Teach
UCSF Fresno Celebrates New Residents, Including Three SJV PRIME Students
By Brandy Ramos Nikaido
On March 15, graduating San Joaquin Valley Program in Medical Education (SJV PRIME) medical students and medical students across the nation, simultaneously opened envelopes that revealed where they will spend the next several years conducting the postgraduate training necessary to practice medicine in the United States. The event is called Match Day and occurs every year in March.
“Match Day is a rite of passage for medical school graduates as they learn where they will spend the next three to seven years of their lives living, working and caring for patients and fine tuning the skills necessary to be excellent patient care providers and advocates,” said Michael W. Peterson, MD, associate dean at UCSF Fresno.
Five UC Davis SJV PRIME students who are currently training at UCSF Fresno pursued residency programs in this year’s Match. The students include:
- Monique Atwal, from Selma and a graduate of the UCSF Fresno Sunnyside High School Doctors Academy and UCLA, matched with UCSF Fresno in psychiatry.
- Kenneth Job, from Fresno and a graduate of Buchanan High School and UC Davis, matched with Long Beach Medical Center in family medicine.
- Neetu Malhi, from Fresno and a graduate of Central High School’s East Campus and Fresno State, matched with UCSF Fresno in internal medicine.
- Stephanie Melchor, who is from Visalia and a graduate of El Diamante High School and UCLA, matched with Stanford University Medical Center in obstetrics and gynecology.
- Kristine “KC” Ongaigui, from Fresno, an alumna of the UCSF Fresno Summer Biomedical Internship Program and Stanford graduate, matched with UCSF Fresno in pediatrics.
“An aim of SJV PRIME is to train physicians for our underserved region and to increase the diversity of the physician workforce,” said Kenny Banh, MD, assistant dean for undergraduate medical education at UCSF Fresno. “These graduating students are from the region and have an ultimate interest in practicing medicine in the Valley or working with underserved populations. We are incredibly proud of them and we’re excited to celebrate their future.”
“I’m so excited. UCSF Fresno was my top choice. I’m from Fresno. I grew up here and I can’t wait to not only learn and continue to learn psychiatry but practice here in the future,” said Atwal.
As part of the Match Day process, graduating medical school students typically register with the National Resident Matching Program (NRMP). The NRMP utilizes a mathematical algorithm to place applicants into residency and fellowship positions. Medical school graduates then begin residency training, usually in June or July, at the hospital or program where they “matched.” A similar “match” occurs for fellows and sub-specialty training each year in December.
The UCSF Fresno residency programs that participated in the NRMP match received 5,654 applications and conducted 1,092 interviews for 91 positions. UCSF Fresno fellowship programs that took part in the October/December NRMP match received 1,097 applications and conducted 200 interviews for 18 positions. The remaining programs filled available positions through another matching service or through interviews.
“On Match Day, we celebrated the medical students we have trained and the residents and fellows who will begin their training with us in June,” said Lori Weichenthal, MD, assistant dean for graduate medical education at UCSF Fresno. “As a branch campus of UCSF and the largest physician training program between Sacramento and Los Angeles, our focus is on training 21st Century physician leaders. Our aim is to provide them with training and experiences that inspire them to stay in the San Joaquin Valley to provide high-quality, culturally competent care.”
UCSF Fresno currently offers residency training in eight medical specialties, one oral and maxillofacial surgery dental residency, fellowship training in 18 medical sub-specialties and three residency programs for physician assistants. UCSF Fresno also trains about 300 medical students, including those in the SJV PRIME, on a rotating basis each year.
SJV PRIME was established in 2010 as a partnership among the UC Davis School of Medicine, UC Merced, UCSF Fresno and the UCSF School of Medicine. The first class of students started in 2011.
In July 2018, the UCSF School of Medicine received approval from the Liaison Committee on Medical Education to establish UCSF Fresno as a branch medical campus to lead SJV PRIME. Up to six students will start in the fall of 2019, with the goal of admitting 12 SJV PRIME students in 2020. Students enrolled in the program will spend 18 months at UCSF in San Francisco and then move to Fresno for the remainder of their medical school training. Acceptance offer letters are being extended now to students who will represent the incoming cohort and who will start training as part of the new UCSF SJV PRIME in August.
Care
UCSF Fresno Offers New Testing and Education for Better Diabetes Management
By Barbara Anderson
Annette Simmons of Clovis had diabetes fatigue. She had pricked her fingers so many times to check her blood glucose that calluses had formed on her fingertips.
“You’re just tired,” Simmons said. “You’re tired of checking your blood and you need to because if you plan on living a long life you need to keep your blood sugar within certain ranges.”
So when UCSF Fresno’s Varsha Babu, MD, suggested Simmons try a continuous glucose monitor that would allow her to control her diabetes without painful fingersticks, Simmons quickly agreed.
“This does not hurt,” Simmons said as she demonstrated how she now can check her blood glucose by swiping her cellphone over a sensor about the size of a coat button placed on her upper left arm.
Babu, an endocrinologist, said a fingerstick can be more painful than an insulin shot because the gauge that pricks the finger is thicker than an insulin needle. “So my patients are willing to do the shots but they are not willing to test their blood sugar,” she said.
Checking blood glucose levels is essential to good diabetes management. Multiple studies show the more testing, the better control. And for the past year, Babu and fellow UCSF Fresno endocrinologists have been placing continuous glucose monitors on patients with Type 1 and Type 2 diabetes, with good results. Both Type 1 and Type 2 diabetes affect the way the body regulates blood glucose, but patients with Type 1 diabetes do not produce insulin, a hormone that takes glucose and uses it for energy. Patients with Type 2 diabetes either do not make enough insulin or they have insulin resistance and require higher levels of insulin to bring down blood sugars to normal ranges.
The monitors eliminate painful finger pricks and the social stigma of checking blood glucose in restaurants or other public places, Babu said.
Babu and her fellow UCSF Fresno endocrinologists have started diabetes education clinics for patients with the new monitors and those with insulin pumps (a medical device that administers insulin through a catheter under the skin). “We have dietitians available and highly trained medical assistants,” Babu said. “We are really trying to promote more care for our Valley.”
Diabetes patients in the San Joaquin Valley can benefit more than most from new technology and education. Kern County has the highest age-adjusted death rate for diabetes, according to the California Department of Public Health. Kern County’s death rate is 36.1 deaths per 100,000 population compared to a statewide rate of 20.7. The counties of Fresno, Madera, Merced, Tulare, Kings, Stanislaus and San Joaquin also have diabetes death rates higher than the state average and among the highest in the state.
Babu has seen improved hemoglobin A1c levels in Type 2 patients who have struggled to control their diabetes. A1c tests show average blood glucose levels and some patients have had significant drops — from higher than 10 percent to less than 7 percent. (An A1c level below 5.7 percent is considered normal).
Patients say the monitors are life changers, said Maria Barajas, a medical assistant at University Diabetes and Endocrine Specialists, one of the many UCSF faculty physician offices in Fresno that are part of the University Centers of Excellence. “Some of the patients are needle phobic. They hate pricking their fingers or they work in offices where they can’t be pricking their fingers.”
Simmons, a high school teacher, has Type 2 diabetes that she controls with oral medications, diet and exercise. It was not practical to prick a finger in a classroom but a Freestyle Libre 14 Day monitor lets her easily check blood glucose throughout the day. The monitor came with a reader that she carries in her purse but she programmed her cellphone to scan for readings.
Two types of continuous glucose monitors are available – intermittent and real time, Babu said. The monitors’ sensors are similar, but patients who have intermittent sensors, such as the Freestyle Libre 14, scan to get a glucose reading. Real-time monitors, such as the Dexcom G6, display the glucose number without scanning and the monitor can be connected directly to an iPhone or any Apple device. The Dexcom G6 also sounds an alarm when glucose levels are low or high and doctors can set the levels for the alerts. Up to five people can share the data.
The Freestyle Libre Day 14 sensor lasts for two weeks and the Dexcom G6 for 10 days and patients are taught how to replace the sensors. Many insurance plans cover the devices, including Medicare and Medi-Cal, and patients are helped through the process of getting insurance approval.
Sharing technological advances, such as continuous glucose monitors, with patients is part of improving the health of the community, Babu said. “I would like to say that very soon we should have some cure for diabetes – but until that time, this is the best we have so far and it’s proven to be useful.”
Research
UCSF Fresno Research Brings Advanced Hip Surgery Alternative to the Valley
By Barbara Anderson
Robert Kollmorgen, DO, a UCSF Fresno orthopaedic surgeon, knew there had to be a safer and better alternative for arthroscopic surgery than placing a large post between a patient’s legs that places undue pressure on the groin.
In traditional hip arthroscopy, the surgeon places the post to pull the hip joint out of the socket so a small incision can be made to insert a tiny camera, called an arthroscope. The camera allows the surgeon to view structures of the hip joint on a video monitor.
But the traditional method may cause nerve injury to the groin in up to four percent of patients. Dr. Kollmorgen, who specializes in hip preservation and who has performed hip arthroscopy for 10 years, felt the odds of a patient having numbness (albeit usually temporary) post-surgery was too high. And for more than a year, he has performed hip arthroscopy using a post-free technique that he developed and researched in partnership with three other hip preservation programs across the country.
Dr. Kollmorgen now uses a pink pad positioning device that eliminates the need for a post to achieve hip distraction. Dr. Kollmorgen, who operates at Clovis Community Medical Center, is the only hip preservationist using the technique in the central San Joaquin Valley.
Three other surgeons across the United States also used the pink pad technique as part of the research. A total of 300 patients had the new post-free distraction for hip arthroscopy performed by the four surgeons without complication. Dr. Kollmorgen presented findings at an international meeting in Melbourne, Australia in October. The study has appeared in “The Journal of Arthroscopic and Related Surgery.”
As of today, Dr. Kollmorgen said the new technique has been used in more than 1,000 hip arthroscopy surgeries. It could revolutionize hip arthroscopy which is the fastest growing arthroscopic surgery in the United States, he said. “There’s just some remarkable things we’re seeing since we’ve changed the way we’re doing hip arthroscopy. And I think it’s only going to get better as we keep refining our technique.”
The pink pad positioning device can save hospitals money by allowing surgeons to use an existing arthroscopic surgery table instead of a postless table that can cost as much as $80,000. And the benefits to patients are many.
“We’ve devised a technique to make it safer to patients. We’re decreasing complications; we’re making it so patients can recover quicker, have a better surgical experience.” Dr. Kollmorgen said. “Patients have reported less after-surgery pain. Our narcotic use after this operation is 10 pills on average.”
Maria Carr of Tulare said she had a pain of eight on a scale of 10 in both hips last year before Dr. Kollmorgen performed revision hip arthroscopy surgery on her left hip on Oct. 29 and on the right on Dec. 31. After each surgery, Carr said she took only one pain pill on her first day at home post-surgery.
Carr, a director of special education for a statewide organization, began physical therapy two weeks after each surgery. By mid-March, she said her recovery was going smoothly. “I was telling everyone I walked five miles’ yesterday in Santa Cruz in the rain and enjoyed a beautiful sunset. And the night before that I was at a yoga class.”
And Carr expects she will have another accomplishment to report soon. “My goal is to go hiking at Lake Tahoe in July.”
Carr has recommended Dr. Kollmorgen to a couple of patients since her surgery. But she almost had hip surgery by a surgeon in Los Angeles who had performed arthroscopic surgery on her hips 10 years ago. He wanted to do hip replacements, but Carr, 52, was reluctant. She heard about Dr. Kollmorgen from a physical therapist, sought his opinion and is glad she did. “Dr. Kollmorgen is amazing,” she said.
Patients need not go out of the Fresno area for the latest techniques in hip arthroscopy, Dr. Kollmorgen said. “We need people to know we’re here. Somehow we need to get the word out that we’re doing great things here. Research is here.”
Partner
UCSF Fresno Mobile HeaL Partners to Provide LGBTQ-Focused Health Care
By Barbara Anderson
There were a lot of drivers involved in UCSF Fresno bringing medical students, residents and faculty volunteers to an LGBTQ-focused preventive health care clinic in Fresno during LGBTQ Health Awareness week in March and many reasons to do so.
The LGBTQ-focused clinic fit the goal of the UCSF Fresno Mobile Health and Learning (HeaL) Clinic which is to address the needs of underserved and at-risk groups in the San Joaquin Valley, ranging from homeless, migrant, ethnic populations and the LGBTQ community. But organizing the first LGBTQ-focused clinic “was really driven by our partners,” said Kenny Banh, MD, UCSF associate professor of clinical emergency medicine and assistant dean of undergraduate medical education at UCSF Fresno. Dr. Banh launched the Mobile HeaL clinic in 2018.
“Without our partners, there would be no way we could begin to provide services here,” Banh said. UCSF Fresno teamed with Common Space, a Fresno nonprofit incubator and social hub; Trans-E-Motion, a transgender advocacy group in Fresno; and Julie Nicole, MD, an obstetrician/gynecologist, who provides transgender care in the Fresno area and a volunteer faculty member at UCSF Fresno.
Dr. Nicole agreed to provide transgender care at the free one-day clinic. Trans-E-Motion provided advertising and patient recruitment. Common Space provided its space in downtown Fresno as a place for free examinations. In addition, California Rural Legal Assistance helped with name changes and other legal issues. Clinica Sierra Vista helped with insurance enrollment and Centro La Familia provided help with social services. Medical students, undergraduate students, residents and faculty participated in the Mobile HeaL Clinic, and everyone volunteered their time.
Collaboration with partners outside UCSF Fresno is vital to the success of Mobile HeaL, said Rafael G. Gonzalez, MD, operations director. “It definitely takes getting in touch with advocacy groups to help organize these events. Someone has to get the word out to patients. They can help us plan these events and make them successful. It’s a privilege on our part to work with these community organizations.”
The LGBTQ-focused clinic provided basic primary care, preventive care, such as blood pressure screenings and blood sugar testing. It also provided some medical care specific for transgender patients, such as hormone therapy for those transitioning. “We’re very proud of this because it’s something that is a big need and we were excited to offer that,” Gonzalez said.
Dr. Nicole has a busy private practice specializing in transgender medicine, but some patients have difficulty getting to her office in Clovis, she said. “We don’t have a lot of providers in Fresno to begin with so there’s a need for any health service.”
Having the clinic at Common Space provided a place of inclusivity for patients. It allowed for assessments of new transgender patients, for example, Dr. Nicole said.
Common Space felt it important to open its doors for the clinic. “The LGBT+ community is one that we heavily serve,” said Founder and Executive Director Justin Kamimoto. “We see in our own teen population that about 80 percent of our folks identify as that community.”
The LGBTQ community can face discrimination and a lack of understanding of their health care needs. “So we knew that being a safe place that was recognizable by the community it was important to be involved in a project like this. And we’re thankful for the opportunity with the help of partners that it actually happened,” Kamimoto said.
Mobile HeaL was made possible by American Ambulance’s donation of an ambulance and financial support from the Central Valley Community Foundation and Anthem Blue Cross.
Mobile HeaL plans to continue providing health care to the LGBTQ community. For partnership or sponsorship opportunities, please contact mobileheal@fresno.ucsf.edu.
Inspire
UCSF Fresno
People Spotlight
Kasan Jones (second from left)
UCSF Fresno’s success and growth are a direct result of the dedication and inspiration of our faculty, staff, residents, fellows, students, alumni, partners, donors and friends. Last year in Focus, we began introducing you to the people who contribute to the greatness of UCSF Fresno through informal interviews.
This month, please meet: Kasan Jones
What is your name? Nickname?
Full name is Kasan Yvette Jones and my nickname is K or Kay. Pretty much all my family and close friends call me K unless it’s serious.
How long have you worked for UCSF Fresno?
As of this coming May 3, I will have worked at UCSF Fresno for 13 years.
What is your current title/current role?
I am manager of Undergraduate Medical Education (UME) and Student Affairs. Editor’s note: Undergraduate medical education refers to medical student education. Residency training is graduate medical education.
What do you like best about your job?
I like meeting awesome new students almost weekly and building rapport with our LIFE and SJV PRIME students who spend a great amount of time at UCSF Fresno.
What was your first job?
At 16, my first job was at Long John’s Silvers.
If you could pick up an instant skill, what would it be and why?
Sewing because then I could create my own fashions and unleash my inner fashionista!
Have you had your 15 minutes of fame yet? If yes, what was it and when? If no, what would you like to be famous for?
Well, if you count singing in three productions with the Fresno Grand Opera: Porgy and Bess and Showboat as well as Christmas on Van Ness. I guess I’m Fresno Famous. Otherwise, I keep it simple.
Do you have a favorite cause or charity you wish people knew more about? What is it and why is it near and dear to you?
I’m pretty passionate about inner city kids and because of that I serve as a member of the board of directors for the West Fresno Family Resource Center. They meet once a month over lunch to discuss programs and activities for kids in the 93706 area of Fresno. It started as a volunteer request for my then high school daughter to get volunteer hours and they asked me to consider becoming part of the board. That was about seven years ago. I also use my voice and time for political endeavors such as registering people to vote or just participating in local events and marches like the Women’s March. This past year, I served as financial coordinator for a city council candidate and this gave me a great amount of experience in campaign financing and laws about that.
The zombie apocalypse is coming, which three people at UCSF Fresno would you want on your team and why?
Hmm, that’s a hard one. Ok, so Dr. Kenny Banh because he’s an ER doc and he would be able to fix me up if one of the zombies attacked. My UME colleague Grace Carlson, because she is spiritual like me, and together we can pray our way out of it. Lastly, probably Alissa Edison from the Department of Pediatrics. She’s like your “Jenny from the block” girlfriend and she will keep it fun and exciting!
What is the favorite aspect of your job at UCSF Fresno?
Leading my team and inspiring them to push through the tough days and to embrace change. I appreciate the opportunity to grow, to not stay “stagnant,” and expand our programs and services so that students will want to come back or at least share how great our program is.
Where do you find your inspiration?
All of the great African American leaders of the past, present and future, including Jesus (yep!) the Obama’s – Michelle especially – Malcolm X – MLK Jr. – Harriet Tubman and more personally and closer to me my grandfather Mr. James Arthur Nichols. He lived to be 92 but born in the south, escaped racism and oppression and eventually moved to California where he worked 40 plus years on the shipyard in Mare Island. He left a legacy for his grandchildren. I had the honor of serving as the family trustee to settle his estate and sold the home where my father grew up. I just want all people to be respected and treated fairly and equitably and these are traits I pass to my children. My family gives me inspiration.
What’s the most important thing you’d like people to know about you?
That I enjoy the simple pleasures in life such as taking care of my family, maintaining my spiritual connection, traveling and serving in my community. I have two adult children and my youngest is in 10th grade. I have been married for 29 years (I know right!!). I’m looking forward to being an empty nester one day.
Supporting UCSF Fresno
UCSF Fresno Receives $3.375M for Medical Education
By Brandy Ramos Nikaido
UCSF Fresno was one of several medical education programs in the San Joaquin Valley that recently received funding to support medical resident education in the region. Physicians for a Healthy California (PHC) awarded more than $12 million to programs in the Valley, one of the areas in the state with the greatest need for physicians. UCSF Fresno will receive $3.375 million in one-time funding over four years.
Michael W. Peterson, MD, associate dean at UCSF Fresno, said, “Receiving these grants as part of a competitive application process is truly gratifying and represents an important step forward in the Valley. Thank you to Physicians for Healthy California. To begin to address the health care needs of our region’s growing, aging and diverse population, many more physicians are needed and to do that, ongoing support for infrastructure in resident education is critical.”
Seventy-three programs across the state received $38 million collectively. The available funds did not meet demand. The PHC received 131 applications from eligible residency programs, totaling $147 million in funding requests. The organization said the $38 million serves as a down payment on increasing graduate medical education.
The San Joaquin Valley has fewer licensed physicians practicing in the region than other parts of the state and California as a whole. There are 133 active physicians (excluding medical residents) per 100,000 population compared with the state rate of 222 active physicians per 100,000 population, according to a Healthforce Center at UCSF report. The situation will only worsen in the coming years. Thirty percent of physicians in the Valley are over the age of 60 and are expected to retire within the next decade. The California Future Health Workforce Commission estimates the state will face a shortfall of 4,100 primary care physicians by 2030.
In 2016, voters approved Proposition 56, which increased the tax on cigarettes and electronic cigarettes by $2 per pack. The tax generates about $1 billion a year and is intended for the purposes of increasing access to health care and supporting crucial health care programs, including a $40 million graduate medical education (GME) fund to sustain, retain and expand GME programs. The goal of the fund is to increase the number of primary care and emergency physicians in California. The fund is administered by PHC, the foundation for the California Medical Association.
Graduate medical education refers to the hospital and clinic-based training of medical school graduates under faculty supervision prior to practicing independently. Residency training typically lasts three to five years, depending on the specialty. Fellowships are advanced training in a subspecialty beyond residency.
Established by UCSF as a regional graduate medical education campus in 1975 and recently designated as a branch campus of the UCSF School of Medicine, UCSF Fresno trains about 300 physicians annually. Each year, approximately 100 complete residency and fellowship training at UCSF Fresno. Up to 50 percent of UCSF Fresno-trained physicians remain in the region to care for community members