Teach
SJV PRIME Celebrates 10 Years of Training Doctors for the San Joaquin Valley
By Brandy Ramos Nikaido
A decade ago, recognizing the ongoing need to address the pressing health concerns and physician shortfall in the San Joaquin Valley, the University of California established the San Joaquin Valley Program in Medical Education (SJV PRIME), a program aimed specifically at training medical students – future physicians – committed to providing culturally appropriate and accessible health care in the Valley. Currently, there are 36 students enrolled in SJV PRIME, with the majority coming from backgrounds underrepresented in medicine. With strong Valley connections, SJV PRIME students call the region home. Including this year’s graduating class, SJV PRIME will have graduated 47 students. Forty-two of the graduates will be starting or are completing residency or fellowship training. Five graduates are now practicing physicians in the San Joaquin Valley, California or in the U.S. military.
“I am incredibly proud of all of our SJV PRIME students,” said Loren, Alving, MD, director of the SJV PRIME at UCSF Fresno. “Our graduates and current students are our pioneers. They are building a legacy for the program in the future, and importantly, represent a pathway for physicians trained in the Valley for the Valley and knowledgeable about the health issues that impact community members.”
In 2007, the University of California started its Programs in Medical Education (PRIME) that supplement standard training with additional curriculum aimed at meeting the needs of various underserved populations. Each PRIME has a specific focus and is aimed at increasing and diversifying the physician workforce in California. SJV PRIME is the sixth PRIME and is the only program with a regional focus.
SJV PRIME started in 2011 as a collaboration among UC Merced, UCSF Fresno, UCSF, and the UC Davis School of Medicine as the medical degree-granting institution. In July 2018, the UCSF School of Medicine became the degree-granting institution, paving the way for medical students enrolled in SJV PRIME to spend the bulk of their training at UCSF Fresno and other clinical locations in the Valley including research and community engagement in collaboration with UC Merced.
“UC Merced is an active partner in the SJV PRIME through our contributions to medical student education, especially population health and research experiences. Later this year, I look forward to co-leading a surgical oncology course for students. We are very proud to have a role in transforming health care in the San Joaquin Valley by training physicians who are able to address rural health care and health care system challenges through innovative thinking and planning — and, most importantly, building upon the strengths of the people and communities in the Valley,” said Thelma Hurd, MD, director of medical education at UC Merced and joint faculty in the UCSF Department of Surgery.
The San Joaquin Valley is among one of the most medically under resourced regions in California. UCSF Fresno was established 46 years ago because of the dire need for more physicians in the region at that time. Roughly 50% of the physicians who graduate from UCSF Fresno remain in the region to provide care, but the Valley’s diverse and rapidly growing population greatly outpaces the number of new physicians entering the workforce. With just 47 primary care physicians per 100,000 population, the region continues to fall short of the 60 to 80 primary care physicians recommended by the Council on Graduate Medical Education. With strong connections to the Valley, all SJV PRIME students call the region home and are committed to providing care in the region and/or working with underserved populations.
“I definitely am hoping to serve the population of the Fresno and Madera area,” said Alejandrez Cisneros Alejandro, a second year SJV PRIME student from Madera. “And I am excited to see medical training continue to evolve in the region, so that we may fulfill the needs of the San Joaquin Valley community.” Alejandro is on a Health Professions Scholarship Program through the U.S. Army.
“I’m definitely applying to pediatrics,” said Michael Montoya, third year SJV PRIME student from Visalia. “My mom is an elementary school principal right now. She was a teacher in elementary schools for 20 plus years and I was always around classrooms. I love seeing kids every day and making sure I apply everything that I’ve learned so they grow up healthy, strong and the best versions of themselves they can be.”
Students in the new UCSF SJV PRIME spend the first 18 months at the UCSF campus in San Francisco. They then move to UCSF Fresno for the remaining two and a half years of their medical education in the Valley
Three classes of SJV PRIME are training at UCSF Fresno now (six second-year, nine third year and nine fourth-year medical students). Twelve students are at the UCSF main campus. COVID-19 drastically changed medical student education, including for SJV PRIME students. The pandemic shifted in-person education to online learning and postponed clinical rotations for a period.
Currently, third year SJV PRIME students participate in patient care in clinics, the hospital and through video visits. Via Zoom, they take part doctoring sessions led by fourth-year students and facilitated by faculty at UCSF Fresno. Doctoring involves small group learning and may include patient interviews, case studies, presentations or social issues related to health and patient care. A recent doctoring session, led by fourth-year students Cristal Suarez and Pong Xiong, discussed LGBTQ+ health and patient care.
“One of the biggest changes, especially in transitioning to clinical (rotations), is that doctoring was one of those settings where we got to interact with the standardized patient. Doing it by Zoom is different,” said third-year SJV PRIME student Ka Xiong from Merced. “But it’s a predictor of how telemedicine is going to be. I think whether it is planned or not, it’s training us to go about doing telemedicine; because we all have to do some things virtually now.”
Students are training at Community Regional Medical Center, Community Medical Center’s North Medical Plaza, East Medical Plaza, Family Health Care Network, the VA Fresno Medical Center and various community clinics from Madera to Mendota. SJV PRIME students have opportunities for community engagement and clinical research in addition to clinical experiences.
“It is amazing doing my rotations here in Fresno because I am learning so much more about the unique health needs my community faces. If anything, I am trying to determine how exactly I want to serve the Fresno area,’ said Lemuel Rivera, a second-year SJV PRIME student and Fresno State graduate. “I really enjoy clinical research, and I may pursue a master’s in biostatistics. I also love mentorship because it was my mentors that helped me get into medical school. Being a medical student has shown me the different ways a physician can impact their community, and I am eager to support my hometown the best way I can.”
SJV PRIME students learn about health issues prevalent in the Valley such as diabetes, coccidioidomycosis (valley fever), immigrant health and pre-term birth among others.
“SJV PRIME teaches specialized skills and we depend on the involvement and buy in from the San Joaquin Valley community because it is an investment on their part to come and speak to our students through our seminar series, our summer programs, and through our clerkships,” said Leticia Rolon, MD, associate program director of the UCSF SJV PRIME. “We are training physicians, but we’re also training health care leaders. We want them to work with community partners, lead research projects, we want them to have the initiative to give back to the community and ready to face the challenges faced by the population of the region.”
In January, second year SJV PRIME students participated in a listening session organized by the West Fresno Family Resource Center in a low-income, predominantly African American community in southwest Fresno. The event took place during a UCSF Fresno Mobile Health and Learning (Mobile HeaL) COVD-19 Equity Project testing at the Mary Ella Brown Community Center. Community health workers and community members voiced concerns about trust in the medical system, health disparities, access to care and participated in a Q&A about the COVID-19 vaccine.
“UCSF Fresno’s emphasis on improving health by partnering with the community, caring for patients outside of clinic and hospital walls and providing care that is culturally appropriate, accessible and equitable is embedded into the SJV PRIME curriculum,” said UCSF Fresno’s Assistant Dean for Undergraduate Medical Education Kenny Banh, MD. “SJV PRIME trains medical students from the Valley for the Valley because patient health improves when physicians look like and understand the patients they care for.”
Enid Picart, MD
As of press time, another cohort of SJV PRIME students was getting ready to participate in Match Day this month. Match Day is when medical school graduates learn where they will spend the next three to five years conducting the hands-on, clinical training (residency) required prior to practicing independently in the U.S. All eight of the SJV PRIME students who participated in last year’s Match Day matched with University of California-affiliated residencies and stayed in California to provide much needed care. Two matched with UCSF Fresno and are in residency training at UCSF Fresno now. Enid Picart, MD, matched with emergency medicine and Brandon Croft, MD, matched with internal medicine. Eight SJV PRIME students pursued residency this year.
“I owe a great deal of thanks to my mentors and the SJV PRIME. My aspiration to become a doctor has never wavered because of patients like one Planada community leader who I met while volunteering in the community,” said Dr. Picart, a UC Merced alumna, SJV PRIME graduate and currently training in the UCSF Fresno Emergency Medicine Residency Program. “He asked if I would be back when I was a doctor. As a Valley physician and after residency, I envision my workday going beyond the clinical and into the community. I want to continue to serve as a resource, as an advocate for patients and a medical provider. I plan to promote much needed pipeline programs, mentor youth who aspire to become doctors, as well as advocate for public and private support for UC’s Programs in Medical Education, including SJV PRIME.”
SJV PRIME has changed over the past decade and it will evolve moving forward to meet the needs of the state and the San Joaquin Valley, with a special emphasis on underserved communities and communities of color. It takes about 10 years to produce a practicing physician. As SJV PRIME celebrates its 10th anniversary this year, the program is paying off, and will continue to do so.
Sidra (Ayub) Suess, MD
Sidra (Ayub) Suess, MD, originally from Modesto, graduated from SJV PRIME in 2015. She completed residency in internal medicine. “(SJV PRIME) helped me further understand the health disparities of the community I wanted to work with. It also helped me make a lot of great connections and the opportunity to work at different hospitals, which helped me decide what type of organization I wanted to be a part of,” Dr. Suess said. “Now, I’m practicing at Kaiser in Stockton. There are many struggles, as we still do not have enough doctors and specialists, but I enjoy being a part of the organization I work for. I’m really happy to be a part of the Stockton community. “
UPDATE:
(L to R) Liliana Samano, MD, and Ramandeep Dhillon, MD.
Match Day 2021 was held March 19. Eight SJV PRIME medical students pursued residency programs this year. The students include:
- Alejandro Ramirez is from Fresno and a graduate of Fresno State
- Ramandeep Dhillon is from Caruthers and a graduate of UC Berkeley
- Robin Draper is from Fresno and a graduate of Fresno State
- Amanda Panh is from Stockton and a graduate of the University of the Pacific
- Lizette Rodriguez is from Woodlake and a graduate of UC Davis
- Liliana Samano is from Fresno and a graduate of the University of Notre Dame
- Cristal Suarez is from Visalia and a graduate of Yale University
- Pong Xiong is from Merced and a graduate of UC Davis
Robin Draper, MD, (center in scrubs)
Seven of the eight will be staying in California to provide much needed medical care. Six of them matched with University of California-affiliated residencies. Three will be staying on at UCSF Fresno – Ramandeep Dhillon matched in Internal Medicine; Robin Draper matched in Surgery and Liliana Samano matched in Emergency Medicine.
Care
UCSF Fresno Department Of Surgery Establishes An Intentional Recruitment Coalition To Increase Diversity
By Barbara Anderson
Providing state-of-the art surgical care to the diverse population of the San Joaquin Valley has been a long-held mission of the UCSF Fresno Department of Surgery. This fall, it strengthened its purpose by forming an Intentional Recruitment Coalition (IRC) with a mission to increase diversity in the surgery program to better reflect underserved and underrepresented patients, and in so doing, improve the health of the community.
“We know that people of color, people of minority communities, have long had issues of trusting doctors. Survey studies show that if medical providers look like their patients, the patients are more trusting. In fact, patients get better care because of better relationships and more trust with the medical providers,” said James W. Davis, MD, FACS, chair of the UCSF Fresno Department of Surgery, chief of surgery at Community Regional Medical Center and the Steven N. Parks, MD, Endowed Chair.
Kamell Eckroth-Bernard, MD, FACS
Creating the IRC grew from a grand rounds lecture entitled, “Time for Change,” given by Kamell Eckroth-Bernard, MD, FACS, a UCSF Fresno residency alumnus and vascular surgeon, and UCSF Fresno associate professor of surgery. Dr. Eckroth-Bernard called on the department to enhance its diversity recruitment efforts and championed the establishment of the IRC in September. “I am very proud of my clinical work as a vascular surgeon, but if I can make some real, positive changes for our society and for our community, I think long-term this will be more important than any of the things I do from a clinical perspective.”
To be successful at increasing diversity, UCSF Fresno’s surgery program must be intentional in recruitment, said Dr. Eckroth-Bernard, who is Black. Despite nationwide goals in the 1970s to increase the percent of Black male physicians in the physician workforce, the efforts were not successful, he said. “There’s a difference between having good intentions and being intentional. The UCSF Fresno Department of Surgery is saying that we are actively embracing diversity, equity and inclusion to change the face of our program for the betterment not only of our community but for the betterment of the patients that we take care of.”
The IRC is a team effort. Surgery faculty, other department faculty, surgery staff, community physicians, surgery residents, community leaders and Fresno State leadership are members of the coalition.
“The best thing about this is we have the support of Dr. Davis,” said Dr. Eckroth-Bernard. “And we have support of General Surgery Residency Program Director Mary Wolfe, MD, FACS, as well as support of Associate Program Director Amy M. Kwok, MD, MPH, FACS.”
The IRC is committed to increasing matriculation and retention of underrepresented minority surgical residents and faculty; providing opportunities for education and teaching with respect to the underserved population in the San Joaquin Valley; providing ongoing conferences dedicated to diversity training and cultural awareness; and improving and fostering relationships between the UCSF Fresno Department of Surgery and the underserved community.
The coalition is divided into subcommittees for residency recruitment, pre-medical surgical internship, health disparity research and underrepresented minority (URM) medicine.
Drs. Wolfe and Kwok are on the subcommittee that reviews resident applications and conducts interviews. They have been leaders in residency recruitment for nearly a decade, and a review by the IRC of this year’s applicant selections concurred overall with the doctors’ recommendations. “We have always striven to make sure that we try to have a diverse department and a diverse panel that we interview,” Dr. Wolfe said. “But while we have always been very committed to diversity, we realize that it is important to state that we are devoted to diversity,” she said. “Even though it is obvious to me, it may not be obvious to other people. We need to make sure it is up front and visible that we are committed to this.”
Medical school outreach and pre-medical school mentoring is important for increasing the residency applicant pool. Yazen Qumsiyeh, MD, a third-year resident in the UCSF surgery program, is leading the ICR pre-medical surgical internship subcommittee. Dr. Qumsiyeh emigrated to the United States with his family as a young teenager. “I did not speak English when I came here and I didn’t have much guidance, except for a few mentors in college and medical school,” he said. “I had to figure it out mostly on my own.”
Dr. Qumsiyeh approached Dr Eckroth-Bernard about bringing pre-medical students from underserved backgrounds to UCSF Fresno to be mentored by a surgery team. “With this program, these students are going to work with medical students from UCSF and with our residents and our attending physicians,” Dr. Qumsiyeh said. “A lot of people who are very smart, very driven and who can contribute a lot to the field of medicine do not have the guidance, and do not know where to go for resources,” he said. “I want to create that opportunity for these students,”
John Moua, MD, interim chair of the UCSF Fresno Department of Pediatrics, is adding a diverse voice from outside of the surgery program as a member of the IRC pre-medical surgical internship subcommittee. He is one of only a few Hmong physicians practicing in the central San Joaquin Valley. There are about 30,000 members of the Hmong community in the Fresno area, but there is no Hmong surgeon to serve them, for example, Dr. Moua said. He gets phone calls, as do other Hmong physicians in town, from family members of patients who are in the hospital, asking for medical advice, he said. “That speaks to the level of trust. They are looking for from someone from their same background.”
Dr. Moua appreciates the invitation to be a member of the pre-medical surgical internship subcommittee. As a high school and college student, he participated in programs at Stanford University that steered students into pre-medical classes. “I was one of the first groups of students to go through that,” he said. I was the student that we are currently trying to attract and recruit into the health care field.”
The UCSF Fresno surgery program is collaborating with Fresno State to find applicants for the pre-medical surgical internship program. “We are a community-engaged university, so we need to be interacting with partners that are going to help our students to succeed,” said Jason Bush, PhD, chair of the Department of Biology at Fresno State. He is coordinating Fresno State’s partnership with UCSF Fresno. “We have to reduce boundaries and obstacles that underrepresented minority students encounter when getting in professional careers in medicine or other bio-medical fields,” Bush said. “We have to change the demographics that are in medicine, that are in science.”
Leah Lucero, MD, a UCSF Fresno third-year resident in the surgery program, is heading the IRC resident recruitment subcommittee to reach out to medical schools and medical student associations to connect with underrepresented medical students. Dr. Lucero is the first in her family to attend medical school and residency. She received help from mentors along the way. “Without that mentorship I don’t think I would be where I am right now,” she said. Through the IRC, UCSF Fresno’s surgery program can show medical students it is willing to invest in them and there are people willing to help them and mentor them, she said.
Dr. Lucero is gratified to be working with an underserved patient population. “Physicians who look like their patients and who are from similar backgrounds can break down some cultural barriers we face when treating patients,” she said.
Sammy Siada, DO, a UCSF Fresno vascular surgeon, grew up the son of immigrants in a bilingual household. Dr. Siada has an interest in research and accepted an invitation from Dr. Eckroth-Bernard to lead the IRC subcommittee on health disparity research. Health disparities affect health outcomes, and he appreciates belonging to an institution that is committed to increasing its diversity to better serve its diverse patient population, he said
The IRC has attracted a diverse group of members since September, said Milena Ocon, administrative manager of the UCSF Fresno Department of Surgery. Ocon is the IRC coordinator, facilitating meetings and making sure tasks are completed. “As our IRC has rooted and grown legs (subcommittees) it’s become this amazing kaleidoscope of diversity and hence diverse solutions,” she said.
Ocon was instrumental in introducing the IRC to Armando Valdez, founder and director of the nonprofit Community Center for the Arts and Technology (CCAT) in Fresno. He has agreed to help create a logo for the coalition. CCAT is a grassroots community-based center that offers free classes for children, youths and adults in digital media and performing arts.
Too often, students who have shown an interest in health care careers are not given any direction after high school graduation, Valdez said. “I want to see them followed through. There are not enough people there to direct them and they lose hope,” he said. “You guys are allowing those dreams to come true for some of those kids who want to get into the medical field. If there is an opportunity for those avenues for those kids, I am always for it. And I hope I can help them out.” He will give the IRC has much time as he can, he said. He is distributing food and other help to farmworkers and their families who are among the most vulnerable to COVID-19.
Dr. Eckroth-Bernard has been happily surprised by the warm reception to the IRC – but recruitment is just getting started. “My goal is to get everybody on the coalition. I want the whole surgical department to be part of the coalition,” he said.
The IRC has his support, Dr. Davis said. The UCSF Fresno Department of Surgery must resemble the community it serves because it is essential to providing outstanding medical care, he said. “We must be successful with this — this must happen.”
Research
UCSF Fresno Expands Research, Names Assistant Dean
Eyad Almasri, MD
By Brandy Ramos Nikaido
Research is integral to UCSF Fresno’s mission to improve health in the San Joaquin Valley and faculty are encouraged to participate in discovery. Among the researchers, Eyad Almasri, MD, who joined the faculty in July 2010, has participated in numerous studies, including COVID-19 related clinical trials that have enrolled their first patients in the nation. Dr. Almasri, recently named Assistant Dean for Research at UCSF Fresno, also has been the principal investigator for all Prevention and Early Treatment for Acute Lung Injury (PETAL) studies for UCSF Fresno’s Department of Internal Medicine. UCSF Fresno has recruited more patients to some PETAL network studies than any other site in California.
Associate Dean Michael W. Peterson, MD, made the announcement of Dr. Almasri’s appointment, noting Dr. Almasri’s successful oversight of the National Institute of Health (NIH)-funded trials and PETAL network studies at UCSF Fresno, and his leadership role in building COVID-19 research during the pandemic. Dr. Almasri joins three other assistant deans at UCSF Fresno, including Kenny Banh, MD, who oversees undergraduate medical education; Roger Mortimer, MD, who oversees academic affairs; and Lori Weichenthal, MD, who oversees graduate medical education and serves as the designated institutional officer at UCSF Fresno.
A UCSF associate clinical professor, Dr. Almasri is faculty at UCSF Fresno in the Department of Internal Medicine – Pulmonary and Critical Care and Sleep Medicine. He also is medical director of the intensive care unit at Community Regional Medical Center (CRMC) and co-directs the pulmonary function lab at CRMC with UCSF Fresno colleague Kathryn Bilello, MD. In addition, Dr. Almasri is a member of the Extra Corporeal Membrane Oxygenation or ECMO team.
“Someone once told me early in my career that busy people are the ones who find time,” said Dr. Almasri. “The busier I am, the more time I carve out for research.” Research leads to solutions for medical problems, he noted.
This includes investigating health conditions specific to the Valley as well as clinical trials that bring new treatments to the area before they are available more broadly. For example, early in the COVID-19 pandemic, UCSF Fresno and CRMC were the first in the region to offer remdesivir as a treatment for COVID-19. Additionally, UCSF Fresno is participating in the NIH-funded ACTIV-3 trial, which is testing monoclonal or synthetic antibodies as a treatment to fight COVID-19. UCSF Fresno was the first center in the world to enroll anyone in the version 2 of this study.
It is not a bragging point that we have more COVID patients than other places in California, Dr. Almasri pointed out.
“Do I wish to be third in enrolling patients instead of the first one? Yes, I wish we didn’t have as many COVID-19 patients here,” he said.
However, because of the expertise at UCSF Fresno and a growing reputation for world-class research, we bring cutting-edge treatments to the area and we can offer them to the people who need them most.
UCSF Fresno is in the process of being considered by the NIH as a Vanguard site for a trial which will be testing a new treatment for advanced COVID disease. A “Vanguard site” is a site that is identified to enroll the first patients to pilot enrollment and modify the trial to suit additional sites.
“We are moving from tagging along in nationwide trials to equal partners at the table with centers such as UC Davis, UCLA, Stanford and others,” said Dr. Almasri.
In the role of assistant dean, Dr. Almasri sees himself as a facilitator. His focus will be on encouraging more multidisciplinary work, which strengthens UCSF Fresno’s ability to compete for clinical trials. One example is a new outpatient remdesiver trial. By partnering, Dr. Almasri and pediatric colleague, Chokechai Rongkavilit, MD, expanded the study to include children 12 and up, instead of adults 18 years and older only. That made their application much more competitive. In addition, Dr. Almasri supported a recent study by Crystal Ives Tallman, MD, that looked at anticoagulants (used to treat and prevent blood clots) as a treatment for COVID-19. Dr. Ives Tallman is faculty in both emergency medicine and critical care medicine.
Right now, Dr. Almasri is in the process of meeting with the various departments at UCSF Fresno to gain a better understanding of the resources most needed to advance research and he is surveying existing resources already available in the UCSF Fresno Clinical Research Center. Feedback received will help inform planning over the next 24 months, he said.
Dr. Almasri would like to increase the involvement of residents and fellows in research projects and in the future, he would like to make research opportunities available to more students (i.e. medical, high school and undergraduates), researchers at other institutions and possibly community members. Being embedded in the community opens opportunities for us to help the next generation of physicians, especially from underrepresented and underserved communities, he said.
We are in the Valley, for the Valley, tackling issues that local people care about like air quality and valley fever among others, said Dr. Almasri. It takes trust to participate in clinical trials and community-based research. We also understand that trust is earned and takes time. We want people to know that when it comes to caring for our community, we advocate for Valley citizens and we hope they will advocate for us and support UCSF Fresno in its mission.
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Partner
By Barbara Anderson
The UCSF Fresno Department of Pediatrics is collaborating with community partners and leveraging grant funding to increase awareness of Adverse Childhood Experiences (ACEs), pilot ACEs screening protocols, provide training in trauma-informed care (TIC) and develop a strong network of support for children and adults affected by ACEs.
“All of us, as providers recognize that an awareness of ACEs and screening patients for ACEs are important, but there was no infrastructure in place for provider training,” said John Moua, MD, interim chief of the UCSF Fresno Department of Pediatrics.
Last year, the California Department of Health Care Services (DCHS) began paying Medi-Cal providers for conducting ACEs screening of children and adults, and this year DCHS and the California Surgeon General’s office are providing ACEs Aware initiative grants for training of providers. The UCSF Fresno Department of Pediatrics received $180,000 to train Pediatric, OB/GYN and Family and Community Medicine providers in Fresno County. It is collaborating with two Fresno community-based organizations – Exceptional Parents Unlimited Children’s Center (EPU), and Every Neighborhood Partnership (ENP) – for the project.
“We are excited to be participating in these initiatives that are going to broaden or expand the incorporation of ACEs screening into pediatric practices all over the state,” said Aimee Abu-Shamsieh, MD, a UCSF Fresno pediatrician and UCSF clinical professor. “We are able to pilot practices in our clinic and be a part of the development of best practices for ACEs screening that can be shared with our pediatric colleagues throughout the state.”
Adversities experienced by age 18 from physical abuse, sexual abuse, exposure to violence and/or household dysfunctions are linked to an increased risk for chronic health problems, including heart disease, diabetes, and premature death. Many of the patients seen by UCSF Fresno pediatricians have experienced four or more ACEs, said Christian Faulkenberry-Miranda, MD, UCSF Fresno Department of Pediatrics program director, ambulatory residency clinic director and UCSF associate clinical professor. In its application for the ACEs Aware Supplemental Implementation Grant, the department said the COVID-19 pandemic has placed even more stress on families, increasing the need for partnerships in the training of providers to be able to recognize and respond to a surge of traumatic experiences.
EPU and ENP are helping produce an ACEs video that can be shown in physician offices to increase acceptance of the screening process. The video will explain why physicians screen for ACEs and highlight examples of protective factors for children. The ability to adapt to adverse experiences – resilience — during childhood can be an offset to toxic stress that children experience when they are exposed to traumatic experiences often and/or over long periods of time. EPU and ENP found volunteer families to videotape regular family moments, such as taking a walk or eating dinner together that illustrate how even small activities of daily living can help reduce stress.
“When parents go in to see the provider and the provider has a conversation with them about ACEs, we want to have already planted the seed for the focus to be on positive things, not necessarily over the negative things,” said Dana Riley, PhD, a licensed clinical psychologist, and manager of clinical services at the Assessment Center for Children at EPU. EPU serves children with medical, mental health and developmental needs and provides support to parents.
ENP Executive Director Andrew Feil has seen positive effects of resiliency. ENP connects churches and community groups to serve at elementary schools. “From our youth program that pairs students with mentors, we have seen kids from age five who now are graduating college,” he said. “We really wanted to be a part of the education on ACEs for ourselves to grow and learn, and also for the community.”
The UCSF Fresno Department of Pediatrics also will provide training on the clinical response to ACEs, including clinic workflows and information about local resources for patients in the Central Valley. The ACEs training sessions will be conducted virtually, and will include physicians, nurse practitioners, medical assistants and office staff. “In many cases, medical assistants may be doing the ACEs screening and they may not quite understand why this is important because no one stops to tell them why it is important,” said Dr. Abu-Shamsieh.
With an $80,000 California ACEs Learning and Quality Improvement Collaborative (CALQIC) grant, the UCSF Fresno Department of Pediatrics will help providers implement PEARLS, the new ACEs screening tool developed by the Bay Area Research Consortium on Toxic Stress and Health (BARC), a partnership between the Center for Youth Wellness, UCSF and UCSF Benioff Children’s Hospital Oakland. UCSF Fresno is one of only 15 organizations throughout California to be awarded a CALQIC grant. CALQIC was launched in cooperation with the UCSF Center to Advance Trauma-Informed Healthcare to identify promising practices, tools, resources and partnerships to further inform California’s ACEs Aware initiative.
UCSF Fresno pediatricians adopted PEARLS screening in December at the 1-, 3- and 5-year well-child visits. “We have incorporated trauma-informed care into our curriculum for the past few years,” said Amy Parks, DSW, LCSW, CLEC, and lead for the ACEs Aware grant. Parks is coordinator of Development and Behavioral Pediatrics, Community Pediatrics, Adolescent Medicine & Child Advocacy and director of Pediatric Healthy Steps at the UCSF Fresno Department of Pediatrics. “UCSF Fresno is really amazing in how supportive our faculty are of trauma-informed care practices and the time that has to be invested to make that culture change to provide trauma-informed care,” she said.
The UCSF Fresno Department of Family and Community Medicine, as part of the CALQIC grant, will soon implement PEARLS screening in its clinic for 1-, 3- and 5-year well-child visits, said Ila Naeni, DO, a UCSF Fresno Family and Community Medicine associate program director and UCSF associate clinical professor. Long-term, the screening can be expanded to adults. “The screening is such an important part of making sure our patients in the Valley get the full, comprehensive care that they deserve,” Dr. Naeni said. “We serve a population at risk that could definitely benefit from the resources that go along with screening for ACEs.”
The UCSF Fresno Department of Pediatrics also is a partner in a $2.6 million ACES Aware Implementation Grant that is being administered by Saint Agnes Medical Center. Funding will allow community health workers to be placed in clinics, including those staffed by UCSF Fresno pediatricians and Family and Community Medicine physicians, Dr. Parks said. The workers will help link patients to resources, and inform physicians of resources their patients have accessed, she said.
The ACEs Aware and CALQIC grants are fostering new partnerships between community-based organizations and UCSF Fresno, Parks said. “It’s creating more receptive and effective and efficient linkages. And ultimately, it’s going to create a healthier Fresno – a more resilient Fresno.”
Partnerships are essential to successfully implementing the ACES grants, Dr. Moua said. “One of the strengths of the UCSF Fresno Department of Pediatrics is we are doing community-based medicine. We are mission-driven to take care of the community we serve; and we collaborate with community partners instead of just being in a silo by ourselves.”
Inspire
UCSF Fresno
People Spotlight
Fred Wu, MHS, PA-C
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. In each issue of Focus, we introduce you to the people who contribute to the greatness of UCSF Fresno through informal interviews.
This month, please meet Fred Wu, MHS, PA-C, Residency Program Director, UCSF Fresno Emergency Medicine Physician Assistant (PA) Residency Program.
What is your name? Nickname?
Sorry, no nickname. I’m just plain Fred.
Where did you grow up and where did you go to school (high school, college, PA program)? Do you have any other degrees or certifications?
I’ve lived in New York, Louisiana, Canada, Colorado, Connecticut and California. I’ve spent the most time in California so I’m a Californian. I went to boarding school for high school in Southern California, attended Colorado College (Colorado Springs, CO) for undergraduate and attended Quinnipiac University (Hamden, CT) for graduate/PA school. In addition to my PA certification, I also have a Certificate of Added Qualification in Emergency Medicine and I am a paramedic.
What inspired you to become a physician assistant?
I knew I always wanted to do something in medicine and really enjoy the flexibility of the PA profession. If desired, there’s always the opportunity to practice in another specialty. I also enjoy being part of the physician-PA team.
Did you encounter any barriers to becoming a PA? If so, what and what advice do you have for others who may want to pursue a similar career?
The biggest barrier that comes to mind is academic undergraduate work. PA school is really competitive now. If I had to apply now, I don’t know that I would be accepted. If you are serious about going to PA school, really focus on your grades during your undergraduate studies, along with obtaining quality patient care experience.
Why did you pick Emergency Medicine?
Getting to help people during their worst moments, creating order out of chaos. Also, the variety of patients and opportunities for procedures. Emergency Medicine is also a team sport so working with physicians, nurses, nurse practitioners, techs, unit clerks, case managers and everyone else is a blast!
What is the best part of caring for patients in the ED? What is the hardest?
For many patients, we are their last hope. Their last hope for health care, food, shelter, comfort and safety. It is a privilege to care for people, especially in an underserved area. In emergency medicine, we take care of anyone, any condition and any time.
You are the program director of the Emergency Medicine PA Residency Program. What is that program and what advanced training does it provide PAs?
The PA Residency is an intense 18-month postgraduate program that trains PAs to work in Emergency Medicine. PA residents in this program spend most of their time in the Emergency Department but also complete rotations in Anesthesia, Trauma, Critical Care, Toxicology, Emergency Ultrasound, EMS, Orthopaedics, OMFS, Ophthalmology, and Dermatology. We also hope our graduates stay in the Central Valley to serve our underserved population.
What is at the top of your personal or professional to-do list?
While I am always striving to accomplish things, I’m typically a content person. I have a wonderful family, career that I love and work with some awesome people.
What are you most proud of having accomplished to date?
I am extremely proud of what Emergency Medicine has accomplished over the past year during the COVID-19 pandemic. Our department, which includes providers, nursing, techs, unit clerks, case managers, housekeeping and everyone else, came together as a team to care for our community. We have taken care of patients in hallways, the waiting room, tents and everywhere else imaginable.
What do you like to do in your off-time?
I enjoy spending time with my family and being in the outdoors. Hiking, skiing, fishing and zoning out at the beach. I do have to admit that I’m an Emergency Medicine nerd and do plenty of EM related things in my spare time, such as serving on national committees, running conferences, podcasting and speaking at conferences.
The zombie apocalypse is coming. Which three people from UCSF Fresno would you pick to be on your team and why?
Danielle Campagne, MD, she’s the nicest person and would probably become friends with the zombies. Michael Darracq, MD, he’s my research partner and could calculate if our odds of surviving are statistically significant (along with the confidence intervals). Eric Schmitt, MD, he is so laid back the zombies wouldn’t even notice us. Plus, I would need to know what he and my younger brother did as fraternity brothers before the zombies eat us.
What is the most important thing you would like people to know about you? Or what else would you like to add about you, your background, family or career?
I have been affiliated with the UCSF Fresno Parkmedic Program longer than I’ve been working here clinically. When I was recruited to start the PA Residency, it was an easy decision having known a good number of the faculty and the culture within the department.
Supporting UCSF Fresno
Scholarship Donations Make Medical School Possible for Valley Students
Amitoj Singh, SJV PRIME Medical Student
By Kathleen Smith, Development, UCSF Fresno
Current and future students of the UCSF San Joaquin Valley Program in Medical Education (SJV PRIME) will benefit from the $1.2 million raised last year for scholarship support.
SJV PRIME is a tailored track of the UCSF School of Medicine for medical students who are committed to ensuring high quality, diverse, and well-distributed medical care to improve health for populations, communities, and individuals in California’s San Joaquin Valley. Students enrolled in the program spend their first 18 months at UCSF in San Francisco and then move to the UCSF Fresno regional campus for the remainder of their medical school training. Donor generosity is helping to make SJV PRIME accessible to the best and brightest students from the Valley – including those who are the first in their families to receive higher education.
The cost of earning professional degrees in the health sciences has increased drastically in recent years, presenting a serious financial challenge for many students, particularly those from groups that are underrepresented in the health professions and biomedical science or whose families lack the resources to help pay their tuition.
Large loan balances can cause emotional distress, and in some cases, there is evidence that it can steer medical students to choose a specialty based on whether it will provide adequate income to repay their loans in a reasonable time. Reducing debt through scholarships may offer students the flexibility to pursue careers in academia, primary care, and generalist practices, and to practice in underserved areas like the Valley.
Amitoj Singh, from Fresno, is a second year SJV PRIME student. In the following Q&A, he shares more about himself, his medical school experience and the impact of scholarship support.
Tell us a little about yourself and how you first became interested in medicine.
I am the single child of Sikh immigrants and grew up in the Central Valley. Through the UCSF Fresno Doctors Academy program at Sunnyside High School, I learned about health disparities in the Valley. Ever since then, I wanted to become a physician and practice in the Valley to try and combat those disparities. My clinical experiences during undergrad at UCLA, including shadowing and volunteering at free clinics, reaffirmed my interest in medicine and desire to give back to the community that helped shaped me.
Why did you choose UCSF?
I chose UCSF because it had always been my dream school. The mission and values of the school resonated strongly with my own. Furthermore, I was accepted to SJV PRIME which allows me to spend much of my time in medical school in the Valley learning more about and working with the population I one day hope to serve.
What can you share about your experience during the pandemic?
Medical school has definitely been tough during the pandemic. Studying has become a lot more independent, with less time spent learning with peers. As I have now entered the clinical setting, I am truly thankful of the opportunity to be able to apply my foundational knowledge to help care for patients and be an effective member of my care teams.
How has scholarship support impacted you?
Medical school is quite expensive, and especially during the pandemic when funds are tight, this scholarship has relieved a lot of financial burden for me and my family.
What would you like to say to donors?
Thank you so much! Your support means a great deal to me. I can’t explain how appreciative I am for the ability to prioritize learning in school rather than spending a great deal of time being concerned about the funds required for the education.
The donors who made educational support a focus of their giving last year are making a true difference in the lives of SJV PRIME students and helping UCSF Fresno transform health care in the Valley. Consider making a gift to the current SJV PRIME Scholarship Fund or for more information about a gift to an endowed SJV PRIME scholarship fund, please contact Kathleen Smith, Development, UCSF Fresno, at (559) 499-6426 or kathleen.smith@ucsf.edu
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