Program Director Message

Ivy Darden

Steven Tringali, DO

Program Director


Quality Improvement

Quality Improvement conference

Our mission is to focus on innovative ways to promote quality and safety improvements within our teaching program. We seek to foster greater evaluation of our clinical care to develop opportunities for improvement, promote interdepartmental collaborations, and improve healthcare for our patient population. Each resident is required to perform a quality improvement project and present their research during the Annual Quality Improvement Research Forum.

Reduce Delays in IR Guided Procedures with Focused Resident Education Regarding DVT Prophylaxis & NPO Status.  Angela Sehgal, MD; Shirley Kim.  Mentor: Antonio Toribio, MD.

Utilizing Alphanumeric Paging to Improve Communication Between Nurses and Resident Physicians at CRMC. 
Diana Moers DO; Tigran Tiraturyan, MD; Andrew Sumida, DO.   Mentor:  Antonio Toribio, MD.

A Quality Improvement on Creating an Interstitial Lung Disease (ILD) Panel to Assist Resident and Fellow Physicians in Diagnosing Interstitial Lung Disease.  Zi Ying Li MD; SiYi Huang, MD; Niraj Bhalani, MD.   Mentor: Candice Reyes.

A Feasible and Efficient Approach to Implementing Rheumatoid Arthritis Disease Activity Measure in A Busy Rheumatology Clinic:  A Quality Improvement Project.   Amani A Elghafri, MD; Ali H Ali, MD; Mandeep Sidhu, MD.  Mentor: Candice Yuvienco, MD.

Improving Management of Diabetes at FHCN by Optimizing Outpatient Order Set.   Dinithi K Iddawela, MD; Mira Tadros, DO.  Mentors:  Seema Policepatil MD; Shreela Mishra, MD.

Implementing the I-PASS Model in Resident Curriculum to Improve Quality and Consistency of Patient Handoff.  Tanner Mortenson, MD; Diana Moers, MD; Mahboub Noori.   Mentor: Kam Lun Au Yeung, MD.

An Antimicrobial Stewardship Approach to Minimizing Misuse of Antimicrobials in Management of Skin and Soft Tissue Infectious.  Mehdia Amini, Matthew Lee, DO; Diana Moers, MD; Kathleen Henscher, Marilyn Mitchell, Marisa Mendez PharmD.   Mentor: Elham Rahmati, MD

Diabetic Emergency Prevention and Sick Day Awareness Among Physicians Caring for Patients with Type I Diabetes.  Linda Jo, MD; Fan Mo, MD; Vanessa Wormser DO.   Mentor:  Soe Naing, MD.

H & P Documentations Improvement at the VA.   Anthony Tabet, DO; Braden Lind, MD.  Mentors:  Deanna Oliver, MD; Hiral Patel, DO; Ivy Darden, MD; Jiang Huang, MD.

Decreasing Inappropriate Use of ECG Monitoring at CRMC.   Humza Maqbool, MD; Shaveta Gupta, MD; Avneet Kahlon, DO.  Mentor:   Jonathan Pham

Optimizing Vaccination of Prevnar in Adults Older Than 65 at FHCN.   Charnjeet Sandhu, MD; Mohammad Hashmi, DO and Mandip Kang, MD    Mentor: Dominic Dizon, MD

Reducing Harms and Costs Associated with Unnecessary Inpatient Labs.   SangOuk Lee, DO; Ogochukwu Molokwu, MD and Andrea Kam, DO    Mentor:  Jian Huang, MD

Reducing Door-in to Door-out Time at Family Healthcare Network Clinic.  Kevin Gandhi, DO; April Manalaysay, DO and Lu Zhao, DO. Mentor:   Dominic Dizon, MD

Simple and Cost-Effective Intervention Doubled the Rate of Osteoporosis Screening in High Risk Rheumatology Patients.  Mosaab Mohameden, MD; Victoria Malkhasyan, MD and Adam Shurbaji, MD      Mentor:  Candice Yuvienco, MD

Early Palliative Care Referral in an Ambulatory Care Setting at the VA.    Aparna Desai, DO      Mentor:  Ivance Pugoy, MD

Enhance the Use of Evidence Based Tool to Assess Rheumatoid Arthritis Disease Activity per the American College of Rheumatology Recommendations: A Quality Improvement Project   Amani Elghafri, MD; Ali Ali, MD and Mosaab Mohameden, MD. Mentor:   Candice Yuvienco, MD

Inpatient Labs: Reducing Harms, Cutting Costs, Meeting Standards.  Ben Rasmussen DO, William Kelley DO,
Mentors: Wessel Meyer MD, Sean McFarland RN, William Walsh and Jian Huang MD

STOPBANG Screening Questionnaire for OSA – A Follow Up Study.  Raj Shah MD, Natasha Singh MD and Swathi Palakodety MD
Mentor:  Ivance Pugoy MD

Reducing Risk of C. diff Infection (CDI) with Focused Resident Education.   Phuong Dang MD, Michele Maison-Fomotar MD, Chelsea Park DO, Kara Schmidt MD     Mentors:   Deanna Oliver MD, Stephanie Wasson RN, Jian Huang MD

The Underutilization of Metformin, the First-Line Agent, in Type 2 Diabetes.   William Kelley DO, Armen Bedrosian MD, Jonathan Pham DO       Mentors:  Mark Aparicio PharmD, Paulette Ginier MD, Cho C Khine MD, Soe Naing MD

Admission, Readmission and Mortality Among Patients with Acute Decompensated Heart Failure at the Fresno CA:  A Comparative Quarterly and Annual Review.   Christopher Smith MD, Daniel Sims DO, Swathi Palakodety MD    Mentors:  Arang Samim MD, Jian Huang MD

Improving Screening for Viral Hepatitis with the Utilization of a Chronic Hepatitis Panel.   Jonathan Pham DO
Mentors:   Chandraprakash Umapathy MD, Marina Roytman MD

Evaluating Current Performance and Identifying Opportunities For Targeted Reduction In COPD Readmission Rates at the Veterans Affairs Central California Healthcare System.    Jonathan Pham DO MPH, Kyle Almodovar DO, Matt Beutner MD, Bruce Manzo PharmD    Mentor:  Jian Huang MD

Utilization of STOPBANG Screening Questionnaire for OSA.    Grace Choi MD, Armen Bedrosian MD, Rajpreet Saini DO; Mentors: Ivance Pugoy MD, Lynn Keenan MD FAASM

Diet and Your Kidneys: Improving Nutrition Education In an Underserved Population with Chronic Kidney Disease.   Matt White MD, Chloe Brandow DO, Agustin Morales MD;    Mentor: Stutee Khandelwal MD

Extra Corporeal Membrane Oxygenation: Why A Dedicated Team Improves Outcomes.  Deepti Mundkur MD, Chirag Rajyaguru DO, Karamjit Dhaliwal-Binning MD, Faye Pais MD, Mohammed Fayed MD    Mentor: Timothy Evans MD

Improving Awareness and Consult Volume For A New Internal Medicine Residency Procedure Service.   Maria Yeh DO, Jonathan Tse DO, Sam Tonthat DO;    Mentor: Mohammed Elhassan MD

Electronic Medical Record Guideline Alerts Significantly Increase Percentage Of Providers Initiating Broad Spectrum Antibiotics

Within Six Hours Among Patients with Signs of Sepsis: A Single-Center Study.  Paymon Ebrahimzadeh MD;   Mentor: Jian Huang MD

SIRS vs qSOFA.    Scott Drew DO, Faye Pais MD, Deepti Mundkur MD;   Mentor: Eyad Almasri MD

The Dreaded Discharge Summary: A Daunting Task Simplified To Improve Patient Safety.  Matt White, MD, Mentor: Regina Godbout MD

Cost Effectiveness And Validation Criteria of HSV PCR in the Diagnosis of Encephalitis.   Jennifer Hoang DO, Hiral Patel DO, Ryan Pierce MD   Mentor: Naiel Nassar MD

Reducing Polypharmacy In the VA Primary Care Setting.   Kyle Heber MD, Harpreet Sidhu MD, Antonio Toribio, MD, Hiral Patel DO, Abbas Hasnain MD, Pooja Reddy MD    Mentor: Ivance Pugoy MD

Pitfalls of A Non-Algorithm Based Pleural Effusion Workup In A Large Community Teaching Hospital.   Sneha Gullapalli MD, Christine McElyea DO, Kenneth Juenger MD    Mentor: Joseph Vempilly MD

The FRESNO (Fresno Residents’ Experience In Sleep and Nighttime Optimization) Project.   Charlie Abraham MD MBA FACP, Kyle Almodovar DO, Armen Bedrosian MD, Chloe Brandow DO, Grace Choi MD, Rajpreet Saini DO, Natasha Singh MD, Mentor: Lynn Keenan MD FAASM

The effect of higher visibility infection control signs on contact precaution compliance (First place)
Residents: Shilpi Gupta, Nitin Thinda and Srilatha Venepally
Mentors: Regina Godbout and Jian Huang

Improving Understanding and Reporting of Adverse Drug Reactions in the VACCHS (Second Place)
Residents: Amarbir Bhullar, Nasir Halim and Lorean Nwosu
Mentor: Regina Godbout and Jian Huang

Medication reconciliation at discharge (Third place – tied)
Resident: Jonathan Rosario
Mentor: Regina Godbout

Quality improvement initiative to reduce polypharmacy in VA primary care setting (Third place – tied)
Residents: Abbas Hasnain, Hiral Patel, Pooja Reddy and Antonio Toribio
Mentor: Ivance Pugoy and Jian Huang

“Flu for you?” Ways to improve influenza vaccination rate
Residents: Amarbir Bhullar, Nasir Halim and Karamjit Dhaliwal
Mentor: Alan Kelton

Decreasing the frequency of post LP headaches via the use of traumatic pencil point spinal needles
Resident: Priya Jayachandran
Mentor: Steve Tringali

Resident initiated feedback sessions to improve the quality and quantity of formative feedback
Residents: Ash Legesse, Jarae Ng and Christine McElyea
Mentor: Ivy Darden

Surveillance of bacterial contamination of elevator-based endoscopes after reprocessing with Steris 1E chemical sterilization: a single-center study
Fellow: Adnan Ameer
Mentors: Jayanta Choudhury and Rabindra Kundu


Easier, Shorter, Faster, Better – Newly Updated Inpatient H&P and Daily Progress Note Templates at Frseno VA Medical Center. Joshua Lin DO, Sanjay Hinduja MD, Ashenafi Legesse MD, Maria Bisaha MD, Paul Goebel MD.

Healthcare Maintenance Immunizations In the Ambulatory Care Clinic at Fresno Community Regional Medical Center: Are those Immunizations that are indicated being administered? Kiran Reddy MD MPH, Lyn Keenan MD, ALan Kelton MD, Erica Kasper MD.

FAST TRACT to a Achieving Blood Pressure Goal in Type 2 Diabetics. Steven Sheh MD MS, Jarae Ng DO, Erica Kapser MD.
Evaluation of Model of Observation and New Studies Indicated in Syncope (EMONSIS). AMir Najafi DO, Robert Ferdman DO, Nabil Baig DO, Steven Tringali DO.

Resident Satisfaction with New Electronic Problem-Based Charting: a questionnaire survey. Miguel Risco MD, Ednann Naz MD, Mark Kestner MD.

A Case-control Study of Risk Predictors for Opioid Overdose: Morphine and Other Opioids Associated Unresponsiveness due to Respiratory Depression Requiring Naloxone Treatment. Joshua Lin DO, Nahera Adams MD, Raman Mattu MD, Leonid Vydro MD, et al.

“Who is my doctor?” Part II – New System to Enhane Communication Between Residents and Nurses. Joshua Lin DO, Sanjay Hinduja MD, Maria Bisaha MD, Titin Thinda MD, Paul Goebel MD, et. al.

Improving Resident Physician Efficiency and Reducing Patient Wait Time at ACC Clinic. Nabil Baig DO, Shruti Joglekar MD, Artem Ryanzantsev DO, Raman Mattu MD, Chris Smith MD, Erica Kasper MD.

Pediatric EKG Teaching in UCSF Fresno Pediatric Residency. Rachel Manalo DO, Paul Francis MD, Serena Yang MD, Swathi Reddy Nimmala MBBS.


Amion Training to Help Improve Communication. Christopher Chin DO, Reza Ronaghi MD, Linda Troung DO.

Asthma Education and Peak Flow Based Action Plan Decreases Health Care Utilization in Asthma. Mai Lee MD, Christopher Pease MD, Kristopher Richter DO, Nick Youssefi DO.

Reduction of Readmission in CHF with use of RN/LVN as Post Discharge Treatment Liason with Discharge Team. Kazi Rahman DO, Paul Goebel MD, Debe Zamorha RN.

The Impact of Organizational Change in the Medical Intensive Care Unit at the VA Central California Health Care System: Comparing Open versus Closed ICU. Deanna Oliver DO, Rebecca Flanagan DO, Gary Rubiaco MD, Ololade James MD, Jian Huang MD.

Extrinsic Patient Reports used to Identify ACC Clinic Patient Population with Cardiovascular Risk Factors, and remotely manage and apply Guideline-directed therapy without the intrinsic limitations of clinic appointments. Marta Nalbandyan DO, Brittany Doremus DO, Dominic Dizon MD.

Integrating Palliative Care in the ICU: An Approach to Improving Communication and Family Satisfaction. Katayoun Edalat-Parsi MS DO, Joshua Krol DO, Hau Nguyen MD, Jose Robles Huerta MS DO, Iris Price MA, Susan Hughes MS, Ivy Darden MD.

Improving Healthcare Worker Hand Hygiene through Patient Empowerment. Paul Goebel MD, Scott Price MD, Stephani Wasson RN.

Impatient Daily PRN orders for Routine Electrolyte Replacements, Nausea, Bowel Regiments, and Blood Pressure Control at Fresno VA Medical Center. Joshua Lin DO, Tina Nhan DO, Linda Truong DO.

Point of Care Clinical Decision Support for Evidence-Based Radiology Ordering: An Implementation of the ACR Guidelines. Joshua Lin DO, Pegah Mashayekhi DO, Pritisheel Banga DO, Puja Thakkar DO, Norman Orr DO.

Improving End of Rotation and Weekend Sign off in the Inpatient Setting. James Simmons DO MBA, Gail Osijo MD, Tony Khan DO, Steven Tringali DO.

Are You My Doctor? A Quality Improvement Study of Patient’s Ability to Correctly Identify Treatment Team Members In An Academic Inpatient Hospital Medicine Service. Nick Youssefi DO, Christopher Russo DO, Jose Robles Huerta MD, Joshua Krol DO.



Use of Peak Flow for Management of Asthma. Mai Lee MD, Nick Youssefi DO, Kris Richter DO, Chris Pease MD, Emerson DeJesus MD, Vipul Jain MD, Dominique Dizon MD.

An Effective Shift Handoff Tool Used by Residents to Improve Patient Care. Reza Ronaghi MD, Michael Cheng DO, Ivy Darden MD.

To improve PAP smear screening measures in the Residents’ Clinic at Community Regional Medical center. Eveleen Bhasin DO, Jaynesh Patel MD, Dominic Dizon MD, Erica Kasper MD.

Strict adherence to guidelines for Hyperlipidemia, Diabetes, Hypertension via clear and easy to use epic software, and its impact on number of CHF hospitalization. Marta Nalbandyan DO, Dominic Dizon MD, Nivedana Ravi.

Improving Outcomes in Management of Chronic Pain in the Outpatient Setting. Gail Osijo MD, James Simmons DO, Jacob Cohen MD, Erica Kasper MD, Anu Poliyedath MD.

Utilization of Clinical Performance Dashboard and Quality Improvement Initiative. Amita Kalra MD, Steven Ratcliff DO, Jacki Deguzman MD, Panos Danapoulos MD, Jian Huang MD, Tin Tin Kyaw MD, Swee-chin Loo MD, Sunitha Nalavenkata, Suneetha Dandala MD, Ivance Pugoy MD.

Self-Management Educational Materials for Patient with Chronic Conditions in the ACC Clinic: Before and After. Dominic Dizon MD, Alexander Pi DO, Elizabeth Parra MD, Apinunt Khemthong DO, Jacki DeGuzman MD.

Analysis of appropriate use of vancomycin in University-Affiliated Community teaching hospital: A retrospective observational study. Robert Libke MD, Naiel Nassar MD, Shobha Sharma DO, Nargid Naheed MD, Simon Paul MD, Paul K Mills, Ph.D., M.P.H,Thi Thi Shwe,MD, Thandar Lwin MD, Anna Agarkova MD.

The Utility of Inferior Vena Cava (IVC) filter placement in management of Venous Thrombo-embolism – A Retrospective study. Malaygiri Aparnath MD, Heather Lee MD, Bhavik Khatri DO, Chandra Venugopal MD, Sachin Gupta MD, Vijay Balasubramanian MD.