Internal Medicine Residency Program

	RESEARCH AT ST. MARY’S MEDICAL CENTER: INTERNAL MEDICINE RESIDENCY 2004-2005 Research is strongly encouraged and supported during the residency program at St. Mary’s. Virtually all residents will have the opportunity to present abstracts or posters at the American College of Physicians Meetings. Many will bring their work to publication in peer-related journals. One elective per year can be dedicated to research, and the senior ambulatory care elective provides time to develop a quality-based research program. Faculty mentors are available at St. Mary’s to help with study design and completion. The Chief of Academic research, Dr. LiXi Yang, is available for biostatistical support, and as a supervisor in a bench or laboratory project. The Chief of Academic Medicine, Dr. Cosentino, will provide a focussed reading elective on topics in ICU, respiratory care and physiology that will lead to a presentation. Specialists in ambulatory care, Dr. Block, Dr. Mendelson and Dr Sockell focus on quality improvement research. Subspecialty faculty, such as Dr. Man and Dr. Michenfelder, are readily available for support in their areas. In all cases, advance preparation of your topic is crucial to use the elective time to best advantage! In general, there are 3 avenues that residents take to design and implement a research project: Discuss and design a project with a St. Mary’s faculty clinician; utilize the hospital’s data and clinical base to study aspects of clinical medicine or care-process, formulate solutions and reassess the outcomes. Work with either Dr. Cosentino on issues of medical physiology and respiratory care, or with Dr. Yang on bench/animal research in cancer therapeutics. Work with faculty at UCSF or Stanford on ongoing projects at their institutions. During academic year 2004-2005 we have already presented 5 posters and 5 abstracts at the regional ACP; our output for research posters was 2nd in California. Many other projects are on their way to other meetings and to publications. Our list of internal projects appears below: Systems Based Quality Research Projects July 2004 – June 2005 (Rev. 3/5/05)
	Resident: De Leon Project type: Case Report. Systems Based Quality Research Project Timeline: Complete 10/1 Question: Anion gap in metabolic alkalosis in a patient with Diabetes mellitus out of control. Discuss pathophysiology. Outcome/status: Due for ACP. Completed 10/2004 Goal: Presentation of Case and scholarly discussion of pathophys. Improve understanding of anion gap. Supervising Faculty: Cosentino Comments: Abstract accepted by ACP.Poster presented at regional ACP meeting 10/2004.
	Resident: Rostovtseva Project type: Retrospective chart audit. Systems Based Quality Research Project Timeline: Sept. 2004. Reaudit spring 2005 Question:Use of ACE-I in pts with CRI. Adequacy of BP control according to JNC-VII. Outcome/status: Complete Goal: Help optimize management of patients with CRI. Awareness of GFR in patients with normal or slightly abnormal serum creatinine will likely lead to more aggressive BP management and timely referral to Renal clinic. Discuss implementation of automatic calculation of GFR by means of MDRD with Quality Committee. Supervising Faculty: Sockell, Tseng Comments: Present data at clinic team meeting Poster presented at the regional ACP meeting on 10/ 23/04. Reaudit later in the year after knowledge of GFR via MDRD.
	Resident: Collins Project type: Retrospective QA. Systems Based Quality Research Project Timeline: Proposed 10/04 Question: Determine incidence outcomes & Risks for C. dificile Outcome/status: QC 11/04 Supervising Faculty: Man
	Resident: Heaphy Project type: Systems Based Quality Research Project Timeline: July 2004 Question: Barriers to successful implementation of MD electronic records in a outpatient clinic. Outcome/status: Interim report given during July team meeting and changes initiated by programmer, Dr. Johnson. Final report pending (resident currently off campus) Goal: Re-audit 6 months post introduction of template as tool in assessing HCM, Med RF; expand to subspecialty clinics. Dr. Block to meet with Dr.Heaphy during her next elective. Supervising Faculty: Block Comments: Could be presented in poster form at ACP meeting in spring? 10/2004 :Needs follow up study now that full templates in place.
	Resident: Jeong Project type: Q/A Retrospective chart review of all clinic patients previously on VIOXX Timeline: 12/04 (Multispecialty month) Question: Assess appropriateness of prescribing a Cox-2 inhibitor. Special focus on patients with heart disease HTN and CRI. Were other pain meds considered and tried? Outcome/status: In planning stage. Goal: Understand prescribing pattern of physicians in trainingPending results educate peers on need for avoidance of cox-2 in certain at risk populations. Supervising Faculty: Block Comments: Briefly discussed data base with Dr Jeong. Need to specify.
	Resident: Ridlovski Project type: Prospective Q/A audit. Systems Based Quality Research Project Timeline: 100 Consecutive patients Question: Difference in automated vs. manual BP. Outcome/status: Data collection Goal: Identify if there is a systematic error with automated cuffs in clinic practice? Supervising Faculty: Sockell Comments: 11/04 Quality presentation. Future poster.
	Resident: Selle, Nagarajan Project type: Prospective chart review. Systems Based Quality Research Project Timeline: Reaudit Spring 2005 Question: Do residents meet national ADAStandards in their own continuity clinic? Outcome/status: Complete Goal: Improve care of pts with DM; point of care audit tool improves care. Supervising Faculty: Sockell Comments: Resident and poster presented at regional ACP meeting 10/04.
	Resident: Teper Project type: Chart revision. Systems Based Quality Research Project Timeline: Complete 10/1 Question: Does care of CKD patients meet NKF guidelines? Outcome/status: Complete Goal: Discuss with QC if lab can report GFR by MDRD formula in lab. Improve care of CKD patients. Supervising Faculty: Sockell Comments: ACP regional abstract 10/04. Q.C. 11/04
	Resident: Truta Project type: Q/A Retro- and- prospective chart review. Systems Based Quality Research Project Timeline: 11/04 Multispecialty month Question: Assess incidence and prevalence of familial colon cancer in the clinic population undergoing screening by colonoscopy Outcome/status: In planning stage Goal: Improve understanding of incidence of familial colon cancer in a multi-ethnic population. Design modified screening protocol pending results. Supervising Faculty: Man, Block Comments: Resident to meet with Dr. Block to develop data base.
	Resident: Xue Project type: Prospective Systems. Based Quality Research Project Timeline: Proposed 11/04 Question: Identify correction factor for serum sodium Outcome/status: Present to Q.C. 11/04 Goal: Devise formula to predict “corrected sodium” Supervising Faculty: Cosentino
	Resident: Ma Project type: Case report Timeline: Complete Question: Small intestinal extranodal follicular lymphoma Outcome/status: Complete Goal: Increase understanding of disease. Supervising Faculty: Mendelson Comments: Send to national ACP for presentation Spring 2005.
	Resident: Hung Project type: SBQRP Timeline: Prepare for elective 1/05 Question: Prepopulate SNF orders and admit data with information from discharge note from the acute floor Outcome/status: Developing Goal: Improve flow, efficiency and compliance in SNF admit note and orders. Supervising Faculty: Chris Johnson; Rey Cordero Comments: ACP Spring
	Some of the research that is in progress at outside institutions includes: Resident: Dan Dang Project: Diagnosis and accuracy of Echo in transplant patients Status: Submitted for publication Facility: UCSF Supervisor: Nelson Schiller, MD Resident: Jafi Lipson Project: MRI in diagnosis of Ectopic Ureter Status: Ongoing Facility: UCSF Supervisor: Fergus Coakley, MD Resident: Brian Kim Project: Diagnosis of Sinus Thrombosis Status: Submitted for publication Facility: Stanford Supervisor: Michael Marks, MD Resident: Brian Kim Project: Clinical follow up of Vertebropalsty Status: Submitted for publication Facility: Stanford Supervisor: Michael Marks, MD Resident: Richard Lu Project: Rhinoviroses: NatURI2 Study Status: Ongoing Facility: UCSF Supervisor: Pedro Avila, MD Resident: Richard Lu Project: EXCELS study Status: Ongoing Facility: UCSF Supervisor: Shuman Tam, MD Resident: Hilary Ma Project: Optimization of Palliative Care Status: Ongoing Facility: UCSF Supervisor:Michael Rabow, MD Resident: Matthew Sharp Project: Cardiac MRI Imaging Status: Ongoing Facility: UCSF Supervisor:

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