Governor's Newsletter, Fall/Winter 2000

From the Governor's Corner

Jan Rival, MD, FACP
Governor, Michigan Chapter

Kudos to all of the participants in our Fall meeting, with special thanks to our Program Chairs, Drs. Kenneth Fisher and Eric Scher. Attendance was excellent with a high degree of family participation. We always stressed the importance of social interaction, and we are delighted that the total number, including, family members accounted for an attendance exceeding 1000.

The Chapter was fortunate to have as our College Representative, William Hall, MD, FACP, President-Elect of the College. Dr. Hall was an active participant in our Town Hall Meeting, featured speaker during our luncheon and a poster abstract judge. Dr. Hall was well received by all and the membership realized again that the College will be in good hands in the future.

I am pleased to inform you that the Chapter was recognized for its efforts for meeting the standards determined by the Chapters Subcommittee in Philadelphia for excellence in chapter management and received the ACP-ASIM Chapter Excellence Award. Dr. Willliam Hall presented this award during our luncheon.

Program Director's Meeting

By Eric J. Scher, MD, FACP, Chair

The committee members discussed various resident evaluation tools being used at different locations. Susan Eggly from Wayne State University indicated they would be going with the Mednav Evaluation software package. Dr. Scher indicated Henry Ford Hospital would be going with the Res-a-Track system. Other program directors discussed other evaluation tools including satisfaction evaluations from support personnel and other outcome measures. The issue of OSCE's came up again but as yet no residency program is doing this on a routine basis. It is still limited to medical student education by and large. The main barriers appear to be cost, logistics and location.

The Annual Michigan Chapter Scientific Meeting was discussed in some detail and the issue of original resident research was raised. The committee felt program directors should enforce higher standards for poster and oral presentations for future meetings. The idea of hypothesis driven research with actual data collected and interpreted was appealing to everyone. Most program directors in attendance felt a gradual, rather than abrupt, change would be the best possible course of action at this point in time. For those residents who still do case reports, it was suggested that guidelines be developed and followed prior to next year's abstract deadline. Appropriate research projects could include such areas are CQI projects and clinical questions answered using evidenced-based medicine practices.

Medical Student Program

By Joel Appel, DO, FACP, Chair

The Seventh Annual Medical Student retreat was held once again during the Michigan Chapter's Scientific Meeting. A record number of student's (63) representing six regional medical schools and two overseas programs attended the event. This year's program featured three sessions geared towards students only, along with the general itinerary covering a broad area of evidence-based clinical presentations, as well as updates on the rapidly changing social/ political/economic climate engulfing medicine that students must begin to digest as they prepare for the world of post-graduate training. The special student presentations included the traditional orientation: A Day in the Life of an Internist, always given and warmly received by Diane Levine, MD, Ruth Hoppe, MD, and Ernie Yoder, MD, our faculty moderators for Balancing Personal Life and Career in Training, an excellent current aid and prep for the future management of the impact of medical training on the lives of young people. Finally, Kenneth Bergsman, MD, offered an update on Peripheral Smears Made Simple, skillfully employing humor to further knowledge and successfully invoking an Audience Response System to engage the students.

Our 2000 Evaluation Form was completed by almost all students and reflected from the most important source, the success of this year's program. The student and general itineraries were rated as relevant by over 90% of the students. The quality of the student presentations was rated as excellent or very good by 90% plus of students. Most important, 95% of students strongly agreed that the weekend further promoted their interest in Internal Medicine as a career option. It should also be noted by the membership that the most frequently cited comment on the form simply thanked the Michigan Chapter for caring enough to sponsor this program. It took a few years, but it is now evident that the Fall retreat has become a part of the culture and perhaps an expectation of medical student training in this state.

Abstract Submissions

The Chapter received over 350 abstract submissions for either oral/poster presentation with 309 accepted for poster and 20 for oral competition. The first place winners will be sent to Atlanta by the Chapter in March 2001 and entered into competition.

Resident Competition:

  • lst place, $100 and a plaque;
  • 2nd place, $75 and a plaque;
  • 3rd place, $50 and a certificate.

Paper Presentations:

  • First Place:
    Roopal Thakkar, MD, St. John Hospital and Medical Center
  • Second Place:
    Ronny Otero, MD, Henry Ford Health System
  • Third Place:
    Freesia Dhingra, MD, Oakwood Hospital and Medical Center

Poster Presentations

  • First Place:
    Pavani Kolli, MD, Oakwood Hospital and Medical Center
  • Second Place:
    Thomas Melgar, MD, Michigan State University/KCMS
  • Third Place:
    Scott Shulman, MD, Michigan State University/KCMS

By the confirming of Fellowship, you have been recognized by your peers for your outstanding accomplishments, achievements and expertise in medicine and most importantly, for your contributions to your patients, communities, the College and to those students and physicians who have benefited from your teaching. Fellowship of course does not delineate an end, but is a beginning of new period of your professional life and offers an opportunity for you to become involved in the leadership of the College, both on the chapter and national level.

Fellowship Advancement Made Easy (FAME)

By Marc Shabot, Texas Southern Governor

Prerequisites

  1. ABIM, RCPSC, or AOBIM certified†
  2. Licensed practitioner
  3. Formal training completed, Member at least 2 years, in practice or teaching for at least 2 years
  4. Proposed/seconded by 2 Masters/Fellows
  5. Commitment to lifelong learning and professional development

    †May be waived in extraordinary circumstances

    Then, Qualify by 1 of the 4 Pathways*

    Pathway 1 — Academician

    • Holds academic appointment as teacher, researcher, administrator, writes scientific papers, scholarly reviews, book chapters, etc.

    Pathway 2 — The Scholar/Teacher/ Multiple Certification

    • Active in community as teacher in Continuing Education and Professional Development activities
    • Re-certified or dual boarded, or MKSAP for score

    Pathway 3 — The Active ACP-ASIM Member

    • 10 years membership in the ACP-ASIM
    • Active in ACP-ASIM meetings and Committees at local and national level

    Pathway 4 — The Senior Physician

    • May have been a longstanding Member or have joined ACP-ASIM later in life
    • Has demonstrated longstanding professional activity in the community, in teaching, in patient care or in service; acts as a role model for other physicians and health professionals

    Note: Community service, especially the voluntary provision of medical care, and ACP-ASIM activities significantly enhance the likelihood of advancement, under all four pathways.

    *Pathways are not mutually exclusive; "combinations" are permissible.

    Governor's Award

    For his tireless efforts to help the Michigan Chapter of ACP-ASIM, for his resourcefulness and ability to teach and share his knowledge, his proven ability to build meaningful relationships with physicians, scientists, educators, administrators, and other members of the clinic and health care management, the first recipient of the Governor's Award of the Michigan Chapter was Kenneth A. Fisher, MD, FACP.

    Laureate Awards

    By Gilbert B. Bluhm, MD, FACP, Chair, Awards Committee

    The Laureate Award honors those Fellows and Masters of the College who have demonstrated by their example and conduct an abiding commitment to excellence in medical care, education, research, and service to their community, their chapter, and the American College of Physicians/American Society of Internal Medicine. There were four physicians honored as recipients of the 2000 Laureate Award during the Awards/Banquet on Saturday evening and were: Howard S. Goldberg, MD, John G. Milliken, MD, Bertram Pitt, MD, and Melvyn Rubenfire, MD. Congratulations on an honor well deserved.

    The Michigan Chapter Committee requests nominees for the 2001 Laureate Award. Nominations for consideration must be received in the Governor's office by February 2001. To assist you, the following is the Laureate Award criteria. For your convenience, the last page of this newsletter contains a nomination form for your use.

    Criteria For Michigan Chapter ACP-ASIM Laureate Award

    The Laureate Award honors those Fellows and Masters of the College who have demonstrated by their example and conduct an abiding commitment to excellence in medical care, education, research, and/or service to their community, their chapter and the American College of Physicians-American Society of Internal Medicine. It is recognized that all these qualities are not likely to be found in a single individual except rarely and that qualification for the award could be either on the basis of medical care, education or research. An emphasis is placed on the continued participation in College affairs at all levels including attendance at regional meetings, as well as annual meetings of the College.

    It is expected the awardees will be senior physicians, Fellows for at least 15 years, and will have a long history of professional excellence and peer approval.

    New ACP-ASIM Masters

    I would like to take this opportunity to congratulate three new Masters of the College
    • A. Martin Lerner, MD,
      Clinical Professor Internal Medicine, Wayne State University School of Medicine;
    • Vainutis K. Vaitkevicius, MD,
      Professor Emeritus of Medicine, Wayne State University, School of Medicine, Director, Community Research, The Barbara Ann Karmanos Cancer Institute, Detroit;
    • Fred W. Whitehouse, MD,
      Professor of Medicine, with tenure, Case Western Reserve University Medical School, Henry Ford Hospital, Detroit.

    Mastership is awarded to those few individuals who have made major contributions to the field of internal medicine and recognized as "giants" in their field.

    Election Of Governor-Elect

    By Park W. Willis, III, MD, MACP, Chair, Nominations Committee

    The term of Governor Jan Rival will conclude in April 2002. The chapter membership was notified early in 2000 and asked for nominations for a Governor-Elect.

    The Committee received fourteen (14) names for nomination. Their qualifications were reviewed and most were found to be qualified to serve as Governor. The Committee selected John P Papp, MD, FACP, and Ernest L.Yoder, MD, FACP, as best qualified.

    All members eligible to vote will soon receive ballots from ACP-ASIM headquarters in Philadelphia. Drs. Papp and Yoder were asked to submit vision statements and these are presented below:

    John P. Papp, MD, FACP, MACG

    My vision for the Michigan Chapter ACP-ASIM is to promote and support the academic and socioeconomic interests of the internist. The internist is increasingly faced with economic challenges from government and competitive health care providers. As Governor, I would be your advocate at the state and national levels.

    Our annual regional meeting is one of the best in the United States. I will strive to continue its academic and collegial atmosphere. It is a forum in which we can discuss our concerns. More focused workshops will be developed to help us learn and survive.

    I will strengthen the annual residents meetings and encourage their involvement in our meeting. I will give high priority to increased involvement of young internists in our chapter.

    A closer relationship with our major medical centers will be developed so what we can address their concerns at appropriate forums. We need to speak with one voice.

    Ernest L. Yoder, MD, PhD, FACP

    Clearly establishing Internal Medicine's identity with the public requires that ACP-ASIM openly and actively advocate for access to quality care. We must work to replace the current reactive model of care with a proactive, patient-centered model emphasizing prevention and health promotion. We should also promote creation of new knowledge, appropriate utilization of technology, improvement of communication skills, identification and dissemination of best practice/best evidence, and lifelong learning among all physicians. To facilitate achievement of these goals, the Michigan Chapter lead-ership must utilize available technology to communicate national ACP-ASIM activities to, and to solicit input from all members, while attracting non-members to join ACP-ASIM. As part of its quality focus, ACP-ASIM should remain actively involved in the continuum of medical education. Allowing our members to model ACP-ASIM standards of professionalism and excellence in patient care will ensure that the best graduates of our four medical schools will select internal medicine as a career.

    Exercise Your Right To Vote

    Your vote counts! Exercise your right to vote and have your voice heard this fall when the ballots are mailed to the elect the next Governor for your chapter. Candidates willing to serve your interests represent your thoughts and positions on nationwide issues and support local activities that will expand and enhance the chapter are running for office.

    You are empowered to guide the College's leadership into the new century. It all starts with one little checkmark. You should have your ballot and all eligible voters (Masters, Fellows and Members, including brief biographical information on the candidates as well as vision statements from. If you did not receive a ballot, you can request that one be sent to you by contacting Joy Crist at 800-523-1546, etc. 2722.

    Support the best your chapter has to offer and take a few moments to review the ballot. It's easy. Just check off one name and return it in the envelope provided. It's that simple and you can make a difference.

    The Future Of Internal Medicine Will Be In Atlanta — March 29-April 1

    Be a part of the College's vision of upholding the best traditions and creating opportunities for excellence in the future. Join us for Annual Session 2001.

    Discover... The Next Generation of Multiple Small Feedings of the Mind

    Back and better than before! Creative formats, short, focused presentations, and practical topics combine to make these sessions a popular favorite. Each session is based on a series of practice-derived questions related to several clinical areas that address some of the most common, yet controversial, patient-management issues.

    Discover... The Most Recent Breakthroughs at the Annual Update Series

    Stay current on the latest information and perspectives from the nation's foremost experts in 20 subspecialty areas. The Update series is a valuable resource to ensure that you're up on the year's most significant findings and their impact on patient care.

    Discover... Meet the Professor Sessions

    Go right to the source. Take this opportunity to hear the experts discuss cases illustrating controversial issues and innovative techniques in patient care. Then get up-close and personal in the new Meet and Eat with the Professor sessions. Sit down with these same experts over breakfast and lunch and get answers to your specific questions in a smaller, more intimate setting.

    Discover... Interactive Learning for the Next Millennium

    Hands-on learning activities are an excellent way to refresh your skills or learn new ones. Take advantage of the Learning Center to help you gain experience or refine your abilities in such vital areas as medical interviewing, physical examination, and office-based procedures. The Learning Center is also the ideal place to familiarize yourself with medical infomatics software that can have an immediate impact on your daily practice.

    Discover... Annual Session and Beyond at the Many Special College Events

    Get in the spirit of Annual Session. Meet fellow internists from around the globe. Share your discoveries and learn from one another. Annual Session is more than a time for learning, it is a time to honor our colleagues' achievements at Convocation, to find out about the latest College initiatives at the Annual Business Meeting, and to meet old friends and make new ones at Regional and Chapter receptions, plus a variety of other events.

    Discover tomorrow Register today...

    Registration is available online at http://www.acponline.org/cme/as/2001/register, or by calling (215) 351-2600.

    I look forward to seeing you in Atlanta and be sure to join your colleagues at our reception on Friday, March 30th, from 6-8p.m. Details to follow.

    Become An ACP-ASIM Key Congressional Contact

    After hearing on the evening news about a proposed change to Medicare or a problem in the healthcare system, have you ever wanted to put your two cents in on the issues? Do you care how legislation coming through Congress affects your patients and the practice of internal medicine? Is one of your friends, family members, patients, church members or civic organization members a legislator?

    If you answered yes to one of these questions, you would make a valuable addition to the ACP-ASIM Key Congressional Contact Program. Recruiting new Key Contacts is an ongoing process but it will be especially important when the elections are over and the new members of the 107th Congress are selected.

    The College's success on Capitol Hill depends on grassroots advocacy by Key Contacts across the country who communicate with their members of Congress on issues of importance to internists and their patients. Key Contacts usually do not have established relationships with their members of Congress. ACP-ASIM gives them the tools necessary to develop and maintain relationships.

    Key Contacts receive a periodic newsletter, the Capitol Key, updating them on important legislative issues. Then, as key issues approach the decision-making stage on Capitol Hill, the College sends Legislative Alerts to Key Contacts that include all the necessary information to make informative contacts with legislators. ACP-ASIM staff is always available to provide support and answer legislative questions. Key Contacts report their contacts back to staff in the Washington, DC office of ACP-ASIM via fax, phone, e-mail or mail.

    The College offers a Grassroots Hotline that Key Contacts can call to hear a legislative update and be matched with and patched through to their members of Congress at no cost. The Grassroots Hotline number is 1-888-218-7770. ACP-ASIM also offers the Legislative Action Center (LAC) website which allows ACP-ASIM members to view the most current ACP-ASIM Legislative Alerts, find out who their legislators are, and send an e-mail, compose a letter or a fax to their members of Congress. It provides the status of key legislative issues of concern to ACP-ASIM, Congress' schedule, and tips on communicating with legislators. The Legislative Action Center can be accessed through the Where We Stand section of ACP-ASIM Online, or at http://congress.nw.dc.us/acp/.

    The College implemented a Key Contact Awards Program to recognize the hard work of members who go above and beyond the call of duty to contact their members of Congress. Each year, ACP-ASIM selects a Key Contact of the Year and a Top Ten Key Contact Special Recognition Winners based on the quality and quantity of responses to Legislative Alerts. The awards are presented each spring at Leadership Day in Washington, DC.

    If you would like to be updated on the legislation affecting internists and their patients and are interested in corresponding with your legislators a few times a year on these issues, contact Jenn Jenkins at 800-338-2746, ext. 4536, and join the College's Key Contact Program.

    Office Precepting Tips

    By Patrick C. Alguire, MD, FACP, Director, Education and Career Development

    The traditional model of case-based learning is familiar to most physicians. In this model, a learner presents a case to you after independently gathering the patient data. You then must know how to create educational opportunities for the learner related to the case and provide care for the patient. These tasks might be accomplished by:

    • Role modeling (watch me care for the patient)
    • Questioning (tell me what you think and why)
    • Expert consultation (ask me what you need to know)
    • Mini-lecture (I will tell you what I know about this topic)
    • Modeling problem-solving (I will think out loud about this case)
    • Self-directed independent learning (What do you want to read about?)
    • Teacher-directed independent learning (I think you should go look it up)

    There are certain pitfalls inherent in case-based teaching that reduces its effectiveness. The most commonly encountered problems include:

    • Taking over the case
    • Insufficient "wait time"
    • Inappropriate lectures
    • Questions with "pre-programmed answers"
    • Pushing past ability

    Taking over the case is one of the most common and educationally destructive pitfalls of case-based learning. Typically, this is most likely to occur when a learner gives an incorrect answer to one of your questions. Rather than probing further to find where the learner has gone astray, the learner is told the diagnosis, what investigations to order, medications to prescribe, and follow up plans to pursue. At best, the learner becomes a scribe, taking notes to follow up on the preceptor's suggestions, and at worst a passive bystander with no role in the case management and no opportunity to learn.

    Closely related to taking over the case is not allowing sufficient "wait-time" when asking the learner a question. Physicians have a tendency to interrupt and ask another question or provide the answer to the first question when an answer is not immediately forthcoming. Effective teachers have learned to allow the learner more time to consider the question and formulate a response. Excellent teachers have also discovered that impatience discourages any real attempt on the part of the learner to answer the question. Alternatively, learners working with preceptors who wait for an answer learn that an answer is expected, even if wrong, and their attempt at answering the question is an essential and expected component of the teaching-learning process.

    Another common problem with case-based learning is giving inappropriate lectures. It is inefficient, as well as ineffective, to transfer large amounts of information vocally when it could more easily, and with greater educational impact, be looked up by the learner at a later time. Teaching can be given in small "bites" of information. The small "bites" include teaching the general rule and relating it to the immediate situation. The learner can be directed to the primary information sources that support this general rule and follow up reading can be done at a later time; the primary data supporting the general rule should not presented by you in the form of a mini-lecture.

    Preceptors must learn not to ask questions with "pre-programmed answers" that immediately suggest the correct answer, thereby preventing any thinking on part of the learner. An example of a question with a "pre-programmed answer" is "What do you think is going on? Could it be gastritis?" The answer is obvious, it requires no problem solving or data synthesis on part of the learner, and it deprives you of the ability to assess the learner's knowledge and problem solving skills.

    Another common problem with case-based learning is pushing the learner past their ability. This usually takes the form of discussing the ramifications of a case beyond their comprehension what is being said or asked. The key to knowing you have pushed beyond the learner's ability is observing the reaction to your question. Lack of response, lack of follow up questions, or a neutral facial expression typically signal learner incomprehension. At this point, the best strategy is assessing what the learner does know by using probing questions. Do not to ask questions that can be answered with a simple yes or no ("Do you know what diabetic nephropathy is?") but require the learner instead to explain and synthesize information ("What do you recall about the effects of diabetes on the kidney?")

    Young Physicians Subcommittee

    College about the practice environment today. Your frank comments will, through the Subcommittee, have a direct impact on you and your colleagues. Visit http://www.acponline.org/private/committees/yps/ and let us know what's on your mind.

    We'd like to know how you feel about recertification, establishing a practice, coping with stress, The Young Physicians Subcommittee (YPS) wants to hear from young physician members of the and time constraints. Would you like a copy of the YPS Practice Management Survival Booklet? An E/M coding card? A curbside consultation about and evaluating and improving a practice via the College's Center for a Competitive Advantage? If you answered "yes" to any of these questions, the web site can also be used to request this information. ALL e-mails will be answered. If you have any questions, please contact Jean Elliott, YPS Staff Liaison at (800) 523-1546, ext. 2692.

    ACP-ASIM Michigan Chapter 2001 Laureate Award Nomination Form

    Name: ____________________________________________

    Date: ________________________

    Address:_____________________________________________________

    City: ___________________________________ Zip:_______________

    Year Elected to Fellowship:_____________

    Check Where Appropriate Comments Welcome On Back Of Form

    Practitioner excellence:

    Above Average

    Outstanding

    General Internal Medicine:

    Subspecialty __________________________

    Educator excellence:

    Above average

    Outstanding

    Teaching Medical Students and/or Home Officers (Hospital, Medical School, Preceptor)

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    Presentations (Ground Rounds, Medical Societies)

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    Scholar excellence:

    Clinical and/or Basic Research

    Scientific Publications

    ACP-ASIM Presentations

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    Service to ACP-ASIM:

    Council , Officer, Committee, Program Chair

    Regular Attendee to State/National Meeting

    Service to Community:

    School Board

    Civic Volunteer—City, County, State

    Foundation Board

    Lions Club, Rotary, Other.......

    _______________________________________________________________

    _______________________________________________________________

    Please mail your nomination to the Chapter Office by February 28, 2001:

    Jan Rival, MD, FACP
    Governor, Michigan Chapter ACP-ASIM
    2799 W. Grand Boulevard
    Detroit, MI 48202
    Attn: Room B-1540

    Newly Elected Fellows July 2000

    • Jonathan A. Cohn, MD
    • Miqdad A. Khan, MBBS
    • Elmahdi M. Saeed, MBBS
    • Kevin J. Embach, MD
    • Warren L. Kupin, MD
    • Herbert C. Smitherman, Jr., MD
    • Marc A. Feldman, MD
    • Barry S. Meyer, DO
    • Jeffrey L. Wilt, MD
    • Gary J. Wortz, MD

    Ways To Contact Your Governor

    Just a reminder—it is very easy to get in touch with us. If you would like to include any of your thoughts in a future Governors letter, give us your fax/e-mail address. We need to hear of your concerns/suggestions/proposals. Our door is open to all. If there is something special that you would like me to do, I would be pleased to hear from you.

    Jan Rival, MD, FACP
    Governor, Michigan Chapter ACP-ASIM
    c/o Henry Ford Hospital
    2799 West Grand Boulevard
    Detroit, MI 48202
    ATTN: Room B-1540

    Phone: (800) 247-2485 (Michigan residents only) or (313) 916-1403

    Fax: (313)-916-1409

    E-mail: Jrival1@hfhs.org

    Please let me know of your ideas, concerns, criticisms.

    May you have a Safe and Happy Holiday Season!

What's New

Contact Information

Ruth Hoppe
Governor, Michigan Chapter

Marty Muth
Michigan Chapter Staff
Phone: 517-353-9548
Fax: 517-353-9604