Program Director Message

Ivy Darden

Steven Tringali, DO

Program Director

We are proud of what we have to offer, and are happy you are visiting us online.


Upcoming Conferences

Cardiology in the Valley

Mini Med School 2018

Sept. 4, 11, 18 and 25

Every Tuesday in September. The cost is $20 for the entire series. Pre-registration is required. Space is limited.

Quality Improvement

two Internal Medicine residents presenting poster

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.



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.