia, pediatrics, and OB.   
  • GP: Where did you do your internship and how would you describe it to applicants?
    AH: I did my internship at Santa Clara Valley Medical Center. I did a transitional internship, so instead of doing a full year of one specialty, you do a year of everything. I really liked the transitional internship because as an anesthesiologist, you take care of everyone—complex critical care patients, pregnant patients, children—which is what you do as a transitional intern. The Valley sees primarily an underserved population, so the patients often have more “basic” medical problems that haven’t been cared for as closely. You also see a lot of trauma; it’s fast paced and you work really hard. There are long hours, but it’s a very compassionate working environment. The nurses, OR aides, everyone who works in ER—they are happy to be there. It’s a good vibe to see as you are beginning your medical training. It’s also a culturally diverse hospital; you take care of and work beside people from so many different places. 
  • GP: Why did you want to be Chief Resident?
    AH: When I was a resident, I looked up to my Chiefs a lot. They were very patient, kind, and helpful; they were the go-to people who knew what was going on in the department, and if they didn’t know the answer to something, they could point you to who did. I wanted to be Chief to be that kind of person—approachable, someone they knew they could come to with confidential matters and silly day-to day-matters to help them make the transition from an intern to a resident a little easier. The first year is really hard, the learning curve can be very tough. And here in anesthesia, because you’re in your own operating room, you might not know that the resident in the OR next door is struggling with the same things. 
  • GP: What are you most proud of in the department?
    AH: One thing our department has really developed involves innovation in anesthesia education. We have both discreet programs developed by the AIM lab through “learnly,” and other programs within the department through the simulation lab, where interns and residents can go through emergency situations in simulated ORs, like mock codes or oxygen failure or power outages, to help develop communication skills and to help prepare you to feel comfortable when the situation arises in real life. And there’s START and STARTPlus, which have both online and in-person curricula, which have been developed for situations that you would encounter as an intern. These programs have expanded across country, so a lot of schools use them for board prep and emergency training.
  • GP: What is the most common question the new residents ask you about?
    AH: Simple scheduling questions, like if you have a doctor’s appointment, how to make it work. Or we get three weeks of vacation, and a fourth week that we have to use for a conference, so people ask about how to schedule those. Basically, maneuvering departmental processes. It’s hard because I may not always be at the main hospital—we’re always rotating between different hospitals—and residents may not want to email the chief account with something they perceive as being too small. So we try to have one of the chiefs at the main hospital as much as we can. That way residents can run into you and ask the small things, like I’m scheduled at a new rotation and I don’t know how to find my patients, or I am supposed to call my attending but I can’t find their phone number.
  • GP: What advice would you give the residents that just started?
    AH: The best advice I received is to try to always maintain a positive attitude. It can be really hard. You’re going to have hard, long days, and cases that are emotionally really tough. Sometimes you’ll feel like you’re close to breaking down, but you’re only here for a short time, so it’s important to soak up everything you can. Try to take a lesson from each day, no matter how hard it is. It’s helpful to find a mentor or friend you can talk to about your days. And try to be as compassionate as possible. Something can happen in the OR, someone might be short with you or vice versa. The argument usually doesn’t reflect the actual problem—it’s usually just because we’re tired or feel overworked. Try to respond with patience and kindness. It’s hard to cultivate compassion in these situations, but I think it is important to find a common ground and remind ourselves we’re all going through this together.
  • GP: Anything else to add?
    AH: I learned throughout my residency that you have to do things that keep you happy. I love playing golf, which can be hard in the winter because we work during the daylight hours, but you have to maintain something that makes you genuinely happy outside of the hospital. When you work really hard, often the things you enjoy are the first to go, but it’s really most important that those things stay. You have to take time for yourself every day, to keep yourself grounded. Whether it’s yoga, hiking, baking, dancing, spending time with your dog or children—and if you play golf, the Stanford golf course is truly amazing. 

An Interview with Chief Resident Austin Schwab

  • Gas Pipeline: Tell us a bit about yourself? What brought you to Stanford? 
    Austin Schwab: I was born and raised in Orange County, CA. Schooling took me away to Provo, UT, for college and Richmond, VA, for medical school. During medical school, I did an away rotation at Stanford and absolutely loved it. The attendings and residents were wicked smart, down-to-earth and friendly (everything I hoped I could eventually be). I came away from that rotation feeling that the possibilities were endless with the incredible resources and people in the department.
  • GP: What do you enjoy the most about your chief resident job?
    AS: I enjoy a greater involvement in the residency program. As chiefs, we are not only tasked with scheduling and responding to emails, but also to try to improve things. Though most of those improvements are small, it is fun having a hand in them.
  • GP: How did you decide to become an anesthesiologist?
    AS: The interest started when I worked as an orderly in the PACU during college. During downtime, I would pop into the ORs to check things out and loved the environment. The surgeons were doing cool things, but the anesthesiologists were the happiest by far. I liked the idea of being the internist in the OR where you get to manipulate a patient's physiology in a very acute care setting. It is easily the best job in the world for me.
  • GP: What are you going next year, and how did you decide on that?
    AS: I am currently looking for a job in private practice. We are looking at Utah; Denver, CO; and Austin, TX for a place to settle. At points during residency, I wanted to do every fellowship (kind of funny that I'm now not doing any). Then, after more consideration, I settled on applying to a regional fellowship. After interviewing at several programs, I started to reconsider the goals I had for my career (along with having discussions with mentors, family, and friends). I started contacting practices in every area we are considering and felt that it would be better to go right into practice and forego the fellowship. 
  • GP: What has been your favorite rotation as a resident?
    AS: Surprisingly enough, I think it is the CVICU. Usually I do not enjoy being in the ICU, at all. The month I was on CVICU, it was well staffed which meant a lower patient load and much more educational opportunities beyond what comes from taking care of patients. We had good lectures, more time doing TTEs, more time to interpret and understand physiologic data. I felt that I really got a good grasp on the mechanics of the cardiovascular system and that education reinforced what I learned from the cardiac rotation. It also gives you a lot of confidence in being able to take care of patients with severe pathology.
  • GP: Where did you do your internship how would you describe it to applicants?
    AS: I did a transitional year internship at Intermountain Medical Center in Murray, UT. One of the major reasons we went there was to live with my parents to save up money to make living in Palo Alto more affordable. As interns, we rotated through inpatient medical and surgical services, the ICU and ED, and several outpatient clinics. I enjoyed the variety of the different services and the perspectives you would get from being on those services.
  • GP: What has been your favorite experience at Stanford outside the resident job?
    AS: The football games have been awesome to go to. My wife, kids, and I have bought season passes the past two years and they are really fun (especially if it isn't a day game in early September in the scorching sun).
  • GP: What are you most proud of in the department?
    AS: How supportive the department is with each resident's goals and aspirations (and that includes both personal and professional). My goals have change immensely throughout residency, but I have always felt great support and encouragement from everyone. 
  • GP: What advice would you give the residents that just started?
    AS: Pace yourself. There is so much to learn, but you have years to learn it. Anesthesia residency is three years for a reason. If passing gas was super easy, we wouldn't be a specialty. Take your time and enjoy the experience.
  • GP: What are your hobbies?
    AS: Outside of residency, I spend the majority of my time wrestling kids to bed, cleaning food off the floor and walls, changing diapers, and loving being a dad. I also enjoy going on dates with my wife (hiking, biking). When I'm not doing those things, I like to play/watch/talk basketball. 

An Interview with Chief Resident Meghana Yajnik

  • Gas Pipeline: Tell us a bit about yourself? What brought you to Stanford?
    Meghana Yajnik: I was born in the Bay Area, but grew up mostly in Los Angeles and Hong Kong. I came to Stanford for medical school and never left!
  • GP: What is the most common question the new residents ask you?
    MY: "When will I start to feel comfortable in the OR?" Although I still don't feel completely comfortable in the OR, that feeling of terror or impending doom started to fade at around 6 months for me.
  • GP: What do you enjoy the most about your chief resident job?
    MY: I really enjoy getting people excited about anesthesiology. Whether it's a medical student still deciding on their career or a resident considering fellowship options, I love talking about our field and all the great opportunities it has to offer.
  • GP: What are you going next year, and how did you decide on that?
    MY: Next year I will be doing a regional anesthesiology fellowship here at Stanford. (I'm never leaving The Farm!) Regional anesthesia was a rotation that really spoke to me as a resident. With a trend in healthcare towards patient satisfaction, I believe management of acute perioperative pain, and therefore regional anesthesia, will play an important role.
  • GP: Where did you do your internship how would you describe it to applicants?
    MY: I did my internship at Kaiser San Francisco. Kaiser San Francisco is a fantastic community hospital smack in the middle of a big city. The patient population is diverse and the teaching there is incredible. Plus, who doesn't want to live in San Francisco for a year? My commute for the year was one street block, and the hospital is just minutes from some of the best restaurants in the city. Did I mention it's in San Francisco?
  • GP: What has been your favorite experience at Stanford outside the resident job?
    MY: I've said it before and I'll say it again - Stanford Theater. I've always loved classic movies and the experience at Stanford Theater is the perfect weekend treat—a beautiful well maintained theater with a balcony, a live organ player during intermissions, and a small museum with still pictures from the making of the movie being shown.
  • GP: What are you most proud of in the department?
    MY: I am definitely most proud of the residents. Each year I'm so impressed by how talented, humble and resilient our residents are—not to mention wicked smart.
  • GP: What advice would you give the residents that just started?
    MY: According to one of our wise attendings, the two rules of residency:
    1. See a donut, eat a donut.
    2. Concentrate the glory, diffuse the blame.
  • GP: What are your hobbies?
    MY: Hiking, trying new foods then trying to recreate them at home, mystery novels and Netflix. (Anyone who doesn't say Netflix is lying!) 

Grants, Special Publications, and Other Awards

Grants

  • Sesh Mudumbai received a $5.3 million grant to study the risks of opioid misuse, abuse, and addiction among patients treated with extended-release/long acting opioids for the treatment of chronic pain. 

Awards

  • Resident Coordinator Janine Roberts received the Outstanding Program Coordinator Award from the Stanford GME office.
  • Jordan Newmark, Natalya Hasan and Louise Wen all received Teaching and Mentoring Academy Innovation Grant Awards.
  • Charles Hill was elected as a Member at Large to the SHC Medical Executive Committee.
  • Two Stanford medical students, Emily Liu and Jason Batten, and Audrey Shafer as the mentor, won the Western Group on Educational Affairs (WGEA) New Investigator Award for their presentation, “Practicing Well: Student Perspectives on a Bioethics and Medical Humanities Scholarly Concentration Program.”
  • Chandra Ramamoorthy was appointed Associate Chief Medical Officer for Diagnostic and Procedural Services at LPCH
  • Rebecca Claure was appointed Medical Director of Anesthesia Services for Diagnostic and Procedural Services at LPCH.
  • Larry Chu and the AIM Lab/Medicine X team created and hosted a symposium on Precision Medicine at the White House.
  • Creed Stary was appointed to Assistant Professor. 
  • Larry Chu was promoted to Professor.
  • Laura Simons was appointed to Associate Professor.
  • Gillian (Hilton) Abir was promoted to Clinical Associate Professor.
  • Beth Darnall was elected to the Association of University Anesthesiologists in July 2016.
  • Beth Darnall was named Co-Chair of the American Academy of Pain Management annual conference.
  • Sean Mackey was awarded this year’s American Pain Society’s Wilbert E. Fordyce Clinical Investigator Award and Lecture. Each year, the APS recognizes a pain researcher who has made significant achievements over the course of their career with this award.  He gave the Fordyce lecture at the American Pain Society’s annual conference in Austin on May 13. To see more information about the award, visit: http://americanpainsociety.org/get-involved/awards-grants/2016-fordyce-award-mackey

Special Publications

  • Jordan Newmark, in collaboration with Anna Lembke and Keith Humphrys of Psychiatry, published a review article regarding the risks and benefits of chronic opioid therapy. The article got cover status of the June 15, 2016, American Family Physician and they were also given an editorial spot in the issue.  
  • Sean Mackey led the effort to create and publish the National Pain Strategy, which was released in February 2016. He co-chaired the oversight of 6 working groups, and also co-chaired 2 of the individual working groups. It was a monumental effort, and the NPS is the roadmap to transform pain care, research, education and advocacy in the U.S.  
  • Beth Darnall was one of the doctors on the panel who reviewed the American Pain Society’s Principles of Analgesic Use, 7th Edition 2016.
  • Beth Darnall published an op-ed in the April 4, 2016 San Francisco Chronicle, Treating Chronic Pain Requires More Than a Pill. 

Say Hello to Two New Employees!

Kathryn (Kat) De Rama

Kathryn (Kat) De Rama has joined the Division of Pediatric Anesthesia as an Administrative Associate 3. She will be supporting Dr. Honkanen and the GOR group, as well as Dr. Krane, the Pain Division and the Pain fellowship (clinical and PhD).     

A little background on Kat: She came from the medical cosmetics/plastic surgery field. She has a BS in health science and is currently working on her MS in Health Administration & Management. She has an aptitude for organization, which led to her 10 years of experience in administrative and operational support for a variety of establishments. Kat is a big foodie, loves animals, and is an advocate for fitness and wellness. On her off time, she loves to read, keep up with current events or spend time with family. She is friendly and outgoing, so please stop by to say hello. 

Contact information as follows:

Physical location: 300 Pasteur Dr., 3rd Floor, Room H3584, MC 5640, Palo Alto, CA 94305 

Email: kderama@stanford.edu

Phone: 650-723-5728

Christina Daniel

Christina Daniel formally accepted the role of full-time Administrative Assistant at the Pain Lab, after working as a temp in the position for a few months. Christina recently graduated from San Jose State with a degree in Kinesiology. In addition to performing various front desk operations, Christina will be the point person for maintaining the personnel database, processing necessary logistics for new Lab employees, and ensuring they have a functioning work station.

Christina’s contact info is:

Email: cdaniel3@stanford.edu

Desk Line: (650) 723-1235

Location: 1070 Arastradero Road Suite 200, MC 5596, Palo Alto, CA 94304

Pilot of Resident Learning App

A new app, Libero, is being piloted by the department. The app allows residents to search all Libero lectures by keyword, answer multiple-choice questions, and save, share and rate their preferred slides. The pilot is in response to residents noting that mobile computing and learning from smartphone apps are useful.

Users can login to the app using their Stanford email at ‪libero.middlescholars.com. The Getting Started video can be found here:

A new app, Libero, is being piloted by the department. The app allows residents to search all Libero lectures by keyword, answer multiple-choice questions, and save, share and rate their preferred slides. The pilot is in response to residents noting that mobile computing and learning from smartphone apps are useful.

Users can login to the app using their Stanford email at ‪libero.middlescholars.com. The Getting Started video can be found here:

Gas Lounge

When Anesthesia Resident Adam Was learned about the PRIME scholarship fund, he knew he wanted to submit a proposal, but didn’t immediately have a proposal idea. The scholarship is open to anything that supports the lives of the residents or their families, and each proposal is limited to $1,500. So Adam thought like the doctor he’s training to be. “I wanted the proposal to be data driven. I thought, how can we most meaningfully impact people within the budget constraints?” He immediately thought about the Gas Lounge—the private lounge for anesthesia residents only. The space was a cherished haven where residents could rest and get away from bosses and patients, but after being used by 75 people, 24 hours a day for years, it was sorely in need of some upgrades. 

Looking to the literature, Adam found evidence to support his idea. Improving the lounge “had a realistic chance of improving resident well being,” Adam said. His research showed that providing common space has improved people’s satisfaction at work; Adam extrapolated that improving a common space that had seen better days would do the same. 

What improvements would make the most impact? Following the PRIME scholarship model of empowering the residents by giving them a say in how the funds are spent, Adam did an online survey of all the residents. “It was pretty straight forward. I just put it out there: What do you want? We pre-populated some answers, but allowed them to put others in. We got everything from making phone chargers available to hot tubs to a masseuse,” he said. The survey also asked questions about the overall satisfaction with the lounge.

He, the Chief Residents, and Dr. Tara Cornaby, Director of the PRIME Program and of the PRIME Scholarship, made the final decisions, ranking the suggestions by cost, time-to-implement, and feasibility. The first round of funding went towards a massive clean-out, painting of the walls, a new couch and coffee table, and phone chargers. (Unfortunately, the hot tub landed on the “unfeasible” list.)

Adam credited Janine Roberts, Residency Program Manager, with completing the biggest part of the job—the cleanout. Adam was working abroad at the time, so Janine shouldered the cleaning responsibility, which included disposing of food found under the couch, such as a loaf of bread and an orange that had turned black with mold. “Janine, as with everything in the department, she made things work. She put us in touch with the right facility people to get the painting done, the carpets cleaned. And she just did the most heroic job of cleaning the place out,” he said. 

When Adam was back at Stanford, he ordered the furniture to arrive just after the facilities department painted and cleaned the carpets. “During one light weekend call, I put everything together. I did it in one fell swoop so everyone could immediately see the before and after,” Adam said.

After the results were revealed to the very grateful residents, Adam conducted another survey to reassess satisfaction with the lounge. “I wanted to show that the funds were well spent, and well appreciated,” he said. “The response was awesome: satisfaction with and the use of lounge went up.” In fact, the score for satisfaction with the lounge went from an average of 3.5 to 7.5 out of 10.

Still, Adam wanted to do more. “One of the parts I loved the most was being able to bring that information [about the results] to the faulty and say, ‘We couldn’t get everything done in one round. The lounge looked pretty different afterwards, having those upgrades in place made for a cozier, homier, more protected space, and more people are using it between cases during the long days in the hospital. But now we’d like to put a new lock on the door, and put in a second computer and desk.’”

Seeing the impact the first round of funding had made, the PRIME scholarship committee granted a second round for these other improvements.

It’s been about a year since the second round of upgrades were completed, and Adam continues to keep to an eye on The Gas Lounge, making sure trash doesn’t pile up (or food slip unnoticed under the couch). But he’s found that the “Disney World effect” really does work: “At Disney World, one reason they keep it so clean is that people won’t litter in a clean space,” he said.

Just like with any medical research, now that the project is over, the next step is to share the results. He and Dr. Cornaby are going to present the project at the International Conference on Physician Health in Boston in September.

2016-7 Faculty Teaching Scholars Named

Faculty who teach must achieve the same high level of expertise (in education) as that achieved by research faculty (in clinical or laboratory investigation). To help meet this challenge, the Dept. of Anesthesia supports Teaching Scholars to obtain further training.

Congratulations to the 2016-2017 Faculty Teaching Scholars:

  • Amy Lu: Design, Implementation, and Evaluation of a Postoperative Medicine Rotation for Anesthesiology Residents.
  • Andrea Traynor/Lynn Nagai: Development of a Mobile App to Enhance Anesthesiology Learning.
  • Christopher Painter/Wendy Ma/Sandra Sacks: Development of a Multisource Feedback Physician Assessment and Curriculum Update to the Orthopedic Trauma Rotation.
  • J. Grant McFadyen/Gavin Hartmann: An Online Pediatric Anesthesia Topic of the Month with Interactive Self-Assessment Questions and Discussion Forum.
  • Marianne Chen/Laura May: Implementation and Assessment of a Focused Perioperative Ultrasound Curriculum.
  • Mark Burbridge: A Curriculum for Anesthetic Management Interventional Neuroradiology Procedures.
  • Ruth Fanning/Felipe Perez: Development of a Resident Elective to Foster Physician Leadership in the Field of Patient Safety and Quality Improvement.
  • Tammy Wang/Gavin Hartman/Adam Was: Pediatric Perioperative Medicine Curriculum for Anesthesia Trainees.

PRIME 2016-17 Scholarship Winners Announced

The Peer Support and Resiliency In Medicine (PRIME) Program recently announced the winners of the 2016-2017 scholarships. They were given to projects that will promote resident wellness and resiliency in the Department of Anesthesia.

2016 PRIME Awardees: 

  • Dr. Nicole Arkin
    • Faculty Mentor: Dr. Natalya Hasan-Hill
    • Project: Behind the Drape: Mentorship Through Storytelling in Anesthesiology
    • Goals:  Create a mentorship program between women faculty and residents with quarterly meetings focused on themes relevant to training female anesthesiologists.  Pre and post surveys will assess the needs of the residents and efficacy of the program.
  • Dr. David Creighton
    • Faculty Mentor: Dr. Jennifer Lee
    • Project: To Attend a National Meeting/Program Focusing on the Promotion of Physician Resiliency/Wellness
    • Goals:  Attend a conference on the promotion of physician resiliency and wellness called "International Conference on Physician Health 2016."  After the conference, design a research project focusing on improving resident wellness or conduct a resident wellness workshop. 
  • Dr. Cynthia Khoo 
    • Faculty Mentor: Dr. Diana Adams 
    • Project: CCARE, Wellness on Wheels, and Mentorship
    • Goals:  Attend an 8-week CCARE course, make the Wellness on Wheels Program available to the Stanford Anesthesia community, and strengthen mentorship among junior and senior residents.
  • Dr. Jocelyn Wong
    • Faculty Mentor: Dr. Jody Leng
    • Project: Wellness Sessions for Anesthesia and Surgery Residents to Help Prevent Burnout, Foster a Sense of Community, Improve OR Dynamics, and Facilitate Collaboration Between Anesthesia and Surgical Departments
    • Goals:  Improve peer support through monthly dinner sessions for all levels of anesthesia residents to discuss stressful situations and coping strategies.  At quarterly dinner sessions, anesthesia and surgery residents will discuss difficulties and accomplishments in the operating room.  A burnout inventory survey will be administered prior to the program and one year later.

Drs. Jonay Hill, Jennifer Lee, Tara Cornaby, and the PRIME Scholarship Selection Committee 
give special thanks to Drs. Macario and Pearl for supporting this exciting program.  

Welcome to the World!

Sebastian Thaddeus Yin

Vicky Yin and her husband Jeff are happy to announce the birth of our second son, Sebastian Thaddeus Yin! He was born rather early at 29 weeks on May 23rd, 7:50 pm, weighing 2 pounds and 2.5 oz. Despite his prematurity, he is doing very well and has since "graduated" from the NICU to the intermediate care nursery. Vicky reports that both she and Sebastian received exceptional medical care throughout, and she says that words cannot express how thankful she is to have such a compassionate and kind health care team. She sends special thanks to Drs. Collins and Kattan for taking excellent care of her.

Ayla Sarenne Bany

Tenille Bany and her husband Adam were happy to welcome Ayla Sarenne Bany on March 25th at 10:45pm. Ayla weighed 7 lbs, 11oz and was 21" long.  Tenille gave her experience at LPCH very high marks, sending special thanks to Victoria Fahrenbach (and Dr. Austin) who gave her an amazing epidural, and Sara Smith who bolused her when the REAL labor pain started. Tenille reports that Ayla is already tons of fun – she loves books, camping, and riding in her bike trailer. Tenille is also grateful to all for the warm welcome back!

Gabriel Stephen Bodley

Vivianne Tawfik and her husband Ian are thrilled to announce the birth of their son, Gabriel Stephen Bodley. Looking just like his big brother Nathaniel, but with a full head of blond hair, Gabriel was born on July 14th, 2016 at 8:27am and weighed in at 7 lbs 9 oz. Vivianne sends special thanks to Caitlin Sutton and Gill Hilton for their wonderful care (and amazing block!), and to everyone in the Department for their support and good wishes.

Stanford Free Back Pain Education Day

The 2016 Stanford Free Back Pain Education Day is taking place Sunday, September 11, 2016, at the Cemex Auditorium at Stanford University from 10-4pm. This free community outreach event offers members of the public great expert lectures on chronic back pain treatments and resources, as well as goody bags, giveaways, and complimentary lunch. The event will be live streamed and archived on YouTube. This is the third year of Back Pain Day, and last year’s event received great press coverage, including Good Morning America. This year’s event is already at capacity (about 600) and another 600 individuals are on the wait list. The event is co-sponsored by the Division of Pain Medicine and SHC. Event Co-Chairs:  Sean Mackey, MD, PhD, and Beth Darnall, PhD.

Close Finish at 14th-Annual Anesthesia Golf Tournament

Reed Harvey making the tie-breaking putt.

After a tie-breaking putting competition on the 18th-green, Chris Press, Reed Harvey, Ivar Brock-Utne, and Chris Miller came in first at the 14th Annual Stanford Department of Anesthesia Golf Tournament. Reed Harvey nailed a 15-foot putt, allowing his team to beat Emmett Culligan, Anna Harter, John Brock-Utne, Richard Grove. Both teams had a score of 61 (9 under par).

Third place went to Kristen Telischak, Nick Telischak, Jerry O’Hara, and John Allan. Other winners of the day:

Ladies; Closest to the Pin and Longest Drive: Anna Harter

Men: Closest to the pin: Andrew O’Gilby

Men: Longest Drive:  Richard Grove

Sportsmanship: Tim Angelotti, Martin Skagen, Amanda Wheeler and Andrew O’Gilby.

The finger supper and awards’ ceremony was held afterwards on the patio overlooking the 18th green. Organizer John Brock-Utne and everyone who participated is grateful to the department for its support of this event

First Place

First-Place team, from left to right: Reed Harvey, Ivar Brock-Utne, Chris Miller and Chris Press.

Second Place

Second-Place team, from left to right: Emmett Culligan, Richard Grove, Anna Harter, and John Brock-Utne.

Beth Darnall, Ph.D., Publishes New Book

Beth Darnall’s new book, The Opioid-Free Pain Relief Kit: 10 Simple Steps to Ease Your Pain is available now on Amazon and will be in bookstores on September 1. Written for patients, it gives people “the right road map and skills to help you reduce your own pain, so you need less medication,” according to the listing on Amazon.com. The book includes a primer on pain; information on the connection between stress and pain; how to use your thoughts, activity, sleep, and pleasure as pain relievers; tips on preventing flares; and information on opioids.  

About the new book, Dr. Daniel B. Carr, a Program Director of Pain, Research Education & Policy at Tufts University School of Medicine said, "Beth Darnall, a compassionate and highly regarded psychologist, has once again distilled her practical wisdom into a clear, concise guide to help patients reframe, reinterpret and self-manage their pain.…For the many millions of patients with chronic pain unable to be cared for by Dr. Darnall in person, and clinicians seeking resources to help their patients benefit from nondrug, behavioral techniques, this handy workbook offers a welcome fresh start.