Friday, June 17, 2016

Hyperkalemia

Published in VC's Notes on June 17, 2016

Hyperkalemia

Good morning!

If the heat and humidity is any indication, summer is here! 

Most of our K-12 and undergraduate kids are out of school, and a much-needed vacation may be on the horizon. However, at health science education institutions like ours, the learning never stops. In fact, summer can sometimes be the busiest time of the year. Nursing and SHRP have already started their “new” classes of students. 

Also around this time, clinicians await the arrival of the newest set of learners to campus - those who have already earned the title “doctor.” Next month, close to 175 new residents and fellows will step foot on campus, some for the first time since becoming doctors.

The Medical Center is home to 650 residents and fellows from 61 different training programs. Another 14 programs are under development. Of the July newcomers, one-third are graduates of our School of Medicine, and 15 are international medical graduates who chose Jackson as the preferred location to further their education.

Residents are more than just an extra set of trained hands. They bring with them an energy and zeal for health care, and they contribute fresh ideas and research experience gleaned during their undergraduate and medical school days. They join a group of clinicians who are extremely valuable to patient care and, in some cases, deserve special recognition for stepping up and serving alongside other members of the Medical Center's leadership teams.

Dr StacyTake for example Dr. Jason Stacy, chief neurosurgery resident, and Dr. Rishi Roy, chief surgery resident. Dr. Stacy has served as chair of the resident's quality council since 2012 and has been an active force in pushing quality improvement initiatives at UMMC. He and Dr. Roy, who has been co-chair with Dr. Stacy since 2014, attend leadership rounds alongside our top clinical and administrative leaders. Thanks to both of them for helping to make the Medical Center a more highly functioning operation.

Our residents' servant leadership is evident in the hands-on work they do to bring medical care to those who need it most - whether that is here in Mississippi or all around the world. Just one example is family medicine resident Dr. Chloe Kilman, who recently took part in a medical mission trip to Haiti, helping to lead nine of our medical students in a volunteer initiative that provided care to more than 1,200 patients in just five days! 

Six current residents were honored during this year's Arnold P. Gold Foundation's Humanism and Excellence in Teaching Awards ceremony. These residents demonstrate an enthusiastic commitment to teaching and serve as role models for the compassionate treatment of patients, families, students and colleagues. The 2016 honorees are Dr. Chance Davis (family medicine), Dr. Savannah Duckworth (internal medicine), Dr. Ashley Griffin (surgery), Dr. Ashley Johnson (obstetrics and gynecology), Dr. John Rushing (obstetrics and gynecology) and Dr. Diana Tate (pediatrics).

Residency training is at the core of our mission as an academic medical center. We are expanding our School of Medicine to aid in supplying our state with more doctors, and the residents who go through our programs are key to swelling Mississippi's physician ranks. Research shows that practicing physicians tend to locate close to where they completed their residencies. According to AAMC data, 68 percent of doctors that do all of their medical training in a specific state will stay and practice in that state. This is huge for us and especially helpful as we've been able to significantly grow our number of residents and programs throughout the past 10 years. GME training at UMMC is the primary feeder for more doctors in Mississippi. We feel so strongly about this responsibility that nearly all of our recent growth in residency slots and programs has been internally funded through the clinical operation.

Part of that growth of residents and programs is thanks to the efforts of Dr. Shirley Schlessinger, who took over leadership of our Graduate Medical Education Program in 2003. Through her, our residency programs have reached new heights and are moving on a steady growth path that will now be led by Dr. Rick Barr, recently named senior associate dean for GME. My heartfelt thanks to Dr. Schlessinger for what she's done for our advanced learners and to Dr. Barr for accepting the challenge of continuing to increase and improve our graduate medical programs at a time when funding and residency slots are at a premium.

I don't just preach the virtues of how valuable resident leaders are. I speak from experience. In my former “life,” I served as the residency program director at UMMC for emergency medicine - the BEST job in the world. I had the privilege of walking in step with residents during their journey from anxious interns to accomplished physicians, ready to take on the world. In the Emergency Department I had the opportunity to work closely with not only the EM residents, but other residents who spent a lot of time taking care of patients in the ED during the course of their training.  

The transformation is remarkable and filled with many significant moments.  This week, while at an LCME (Liaison Committee for Medical Education) meeting in Chicago, I had the chance to visit with Tom Nasca, chief executive officer of the Accreditation Council for Graduate Medical Education (ACGME) and chief executive officer of ACGME International.  He met with us to discuss a number of topics that are vitally important to both students and residents - burnout, rates of suicide among learners and practicing physicians, the learning environment, resilience, etc. - and what we, as accrediting bodies, can do to be a positive force in the efforts to tackle these issues.  

The first year as a resident, the intern year, is made up of especially intense moments that are forever etched in to one's memories. Because of the intensity, every physician has endless stories from his or her intern year - some not suitable to recount in this column. A doctor's learning curve takes a giant leap forward that year. I can recall being on old 6 West during my intern year in the middle of the night taking care of a patient with hyperkalemia (too much potassium in the blood). I had learned all about hyperkalemia in medical school and could correctly answer test questions on the topic, but when faced with MY first hyperkalemia patient, I poured intensely over that section in the Washington Manual to be extra sure I knew exactly what to do. I read that section and seared it into my brain with intense focus and purpose so that I would never have to look it up again. The intern year is full of such fierce moments. 

To our incoming trainees, I want to extend a hearty welcome. To those who are tasked with assisting these newbies through this gauntlet, I say thank you. Transition points in training and education are particularly vulnerable times - be mindful of this. For the new residents who have already received a portion of your education here, thanks for continuing this journey with us. And to those who are coming from other parts of the world - welcome to Mississippi, where the need is great and stakes are high.

Thank you for all that you have done and will do to help us in our quest to create A Healthier Mississippi.



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