Sharp HealthCare Continuing Medical Education Newsletter Fall 2019

Thank you to all Sharp HealthCare CME Committee Members

Sharp Community Medical Group CME Committee

Gregg Garner, DO - Pulmonology (Chair), Jeffrey Dysart, MD - Family Medicine, Noah Johnson, MD – Family Medicine, Bernard Michlin, MD – Internal Medicine, Lynne Milgram, MD, MBA – Internal Medicine, Jerome Stenehjem, MD – Physical Medicine/Rehab, Michele Bautista-Meredith, PharmD, Manager, Pharmacy Services

Sharp Grossmont Hospital CME Committee

Rokay Kamyar, MD – Gastroenterology (Chair), James Cary, MD – Pathology, Yangheng Fu, MD – Hospitalist/Intensivist, Anitha Garlapati, MD – Hospitalist/Intensivist, Fadi Haddad, MD – Infectious Disease, Sathya Pokala, MD – Hospitalist/Intensivist, Suhail Zavaro, MD – Cardiology, Nancy Greengold, MD – CMO

Sharp Rees-Stealy Medical Group CME Committee

James Lin, MD – Internal Medicine (Chair), Brian Barmettler, MD - Internal Medicine, Cheryl Wright, MD - Rheumatology, Cyril Light, MD – Family Medicine, Diana Rowell, MD – Internal Medicine, Douglas Schulz, MD – Family Medicine, Eric Mair, MD - Otolaryngology, James Wolosin, MD – Gastroenterology, Kim Allen, PharmD – Director, Pharmacy Services, Miranda Sonneborn, MD – Family Medicine, Pamela Lee, MD - Colon and Rectal Surgery

What’s New in CME

SRS Dementia Guidelines Update – Implementation

In FY 2019, the CME Department developed a comprehensive needs assessment demonstrating the need for dementia training aimed at primary care providers. The CME Department collaborated with community organizations, including Champions for Health and the Alzheimer’s Project Clinical Roundtable, to develop education focused on addressing dementia in San Diego County. This concerted effort reached over 300 clinicians and led to countless additional non-CME educational strategy meetings with internal and external stakeholders, and important conversations regarding dementia at Sharp HealthCare.

The Department provided four hours in live and online CME activities for San Diego health care providers including more than 50 hours of planning and development with providers. This included a panel discussion at the Sharp Community Medical Group's (SCMG) annual conference and grand rounds at both Sharp Grossmont and Sharp Coronado. The Alzheimer’s Project Clinical Roundtable Physician Guidelines were converted into an online CME activity. These guidelines can be accessed by visiting, https://sharp.cloud-cme.com/dementia/. Additionally, the Alzheimer's Project Clinical Roundtable exhibited and promoted the Round Table’s clinical guidelines at the SCMG conference.

Results from post-evaluation surveys collected from these CME-accredited events showed markedly increased confidence is treating patients with Alzheimer and other related dementias. There was a self-reported increase confidence of 27% across all participants in our educational efforts. Nearly 100% of participants stated that the activities met their educational needs and 91% of those participants stated that the provided education was immediately applicable to their practice.

Additionally, Sharp Rees-Stealy’s (SRS) Clinical Guidelines committee updated their management of cognitive impairment and dementia guidelines on June 2019. This update is based in part because of the collaborative efforts of San Diego’s Alzheimer’s project clinical roundtable, the CME department, and SRS’s Population Health Department and their clinical guidelines committee. The guidelines are designed to assist clinicians in the evaluation and treatment of the more common medical problem as well as provide a resource list to support patients and their families. The updated clinical guidelines can be accessed through SRS’s EHR.

Physician Spotlight

Q&A with Ashraf Kasto, DO Emergency Medicine, Sharp Grossmont Hospital Emergency Department

Ashraf Kasto, DO

Please tell us a little bit about yourself and your affiliation with Sharp HealthCare.

Hello, I am Dr. Ashraf Kasto, DO Emergency Medicine, Sharp Grossmont Emergency Department. I Graduated Med School in 2002, and did my residency at Henry Ford Health System-Michigan in 2007

Could you define Physician burnout?

I would define physician burnout as long-term unresolved job stress that leads to emotional exhaustion, feeling overwhelmed, cynical, depersonalization (detached from the job), and lacking of sense of personal accomplishment.

Tell us about the Physician Wellness Project, your role, and some of the goals or objectives for the project.

I am one of the committee members that meets monthly to help discuss future plans for reducing physician burnout at Sharp HealthCare Hospitals. Our goals are to brainstorm ways to reduce stress at work, improve physician recognition system wide, as well as help physicians recognize, acknowledge, and treat symptoms of burnout early on.

Earlier this year the 2019 Medscape National Physician Burnout, Depression and Suicide Report was published. One of the recommendation this report makes, is for physicians to ask themselves two questions in order to identify and address burnout in themselves. (1) How am I feeling right now? (2) What am I going to do about it?

What are your thoughts on these questions? Is this something you do or is there something else that works for you?

I would like to start of by saying that these two questions are very simplified, it is important to recognize that physician burnout is multifactorial and looking at physician burnout requires more thought. That being said, asking these two questions may help with identifying or understating some of the frustrations we encounter in our day to day lives. I find that asking myself these questions help re-focus me back to my goal of what makes me love what I do. I find that working on fixing issues that cause me frustration leads to a sense of accomplishment which helps reduce any job stress overall. Some of the things I find help reduce feelings of frustration are: attending Sharp CME event, attending meetings for physician wellness and working with staff at Sharp Grossmont to improve our physician experience. Also, keeping a balance between work and home life is very important to reducing job stress. Overall these two questions aren't enough to address physician burnout but it's a good starting point.

What are some of the resources currently available with in Sharp to address physician burnout?

I know that we have Happiness Committee events schedule regularly at Sharp Grossmont which have included chess tournaments, fishing trips, padres baseball event, currently coming up breakfast at father Joe's, Holiday parties and events to promote physician comradely. I find that these activities help reduce stress and allows us to enjoy each-others company outside of a stressful work environment. Within our own ER department, we organize meetings and get together at a physician's house, hang out, talk and not deal with work. It's been a great way to get to know my colleagues in a non-work setting and let our hair down as they say.

What does the literature say about physician wellness/ burnout?

Based on some of the literature that I have read, I've learned that some specialties such as Urology(54%), Neurology(53%), Internal Medicine(49%) and Emergency Medicine(48%) seem to have the highest rate of burnout. Women are more reported to be "burned out" than men, but this could be that men are less likely to admit to psychological problems or seek help. Some of the most common contributing factors are: charting & EMR, too many hours at work, which equates to higher rates of burnout, and lack of respect or recognition from administration/colleagues/staff.

Some of the most common ways to cope with physician burnout are exercise and talking to close friends/family.

The most concerning part is that some of these physicians experiencing burnout may also suffer from depression or other underlying issues that are not discussed for one reason or another and they don't seek help. Physician burnout is a very serious concern because in some cases has lead to physicians taking their own lives.

The 2019 Medscape National Physician Burnout, Depression and Suicide Report states that there are 6 domains of wellness: Physical, Emotional, Spiritual, Intellectual, Environmental, and social. - Can you share whit us something you do to address one or some of these domains?

- Physical: I enjoy doubles tennis regularly and enjoy fishing and photography

- Emotional: I enjoy taking monthly 2-3 days off to specifically relax and unwind from everything

- Spiritual: I enjoy attending Sunday mass at church with my lovely wife

- Intellectual: I attend CME events and lectures as often as possible to rejuvenate the reasons why I choose medicine as my profession

- Environmental: Practice my photography while on hikes & walks to mentally resolve any frustrations from work.

- Social: I like to attend hospital events such as fundraisers, CME, holiday parties, and fishing trips.

What would you say to a physician going through burnout and is not sure what to do?

I would suggest that they talk to a colleague, family member or friend. Try to focus on the positives and avoid fixating on the negative. The most important thing is to talk to someone and get help.

Online Learning Spotlight

Incorporating Updated Guidelines into the Management of Breast Cancer: Case Studies and Best Practices – Online

Dr. Christy Russell is a member of the American College of Physicians, the American Society of Clinical Oncology, the European Society of Medical Oncology, and the American Society of Breast Surgeons.

Sharp Equality Alliance: Mental Health Challenges for Adolescents and Young Adults - Online

Speaker addresses topics surrounding mental health challenges for adolescents and young adults including strategies for building trust and clear communication.

Integrating Food Security into Healthcare Settings - Part 1 of 4: Definition, Policy and Health Outcomes

Review current research on the impact of social determinants - specifically food insecurity/access to healthy food - on health outcomes & chronic health conditions (diabetes, heart health, obesity, etc.) and health care utilization.

SHC Safe and Effective Pain Management Part 1 of 4: Functional Pain Scale

Effectively use a functional pain scale when determining a patient's pain management needs. Determine appropriate multimodal pain management options based on a patient's stated pain scale rating


iOS  // Android

Activity Spotlight

Looking Back

Sharp’s System Heart and Vascular Conference

Sharp’s System Heart and Vascular Conference at the Hotel Del on October 5-6, 2019 was a great success with 392 attendees, 20 table booths, and an overall positive attendee survey of 100% response to meeting their educational needs, 98% response to providing information that is immediately applicable to their practice and an overall pre/post +1.3 increase in confidence level. We had an expert panel of speakers on topics including cardiovascular disease and treatment, vascular disease and treatment, structural heart, heart failure, sudden death in athletes, transplant, stroke, cardio oncology toxicities, sleep apnea, and more. Thank you to our committee chairs Robert Adamson MD, Vince Guzzetta MD, Brian Jaski MD, Joe Lo Duca MBA, MPH, Scott Musicant MD and our amazing team of committee members for coordinating this year’s event!

Do No Harm Conference

This year’s Do No Harm Conference (September 13, 2019) was a huge success. Susan Scott, PhD, RN, CPPS, FAAN was so well received in 2018 she was invited back for an encore presentation and she did not disappoint. Her passion for supporting those in healthcare who may suffer emotional trauma as a result of unexpected clinical events was very impactful for all those in attendance. Sharp HealthCare continues to develop the CAREforYou support program and spent the afternoon training another cohort of peer supporters. Sharp continues to strive to truly be the best place to work and the best place to practice medicine as well as the best place to receive care.

Looking Forward

Early Intervention and Prevention of Breast Cancer-Related Lymphedema - November 18, 2019

Join Frank A. Vicini, MD, National Director, Breast Care Services & Research from Pontiac, Michigan and Panelists; Carol Long, OTR/L,CLT-LANA, Christina Casteel, MD and Siavash Jabbari, MD on Monday, November 18, 2019 from 5:30 p.m. to 8 p.m. in the Sharp HealthCare Spectrum Auditorium. This educational activity is designed for Primary Care Physicians, Radiation Oncologists, Medical Oncologists, Surgeons, Lymphedema and Physical Therapists, Oncology Nurses, Navigators, Quality/Outcomes Specialists and other Allied Health Professionals. To register, visit https://sharp.cloud‐cme.com/lymphedemac.

SGH Pulmonary and Critical Care Symposium - January 25, 2020

Please join Symposium chairs Kaveh Bagheri, MD and Ara Klijian, MD for the inaugural SGH Pulmonary and Critical Care Symposium. The symposium is open to physicians, nurse practitioners and physician assistants interested in the latest techniques in diagnosis and management of lung conditions. Topics include pneumonia, thoracic radiology, lung cancer, pulmonary arterial hypertension, interstitial lung disease, lung transplant, vaping and e-cigarettes and awake video assisted thoracic surgery (AVATS). Seating is limited, so register now at sharp.com/SGHLungCME.

CME in Action

Role of Percutaneous Left/Right Sided Devices and ECMO in Cardiogenic Shock: Navin K. Kapur, MD and Brian E. Jaski, MD
SMH Complex Venovenous ECMO Cases - Phillip Mason, MD, and Joseph Bellezzo, MD
Sharp Rees-Stealy Annual Conference 2019: James Ochi, MD, Eric Mair, MD, and Philip Littlefield, MD
Sharp Community Medical Group Annual Conference 2019: Omid Bakhtar, MD, and Lynne Milgram, MD
Thank you for your ongoing audiovisual support! Sharp HealthCare Information Systems - Edzon Malaga, Erwin Jocosing, Luis Tec


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