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Governor's Newsletter, Spring 2000

Rashida A. Khakoo, MD, FACP
Governor, West Virginia Chapter

Governor's Message

I remain very excited to serve as the Governor of the West Virginia Chapter ACP-ASIM. I have received tremendous support from all of you. We have formed several new committees including Membership, Health and Public Policy and Awards, and have continued the previous ones. I have been very pleased with the willingness and excitement of people to serve on these committees. The Medical Student Council has been expanded. They are already engaged in a number of activities including helping with the walk organized by the Health Right clinic. It is great to be engaged in this way and to continue the mission of the ACP-ASIM.

As all of you know, our next Chapter Meeting is on May 19-20, 2000, at the Radisson Hotel in Huntington. The theme of this year's meeting is "Teaching and Learning in Medicine." The program has many excellent features. I am deeply grateful to Drs. Lynne Goebel and Melanie Fisher, Chair and Co-Chair of the Program Planning Committee respectively, and all the members for their hard work and insight. Antimicrobial resistance is the theme of the College this year and we are very fortunate to have Dr. Ralph Gonzales addressing the issue of "Improving Antimicrobial Use in the Ambulatory Practice," a very important topic for all of us. Other usual formats include "Thieves Market" and "Multiple Small Feedings of the Mind" (both back by popular demand.) We have scheduled interesting workshops including those for skill building. For the first time we have included medical students in the Medical Knowledge Challenge program. Many residents are excited about presenting abstracts for the Associates' Competition. Dr Gibbons, MD, is our College Representative this year. He will participate in "Multiple Small Feedings of the Mind" session. In addition, he will be amongst a panel of faculty demonstrating critical clinical thinking. We are also planning breakfast interest groups for students and housestaff. I am very grateful also to all Chairs of the Departments of Medicine in all the programs in the State for their valuable input and co-sponsorship.

I look forward to seeing all of you at the Chapter Meeting. Please bring family members, friends, and colleagues. Encourage others that you know who have not come previously.

Please send me any comments you have or let me know if you have any questions. My e-mail address is rkhakoo2@wvu.edu. I look forward to hearing from you. We will be adding to this web page as time goes on and additional information becomes available. If there is anything you would like included on the web page, please let me know.

West Virginia Chapter Committees

Program CommitteeNominating Committee

Lynne Goebel, MD, Chair
Charles Turner, MD, Chair
Melanie Fisher, MD, Co-Chair
Orton Armstrong, MD
Kevin Yingling, MD
Anthony DiBartolomeo, MD
J. Thomas Dorsey, MD
Maurice Mufson, MD
Elizabeth Powers, MD
Jeffrey Shultz, MD
Ronald Stollings, MD
Ronald Scobbo, MD
Timothy Jackson, MD

Membership Committee

Christine Kincaid, MD
Jeffrey Neely, MD, Chair
Jeffrey Shultz, MD
Robert Altmeyer, MD
Karen Rudolph, MD
Ilene Blacksberg, MD
Gregory Rosencrance, MD
Nick Cassis, MD
Shelly Nuss, MD
Eduardo Goo, MD
Niti Armistead, MD
Suzanne Romeo, MD
Anthony Morise, MD
Karen MacKay, MD
Laura Westfall, MD

Medical Student Council

Benjamin Fano, MD
Allison Oley, Chair
Cassy Salgado, MD
Jason Gunn
Danille King, MD
Brenda Arnett
Mark Call
Doug Haden

Health and Public Policy Committee

Melinda Hooton
John Holloway, MD, Chair
Amy Jarvis
Derrick Latos, MD
Eric Shouldis
Al Pfister, MD
Stephen Smith, MD

Associates Council

Jamie Boris, Chair

Awards Committee

Charles Meadows
Irma Ullrich, MD, Chair
Imran Arif
Warren Point, MD
Khurram Butt
Robert Marshall, MD
Hernan Castro
Jeffrey Shultz, MD
Erica Caveney
Elizabeth Powers, MD
Lori Eddy
Sridhar Yaratha

Annual Session 2000 - Philadelphia Style

The ACP-ASIM invites you to celebrate the new millennium in the Birthplace of America, at Internal Medicine's premier educational event - Annual Session 2000, from April 13-16. From recertification courses to a history of medicine series, computer workshops to subspecialty updates, Annual Session 2000 guarantees you an abundance of educational and professional opportunities.

For the first time ever, the College's governing Boards have chosen a Clinical Theme for special emphasis in ACP-ASIM educational programs - Emerging Antibiotic Resistance. Since antibiotic resistance is now a major threat to the health of people worldwide, numerous sessions will provide up-to-date information on this topic, strategies on how to reduce this threat and skills to enable physicians to resist the importuning of patients for inappropriate antibiotics for self-limited non-bacterial infections.

With the first set of time-limited internal medicine certificates due to expire in 2000, recertification will be the theme of a two-day Pre-Session Course. By providing an intensive review of core topics in internal medicine, this session will allow you to tailor your own curriculum to meet the upcoming examinations.

Other Annual Session highlights include a four-part series on the history of medicine, the ever-popular "Multiple Small Feedings of the Mind," Clinical Skills workshops and the Learning Center, as well as over 250 educational sessions. Members are encouraged to register now for Annual Session 2000 to have the best selection of sessions requiring advance reservations, including workshops and the new "Meet and Eat with the Professor" sessions (informal breakfast and lunch sessions with distinguished faculty that provide opportunities to discuss recent advances and new developments in selected topics.) Requests are filled on a first-come, first-serve basis.

For more information on Annual Session 2000, or to register, visit ACP-ASIM Online or contact Customer Service at 800-523-1546, ext. 2600.

ACP-ASIM PAC Decision

BOG Resolution #144 (Nevada, North Carolina and Pennsylvania chapters) called for the establishment of an ACP-ASIM political action committee (PAC). The resolution was approved by the Board of Governors in October 1998 and was subsequently referred to the College's Health and Public Policy Committee and the Ethics and Human Rights Committee.

The reports of the two committees were reviewed and discussed by the Board of Regents of ACP-ASIM on February 6, 1999. The Board of Regents, after considering all the information that it received from committees, and after a lengthy discussion, voted to defer making a recommendation to ACP-ASIM Services, Inc. on establishing an ACP-ASIM Services, Inc. PAC for one year. Throughout 1999 the College gathered information from ACP-ASIM members to consider when making a decision about establishing a PAC. Membership feedback was encouraged through Governors' newsletters, Chapter and regional meetings, and formal discussion by College leadership.

After careful evaluation of member feedback, on January 21, 2000 the Board of Regents of ACP-ASIM voted not to recommend to establish an ACP-ASIM Services, Inc. PAC. The Board of Regents' decision was based on the following reasoning:

  • Membership feedback seemed to be mixed. With no apparent membership majority in favor of, or opposed to, creating a PAC, it was decided not to establish a PAC at this time.
  • The Board recognized the value of the views expressed by those who believe that a PAC could provide greater access to legislators. It concluded, however, that the College could continue to be effective without a PAC.
  • The College already enjoys ready access to many of the decision-makers on Capitol Hill and is a respected voice in the public policy arena. ACP-ASIM public policy staff is well established in Washington and is active in advising national committees and institutes on matters of public health and policy of importance to internists and their patients.
  • The College is aggressively continuing its public policy initiatives. We will continue to fight for legislation that is friendly not only to those of us in the practice of medicine, but to our patients as well.
  • The College strongly encourages all members to understand health-related issues on both a state and national level and to get involved with the legislative process. An excellent resource for those who wish to become more active can be found on the College's Web site under "Where we stand."
  • Individual College members are free to donate money directly to candidates who espouse agendas in support of public health.

Tips for Office-Based Preceptors

What do students and residents want from a community-based teaching experience?

To students, preceptor characteristics are the most important factors defining a successful office-based experience. One of the most highly related teaching characteristics is the preceptor's ability to promote student independence.

(1)

Most often this was accomplished by giving the student increasing patient care responsibility. Other highly favored characteristics is the willingness to allow students to practice technical and problem-solving skills, enthusiasm and interest in students, and the ability to actively involve the student in learning. The willingness of a preceptor to act as a mentor and advise the student is also highly valued.

(1-3)

Characteristics of the office are of secondary importance to the learner when compared to preceptor characteristics. Valued office characteristics include having a wide mix of different available preceptors, a wide variety of presenting patient problems, and a range of patient ages.

(1)

The areas providing the most difficulty for students are learning to work within the time constraints of the office setting, performing a focused examination, and learning to rely upon data gathering skills and problem-solving abilities rather than imaging and laboratory tests.

(4)

Other highly valued educational experiences include discussion of general management issues, diagnosis, and demonstration of physical examination skills.

(5)

Residents value the opportunity to discuss differential diagnosis and management issues, and appreciate the close supervision, feedback, and to practice and improve clinical and procedural skills.

(5)

The message from the learners is consistent and clear; they want the opportunity to practice basic data collection and management skills on a wide variety of patients typically seen in the office setting. They desire feedback on their performance and a role model to emulate.

  1. Biddle WB, Riesenberg LA, Dacy PA. Medical student's perceptions of desirable characteristics of primary care teaching sites. Fam Med 1996;28:629-33.
  2. Prislin MD, Feighny KM, Stearns JA, et al. What students say about learning and teaching in longitudinal ambulatory primary care clerkships: a multi-institutional study. Acad Med 1998;73: 680-87.
  3. Epstein RM, Cole DR, Gawinski BA, Piotrowski-Lee S, Ruddy NB. How students learn from community-based preceptors. Arch Fam Med 1998;7:149-54.
  4. Feltovich J, Mast TA, Soler NG. Teaching medical students in ambulatory settings in departments of internal medicine. Acad Med 1989;64:36-41.
  5. O'Mallery PG, Kroenke K, Ritter J, Dy N, Pangaro L. What learners and teachers value most in ambulatory educational encounters: A prospective, qualitative study. Acad Med 1999;74:186-91.

Documentation and Billing When Teaching in the Office Setting

Many internists teach students and residents in their office setting. Frequently, these preceptors have questions regarding proper documentation for Medicare billing when a learner is present. Here are some useful guidelines.

Documentation Requirements for a Resident

Current Medicare rules permit a teaching physician (preceptor) to substantiate a bill based on the combination of the resident's and the teaching physician's documentation of a specific service. The teaching physician must clearly convey that he/she saw the patient and participated personally in the patient's care up to the level of the EM services billed. The teaching physician can confirm that he or she verified the findings in the resident's note and agree with findings as documented by the resident. The teaching physician can also indicate that he or she agrees with the diagnosis and plan as written by the resident. These requirements, for the most part, permit a certain amount of time saving by using the resident's documentation as part of your own note. This will somewhat decrease the overall work associated with teaching by allowing you receive some "service" for your educational endeavors.

Documentation Requirements for a Student

The only documentation by medical students that may be used by the teaching physician is their review of systems (ROS) and past history, family history, and social history (PFSH). Currently, the teaching physician may not refer to a medical student's documentation of physical examination findings or medical decision making in his or her note. These restrictions will obviously have an impact on office efficiency. However, there are certain strategies that can be used to maximize efficiency in spite of these regulatory requirements. The use of the "wave scheduling" collaborative examinations, and presenting in the room are other methods to help manage documentation requirements when a student is present.

For more information regarding these techniques, contact the ACP-ASIM Community-Based Teaching Program at 800-523-1546, ext. 2845, or e-mail palguire@acponline.org.

Supporting Your Chapter Through Chapter Dues

Chapter dues are the backbone of local activities and vital to the success of our chapter. While we are provided some financial support from the national office, the chapter dues collected provide the majority of financial support for local activities. Educational meetings, mentoring programs for medical students, local Associates' research competitions, advocacy with state legislators, and participation by chapter leaders in Leadership Day on Capitol Hill are just some of the activities supported by your chapter dues. Many of these activities are orchestrated by unpaid volunteer leaders in our chapter. However, the increase in activities at the local level

has created the need for additional staff support to help manage the day to day operation of the chapter. Your chapter dues help support the cost of local staff and provide funding for new and existing chapter initiatives. When you receive your dues notice, please remember to include the chapter dues in your payment. You will be contributing to the success of many grass roots activities happening right here at home.

Newly Elected Fellows 2000

Eduardo Goo, MD
Omar Hallak, MD
William Noble, MD
Thomas Rushton, MD

1999 Elected Fellows

Sammar Atassi, MD
Syed Rasheed, MD
Sathyanarayan Reddy, MD
Goutam P. Shome, MD