Division of General MedicineDepartment of Medicine

Annual Report, July 2003 - June 2004

The Division of General Medicine recently concluded another highly successfulacademic year. This report summarizes our activities and achievements in research,teaching, and patient care during 2003-2004.

This year’s Annual Report is dedicated to the memory of Timothy O. Jones, M.D., agraduate of our medical school and residency program and a member of the Divisionsince 1991, who died in November 2003.

Division Faculty

New Faculty: The Division welcomed 3 new faculty members this year:

Sarah E. Lapey, M.D., Assistant Professor, joined us after completing herresidency in primary care internal medicine at Brigham and Women’s Hospital inBoston. After obtaining a B.A. in English and music at Williams College, she studied atBryn Mawr before attending Harvard Medical School. Dr. Lapey has also studied jazzperformance and composition at Berklee College of Music in Boston. She has a stronginterest in medical humanities, international health, and the management of obesity.She joins our group of clinician-educators based at the VA Hospital.

Chen-Pin Wang, Ph.D., Assistant Professor, came to us from the Department ofEpidemiology and Biostatistics at the University of South Florida. After attendingcollege in Taiwan, she earned her doctoral degree in statistics from the University ofFlorida. She has served as a co-investigator and biostatistician on several NIH-fundedprojects, and held the rank of Research Assistant Professor at South Florida. Inaddition to her work with our VERDICT Center, she is a member of the Center forEpidemiology and Biostatistics at the Health Science Center.

Christine N. Runyan, Ph.D., Assistant Professor, moved to our VERDICTresearch group from the Population Health Support Division at Brooks Air Force Basein San Antonio. A magna cum laude graduate of the University of Maryland-BaltimoreCounty, she completed her doctorate in clinical psychology at Virginia PolytechnicInstitute. She brings experience in behavioral health and the assessment ofpsychosocial risk factors.Continuing Faculty:

Andrew K. Diehl, M.D., M.Sc., O. Roger Hollan Professor; Chief, Division ofGeneral Medicine.

Jacqueline A. Pugh, M.D., Professor; Head, Section of General Medicine, AudieL. Murphy VA Hospital; Director, Veterans Evidence-based Research, Dissemination,and Implementation Center (VERDICT).

Henry S. Perkins, M.D., Professor; University Health Center-Downtown.

Valerie A. Lawrence, M.D., M.Sc., Professor, Audie L. Murphy VA Hospital.

Kristy Y. Kosub, M.D., Professor; Director of Medical Student Education,Department of Medicine.

Cynthia D. Mulrow, M.D., M.Sc., Clinical Professor; Deputy Editor, Annals ofInternal Medicine; Program Director, Robert Wood Johnson Generalist PhysicianFaculty Scholars Program.

José M Benavides, M.D., Clinical Professor; Internal Medicine Group, UniversityHealth Center-Downtown.

Debra K. Hunt, M.D., M.S.P.H., Associate Professor; Residency ProgramDirector; Director, Adolescent Medicine rotation for residents.

Robert G. Badgett, M.D., Associate Professor; Director of Office Medicineelective for residents; Director of Clinical Informatics, Department of Medicine.

Patricia I. Wathen, M.D., Clinical Associate Professor; Associate ResidencyProgram Director; Director, Women's Health elective for residents.

Hasi M. Venkatachalam, M.B.B.S., M.P.H., Associate Professor; co-appointmentwith Student Health Service, UTSA.

Barbara M. Fishman, M.D., Associate Professor; University Hospital EmergencyCenter.

Timothy O. Jones, M.D., Assistant Professor; Coordinator for general internalmedicine, The Diagnostic Pavilion.

C. Jeffrey Griffin, M.D., Clinical Assistant Professor; Co-Director of InternalMedicine Clinic, Audie L. Murphy Veterans Hospital.

Jane E. O’Rorke, M.D., Assistant Professor; Director, General Medicine Clinic,University Health Center-Downtown; Director, Office Orthopedics elective for residents.

Michelle V. Conde, M.D., Clinical Assistant Professor; Audie L. Murphy VeteransHospital; Director, Primary Care block rotation for interns.

Edward J. Lefeber, Jr., Assistant Professor; The Diagnostic Pavilion.

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Eric M. Mortensen, M.D., M.Sc., Assistant Professor; VERDICT Center, Audie L.Murphy Veterans Hospital; Director, Medicine Consultation Service.

Vineeta Kumar, M.D, Assistant Professor; University Health Center-Downtown.

Polly Hitchcock Noël, Ph.D., Assistant Professor; Associate Director, VERDICTCenter, Audie L. Murphy Veterans Hospital.

David F. Montemayor, M.D., Assistant Professor; University Health Center-Downtown.

H. Edwin Tamayo, M.D. Assistant Professor, Audie L. Murphy Veterans Hospital;Director, Internal Medicine Clinic.

Deborah L. Baruch-Bienen, M.D., Assistant Professor; liaison to the internalmedicine residency program at the Regional Academic Health Center in Harlingen.

Honors

Dr. Kosub was promoted to full Professor of Medicine. Dr. Fishman waspromoted to Associate Professor of Medicine.

Dr. Kumar was named by our residents as the Outstanding Faculty Teacheramong all faculty in the Department of Medicine for the third consecutive year. Inaddition, the Medical School Class of 2005 voted her the Outstanding Faculty Teacherof 2003-04.

Dr. Kumar also received the Division of General Medicine’s OutstandingTeacher Award for the third time. Dr. O’Rorke received the Division's OutstandingTeacher Award for the fourth year in a row, and Dr. Wathen was so honored for theninth time.

Dr. Kosub received the Outstanding Faculty Award from the Medical SchoolClass of 2004 at their commencement in May. She has received this honor from 8 ofthe past 9 medical school classes.

Dr. Diehl was listed in Best Doctors in America 2003-2004. He received anOutstanding Faculty Award from the third-year medical students.

Drs. Conde and Mortensen were recognized by the Annals of Internal Medicinefor the quality of their manuscript reviews in 2003.

Dr. Mortensen’s research won the Department of Medicine’s 7th AnnualResearch Day competition in the junior faculty category.

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Dr. O’Rorke’s pre-course on the medical orthopedic examination received theaward for the best pre-course at the 2004 National SGIM meeting.

Dr. Wathen’s poem “Housecalls” won the Healing Power of Poetry competition inthe medical school’s 2004 Spring Enrichment Program.

Regional and National Responsibilities

Dr. Perkins remained on the editorial board of Theoretical Medicine andBioethics. He served as an expert witness on bioethics for three lawsuits.

Dr. Lawrence continued on the editorial boards of ACP Journal Club and TheJournal of Clinical Epidemiology. She is a consultant to the Technology AssessmentPanel, Patient Care Services of the VA. She served as a technical advisor for theEvidence-based Practice Center at Stanford-UCSF.

Dr. Diehl continued as a member of the National Board of Medical Examiners.He completed his fourth year as chair of the USMLE Step 3 Test Material DevelopmentGroup for Family and Community, and served on a Test Item Review Committee for theStep 3 examination. He was appointed to a 3-year term on the USMLE Step 3Committee. He continued on the editorial board of The American Journal of theMedical Sciences. He served as SGIM's representative to the 18th Annual PrimaryCare Research Methods and Statistics Conference. He reviewed abstracts for the 27th

annual National SGIM meeting, and served as an expert consultant on a lawsuit.

Drs. Kosub and Diehl planned and co-chaired the scientific program for the 2003annual meeting of the Texas Academy of Internal Medicine.

Dr. Pugh continued as a member of the VA’s Clinical Practice Guideline Council,and served as well on its Implementation and Education Committee. She was amember of the Research and Methodology Committee for the VA’s QualityEnhancement Research Initiative. She served on the VA Advanced Clinical AccessSteering Committee, and the planning committee for the State of the Art conference.Dr. Pugh was installed as President of the UTHSCSA Medical School AlumniAssociation.

Dr. Hitchcock Noël was invited to serve a 4-year term as a member of the VAHSR&D’s Scientific Merit Review Board.

Dr. Mulrow continued as Deputy Editor of the Annals of Internal Medicine andProgram Director of the Robert Wood Johnson Foundation’s Generalist PhysicianFaculty Scholars Program. She remained on the editorial board of ACP Journal Club.She is a member of the editorial board for electronic and print versions of ClinicalEvidence, a compendium of the best available evidence for effective health care.

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Dr. Benavides completed his fifth year as a member of the Texas State Board ofMedical Examiners, where his specific responsibilities include disciplinary actions, peerreview, and current proficiency. He chairs the finance committee.

Dr. Conde worked with the ACP to present the 15th Annual San Antonio InternalMedicine Board Review course in May, serving as the course's Director. She is aneditorial consultant to the ACP’s PIER electronic resource. She served on the annualMeeting Planning Committee for Southern SGIM, and chaired its Vignette Committee.In addition, she reviewed education workshop submissions for SGIM’s Nationalmeeting.

Dr. Kumar served as Co-Director of the ACP’s 15th Annual San Antonio InternalMedicine Board Review course. In addition, she reviewed workshop submissions tothe 2004 Southern SGIM meeting, and served on Southern SGIM’s NominatingCommittee. She moderated a clinical vignette session at its annual meeting in NewOrleans.

Drs. Lapey and Conde also moderated clinical vignette sessions at the SouthernSGIM meeting in New Orleans.

Dr. Badgett continued as the Associate Editor for Electronic Publications for theAnnals of Internal Medicine. He remained on the editorial board of the Journal ofGeneral Internal Medicine.

Dr. O’Rorke continued her term as Secretary-Treasurer of Southern SGIM. Shealso served on the national SGIM’s Membership Committee.

Dr. Baruch-Bienen organized and chaired the 2003 Republic of Texas SGIMmeeting in Austin.

Guests of the Division

Eliseo Pérez-Stable, M.D., Professor and Chief of the Division of GeneralInternal Medicine at the University of California-San Francisco, visited in August as aHispanic Center of Excellence professor.

Donald M. Marcus, M.D., Professor of Medicine at Baylor College of Medicine,visited in March to give Grand Rounds. His visit was co-sponsored by our Center forthe Medical Humanities and Ethics.

Leo S. Morales, M.D., Ph.D., Assistant Professor of General Internal Medicine atUCLA School of Medicine, visited in April to give Grand Rounds as a Hispanic Centerof Excellence Professor.

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Finally, Stephan D. Fihn, M.D., M.P.H., Professor and Head of the Division ofGeneral Internal Medicine at the University of Washington, visited in June as our 7th O.Roger Hollan Visiting Professor. During his visit he met with University leaders andDivision faculty, and gave Medicine Grand Rounds.

Community Activities

Dr. Perkins continued as Consultant in Bioethics and adjunct staff member at theEcumenical Center for Religion and Health. He serves as a member of the AdvisoryBoard of Planned Parenthood of San Antonio and South Central Texas, and is amember of the Health Cabinet at Laurel Heights United Methodist Church. During theyear he gave a bioethics presentation to the Women of Texas Lutheran University. Hevolunteered on a medical mission trip to Puerto Morelos, Mexico that was sponsored byYucatán Presbyterian Ministries and First Presbyterian Church. He provided fourinterviews to local radio and television stations.

Dr. Benavides volunteered at the annual October health fair at the SanFernando Cathedral. He also performed summer camp physicals for boy scouts andscout masters in Troop 405.

Dr. Tamayo traveled to Honduras as a medical volunteer in the Helping Handsfor Honduras organization. Dr. Lapey also served as a visiting attending for a ruralmedicine elective in Honduras, where she supervised medical students and residentsand provided basic medical care.

Dr. Kumar spoke on women’s health issues at Mahila Sam-malan at the India-Asia Association of San Antonio community center.

Dr. Venkatachalam wrote invited columns on hypertension and cholesterolmanagement for the health newsletter at the University of Texas at San Antonio. Shevolunteered to give pre-camp physicals for the Girl Scouts of America. In addition, shespoke on immunizations, cholesterol, and cardiovascular health for the India-AsiaAssociation of San Antonio.

Dr. Fishman spoke at career day at Locke Hill Elementary School.

Dr. Wathen gave frequent presentations on first aid and safety to cub scoutgroups.

Dr. Pugh volunteered at a clinic for the homeless at Travis Park MethodistChurch.

Dr. Baruch-Bienen organized and chaired the 1st annual Bob Beard ElementaryPTA Health and Safety Fair. She also served on a panel discussion on ethicalconsiderations for euthanasia and assisted suicide for the President’s PeaceCommission Lecture Series at St. Mary’s University.

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Extramural Presentations

Several faculty gave invited presentations at the 2003 Texas Academy ofInternal Medicine annual meeting, held in San Antonio. Dr. Conde spoke on pre-operative pulmonary evaluation. Dr. Wathen discussed the management ofmenopause. Dr. Diehl presented cases studies in sexual dysfunction. Dr. Kosublectured on the management of partner violence. Dr. Badgett gave a workshop on theuse of personal digital assistants, and Dr. O’Rorke gave a workshop on the clinicalapproach to the painful shoulder.

Dr. Lawrence was an invited speaker on rates of functional recovery in eldersafter major abdominal surgery at a symposium on surgery in the elderly patient at theUniversity of Texas Medical Branch at Galveston.

Dr. O’Rorke was a faculty member for the precourse “Where Does It Hurt? AHands-on Approach to the Medical Orthopedic Exam for the Practicing Internist” at the2004 SGIM meeting in Chicago. This presentation subsequently received themeeting’s “Best Precourse” award.

Dr. Pugh participated in a panel discussion on multidisciplinary research at the18th annual Primary Care Research Methods and Statistics Conference in San Antonio.She also lectured on evidence-based practice and the VA’s QUERI initiative at the 2nd

annual Summer Institute on Evidence-based Practice, sponsored by the UTHSCSASchool of Nursing.

Dr. Diehl lectured on the treatment of sexual dysfunction at the 28th annualFamily Practice Review Course in San Antonio.

Dr. Baruch-Bienen spoke on the ethics of the use of opioids for non-cancer painat the same Family Practice Review course, and lectured on ethical considerations ofhuman growth hormone replacement at the GMR Consortium on the Use of GrowthHormone in Adults in Phoenix. She also participated in a panel discussion at the lattermeeting. She co-presented the workshop “Unpacking an Ethics Case on Rounds” atthe 27th National SGIM meeting in Chicago.

Dr. Badgett described the Cochrane Collaboration at the Regional AcademicHealth Center’s faculty retreat in Harlingen. He also gave two presentations oninformatics at the HighWire Publishers’ fall meeting in Washington D.C. He was a co-leader of the clinical examination research interest group at the national SGIM meetingin Chicago. He taught electronic literature searching at our Medical Student SummerResearch Seminar.

Drs. Baruch-Bienen and Badgett were both featured speakers at the 2004UTHSCSA Medical School reunion. Dr. Badgett spoke on managing clinical

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knowledge, while Dr. Baruch-Bienen described the “Ethics Bites” case discussionseries.

Dr. Fishman spoke on the acute complications of cocaine use at Grand Roundsfor the combined military emergency medicine program, held at Brooke Army MedicalCenter.

Dr. Tamayo co-presented two workshops at the annual Southern SGIM meetingin New Orleans, on teaching empathy through role play and videotaping, and on skillsfor dealing with confusing or difficult patient encounters.

Dr. Perkins spoke on cultures, values, and patient care at a conferencesponsored the VA Ethics Advisory Committee in San Antonio. He also gave apresentation on practical ethics, using a case-question format, at the 15th annual SanAntonio Internal Medicine Board Review course.

Dr. Mulrow participated in a workshop on writing and reviewing for medicaljournals at the 2004 SGIM meeting in Chicago.

Dr. Hunt participated in the workshop addressing “problem residents” at thenational Association of Program Directors of Internal Medicine Spring meeting in NewOrleans.

Dr. Kumar gave a presentation on medical abbreviations at the annual regionalmeeting of the Student National Medical Association in San Antonio.

TEACHING ACTIVITIES

Our major teaching commitment is to residents and medical students, and occursin a variety of outpatient and inpatient settings. During 2003-2004 our educationalefforts were focused in the following areas:

• Two resident General Internal Medicine Clinics (at the Audie Murphy Veterans Hospital and the University Health Center-Downtown)

• Ambulatory Internal Medicine rotation for third year medicine clerkship students

• Primary Care block rotation for interns

• Medicine Consultation Service rotation for senior residents

• Inpatient attending on the general medicine wards

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• Adolescent Medicine block rotation for residents

• Emergency Center rotation at University Hospital for residents and students

• Elective rotations in Office Medicine, Primary Care Orthopedics, and Women's Health for residents

• Administration of the Introduction to Clinical Sciences course for second year medical students

Selected details of these and other teaching activities follow:

Primary Care Block rotation:

The month-long Primary Care Block rotation, directed by Dr. Conde, is requiredof all categorical residents during their PGY-1 or PGY-2 year. Additionally, the rotationis a required of all obstetrics/gynecology interns. It provides instruction in theprinciples and knowledge base of primary care internal medicine, with a specialemphasis on evidence-based medicine and health maintenance and prevention.Curricular components include evaluations of walk-in patients under facultysupervision; a formal curriculum in medical interviewing, including a syllabus of articleswith study questions and reviews of videotaped encounters (taught by Dr. Tamayo);training in searching the medical literature (taught by Dr. Badgett); lectures by Drs.Diehl and Badgett on prevention and screening of breast, colon, and prostate cancer;seminars in ethics (taught by Dr. Perkins) and behavior change (including smokingcessation and exercise counseling, taught by Dr. Hunt); a weekly women's healthconference and clinic (taught by Dr. Wathen) and a weekly musculoskeletal medicineclinic (taught by Dr. O’Rorke, with assistance from Dr. Baruch-Bienen); continuityclinics; and twice-weekly journal article appraisals (facilitated by Drs. Conde, Tamayo,Lapey, and Griffin). Faculty gave each resident individualized feedback at the end ofthe month.

Adolescent Medicine Rotation:

This month-long required ambulatory rotation in Adolescent Medicine completedits sixth year. Dr. Hunt serves as the course director. Taught primarily by our affiliatedfaculty at Brooke Army Medical Center, the rotation includes extensive experience incaring for young people with acute symptoms, pregnancy prevention, and psychosocialissues. The two senior residents rotating each month also attend the Partner Violenceseminar series taught by Drs. Kosub and Wathen. The rotation has been well receivedby our residents, who give it superior evaluations.

Women's Health Elective:

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Dr. Wathen supervised the residents' elective in Women's Health. The rotationincludes experiences in Family Planning Clinic, Gynecology Clinic, Surgery BreastClinic, Osteoporosis Clinic, Urodynamics Clinic, and the Medicine Women's HealthClinic. The curriculum emphasizes physical examination, management of menopause,osteoporosis, management of abnormal Pap smears, breast diseases, contraception,and partner violence. Four residents completed the elective during 2003-2004.

Musculoskeletal Medicine Elective:

This was the third year that a month-long elective rotation in MusculoskeletalMedicine was offered to our residents. Directed by Dr. O’Rorke, it includes clinicalexperiences at Brooke Army Medical Center and with the University’s podiatry service.Rotating residents are guided by a comprehensive compendium of relevant literatureprepared by Dr. O’Rorke, with assistance from Drs. Conde and Kumar. Ten residentsparticipated in the elective during 2003-2004. Also during the year, the weeklyMusculoskeletal Medicine Clinic serving patients with non-rheumatic musculoskeletalsymptoms continued for Primary Care Block interns and for residents taking theelective. Dr. O’Rorke served as the clinic’s principal attending physician, and alsoprovided didactic sessions before each clinic on the evaluation of knee, back, andshoulder pain. Dr. Baruch-Bienen filled in while Dr. O’Rorke was on maternity leave.They were assisted by Jim Jelen, a physician assistant from the Department ofOrthopaedics.

Resident Elective in Office Medicine:

This elective rotation, introduced in 1990, is offered to internal medicineresidents who desire to learn more about the common diseases and proceduresencountered in office practice. Directed by Dr. Badgett with assistance from Dr. Diehl,the month-long curriculum allows residents to attend their choice of clinics inophthalmology, ENT, gynecology, orthopedics, urology, radiology, and other areasrelevant to primary care practice. One day per week is spent in the practice of acommunity internist from our clinical faculty. At the end of the rotation, Dr. Badgettprovides an evidence-based teaching session on a primary care topic. He also reviewsthe residents’ experience with their community internists, and counsels them on what tolook for in assessing practice opportunities.

During 2003-2004, 13 residents participated in the elective; most of ourresidents elect this rotation at some time during their final two years of training. Muchof the course's curriculum is posted on our Division's web page.

Residency Program Administration:

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Dr. Hunt leads our postgraduate educational curricula as Residency ProgramDirector. Among her principal responsibilities are housestaff morning report (which shestaffs four days weekly), the weekly Evidence-based Medicine course, Morbidity andMortality conferences, guidance of our 3 chief residents, and leadership of the internselection process. Dr. Hunt oversees curriculum development, clinical teaching, andthe scholarly activities of our residents. She provides individual feedback to eachresident twice yearly, and chairs the program’s Clinical Competency Committee. Drs.Wathen, Kosub, and Kumar served as members of this committee. The annual internalmedicine convocation at the end of the academic year was continued. The successrate of our graduating residents on the ABIM examination attained a three-yearaverage of 96%. She also organized and gave several presentations at the 8th annualIntern-to-Resident Leadership Retreat and Teaching Skills Workshop in late June.Drs. Wathen and Kosub led workshops in the retreat as well. Dr. Hunt led a well-received “finding a fellowship” seminar for our residents, and placed senior residents ina number of competitive training positions.

Dr. Hunt continued a seminar to educate residents in issues relevant tocommunity private practice. She increased resident participation in research, andpromoted study groups for residents preparing for the ABIM certifying examination.One of her major accomplishments during the year was implementing structuralchanges in the residency curriculum in response to ACGME work hours requirements.

Dr. Wathen served as Associate Residency Program Director. As chair of theResidency Curriculum Committee, she oversaw the ongoing review of our residentteaching programs. During the year, she focused her efforts on updating our writtencurriculum in preparation for ACGME re-accreditation. She met with faculty fromseveral divisions in the Department of Medicine to explain ACGME requirements andtrain them in the implementation of competency-based evaluations. In addition, sheimplemented competency-based assessment tools in a variety of clinical settings,including the development of portfolios for Journal Club, patient questionnaires,utilization of MiniCEXes, and checklists for a variety of clinical settings.

In April, Drs. Hunt and Wathen were very involved in the ACGME’s re-accreditation site visit. Our residency and fellowship programs were reviewed by anexternal panel from the RRC-IM over a two week period. Their report was expected inthe Fall of 2004.

The Intern Learning Groups, now in their eighth year, were continued. Theprogram consists of two one-hour small group meetings weekly throughout the year tobuild the interns' medical knowledge and develop their clinical problem solving skills.Interns are given reading assignments coupled with brief presentations and casediscussions. Dr. Kumar, Course Director, led one of the groups and also served asSenior Editor of the updated workbook that guides the curriculum. She additionallyserved as Senior Editor of the first two editions of a guidebook that addresses thecross-cover and night float issues that our residents encounter.

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Resident Journal Club, an evidence-based medicine course, continued onemorning per week. Dr. Hunt remained its director. Dr. Badgett mentored the residentsin identifying relevant literature via electronic searching. Dr. Wathen led a task forcethat designed a new Intern Journal Club that will be inaugurated in 2004-05.

ACP Associates' Scientific Program:

Dr. Hunt served as our representative to the program committee of the 11thAnnual South Texas ACP Associates' Program, held in May in San Antonio. She alsowas the featured speaker, addressing the role of professional organizations in clinicalpractice. The Associates’ program allows our residents and those from five arearesidency programs to present the results of research performed under facultyguidance, or to present informative clinical vignettes. Dr. Hunt oversaw submissionsfrom 29 residents. Two residents won first and third places in the research category,and another won first prize for a clinical vignette poster. Dr. Kumar advised tworesidents in presenting their vignettes, and Dr. Montemayor served as a reviewer.

Dr. Hunt also assisted medicine residents participating in our 7th AnnualDepartment of Medicine Research Day. Twenty-nine residents presented theirresearch, and one won an award. Dr. Mortensen received a Junior Faculty Award forhis research presentation. Dr. Kumar advised two residents in preparing theirvignettes, and presented a research poster of her own. Dr. Pugh participated in apanel discussion on research strategies.

Medical Consultation Service:

Dr. Mortensen assumed leadership of this service from Dr. Lawrence, withattending assistance from Drs. Lawrence, Griffin, Kumar, Tamayo, Lapey, and O’Rorke.Two senior residents rotated on the service each month, answering inpatientconsultations from non-internal medicine services at our two teaching hospitals.Faculty conducted daily teaching rounds with the residents and remained on beepercall for questions. Drs. Tamayo, O’Rorke, Conde, Mortensen, Perkins, Pugh, Badgett,Lawrence, Griffin, Wathen, Diehl, and Hunt provided weekend on-call support for theservice.

Dr. Conde again served as senior editor and chapter author of an updatedsyllabus in medical consultation that provides concise reviews of core topics as well asreprints of selected literature. Drs. Lawrence, Griffin, Kumar, O’Rorke, and Mortensenassisted as co-editors and also authored chapters. Sections include the art ofconsultation; perioperative medical risk assessment and management; monitoring andmanagement of cardiac risk, deep venous thrombosis, and postoperative delirium;preoperative pulmonary evaluation; diabetes in the perioperative patient; interruption oforal anticoagulant therapy; and common surgical procedures and anesthetic agents.Drs. Lawrence and Conde updated the "quick reference" pocket card on pre-operativepatient risk assessment. Dr. Badgett placed the full curriculum and the pocket card on

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the web at http://clinical.uthscsa.edu. Dr. Conde evaluated patients at a weekly pre-operative evaluation clinic at the Audie Murphy Veterans Hospital. Additionally,rotating residents evaluated patients at a twice-weekly resident pre-operativeevaluation clinic at the VA under the supervision of faculty attendings.

Inpatient General Medicine Wards:

The Division continued to devote substantial resources to the teaching ofgeneral internal medicine on the inpatient services. At the VA hospital, Division facultyserved as attending/teaching physicians for a total of 22 months, providing 37% of theDepartment's inpatient teaching in general medicine at that site. At University Hospital,Dr. Kosub contributed 30% of the student teaching attending duties. Dr. Baruch-Bienen presented monthly conferences on advance directives and delivering bad newsto clerkship students.

Dr. Kumar and a task force of residents revised and published a guide to internalmedicine cross-cover and night float responsibilities on the wards of both teachinghospitals.

University Hospital Emergency Center:

Dr. Fishman represents the Department of Medicine in the Emergency Center atUniversity Hospital, where she holds a cross-appointment with the Division ofEmergency Medicine, Department of Surgery. Our Emergency Center is the region’sonly civilian level I trauma center, managing 70,000 patient visits annually. The onlyfaculty general internist based in the EC, Dr. Fishman teaches medical students andresidents from internal medicine, surgery, family and community medicine, psychiatry,obstetrics-gynecology, and other disciplines. In addition, she teaches emergencymedicine residents, physician assistant students, and PAs in advanced training whorotate through the EC. During the year, she wrote and published a new EC housestaffmanual that was provided to all residents who rotated there. Dr. Fishman also servesas the EC’s Director of Patient Relations.

Medical Student Education:

Dr. Kosub currently chairs the medical school’s Curriculum Committee, and alsochairs its task force that during the year began reviewing and revising the first yearmedical student curriculum. In her position as Director of Student Education for theDepartment of Medicine, she continued her administrative leadership of all of theDepartment’s medical student educational programs. These include the third yearmedical student clerkship in internal medicine (as well as its Ambulatory Medicinecomponent), the required fourth year rotation in internal medicine, and all seniorstudent electives in internal medicine. For the second year, 17 of our third year

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medical students took their entire medicine clerkship in Harlingen through our RegionalAcademic Health Center.

Dr. Kosub continued to chair the Department's Student Education Committee,whose membership includes Drs. Hunt, Baruch-Bienen, and Lawrence. She alsoserved on the Clinical Skills Center advisory board, the planning committee for theStudent Clinician Ceremony, the planning committee for the proposed Academy ofDistinguished Educators, the Cancer Teaching and Curriculum Enhancement(CATCHUM Project) committee, the Multidisciplinary Primary Care Project Team, andthe RAHC Faculty Development Committee.

Advanced Clinical Evaluation Skills:

Division members were involved in teaching the Advanced Clinical EvaluationSkills (ACES) course for second year medical students. The purpose of the course isto teach students how to perform comprehensive patient evaluations. The courseoffers a series of introductory lectures, followed by four patient examination sessionsconducted by student pairs. Drs. Conde, Baruch-Bienen, Wathen, Tamayo, and Kumarwere among the faculty who precepted students in the course. Dr. Wathen alsoassisted in teaching students the female reproductive examination.

Introduction to the Clinical Sciences:

Dr. Kosub continued as Director of this multidisciplinary second year medicalstudent course that emphasizes pathophysiology. Duties include planning the year-long schedule of lectures and conferences, editing syllabus handouts, advising facultyand counseling students, writing and preparing examinations, and course evaluation.Providing a comprehensive foundation of information in clinical medicine, thecurriculum draws faculty from the Departments of Medicine, Pediatrics, Obstetrics andGynecology, and Surgery. Dr. Diehl lectured on cancer prevention and screening inthe hematology-oncology module.

Third Year Medical Student Clerkship in Ambulatory Internal Medicine:

Dr. Kosub also continued to direct this introduction to the management of adultoutpatients. A component of the required 12-week medicine clerkship for third yearstudents, each 4-week block assigns 5-6 students to several University Health Systemand VA facilities. Until mid-year, 5 additional students attended clinics at Brooke ArmyMedical Center. Students gain experience in both continuity and episodic care. Whilemost of the experience involves the management of outpatients under faculty

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supervision, the curriculum also includes lectures given by Drs. Perkins, Diehl,O’Rorke, Griffin, Baruch-Bienen, Wathen, Badgett, and Kumar. In addition, Dr. RobinBrey of our Neurology division lectures on dementia and headache. Students attendthe offices of community internists from our clinical faculty one day each week. UnderDr. Badgett’s guidance, they also complete a "Controversies in Clinical Prevention"assignment, in which they choose a controversial issue, review relevant medicalliterature retrieved by electronic searching, and deliver a 10-minute presentation.

Continuing this year was a multi-session Informatics/Evidence-based Practiceseminar series, taught by Dr. Badgett. The curriculum includes a basic introduction tostudy design, efficient assessment of secondary publications such as textbooks andreviews, demonstration of methods of information retrieval, and advanced searchingtechniques. The sessions provide classroom PCs so that students can acquire hands-on experience as they learn. The students complete a literature search and evidencetable in preparation for a presentation at the end of the rotation. Their response to thecurriculum has been enthusiastic.

Also continuing this year was a series of two one-hour seminars on partnerviolence, delivered by Drs. Kosub and Wathen. These seminars cover backgroundissues and the dynamics of partner violence, teach interviewing skills through roleplaying exercises, and include an interactive session with an outreach worker from thelocal Battered Women’s Shelter. Residents from the Adolescent Medicine andWomen’s Health rotations attended these seminars as well.

A half-day medical student Women's Health clinic is taught by Drs. Kumar andO’Rorke, during which students receive an intensive exposure to women's healthissues from a primary care/internal medicine perspective.

A major improvement to the rotation this year was the relocation of the students’Acute Care Clinic to the walk-in module of the University Health Center-Downtown.This change, accomplished by Dr. Montemayor, resulted in a larger pool of patients forteaching episodic care.

In addition to students taking the Ambulatory Medicine rotation locally, four orfive San Antonio-based clerkship students traveled to the RAHC campus in Harlingeneach month for an ambulatory internal medicine experience.

Student Preceptorship in General Internal Medicine:

Dr. Diehl coordinates this senior student elective that provides students a full-time experience in the practice of a community internist for up to a month. Students areexpected to observe systems of providing care in private practice, and to contrast themto their previous experience in a brief essay. Four medical students took the rotationduring 2003-2004.

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Programs in Bioethics:

Dr. Perkins continued to direct the twice-monthly UTHSCSA Faculty Ethics andHumanities Journal Club, and presented articles at three of its meetings. Dr. Baruch-Bienen led a session as well. Dr. Perkins gave ethics-related presentations at theDivision’s Journal Club and at its Research conference. He frequently lectured onethical issues in ambulatory care to third year medical students on the ambulatory carerotation, and gave two seminars each month to residents assigned to the Primary CareBlock and Geriatrics rotations.

In October, Dr. Perkins repeated his month-long intensive “Ethics for theClinician” course. Seventeen students enrolled, including five medical students, 10post-graduates in fellowship training, one faculty member, and a PhD candidate.Meeting daily in seminars, students covered the contents of two books and a syllabusof recent journal articles assembled by Dr. Perkins. Participants wrote up their ownreal-life ethics dilemmas and presented them for class discussion. Students gave thecourse excellent evaluations.

Dr. Perkins mentored a senior medical student on a research elective, and alsoprecepted four students from Trinity University and Kalamazoo College for researchassistantships in ethics. He and Dr. Baruch-Bienen co-presented an ethics case atMorbidity and Mortality conference.

Dr. Baruch-Bienen presented two Morbidity and Mortality conferences,discussing the dilemma of patients who refuse treatment. In addition, she gavebioethics-related Grand Rounds presentations to our Departments of Anesthesiologyand Radiation Oncology, Division of Transplant Surgery, and VA Diabetes Group. Shespoke on patient confidentiality and HIPPA privacy rules for the “Ethics Bites” seriessponsored by our Center for Medical Humanities and Ethics, of which she is anassociate faculty member. She served as Vice-chair of the Ethics Committee atUniversity Hospital, and was the liaison from the Faculty Senate to the medical dean’sEthics Committee.

Clinical Informatics:

As Director of Clinical Informatics for both the Division and the Department ofMedicine, Dr. Badgett devoted considerable energy to promoting education ininformatics for our medical students and residents. He continued to teach a series ofinformatics seminars to third year medical students, and instructed residents inelectronic knowledge management at Morning Report and during the Primary Careblock rotation. Dr. Badgett directed a two-week long selective in medical informatics forfourth year medical students, and contributed to four presentations. Dr. Mortensenpresented two seminars for that course, on electronic communication with patients andusing electronic medical records for quality improvement. At the beginning of the

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academic year, Dr. Badgett gave two-hour seminars on how to search for medicalevidence to 8 groups of third year students during their Clinical Foundations course.

Dr. Badgett continued his service on the Web Advisory subcommittee of theComputing Resources Committee, which oversees the policies of the Health ScienceCenter’s web sites. He serves on the planning committee for our Academic Center forEvidence-based Nursing’s Summer Institute. He is a member of the university’sBioinformatics Advisory Board, and the medical school’s PDA Task Force.

He maintained his own SUMSearch software, which quickly identifies relevantguidelines, systematic reviews, and original research articles on topics in clinicalmedicine (http://sumsearch. uthscsa.edu).

Dr. Badgett continued to maintain the Department of Medicine’s web site,including portions describing our residency program and its sister program inHarlingen. In addition he maintained the Division's page(medicine.uthscsa.edu/genmed), which includes our mission statement, current andpast Annual Reports, links to the web sites of SGIM and other academic societies, andeducational resources. He also maintained a clinical resources home page thatprovides access to electronic databases for staff based at UTHSC, University HealthSystem, and the VA (clinical.uthscsa.edu).

He maintained several electronic information services, including the web page ofSGIM’s Clinical Examination Interest Group and the ClinDx listserv, which distributes amonthly compilation of research on the medical history and physical examination. Heprovided similar services monthly for MedConsult, a compilation of research on pre-operative clinical assessment prepared by Dr. Lawrence for the SGIM MedicalConsultation Interest Group.

Finally, Dr. Badgett continued as Associate Editor for Electronic Publications atthe Annals of Internal Medicine. His work involves enhancing electronic versions of theAnnals and revising its web site, www.Annals.org. He launched an electronic version ofthe Annals that can be downloaded on PDA and wireless devices. He has madeAnnals the first journal to incorporate electronic decision aids into its articles.

The Regional Academic Health Center:

Drs. Kosub and Baruch-Bienen were involved in planning the teaching programsat the Regional Academic Health Center (RAHC) in Harlingen. Dr. Kosub focused onmedical student education, identifying, recruiting, and preparing physicians from thelocal community for ambulatory and inpatient teaching.

For the second year, 17 third year students took their required 12-weekmedicine clerkship at the RAHC campus. Dr. Kosub served as clerkship director,assisted by a RAHC site director. The rotation includes 6 weeks’ inpatient experienceat Valley Baptist Hospital. In addition, each student spends six weeks in various clinicsand private physicians’ practices, dividing time between a general internist and two

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medicine subspecialists. As at our home campus, students evaluate patients with abroad range of acute and chronic illnesses, and participate in an on-site version of theinformatics course. Students also attend a series of conferences in primary care.Student evaluations of the experience were positive, with the one-on-one exposure toteaching physicians receiving the highest ratings.

Dr. Kosub lectured to clerkship students at the RAHC campus, and alsoimplemented new fourth year outpatient electives in Harlingen in both general medicineand various subspecialties. She participated in the RAHC’s Career Development Dayfor third year students.

Dr. Baruch-Bienen assisted in the second year of the internal medicineresidency program at Valley Baptist Hospital. She assisted in the ongoing updating ofits curriculum and policies, and oversaw many of the program’s administrativeprocesses, including its budget, interview process for residency applicants, newaffiliation with the VA in Harlingen, and creation of new faculty positions for anAssistant Program Director and Chief Resident. In addition, she was instrumental increating hospital “buy in” for a hospitalist group to augment teaching. Dr. Baruchrepresents the RAHC at the UTHSCSA Graduate Medical Education Committee, andparticipated in the program’s internal review in December.

Drs. Kosub and Baruch-Bienen served on the medical school’s RAHC FacultyDevelopment Committee and were co-directors for internal medicine on HRSA grantsthat support our efforts.

San Antonio Internal Medicine Board Review Course:

In June, Dr. Conde served as Director of this 15th annual intensive coursedesigned to help attendees prepare for the 2004 ABIM certifying examination. Dr.Kumar continued as Co-director. The course, sponsored by the ACP and held at thePlaza San Antonio Hotel, continued the three and a half day format that has been sosuccessful in the past. Drs. Conde and Kumar worked with the continuing educationstaff of the ACP to prepare the curriculum and coordinate the conference. In additionto traditional lectures, the course included intensive case studies presented ininteractive workshops. New this year was a workshop in dermatology. Dr. Perkinsgave a new lecture, “Ethics You Can use,” employing a case-question format. Some113 physicians attended. Consistent with previous years, course ratings by theattendees were highly favorable, with the workshops receiving especially positiveevaluations. Drs. Conde and O’Rorke will serve as Directors for the 16th annual SanAntonio Internal Medicine Board Review course, to be presented in June 2005.

Division Faculty Conferences:

Division faculty gather weekly for conferences after Medicine Grand Rounds. Afaculty Journal Club, also attended by interns on the Primary Care rotation, is held

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monthly. A Research conference, Division business meeting, and a FacultyDevelopment Conference focusing on educational issues rotate on the month’s otherWednesdays. Bimonthly HemiDivision meetings of faculty based at the UniversityHealth Center-Downtown and the VA are held to discuss clinical issues relevant tothose sites. Division faculty participate in presenting these sessions on a rotatingschedule. Sixteen Division members contributed to the Journal Club schedule, whileDrs. Diehl, Kumar, Perkins, and Noël presented their research. Drs. Wathen, Badgett,Tamayo, Kumar, and Conde gave the year’s Faculty Development conferences.

Conferences, Rounds, and Classroom Lectures

Department of Medicine Grand Rounds:

Dr. Eliseo Pérez-Stable: “Latinos and Cancer: Where are the Disparities?”

Dr. Badgett: “Managing Medical Minutia”

Dr. Lawrence: “Dancing Again After the Blade – Recovery ofIndependence and Preoperative Functional Status inElders Having Major Elective Abdominal Surgery”

Dr. Donald Marcus: “Alternative Medicine: What Do We Know About itsSafety and Efficacy?”

Dr. Leo Morales: “Racial/Ethnic Differences in Experiences with Care”

Dr. Stephan Fihn: “Improving Care for Cardiac Disease – Where are theLesions?”

Housestaff Conference Series:

Dr. Kosub: Evaluating medical studentsDr. Kumar: Acute mental status changesDr. Diehl: Practicing prevention in Medicine ClinicDr. Lawrence: Pre-operative evaluationDr. Pugh: Diabetes management in Medicine ClinicDr. Badgett: Dyspepsia, reflux, and PUDDr. Conde: Sinusitis/rhinitis/otitisDr. Lapey: Nutritional guidelines and obesityDr. Kumar: SyncopeDr. Griffin: The dizzy patientDr. Diehl: Vaginal dischargeDr. Noël: Depression in primary careDr. Wathen: Management of hypertension in Medicine ClinicDr. Tamayo: Management of alcoholism 1 –- Screening and diagnosis

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Dr. Conde: Anxiety disordersDr. Kumar: HematuriaDr. Lapey: Dysuria and UTIDr. Diehl: Urethritis and STDsDr. Hunt: Patient education and complianceDr. Mortensen: Complementary and alternative medicineDr. Tamayo: Management of alcoholism 2 – Resources and interventionsDr. Perkins: Ethics you can useDr. O’Rorke: Shoulder, elbow, wrist pain

Department of Medicine Research Conference:

Dr. Noël: “Collaborative Care Needs and Preferences of Primary CarePatients with Multi-morbidity”

Other teaching activities:

Drs. Lawrence and Pugh were instructors in the Introduction to ClinicalInvestigation course for subspecialty fellows in the Department of Medicine. Bothadditionally lectured in the Patient Oriented Clinical Research Methods component ofthe Master of Science in Clinical Investigation curriculum at the Health Science Center.Dr. Wang gave three lectures on biostatistics in the MSCI curriculum.

Dr. Pugh also mentored one of our residents during a research elective month.

Dr. O’Rorke continued the selective in women’s health that she developed forpreclinical medical students. She also repeated a coding and billing workshop forPGY3 internal medicine residents planning to enter practice.

Drs. Kosub and Kumar served as small group facilitators in the “Getting Readyto Teach During Residency” elective for fourth year medical students.

Dr. Kosub also was a small group instructor for the “On Becoming a Doctor”course for fourth year students, the Clinical Foundations course for third year students,and the “On Doctoring” literature and medicine course of the joint admissions medicalprogram.

Dr. Wathen lectured on women’s health in the fourth year student pharmacologyelective.

Dr. Baruch-Bienen was a preceptor in the intensive initial month of the first yearstudents' Clinical Integration Course. In addition, she continued as CME FacultyAdvisor for the Department of Medicine.

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Dr. Hitchcock-Nöel continued as director our VA Associated Health ProfessionsPostdoctoral Fellowship in Health Services Research and Development, which trainstwo postdoctoral fellows annually.

Dr. Kumar discussed patients at two Morbidity and Mortality conferences. Shereviewed night float and cross-cover issues with the residents during a Morning Reportconference. She participated in a mini-workshop for our chief residents on how tomentor “problem” residents. Later in the year, she collaborated with our Division ofEducational Research and Development to co-present a program on workingproductively with “challenging” students and residents. She assisted two of ourresidents in their presentations of clinical vignettes at the Southern SGIM meeting inNew Orleans. Finally, she was a small group facilitator for three sessions of theHumanities track of the Clinical Integration course for first year students.

Dr. Conde revised and updated two chapters she had authored for UpToDate,and a chapter she had prepared for the ACP’s PIER resource.

Dr. Fishman was an invited participant at a workshop on Women in Medicine forthe incoming medical school class.

Drs. Wathen and Kosub served on a Dean’s committee planning to establish anAcademy of Distinguished Educators at our medical school.

During the fall, Dr. Lapey completed the Health Science Center’s two-monthTeaching Excellence course.

Dr. Tamayo spoke to the Students for International Health Group on hisexperiences as a volunteer. He also served as the group’s faculty advisor.

PATIENT CARE HIGHLIGHTS

Resident Continuity Clinics, University Health Center-Downtown and Audie Murphy VA:

These clinics, each held five afternoons weekly, provide longitudinal care topatients with chronic medical conditions. Residents follow their own patients at bothinstitutions. Most commonly, patients receive treatment for hypertension, diabetes,coronary disease, heart failure, chronic liver disease, obstructive lung disease,depression, thyroid disorders, and degenerative arthritis. Health maintenance anddisease prevention are emphasized. Division faculty oversee care and teach in bothclinics.

Dr. O’Rorke continued as Director for Resident Education at the GeneralMedicine Clinic, University Health Center-Downtown. The Medicine Acute Care Clinic,

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which serves the clinic’s patients who develop acute symptoms, continued tosupplement the learning experience for residents. Dr. O’Rorke conducted anorientation program for interns during July, and continued a program that recognizesresidents who display excellence in the care of their patients. She chaired faculty worksessions that evaluated residents’ performance in the clinic.

The reorganization of the clinic into resident-staff teams continued for its secondyear. Dr. O’Rorke, assisted by Robyn Childress, Clinic Manager, assigned residents tofour sections of the clinic’s space. Each was staffed by stable personnel, so that ateam relationship could develop. Residents, faculty, and staff continued to expresssatisfaction with the system. The General Medicine and Medicine Acute Care clinicsmanaged 7,030 patient visits during the year.

Nancy Sugarek, the clinic’s longtime nurse practitioner, also served as a clinicalpractitioner for nurse practitioner students from the Geriatric and Family Nursingprograms at our Nursing School. Patience Cain, the clinic’s second nurse practitioner,assumed leadership of our anticoagulation service and expanded the number ofpatients served.

In addition to their clinical teaching at the University Health Center-Downtown,Drs. Wathen, Hunt, and Badgett maintained their own weekly personal practices ofmedicine in the General Medicine Clinic. Dr. Montemayor initiated his practice duringthe year.

At the VA hospital, Dr. Tamayo assumed oversight of resident education atInternal Medicine Clinic from Dr. Griffin. He coordinated the clinic's resident evaluationprocess, and revised the forms used to document feedback. He updated andstandardized the orientation process for residents new to the clinic. Under theleadership of Dr. Pugh, the entire Internal Medicine Clinic was successfully convertedto “open access” scheduling to improve patient access. Drs. Lapey, Conde, Lawrence,and Tamayo assisted in this large project. The Division's attendings provided oversightof over 3000 patients in continuity clinics staffed by residents and mid-level providers,as well as anticoagulation and drug monitoring clinics staffed by Pharm.D. faculty.

The Diagnostic Pavilion:

The Diagnostic Pavilion serves as the principal site for the medical school'sfaculty practice, which provides care to university and hospital employees as well aspersons from the San Antonio community and beyond. Dr. Jones headed generalinternal medicine activities there until his illness. Among his duties were the reviewand authorization of physician referral requests. Dr. Lefeber continued his busypractice and precepted third year medical students. He was appointed MedicalConsultant to the Medical Director of University Physicians’ Group in June. Drs. Diehl,Venkatachalam, and Fishman continued to see their patients at the Pavilion one half-day weekly.

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Audie Murphy Veterans Hospital Continuity Care Clinic:

Division faculty at the Audie Murphy Veterans Hospital maintain their ownpractices of general internal medicine in the Continuity Care Clinic. Drs. Pugh, Griffin,Lawrence, Mortensen, Lapey, and Tamayo supervised nurse practitioners and providedpersonal care to veterans with chronic diseases.

Internal Medicine Group at UHC-Downtown:

Drs. Benavides, Kumar, and O’Rorke staffed this general internal medicinegroup that provides primary care to University Health System patients. The InternalMedicine Group practice supplements the clinical services provided by our residents inGeneral Medicine Clinic. Our internists have developed large and loyal panels ofpatients and provide personalized care. Dr. Benavides took time from his practice onesession weekly to teach in the students' Ambulatory Care Clerkship.

RESEARCH AND SCHOLARLY ACTIVITIES

Research Focus: Our Division's research employs the methods of clinicalepidemiology and health care research. While the investigative interests of Divisionfaculty are wide-ranging, there is an ongoing focus on informatics and evidence-basedmedicine, guideline implementation, cross-cultural epidemiology, clinical ethics, andhealth manpower.

The Division’s principal research base is the Veterans Evidence-basedResearch, Dissemination, and Implementation Center (VERDICT), directed by Dr. Pughand co-directed by Dr. Noël. Funded as a Center of Excellence by the VA’s HealthServices Research and Development office, VERDICT seeks to translate andimplement guidelines into clinical practice.

New Grants, 7/03-6/04

Dr. Lawrence (Principal investigator), Dr. Pugh (Co-principal investigator), Dr. Noël(Co-investigator): Systematic review and tracking database for clinical practiceguideline implementation research. VA HSR&D, 2003-2008, $735,400

Dr. Noël (Principal investigator): Implementing evidence-based behavioral health carevia the chronic care model. VISN/HSR&D Implementation CollaborationPlanning Grant, VA HSR&D, 2003-2004, $50,000

Dr. Pugh (Co-investigator): Evidence-based approaches to primary care staffing: jobanalysis. VA HSR&D, 2003-2005, $795,400

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Dr. Wang (Principal investigator): Design and analyses for mental health preventativetrials. University of Florida, 2003-2004.

Research Presentations at Scientific Meetings, 7/03-6/04

Duggirala R, Dodd GD, Fowler S, Schneider J, Arya R, Diehl AK, Almasy L, ConnellPO, Stern MP, Blangero J. A major susceptibility locus for gallbladder disease ison chromosome 11p in Mexican Americans. 53rd annual meeting, AmericanSociety of Human Genetics, Los Angeles, 11/03.

Kumar V, Diehl AK, Gateley A, Appleby JL, O’Keefe ME. Training international medicalgraduates will not increase the supply of practicing general internists: TheResident Careers Cohort Study. Republic of Texas SGIM meeting, Austin,10/03; Southern SGIM meeting, New Orleans, 2/04; 27th National meeting,SGIM, Chicago, 5/04.

Lawrence VA, Pugh JA, Noël PH, Parchman M, Best RG. Creating SynERGI throughorganizational interventions to implement clinical practice guidelines for QUERIdiseases. National meeting, VHA Quality Enhancement Research Initiative,Washington, 12/03, and National meeting, VA HSR&D, Washington, 2/04.

Restrepo ML, Mortensen EM, Anzueto A, Pugh JA. Short-term mortality withfluroquinolone monotherapy versus combination therapy in severe community-acquired pneumonia: a systematic review. 41st annual meeting, InfectiousDisease Society of America, San Diego, 10/03.

Mortensen E, Restrepo M, Anzueto A, Pugh J. The association between statin andACE inhibitor use and mortality for patients hospitalized for community-acquiredpneumonia. 27th National meeting, SGIM, Chicago, 5/04.

Noël PH, Parchman ML, Williams JW Jr., Cornell JE, Kazis L, Frueh BC, Larme A, LeeA, Pugh JA. Collaborative care needs and preferences of primary care patientswith multimorbidity. Annual research meeting, Academy Health, San Diego,6/04.

Perkins HS. Culture as a useful conceptual tool in ethics consultations. 7th annualDavid C. Thomasma Memorial International Bioethics Retreat, Padova, Italy,6/04.

Arar N, Abboud H, Pugh JA. Health care transformation: towards proactive health caresystems in the management of diabetes and its complications. 5th InternationalConference on the Scientific Basis of Health Services, Washington, 9/03.

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Parchman ML, Pugh JA. Competing demands for diabetes care: observations fromprimary care practices. 31st annual meeting, North American Primary CareResearch Group, Banff, Alberta, 10/03.

Wang CP, Ghosh M. Bayesian analysis of change-point competing risks models: twoposterior predictive P-value approaches. International Society for BayesianAnalysis World Meeting, Viña del Mar, Chile, 5/04.

Markland AD, Wang CP, Lee S, Gerety MB, Hazuda HP. Ethnic differences andurinary incontinence in older, community dwelling Mexican and EuropeanAmericans. Annual scientific meeting, American Geriatrics Society, Las Vegas,5/04.

Publications, 7/03 - 6/04

1. Badgett R. Review: Helopoulos C. The Medical Professional’s Guide toHandheld Computing. Ann Intern Med 2004;140:236.

2. Kammerer CM, Schneider JL, Cole SA, Hixson JE, Samollow PB, O'Connell JR,Perez R, Dyer TD, Almasy L, Blangero J, Bauer RL, Mitchell BD. Quantitativetrait loci on chromosomes 2p, 4p, and 13q influence bone mineral density of theforearm and hip in Mexican Americans. Journal of Bone & Mineral Research2003;18:2245-2252.

3. Mitchell BD, Kammerer CM, Schneider JL, Perez R, Bauer RL. Genetic andenvironmental determinants of bone mineral density in Mexican Americans:results from the San Antonio Family Osteoporosis Study. Bone 2003;33:839-846.

4. Kao WH, Kammerer CM, Schneider JL, Bauer RL, Mitchell BD. Type 2 diabetesis associated with increased bone mineral density in Mexican-American women.Archives of Medical Research 2003;34:399-406.

5. Baruch-Bienen DL. Ethics: Palliative Care. PIER, May 2004. Available from:pier.acponline.org/physicians/ethical_legal/el755/el755.html?hp

6. Smetana GW, Cohn SL, Lawrence VA. Update in perioperative medicine. AnnIntern Med 2004;140:452-461.

7. Lawrence VA, Silverstein JH, Cornell JE, Pederson T, Noveck H, Carson JL.Higher Hb level is associated with better early functional recovery after hipfracture repair. Transfusion 2003;43:1717-1722.

8. Lawrence VA. The relation between postoperative cardiac and noncardiaccomplications: pathophysiological dominoes or doubles tennis? Am J Med2003;115:580-581.

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9. Mortensen EM, Kapoor WN, Chang CC, Fine MJ. Assessment of mortality afterlong-term follow-up of patients with community-acquired pneumonia. ClinicalInfect Dis 2003;37:1617-1624.

10. Pignone M, Sheridan SL, Lee YZ, Kuo J, Phillips C, Mulrow C, Zeiger R. Heartto Heart: a computerized decision aid for assessment of coronary heart diseaserisk and the impact of risk-reduction interventions for primary prevention.Preven Cardiol 2004; 7:26-33.

11. Sheridan S, Pignone M, Mulrow C. Framingham-based tools to calculate theglobal risk of coronary heart disease: a systematic review of tools for clinicians.J Gen Intern Med 2003;18:1039-1052.

12. Laine C, Mulrow C. Peer review: integral to Science and indispensable toAnnals. Ann Intern Med 2003;139:1038-1040.

13. Mulrow CD, Townsend RR. Guiding lights for antihypertensive treatment inpatients with nondiabetic chronic renal disease: proteinuria and blood pressurelevels? Ann Intern Med 2003; 139:296-298.

14. Williams JW Jr., Katon W, Lin EH, Noël PH, Worchel J, Cornell J, Harpole L, FultzBA, Hunkeler E, Mika VS, Unutzer J, IMPACT Investigators. The effectiveness ofdepression care management on diabetes-related outcomes in older patients. AnnIntern Med 2004;140:1015-1024.

15. Perkins HS, Cortez JD, Hazuda HP. Advance care planning: does patientgender make a difference? Am J Med Sci 2004;327:25-32.

16. Perkins HS. Commentary on “Ethics consultation reduced hospital, ICU, andventilation days for ICU patients who died before hospital discharge.” ACP JournalClub 2004;140:36.

17. Young BA. Pugh JA. Maynard C. Reiber G. Diabetes and renal disease inveterans. Diabetes Care 2004;27(Suppl 2):B45-B49.

18. Best RG, Hysong SJ, McGhee C, Moore FL, Pugh JA. An empirical test ofNonaka’s theory of organizational knowledge. E-Journal of OrganizationalLearning and Leadership 2003;2:1-19.

19. Pugh J, Lawrence V. Commentary on “A nurse-facilitator intervention improved theuse of ß-blockers in outpatients with stble congestive heart failure.” ACP JournalClub 2004;140:22.

20. Davies M, Spears W, Pugh J. What VA providers really think about clinical practiceguidelines. Fed Pract 2004;21(2):15-30.

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21. Arar N, McGrath J, Rosales J, Pugh J. The role of electronic medical records inimproving patient-centered care in outpatient encounters. J Inf Technol Healthc2004;2:187-202.

22. Wang CP, Ghosh M. Bayesian analysis of change-point competing risksmodels: two posterior predictive P-value approaches. Technical Report,Department of Statistics, University of Florida, 2004.

Other Activities

Dr. Kumar was the featured speaker at the 2004 Convocation of our internalmedicine residency.

Dr. Conde performed Chopin’s Fantasie Impromptu and a Mozart sonata aspiano preludes for the Residency Convocation. She also played the Scherzo in b-flatminor by Chopin for a Musical Bridges Around the World physicians’ concert at TrinityUniversity.

Dr. Diehl worked with the Texas Academy of Internal Medicine's General InternalMedicine Statewide Preceptorship Program to recruit 29 of our medical students forsummer experiences with community general internists. He continued to serve asfaculty sponsor for the Medical Student Internal Medicine Interest Group.

Dr. Hunt spoke to the Medical Student Internal Medicine Interest Group onprocedures for applying for residencies in internal medicine. She also met individuallywith over 30 students to discuss their career plans and specific residency programs.

Drs. Kosub, Hunt, Diehl, Fishman, Tamayo, O’Rorke, Badgett, Baruch-Bienen,and Kumar served as faculty advisors to medical students.

Members of the Division led all Divisions of the Department of Medicine in totalcontributions to the State Employees Charitable Campaign.

Ms. Sugarek again coordinated the Division’s sponsorship of three needyfamilies during the Christmas holidays. She also arranged the donation of a medicaltextbook to a rural clinic in Iran.

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