Fall 2012 Saint Louis University School of Medicine

GrandRounds

Seeds of Student Wellness Take Root Educators Reflect Outcomes Research Shapes Policy

Positive PrognosisStudent wellness initiatives wo-ven into the curriculum to de-crease stress and depression are having the desired impact on campus. The initiatives also are attracting attention from medical schools throughout the country. | page 10

For more information about the magazine or to submit story

suggestions, please contact 314 | 977-8335 or

grandrounds@slu.edu.

Vol. 10 No.2 Saint Louis University School of MedicineFall 2012

Grand Rounds is published biannually by

Saint Louis University Medical Center

Development and Alumni Relations.

Grand Rounds is mailed to alumni and friends of the

School of Medicine.

Philip O. Alderson, M.D. Dean|Saint Louis University

School of Medicine Vice President|Medical Affairs

Schwitalla Hall M268 1402 S. Grand Blvd.

St. Louis, MO 63104-1028

GRAND ROUNDS EDITORIAL BOARD Philip O. Alderson, M.D.

Edward J. O’Brien Jr., M.D. ’67 Cheryl Byrd

MAGAZINE CONTRIBUTORS Coordinator and Writer|Marie Dilg|SW ’94

Designer|Dana Hinterleitner Laura Geiser|A&S ’90|Grad ’92

Nancy Solomon Carrie Bebermeyer|Grad ’06

PHOTO AND ILLUSTRATION CREDITS Steve Dolan|front cover, 1-16 and back cover

Michelle Marie Peltier|3

ALUMNI EXECUTIVE BOARD

President|Edward J. O’Brien Jr., M.D. ’67|St. Louis

Anne T. Christopher, M.D. ’94|St. Louis

Emil DiFilippo, M.D. ’66|St. Charles, Mo.

Thomas F. Lieb, M.D. ’82|St. Louis

James T. Merenda, M.D. ’82|St. Louis

Ellen M. Nicastro, M.D. ’04|Chesterfield, Mo.

Leroy F. Ortmeyer, M.D. ’55|St. Louis

Joan M. Pernoud, M.D. ’74|St. Louis

Keith M. Starke, M.D. ’81|St. Louis

Jane Willman Turner, M.D. ’92|St. Louis

Terrence A. Tyrrell, M.D. ’73|Belleville, Ill.

Peter Kong-Woo Yoon, M.D. ’81|St. Louis

© 2012, Saint Louis University All rights reserved

From the Dean | As I write this message, we are a few short weeks away from electing the next president of the United States. Regardless of the outcome of that election, the next four years almost surely will see major changes in the organization of and payment for health care services. This will cause us to modify certain aspects of our medical practices and to teach our students about new models of medical care. In addition, we will need to teach our students to withstand the pressures of the seemingly constant regulatory changes and bureaucratic ambigui-ties of modern medicine. Here at SLU, we are trying to get ahead of this wave of change with new educational pro-grams that are highlighted in this issue of Grand Rounds.

Resilience training for first- and second-year medical students at SLU is part of the new approach and seems to be making a positive difference. The rates of anxiety and depression in our freshman and sophomore students have declined significantly. New curricular changes provide the opportunity for students to break away from the constant flow of new information and the stress of exams. Our students now begin their first year in classroom courses where they get to know one another and develop a bit of confidence. A few weeks later, they address the challenge of the rigorous course in human anatomy. This change has led to better performance and more enjoyment of the anatomy course than in previous years. Medical students work with hundreds of students from six other health pro-fessions in the third-year Interprofessional Team Seminars. In the fourth-year capstone, one of the most popular and useful courses addresses the business aspects of medical practice.

In a new health care environment that is likely to be characterized by more emphasis on primary care, on more physician employment in hospitals or health systems, on compensation related to quality metrics and to efficiencies obtained through collaborative care with non-M.D. health care providers, young physicians need more than the skills learned traditionally in medical school. We believe that training in resilience and related psycho-social skills as part of the new curriculum at SLU is helping students prepare to be tomorrow’s leaders as the health care system evolves.

Mining for the Gold StandardOutcomes research has become a hot topic and the SOM is helping lead the discussion. Collaborating with national health care providers, researchers and drug compa-nies, the University is discover-ing what works at the bedside and what doesn’t. | page 14

Award WinningRespected SOM educators find that teaching future physicians is as much about inspiration as it is information. They reflect on what their students continue to teach them.| page 6

Poised for DiscoveryBig risks lead to big rewards for researchers studying breast cancer and antibiotic resistance. | page 16

Living the MissionA SOM alumna leaves private practice to serve a public need. | page 18

Vital Signs | page 2

Alumni Pulse | page 19

Profile of Philanthrophy | back

GrandRounds

Philip O. Alderson, M.D.Dean | Saint Louis University School of Medicine

Vice President | Medical Affairs

On the coverWhether they’re cultivating fresh basil in the student gar-den, attending yoga classes or taking a frozen custard break, SOM students learn that in order to take care of others they first must take care of themselves. Third-year students Stefanie A. Rademacher and Amy R. Hurt find it therapeutic cultivating their shared plot in the student garden on campus.|page 11

VitalSigns

Researcher Examines Treatment Options for Youth with Type 2 DiabetesA multi-center, NIH-funded study published in the New England Journal of Medicine found that a combination of two diabetes drugs, metformin and rosiglitazone, was more effective than metformin alone in treating adolescents with type 2 diabetes.

The TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) study at Saint Louis University was led by Sherida Tollefsen, M.D., professor of pediatrics and director of the division of pediatric endocrinology at SSM Cardinal Glennon Children’s Medical Center.

“The recent rise in childhood obesity has been accompanied by an increased incidence of pediatric type 2 diabetes,” Tollefsen said. “The TODAY study is the first major treatment efficacy trial

individuals reporting three to five cases. Offenses ranged from minimal procedure violations to more extreme cases of data falsification, fabrication or plagiarism.

“The results of the assessment confirmed that wrongdoing in research is a widespread problem. It also highlighted the fact that institutions have very few options for responding to these cases,” DuBois said.

Overall, the consequences for the accused researcher are minimal. DuBois said, on one extreme, researchers get a slap on the wrist — the institution issues a letter of reprimand and may increase oversight of the wrongdoer. Some institutions also offer limited internal training for researchers accused of wrongdoing. Universities can choose to fire the researcher, but this has financial implications, including the loss of grant funding and the elimination of support positions. Only 30 percent of institutions that responded to the needs assessment indicated that they were very satisfied with their options for responding to research wrongdoing.

“We’re hoping the RePAIR program will provide a good middle ground. It will be a substantial educational program that addresses the major causes of research wrongdoing and fosters good research practices and decision making skills,” DuBois said. “No one has ever attempted a formal program like this for researchers, but we’re inspired by the success of physician remediation programs at the University of California San Diego and at Vanderbilt University, which have demonstrated that remediation programs can work.”

in adolescents with recent-onset type 2 diabetes.”

The study enrolled 699 youth aged 10-17 who had type 2 diabetes for less than two years. Participants were randomly assigned to one of three treatments: metformin alone; metformin and rosiglitazone; or metformin combined with a lifestyle-intervention program focusing on weight loss through changing eating and activity behaviors. Of the three treatments, metformin combined with rosiglitazone was most effective.

“These results are significant because they suggest that the failure rate with metformin alone is higher than that in adults,” Tollefsen said. “Most youths with type 2 diabetes will require multiple oral agents or insulin therapy within a few years after diagnosis to achieve the control needed to prevent complications.”

Program to Help Institutions Address Research WrongdoingA $500,000 grant to Saint Louis University’s Gnaegi Center for Health Care Ethics will fund the first ever remediation program to aid institutions when they discover researchers who have engaged in wrongdoing or unprofessional behavior. The Restoring Professionalism and Integrity in Research (RePAIR) program is expected to launch in November 2012.

The one-year grant from the NIH comes to SLU through its partnership with the Washington University Institute for Clinical and Translational Science.

“Maintaining the public’s trust and support is critical to the success of research. As the first program of its kind aimed at correcting problematic research practices, RePAIR will provide an important mechanism to support ethical researcher practices and maintain the public’s trust,” said Raymond Tait, Ph.D., vice president for research at SLU and a member of the RePAIR advisory committee.

James DuBois, Ph.D., D.Sc., project director and the Hubert Maeder Professor of Health Care Ethics at SLU, and his team kicked off the project in January with a needs assessment that was sent to 194 medical schools and comprehensive doctoral institutions. When responses were received from the individuals responsible for overseeing both research integrity and human subjects protections, 96 percent of institutions had investigated credible cases of wrongdoing in the past two years. Rates varied widely from none to more than 15 cases, with most

2 Grand Rounds Saint Louis University School of Medicine

Former missionaries, several Eagle Scouts, Teach for America educators and Global Medical Brigade

volunteers slipped on their white coats in August to symbolize the beginning of their medical educa-

tion journey. The 107 men and 71 women in the Class of 2016 took part in the annual White Coat ceremony in front of a standing-room-only crowd

at St. Francis Xavier College Church.

You Wear It Well Saint Louis University School of Medicine Welcomes the Class of 2016

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countries represented

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Sherida Tollefsen, M.D., reviews glucometer read-ings with 15-year-old high

school sophmore, Talia Hempel. Hempel was diag-nosed with Type 1 diabetes

two years ago. Tollefsen specializes in caring for

young patients with Type 1 and Type 2 diabetes.

Umangi Patel, M.D., embraces her son, first-year medical student Neil Patel of Newburgh, N.Y., after he receives his white coat.

New Meningitis Vaccine InvestigatedScientists at Saint Louis University’s Center for Vaccine Development are conducting a clinical trial of an investigational vaccine for meningococcal B disease, the only remaining predominant meningococcal serogroup for which no vaccine is available. The trial is part of a national study.

Worldwide, there are 500,000 cases of meningococcal meningitis each year, with at least 50,000 deaths. Meningococcus B is now the leading cause of meningitis in industrialized countries and accounts for about one-third of cases of invasive meningococcal disease in North America and up to 80 percent of cases in some parts of Europe.

While meningococcal B disease can occur at any age, it most often strikes infants and young adults. Because a delay in treatment

can have life-threatening consequences, finding a safe and effective vaccine is a top priority, said Edwin Anderson,

M.D., professor of internal medicine.

“An effective

adolescent vaccine against

meningococcal B disease has the potential to help save lives and reduce emotional and psychological stress caused by long-term consequences of the disease,” Anderson said.

VitalSigns

Norman J. Stupp Foundation Gives $50,000 to the Eye InstituteThe Saint Louis University Eye Institute has received $50,000 for ongoing research support from the Norman J. Stupp Foundation-Commerce Bank Trustee.

The Eye Institute houses state-of-the-art facilities to conduct basic and clinical eye research. Current areas of basic science investigations include: animal models of hereditary retinal degeneration; lipid metabolism in the context of retinal degeneration; molecular mechanisms of photoreceptor signal transduction; and the molecular basis of glaucoma.

Clinical research investigations are ongoing in pediatric ophthalmology, diabetic retinopathy, age-related macular degeneration, glaucoma and ocular plastics. In addition, the department participates in study protocols in collaboration with the University’s department of internal medicine and its divisions of cardiology, endocrinology, hematology/oncology, as well as the department of neurology and psychiatry.

For decades, the Norman J. Stupp Foundation has been a generous donor to the University, including annual gifts to the Eye Institute, as well as major gifts to fund the Stupp Geographic Information Systems Lab, the Floodplain Ecosystems Research Institute and other priority University projects and programs.

an improved standard of care through the experience of practicing medicine in countries with lower resources.

“I’ve always been interested in different lands and cultures,” said Rodrigues, who will travel to Belize in February to practice at the Hillside Clinic. “This experience can help deepen my adaptability, humility and empathy with human suffering.”

Dr. Delecaris hopes this experience will provide her with different ways of practicing medicine. She said this is important for all physicians at some point in their careers.

“Overall, I hope the experience will make a change for the better in the way I care for patients,” said Delecaris, who may travel to Belize or Botswana in March. In addition to seeing patients, the residents also work on broader health care issues affecting the community and help local clinicians modernize their practices. Upon return, the residents also give a talk for the department to share their experiences and what they learned.

from working and living in another culture.”

During the last six years, the program has awarded 30 scholarships. The department of pediatrics contributes significantly to the medicine abroad program to ensure that as many residents as possible can participate. Because of the department’s contribution, this year every resident who applied received funding.

In December 2007, the Rileys made a donation to endow the program. Dr. Riley had participated in medical mission trips during his career and wanted to share that experience with others. Several award recipients hope to gain better insight on providing

SLU Residents Chosen for Medical Mission TripsFive pediatric and combined medicine/pediatric residents were awarded the Dr. Philip A. Riley Jr. (’49) and Mrs. Joane Riley Endowed Medicine Abroad Program (MAP) Scholarship for the 2012-2013 academic year.

The residents are: Mwela Njabi Asombang, M.D., Angela Delecaris, M.D., Venkat Kanchustambham, M.D., Sreecharan Mavuram, M.D., Jonathan Rodrigues, M.D., Eric Strodtman, M.D., and Paul Tuttle, M.D. Each of the residents will go on a one-

month medical mission trip to a country of their choice.

This year, residents will travel to Botswana, Belize and Congo. The scholarship award covers their salaries while away, along with their travel and related expenses. The program provides residents with an opportunity to give back as well as be engaged in an excellent learning experience, said Timothy Rice, M.D., director of the medicine abroad program.

“The residents will be a benefit to the medical system, the patients and the broader communities where they will serve,” Rice said. “They will also receive great benefits

Alireza “Ray” Rezaie, Ph.D., professor of biochemistry and molecular biology, has received a $1.5 million NIH grant to study how the key blood clotting inhibitor anti-thrombin might be exploited to prevent premature death from heart disease.

The four-year grant from the National Heart Lung and Blood Institute will allow Rezaie to continue studying how to maintain the delicate balance between the life-pre-serving and life-threatening activity of blood clotting.

“Blood clotting factors must be turned on and off at exactly the right time so a person does not bleed to death or die of an episode such as a heart attack, which is triggered by a blood clot,” said Rezaie, who has been studying the control of blood clotting factors for 23 years and has engineered molecules that impose equilibrium on the delicate system.

Rezaie recently discovered that antithrombin, a mol-ecule produced by the liver that turns off several proteins in the coagulation system, can block inflammation in the blood vessel wall. This inflammation can lead to heart disease and acute sepsis. Rezaie is working on harness-ing the anti-inflammatory activity of antithrombin to reduce the incidence and severity of these conditions.

In parallel with his pioneering work on antithrombin, Rezaie also is working to improve the anticoagulant acti-vated protein C. This FDA-approved vitamin K-dependent blood clotting factor has been used to treat acute sepsis in adults, which affects nearly 750,000 Americans annu-ally and results in at least 225,000 deaths.

His ongoing studies on activated protein C are funded by another $1.5 million grant from the NIH, awarded in 2010. They aim to improve the ability of the protein to prevent organ failure while reducing its anti-clotting activ-ity, so that bleeding complications can be avoided.

Clotting Th Fib

+++ Th Inhibit Clotting AT

+++ Inhibit Inflammation

AT

EC

HSPG

Thrombin (Th) is the final enzyme of the clotting cascade that stops bleeding by converting fibrinogen (Fib) to a fibrin clot at the site of vascular injury. When thrombin moves away from the injury site, it is rapidly inhibited by the plasma inhibitor antithrombin (AT). In addition to inhibiting clot formation, a positively charged loop of AT can bind to the distinct negatively charged carbohydrate moiety of heparin sulfate proteoglycans (HSPG) on the surface of vascular endothelial cells (EC) to inhibit inflammatory responses elicited by proinflamma-tory cytokines.

More Than 150 SLUCare Physicians Chosen as St. Louis Magazine’s “Best Doctors”

Spanning more than three dozen specialties, 153 doctors from SLUCare have been selected for St. Louis Magazine’s 2012 “Best Doctors” list. The list is based on the

annual “Best Doctors in America” database, which considers more than one million peer evaluations to create a directory of approximately 30,000 doctors.

Managing Antithrombin Could Be Key to Saving Lives

To see the complete list, go to the Beyond Vital Signs link at medschool.slu.edu.

4 Grand Rounds Saint Louis University School of Medicine

Christelle Ilboudo, M.D., a 2012 graduate of the pediatric residency program at the School of Medicine, assists a mother and child at a mobile clinic in Yako, Burkina Faso West Africa. She served with the St. Louis-based non-profit organization Small Rain. Last year, Ilboudo received a Riley Endowed Medicine Abroad Program Scholarship. This year’s recipients are preparing to go on their missions.

When you consider the demands placed on medi-cal educators today, it is a wonder anyone chooses that career path. Medical faculty must teach large amounts of information in various settings while ensuring that the needs of both patients and students are met. They must keep pace with rapid improvements in technology to deliver rapidly changing content.

According to a 2008 article in the Journal of Aca-demic Medicine, for every reason that could engender the choice of academic medicine as a career, there are barriers discouraging professionals: tough compe-tition for funding, long hours of patient care, administra-tive demands, less pay and heavy teaching schedules.

Yet if you ask Jay E. Noffsinger, M.D., or Adriana M. Montano, M.D., they can’t imagine doing anything else. They are among the faculty members highlighted in this article celebrating those who have taken the higher education road. These are professors who overcome or tolerate the barriers in the hope of inspiring future physicians. They believe in their students. They leave imprints on their students, and, in return, students take their influence forward, which most educators tell you, is the greatest reward of all.

Although the School of Medicine is populated with dedicated, passionate edu-cators, for the purposes of this article we have selected recipients of the school’s highest teaching honors — the Golden Apple and the Distinguished Teaching Awards.

AWARD WINNING

TEACH EXCELLENCE TEACH EXCELLENC TEACH EX-CELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EX-CELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EX-CELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EX-CELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EX-CELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EX-CELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EX-CELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EX-CELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EX-CELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EX-CELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EX-CELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EX-CELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EX-CELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EXCELLENC TEACH EXCELLENCE TEACH EX-CELLENC TEACH EXCELLENCE TEACH EXCELLENC

Esteemed School of Medicine educatorsreflect on the lessons they’ve learned.

ROBERT J. BLASKIEWICZ, M.D. (’75)PROFESSOR, DEPARTMENT OF OBSTETRICS, GYNECOLOGY AND WOMEN’S HEALTH

JAY E. NOFFSINGER, M.D.PROFESSOR EMERITUS, DEPARTMENT OF PEDIATRICS

YEARS TEACHING 37 GOLDEN APPLES 7 DISTINGUISHED TEACHING 1

YEARS TEACHING 37 GOLDEN APPLES 6 DISTINGUISHED TEACHING 1

You have to be available to students. That’s why I have an open-door policy. Students can talk to me about curriculum, my lectures, my lab sessions or whatever’s on their minds.

I try to make my material clinically relevant. Histology can be a dry science. For example, you can take a piece of skin, put it under the microscope and certainly describe what comprises it. I make the material come alive by relating the material more easily so that students remember it. Instead of teaching just about normal skin, I teach how tattoos are applied and why they seem to last for so long. That gets students thinking in a totally different light.

I like to ask probing questions. For example: “How can it be that your stom-ach can successfully digest a meal without digesting itself?” That gets students more interested in physiological principles.

You have to evolve with the technol-ogy or you’ll lose your students. I’m a big fan of virtual microscopy. We’re not banging around with microscopes and glass slide sets anymore. My phone is my microscope. My entire slide set is loaded on my phone. It’s much more efficient, and that’s what students are looking for.

EXCERPTS FROM STUDENT EVALUATIONS:

“Dr. Smith goes out of his way to make sure students are able to achieve their full poten-tial. He treats students as equals which makes for a good learning environ-ment.”

“Dr. Smith did a great job making himself available for anything a student needed. Really loved that he would personally call occasion-ally and ask how things were going.”

GREGORY S. SMITH, PH.D.PROFESSOR, DEPARTMENT OF SURGERY ASSISTANT DEAN FOR EDUCATIONAL DEVELOPMENT

DISTINGUISHED TEACHING 5

GOLDEN APPLES 5

YEARS TEACHING 17

Our students are very bright. I don’t want to do their thinking for them. I like to give them just enough information so that they can make the connection between what

they know and what they need to know.

I want students to

appreciate that patients

are people, not a collec-tion of symptoms. It’s not “The patient in 543 with preeclampsia.” It’s “Mrs. Jones.”

Part of what I teach students is how to find good information, and it’s so easy to do now. You just take out your phone, pull up PubMed and you get what you need. This is a dramatic change for the better. I’m looking up information four or five times a day at least.

I teach students how to assess a baby’s orientation in a simulation exercise during which they’re blind-folded and can’t see what they’re doing with a model of a pelvis and a baby doll. They come in knowing zip, and at the end of the 45-minute session I sense

they’ve learned a lot and gained some confidence. It’s very gratifying.

EXCERPTS FROM STUDENT EVALUATIONS:

“Dr. B. has made an important and lasting impression on me, and on the way that I perceive myself and the patients I care for in a profound way. Forever.”

“Dr. Blaskiewicz is a walk-ing encyclopedia of Ob/Gyn knowledge and it was clear that he enjoyed sharing his knowledge and helping students learn. He actively engaged students during teaching rounds, creating lively discussions.”

6 Grand Rounds

My plan was to become a small town doctor in Indiana. After med school I joined the Navy though, and as fate would have it, I kept getting assigned to academ-ic institutions where I became involved in various aspects of teaching. I fell in love with imparting knowledge.

I prefer one-on-one or small group teaching. I like making eye contact. I like seeing their synapses fire. I need that feedback.

Passion for teaching is extremely important. If you can’t wake up every day and be excited to go to work because you truly enjoy what you are doing, then maybe you shouldn’t be doing it.

Even better than the awards are the kind words often used in evaluations submitted by students at the end of their rotations. There’s nothing more rewarding than when students write that I’ve made a difference in their lives or they find them-selves using things they learned from me.

I don’t believe teaching is about giving students information. It’s about teaching them to problem solve.

EXCERPTS FROM STUDENT EVALUATIONS:

“Every time I worked with him I felt like I picked up a textbook worth of knowl-edge. He loves teaching students, and you can tell by his interactions with them.”

“Dr. Noffsinger is fantastic, has an incredible wealth of knowledge and is friendly and forthcoming with students. He’s the best professor on the rotation.”

11

Everybody likes a good story, and stu-dents are no different. Rather than lectur-ing about abdominal aortic aneurysms, I tell the students about my first autopsy of a patient who died with an unrecog-nized abdominal aortic aneurysm. The story about a real case helps put the subject in context, which makes it easier to understand.

In class I like to have a small speci-men or image out for demonstration pur-poses, and I call on a student, often one in the back trying to stay out of the line of fire. I address the student as “doctor,” and I pose a clinical question about the specimen that they can answer based on what was taught in class. It engages them, gives them a chance to solve a problem with the knowledge they have gained, and it also keeps them on their toes.

I have a motto: teach less, learn more. You can’t possibly teach students every-thing in the book or everything they need to know about a subject. You teach them the key elements to get them started and trust that they’re interested enough to go from there.

Students keep me focused; even after all these years of teaching pathology, they still come up with questions that I’ve never thought of before.

EXCERPTS FROM STUDENT EVALUATIONS:

“You can tell that she is truly passionate about teaching pathology. She was very effective in delivering the material and possesses an incredibly warm demeanor.”

“She makes me inter-ested in any topic she teaches, even the boring ones. She is phenomenal. Never stop teaching. SLU is blessed to have you.”

CAROLE A. VOGLER, M.D.PROFESSOR AND CHAIR, DEPARTMENT OF PATHOLOGY

My teaching style is to let students participate in class and be more active than passive. In small group facilitation I let stu-dents know that they are the engine of the class. If

they spend time investigating and discuss-ing a topic, they’ll learn it much better than if I recite from a text-book.

Textbooks are avail-able for everybody, but the personal experience a professor brings into the class has an impact. It’s an incredible experience to know that I might make a difference in someone’s life.

I have learned to never underestimate a student. They have great potential and are very bright. If I give them the appropriate tools I can guide them much better.

I want students to become interested in the topic not because of a grade but because they love to learn.

To stay fresh it’s es-sential to keep up with the literature in research, science and academic

medicine. It also helps to interact with students and listen to their points of view.

EXCERPTS FROM STUDENT EVALUATIONS:

“I really liked her style of small group facilitation. We learned a lot, did it ourselves, and she led us in just the right manner. You could feel there were high expectations, but it was in a relaxed way.”

“She does a very good job of explaining the con-cepts of her topics and in engaging the class in ques-tions during lectures.”

ADRIANA M. MONTANO, PH.D.ASSOCIATE PROFESSOR, DEPARTMENT OF PEDIATRICS

I like teaching physical diagnosis the best. Med students are masters of taking science courses with lectures and notes and tests. They’ve been doing that since they were little kids. But when they’re exposed to physical diagnosis, they’re not so sure of themselves. They worry about whether they’re holding the stethoscope correctly or whether they’ll be able to hear a third soft heart sound. Once you show them and it clicks, it’s wonderful.

One of my mentors, Dr. Joseph Sapira, told me that the goal of a medical educator is to allow a student to be inde-pendently ignorant. It means the student has figured out the questions and knows how to find the answers. That task is easier for this generation because they’re used to getting information online. Our job is to make sure they know their best resources.

My favorite evaluation was from a student who was critical of me. He said, “Whenever I asked Dr. Mootz a question, he answered me with another question. He continued to do this until I came up with the correct answer. It would have been much easier if he had just answered

my question from the get go.” The student didn’t like it, but he discovered he could work through a problem on his own, which is what he has to do in the real world.

EXCERPTS FROM STUDENT EVALUATIONS:

“I really appreciate that he sticks to the clinically relevant information and really explains what is going on and not bog us down in lists of useless information. I like that he teaches us everything (big picture and details), but then tells us EXACTLY what is important for the future — test and clinic.”

“Loved his enthusiasm!”

WILLIAM C. MOOTZ, M.D.PROFESSOR, DEPARTMENT OF INTERNAL MEDICINEASSISTANT DEAN FOR CURRICULUM

You need four things to be a great teacher. You need to know your students, you need to be able to put yourself in their shoes, and you need to simplify your subject, break it down. Most importantly, however, you have to love your subject. Students won’t get turned on if you’re not turned on.

I teach for two months of the year, and I’m pretty much bored for the other 10 months. I have all sorts of sicknesses and aches, but when I’m teaching, I’m 100 percent healthy and ready to go. I’ll teach as long as I’m able to get here.

As a young faculty mem-ber I had the good fortune of working with clinicians in the hospital. Very few basic scientists had the opportu-

nity to get bedside exposure. It helped me as an educa-tor because it allows me to correlate the anatomical with the clinical, which is what students want. They don’t want to just learn anatomy. They want to know how they can use that informa-tion with their patients.

It’s been estimated that I’ve taught neuroanatomy to 90 percent of all living SLU medical alumni. That sounds about right. I run into some-one I’ve taught just about everywhere I go.

EXCERPTS FROM STUDENT EVALUATIONS:

“He is clear, engaging, funny and brilliant. It was truly an honor being his student.”

“He somehow makes the study of neuroanatomy interesting and very manage-able! I was easily able to recall his lectures, and the reviews really helped to focus my attention on the big picture rather than get-ting caught up in the details.”

PAUL A. YOUNG, PH.D. (’57)PROFESSOR AND CHAIRMAN EMERITUS, DEPARTMENT OF ANATOMY AND NEUROBIOLOGY

What keeps me fresh is what I call the “cycle of life!” Every month or academic year brings new faces to the ward. It never gets old when I teach something, even something I’ve taught repeatedly, and I see that glimmer and excitement in their eyes. You know that

they got it. Forming relationships with

students makes the difference between a good teacher and a great teacher. If you can cultivate a learning climate

that permits open and comfortable inquiry

from all parties it really stimulates self-direct-ed learning.

My classroom is the patient’s bedside. One of the most impor-

tant messages comes from role

modeling my in-

teraction with the patient and having students realize that the patient is the best teacher we have in medicine.

Humility and admitting my limitations can be just as effective teaching tools as the studies, facts and knowledge I teach. Allowing learners to hear me say “I don’t know,” or “I made a mistake,” even to a patient, is incred-ibly powerful and important to role model. In the end, we’re all students of medicine until we no longer practice.

EXCERPTS FROM STUDENT EVALUATIONS:

“Words can’t explain how great of a teacher Dr. Paniagua is — always challenging students to dig deeper for more knowledge. He in-spires curiosity in students.”

“He is always willing and available to help stu-dents. He regularly takes time to help students to further develop their clinical exam skills.”

MIGUEL A. PANIAGUA, M.D. ASSOCIATE PROFESSOR, DEPARTMENT OF INTERNAL MEDICINEDIRECTOR, INTERNAL MEDICINE RESIDENCY

To see a complete list of the Golden Apples and Distinguished Teaching Award recipients visit Beyond Vital Signs link at medschool.slu.edu/alumni.

Most of what today’s medical school faculty learned about teaching came from observations made during their time in medical school, residencies or fellowships. Academic medicine historically paid little to no attention to developing teaching competencies — competencies that continue to shift with curricular changes that include small-group teaching, problem-based learning and e-learning.

SLU School of Medicine, how-ever, is joining a growing movement in medical education that recog-nizes teaching as a skill that must be developed. Angela M. Sharkey, M.D. (’86), associate dean for faculty affairs and development, said the school is interested in creating an academy that will help faculty improve instruction and implement innovative approaches to learning.

“We have to focus not only on what we teach, but how we teach,” Sharkey said.

The academy’s first step is the launch this year of a program to ad-dress the professional development needs of educators. The curriculum includes course design, effective instruction, assessment and evaluation. The information will be disseminated through grand rounds, continuing medical education programs and on-line learning modules.

“Although the curriculum is de-signed primarily for our faculty, there is a trickle-down factor,” Sharkey said. “Students and other health care profes-sionals on campus will be exposed to the curriculum through grand rounds. And because we work as part of inter-professional treatment teams, School of Medicine faculty will serve as role models for excellence in education and advocates for positive change.”

YEARS TEACHING 56 GOLDEN APPLES 2

YEARS TEACHING 10 GOLDEN APPLES 1 DISTINGUISHED TEACHING 1 YEARS TEACHING 4 GOLDEN APPLES 1

YEARS TEACHING 30 GOLDEN APPLES 8 DISTINGUISHED TEACHING 1 DISTINGUISHED TEACHING 5

GOLDEN APPLES 5

YEARS TEACHING 17

TEACHING DOCTORS TO

TEACH

Grand Rounds 9

Grand Rounds 11

Gillian S. Stephens, M.D., M.Sc., was not the traditional medical student. She was 42, married and had four children when she entered medical school in 1994.

“Medical school was an isolating experience for me,” said the assistant professor of family and community medicine. “I was overwhelmed with the stress, and struggled quite a bit at times with my mood and self-esteem. I assumed it was hard for me because I was older and had a family.”

Stephens’ assumption was proven wrong in 2001 when her son, a traditional medical student — 21, outgoing and brilliant — entered the same medical school. Stephens said her son excelled academically and was a leader among his peers, but he experienced similar isolation and stress.

“His experiences made me feel somewhat better because they validated my impressions,” she said. “Clearly, I wasn’t alone.”

WHITE COAT-BLUE MOODStephens definitely is not alone. Several studies have indicated that about one-fourth of medical students suffer from symp-toms of depression and significantly more suffer from anxiety, especially during the first and second years. Stuart Slavin, M.D. (’83), M.Ed., associate dean for curriculum and professor of pediatrics, was aware of the studies, but when he looked around SLU’s Medical Center he saw students who seemed happy and engaged. Those studies were about students at other schools, not his. Because he is charged with doing everything he can to ensure student success, however, Slavin decided to survey SLU School of Medicine students anyway. Using validated depression and anxiety instruments, he began with the Class of 2011. He said the results were shocking.

“We looked like everybody else, and it wasn’t pretty,” he said. Twenty-seven percent of the students had moderate-to-

severe symptoms of depression by the end of their first year, and 57 percent suffered from moderate-to-high levels of anxiety. Twenty-nine percent of second-year students and 31 percent of third years had moderate-to-severe symptoms of depression.

“Things had to change,” said Slavin, chair of the curriculum management committee. “I didn’t want to be in charge of an enterprise that had such poor mental health outcomes. Think about it. How can we expect our students to become wonderful doctors if we injure them in the process?”

AGGRESSIVE APPROACHSlavin said medical education’s traditional approach to mental health intervention largely has been to remove the stigma of seeking help and provide students with better psychiatric care. His approach, on the other hand, is preventive. Reduce unnec-essary stress in medical school and give students better coping skills so they don’t become as depressed and anxious.

Slavin and the curriculum management committee are at-tempting to do this through curriculum changes. They imple-mented the first change in 2009 when the school joined about 40 of the nation’s 125 medical schools in adopting a pass/fail grading system for the pre-clinical years. Studies have demon-strated that a change to pass/fail was accompanied by a statisti-cally significant improvement in psychological factors related to anxiety, depression, positive well-being, self control, vitality and the general physical health of students in the early semesters of medical school.

Next, the Office of Curricular Affairs (OCA) created longitu-dinal electives. Instead of engaging in electives one-half day per week over a seven-week span, electives were extended across the majority of Year One and Year Two, with one full day of elective time every two weeks. The idea is to allow students to focus less on absorption of knowledge and more on finding their passion.

Two years ago, the OCA instituted a required resilience and mindfulness curriculum for first-year students comprised of five 30-minute sessions on stress management, positive psychology and cognitive-behavioral practices.

BREAK THE ROUTINEThe OCA also created learning communities in which students and faculty members who share a common interest — some-times interests that transcend medical specialties — spend time working on projects outside the classroom. The learning com-munities were divided into five groups: Global Health, Medical Education, Research, Service and Student Wellness.

When Slavin presented his idea for the wellness learning com-munity to faculty, Stephens said she was eager to serve as liaison.

“It was a very personal thing for me,” she said. “I saw this as an opportunity to make medical education a better experience than it was for me.”

Once a month, Stephens meets with students to discuss ideas for keeping balance in their lives. During the past three school years, the students have organized ski trips, ice skating parties and Mardi Gras celebrations. The community sponsors Pump-kin Pie Day, a watermelon festival, a photography contest, Jelly Donut Day and movie nights.

Ting Zhang, a third-year student from Beijing and a member of the learning community, has participated in the photography contest and a student cook-off. She said the events are diversions that actually improve her study habits.

“I’ve gone to the library and tried to study for eight hours, but it’s impossible,” she said. “I zone out for at least two of those hours. I’m reading the same thing over and over. But if I have something to pull me out of the library for a little while, I find I’m much more focused and the break refreshes me.”

The community also sponsors lectures on good sleep habits and stress management. And, during high stress times, such as right before exams or waiting for results, Stephens sends motivational emails to students reminding them to eat properly, sleep adequately, exercise regularly and think positively. Each email ends with a trivia question about her homeland, Australia. The first student to respond with the correct answer is awarded a package of Tim Tams, a chocolate biscuit popular down under and coveted by School of Medicine students.

PRO

GN

OS

ISStudent wellness

initiatives are achieving

desired results. Fourth year student Amy Nuismer

Grand Rounds 13 12

“I think medical school would have been infinitely harder had I not found this outlet,” she said. “No matter which path you choose, you have to find something that keeps you balanced and energized because if you don’t you’ll hurt yourself and by exten-sion hurt those you’re trying to help. I’m grateful to be part of a school that takes this aspect of self-care seriously.”

Slavin said the combined curriculum and wellness interven-tions, unprecedented in medical education, are effective tools in student recruitment.

“I believe we’re the only medical school in the country taking this comprehensive approach to student wellness, and word is spreading,” he said. “We have prospective students asking spe-cifically about opportunities that will help them grow outside the classroom and library. It shows we care not just about a grade but the whole person.”

MIND AND BODYOther health diversions created by students who are part of the wellness community include a student garden, a book club, a knitting club and a weekly yoga class held in the Learning Resources Center. Fourth-year medical student Amy Nuismer has attended regularly since her first year.

“Originally I came to the class to reduce stress and meet other people with similar interests, but I discovered a lot more than that,” said the Michigan native. “I learned how to breathe, how to relax and was able to make dietary changes for the better. I learned the importance of focusing on something other than my books, even just for an hour a week.”

Nuismer was so empowered by the yoga classes that she completed the rigorous 200 hours of training to become a certified yoga instructor and plans to bring the philosophy and lifestyle behind yoga into her practice.

1. Students take a break from studies for a cup of frozen custard and some sunshine during the Student Wellness Community’s annual ice cream social. 2. Third-year student, Amy Hurt, uses a day off from her internal medicine rotation to do a little pruning in her plot at the student garden on campus. 3. Victoria E. Cornelius, M.D., adjunct associate professor of pediatrics, has been leading the weekly yoga sessions for more than a year. 4. Weekly yoga classes help students maintain balance in their lives. 5. Gillian Stephens, M.D., (right) at the August ice cream social with first-year student Abby Thuet.

POINT OF IMPACTSlavin said that the curriculum changes and the wellness commu-nity are having the desired impact on students. His data indicate that since implementation of the wellness initiatives, depression and anxiety levels have dropped significantly [see graph].

“The changes are staggering,” he said. “Plus, there’s no evidence of a drop in performance. If anything, the average scores on our exams are slightly up, which makes sense. If you’re depressed or anxious, you’re not going to perform well.”

As for the future, Slavin and his team will allow the longi-tudinal electives and learning communities to flourish. Other changes are in the works. Most of the attention has been limited to the first two years of medical school. Now, he is restructuring the third year.

Third-year students usually go 24 weeks without a vacation, but a curriculum restructuring in the works will give third years a break after 16 weeks. Also, every eight weeks, third-year students will not be required to report for their clerkships. Instead they will have breakfast with their classmates, attend a lecture on topics such as end-of-life-issues or pain management, and break into small group discussions facilitated by fourth-year students. The students will discuss the lecture, as well as process their clinical experiences in a safe environment.

“We’ve made all of these changes at little or no cost,” Slavin said. “And we’ve done nothing to compromise the educational quality of our program. In fact, I would argue that these efforts have significantly enhanced the education and training we provide.”

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Trends in Anxiety and Depression Symptoms Before and After SLU Medical Student Wellness Initiatives

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One Week BeforeMedical School

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Before Wellness Initiative (2007-09)Significant Anxiety Symptoms

After Wellness Initiative (2011-12)Significant Anxiety Symptoms

Before Wellness Initiative (2007-09)Significant Depression Symptoms

Trends in Anxiety and Depression Symptoms Before and After SLU Medical Student Wellness Initiative

After Wellness Initiative (2011-12)Significant Depression Symptoms

or someone who once hated math, Thomas E. Burroughs, Ph.D., finds himself surrounded by numbers. The execu-tive director of the Saint Louis University Center for Out-

comes Research (SLUCOR) can tell you how many Americans are prescribed insulin, what other medications they are taking, how often they refill and, if they don’t refill, can predict how long before they wind up in an emergency room.

Burroughs said these kind of data can help clinicians and patients make informed decisions about their care. Outcomes re-search determines which treatment options will be most effective for specific types of patients in specific situations.

“There are a multitude of treatments available for many diseases, and relatively little is known about how they compare to one an-other in the real world,” he said. “They all have strengths and weaknesses. There never will be one treatment that works best for all patients in all situ-ations.”

Best, Burroughs said, does not refer solely to clinical outcomes. It also refers to patient experi-ences and preferences; quality of life; ability to work; and the cost of delivering care.

Because the science of outcomes research is vital to making informed policy decisions, the field is playing key roles in the era of health care system reform. As part of the American Recovery and Reinvestment Act, the federal govern-ment allocated more than a billion dollars in data and research to compare the effectiveness of medical interventions, care delivery and systems, and policies. It also created a new institute that will infuse about $600 million annually into outcomes research.

In this Q&A with Grand Rounds, Burroughs explained the increased interest in outcomes research and how SLUCOR has become a nationally recognized leader in generating this state-of-the science information.

GR To what do you credit the strong interest in outcomes research?

TB Several things have played a role. Consumers are more savvy about health care. They use the Internet to learn what it’s like to have a certain disease and explore their options for managing it. Increasingly, they want to be in the driver’s seat. Also, our health care costs are skyrocketing, and this just can’t be sustained. Outcomes research can provide an important piece of information about which treatment option is most likely to be successful for a specific patient in a specific situation. It can help

us use our limited financial resources in the best way possible. Regardless of what happens with health care reform, outcomes research is going to play a role in knowing the impact of policy changes on the health of the population.

GR How does SLUCOR work to achieve its primary mission?

TB SLUCOR basically does three things. First, we lead a wide range of research studies. Our dominant areas of study are organ transplantation, diabetes, cardiovascular disease and health care quality. We draw on massive databases and collaborations

with other institutions to conduct research funded by the NIH, the Agency for Healthcare Research and Quality, the FDA, private foundations and biotech companies. Sec-ond, we run a consulting practice that provides applied research services to health systems, foun-dations, government and biotech firms through-out the country. Our consulting team brings together expertise in statistics, medicine, pub-lic health, economics, program evaluation and research methodology. Third, we offer graduate

degrees in outcomes research. We were the first center to offer a completely online master’s degree in Outcomes Research and Evaluation Sciences. This fall, we began offering a joint online master’s degree with SLU’s School of Law. Outcomes research data are increasingly being used in contracting and litigation, and attorneys need to understand the methods and data. In addition, we offer a certificate, accelerated master’s degree and a doctoral degree with the School of Public Health. I’m very excited about the new degree programs. We’re getting great students and great feedback on the programs.

GR From where do you gather data for your massive research projects?

TB The data come from a number of places, including national registries, Medicare, Medicaid, electronic medical records and national insurance companies. Some databases contain millions of points of observation along the care spectrum. We know their diagnoses, when they saw the doctor, what labs were ordered and what prescriptions were filled. Our organ transplant research team has data on every organ transplant performed in

Grand Rounds 15 14

the United States. I’m working with one of our doctoral students on a study examining the outcomes associated with complex combinations of diabetic medications in patients who have multiple chronic health conditions. In that study, the database includes health care encounters and prescription fills for more than 800,000 people with diabetes. This kind of research takes big data, complicated analysis and powerful computing. The databases we use have all identifiable information stripped out to maximize confidentiality protection. Access is highly secured. Our somewhat hidden office suite in the Salus Center is secured behind card-reader doors and other security systems. Sometimes we refer to our office space as the Bat Cave.

GR How do you answer critics who say that outcomes research is not pure research because the data weren’t collected for investigative purposes? The data may have been collected for billing purposes.

TB The critics are right in some ways and wrong in others. Definitely there are limitations to this type of data. Much of it wasn’t collected for research and doesn’t have many of the variables that are important, such as weight, blood pressure and diet. At the same time, it’s the only source of information about how care is being delivered in the real world and about the out-comes of that care. It’s different than a clinical trial with carefully defined patient populations. Outside of clinical trials, patients have multiple chronic illnesses, are on complex combinations of prescription medication and have financial challenges that keep them from filling their prescriptions. Both types of research are critical and help paint a picture of what’s going on with treat-ments and outcomes.

GR SLUCOR was one of the first centers of its kind in the country, but with increased interest in outcomes research, more institutes are establishing their programs. What’s unique about SLUCOR?

TB Our interdisciplinary approach is one thing that has made us successful. We bring together faculty experts from across the University to solve problems. Also, at some point in our careers, nearly all of SLUCOR’s faculty members have worked outside academia, whether on the business side of health care or on the delivery side. The faculty member who teaches our pharmaco-economics courses, for example, worked for the FDA. Most of our physician researchers still practice medicine. This experience really helps our research, teaching and consulting.

GR You were involved in outcomes research before it was making headlines. What attracted you to the field?

TB I like conducting research that can be used quickly to change how care is delivered. I’ve seen firsthand how our organ transplant and diabetes research have given patients information that shaped their decisions about treatment. They made different choices than they might have made without the information. It’s gratifying to know that what we do makes a difference.

Collaborating with the non-profit St. Louis Diabetes Coalition on KICK Diabetes, a program that takes diabetes education to where the patients are — coffee shops, community centers, libraries — and connects those patients with personal diabetes educators

Partnering with Ascension Health, the largest Catholic and largest nonprofit health system in the country, to evaluate a diabetes care management program for Medicaid patients in Arizona and Pennsylvania

Conducting motion-sensor studies at Ascension hospitals in Tennessee to create a new medication delivery process on inpatient floors

Using the same motion-sensors to help the Veterans Adminis-tration redesign its emergency departments

Helping the American Heart Association develop cardiac evaluation policies that assess a patient’s overall health before transplant surgery

Highlighting geographical disparities in organ allocation and developing policies to correct imbalances

Identifying health disparities among black and Hispanic kidney donors and making recommen-dations for pre- and post- donation evaluation

Working with the St. Louis County Health Department to integrate behavioral health services into primary medical care, specifically for the under-served and underinsured

Researching with the Missouri Hospital Association trends in preventable hospitalizations

[ ]SLU’S Center for Outcomes Research strengthens

patient care through innovative research

MINING FOR THE

STANDARD

SOME OF SLUCOR’S PROJECTS

GOLD

17

F

Now Gonzalo is asking research questions about ‘triple negative’ breast cancer, a particularly deadly form of cancer that often strikes young women. The tumors associated with this type of cancer show DNA repair problems tied to BRCA1, a tumor suppressing ‘caretaker gene’ responsible for repairing DNA.

In her lab, Gonzalo dis-covered a new pathway that allows sick cells to continue to grow, and that may contribute to tumorigenesis, especially breast cancer. The pathway has the potential to serve as a predictive biomarker for how effective chemo- or radio-therapy will be. In addition, because Gonzalo’s group has identified compounds that inhibit this pathway, includ-ing vitamin D, the discovery offers the potential for new anti-tumoral therapies. Her recent Department of Defense grant will allow Gonzalo to continue her work in this area.

“Our next step, with this big grant, will be to charac-terize the process better, to understand how this pathway is activated and how we can reverse the pathway,” Gonzalo said. “Why it is turned on, and how we can turn it off?”

“The most exciting part of this work is that we may be able to develop ‘targeted’ therapies that bring us closer to individualized medicine.”

16 Grand Rounds 17

G R A N T S at a GlanceTerry L. Moore, M.D., rheumatology, has received a five-year, $1.8 million grant from the NIH for the project T-cell Activation by Immune Complexes and Comple-ment in Autoimmunity.

Stuart J. Slavin, M.D. (’83), curricular affairs, has received a five-year, $1.4 million grant from the U.S. Department of Health and Human Services for the project, Saint Louis University Urban Underserved MD/MPH Program and Medical Curriculum.

Richard John DiPaolo, Ph.D., molecular microbiology and immunology, has received a four-year, $720,000 grant from the American Cancer Society for the project, Regulation of Gastric Cancer in a Model of Autoimmune Gastritis.

Robert B. Belshe, M.D., infectious diseases and immunology, has received a five-year, $560,000 grant from EMMES Corporation for the VRC Master Clinical Office Agreement with the EMMES Corp.

“My parents made a pain-ful but wise decision to send me to a private school in the city,” Yap said. “Although they were not educated themselves, my parents knew that educa-tion was the only way their seven children could leave poverty behind.”

The risk of leaving the familiar paid off for Yap, and her research career has flourished. Joining SLU last fall from the National Institutes of Health, Yap is tackling antibiotic resistance, a growing problem due, in part, to overuse of antibiotics in livestock.

Yap is examining the mechanism by which the anti-biotic erythromycin “hijacks” the ribosome and turns on the synthesis of protein that promotes the drug resistance. She is searching for molecules that can reverse this process, findings that could lead to the discovery of a new class

of antibiotics and therapies to treat antibiotic resistant infections.

“During the past 10 years or so we have witnessed tremendous progress in ribo-some studies,” Yap said. “The molecular structures of the ribosome and the antibiotic-bound ribosome have been solved in atomic detail and were the areas for which the Nobel Prize in Chemistry was awarded in 2009.

“New technology has enabled a better understand-ing of ribosome dynamics and snapshots of almost every step of protein synthesis. The increasingly affordable deep-sequencing technology has allowed mapping of the ribosome position at a single-nucleotide resolution.

“These new tools definitely have opened up new avenues for research and facilitated discovery. This is an exciting era for ribosome biologists.”

And, as Yap plans to demonstrate, it’s an exciting time to reap the rewards of risk-taking.

“Many of the diseases that affect the human population, from cardiovascular disease to Alzheimer’s to cancer, are associated with aging in

that their incidence increases rapidly with age.”

Susana Gonzalo, Ph.D., assistant professor of biochemistry and molecular biology, begins her work with this idea, studying genome stability and aging in her lab. She recently received a $500,000 grant from the U.S. Department of Defense to study breast cancer from this perspective.

“Cancer is one of the most prevalent aging-related diseases,” Gonzalo said. “I am interested in understand-ing the changes that happen in the genome that contribute to the disease over time.”

When it comes to main-taining the integrity of the genetic information contained in the genome, Gonzalo’s work focuses on two key mechanisms for genome stability: DNA repair and telomere biology.

DNA repair mechanisms are in place to correct damage to the DNA. Failure to properly repair the damage compromises cell proliferation and viability, and can also cause alterations in the genome that will lead to disease. Telomeres are special structures at the end of chromosomes that protect them, like the plastic tips on shoelaces, from degradation or attack, or from fusion with neighboring chromosomes.

Though Gonzalo studied biology as an undergraduate, her passion for research truly began when she worked as a lab technician. “I fell in love with the idea of addressing a scientific question,” she said. “When I worked in the lab, I found I wanted to come up with my own questions and my own hypotheses. I knew I wanted to go back to school to learn more.”

Soon, Gonzalo did return to school, and educational and professional opportunities led her back and forth across the globe, from Washington University in St. Louis, to Madrid, where she was born, and back to St. Louis again.

Poised for Discovery

»

Frances Yap, Ph.D.Assistant Professor/Biochemistry and Molecular BiologyJoined SLU in 2011

Susana Gonzalo, Ph.D.Assistant Professor/Biochemistry and Molecular BiologyJoined SLU in 2012

left to right | Susana Gonzalo, Ph.D.and Frances Yap, Ph.D.

Big risks can lead to big re-wards, and biochemist Frances Yap, Ph.D., is set to prove the point in her lab. Earlier this year, Yap, assistant professor of biochemistry and molecu-lar biology, became the University’s first Pew Scholar for her work studying ribosomes and antibiotic resistance. The rigorously competitive Pew Charitable Trusts program backs promis-ing young scientists early in their careers.

“The Pew foundation is unique in that it encourages high-risk research that shows promise,” Yap said. “Though I don’t have a lot of preliminary data, the committee thinks what I want to do is feasible. This is an unexplored area.”

Born in the small Ma-laysian village of Kampung Api-Api, Yap spent her child-hood working on cocoa and long bean farms. As a child, she assumed her life would go on as she knew it: Following her parents’ path in farming. That thought quickly vanished when her parents, valuing education, made a decision to send her to a private high school.

»

»

1 Labeling of a cell nucleus to visualize telomeres (red), sites of unrepaired DNA damage (green), and dysfunc-tional telomeres (yellow). 2 Genomic instability as shown by fusion between chromosomes (blue) due to telomere (yellow) dysfunction. 3 2D-PAGE of E. coli proteome. 4 Isoelectric focusing analysis of alkaline proteins obtained from Off-gel electrophoresis.

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34

Living the Mission WE TREAT, GOD HEALS

Her first trip to Kenya in

2002 left Elizabeth Sugar-baker, M.D. (’91), numb. She felt powerless against the wave of poverty she witnessed along the four-hour drive from Nairobi to the Nyeri District, home to a growing number of orphanages. The HIV-AIDS pandemic killed most of the children’s parents. Those left behind were threatened by famine, unsafe drinking water and deadly diseases.

Sugarbaker, a pediatrician, traveled to Kenya with her sister, an ordained minister, to visit a lunch program created in 1998 for the impoverished residents of Nyeri. That lunch program, started in partner-ship with the Presbyterian Church of East Africa Riamu-kurwe Parish and Presbyterian churches in the United States, revealed the need for another orphanage, which led to con-struction of the Tumaini Chil-dren’s Home. These children also needed medical care.

“Initially I examined pa-tients in a feed shed or a little

shack, and the only equipment I had was what I could bring in my suitcase,” said Sugar-baker, an assistant professor of pediatrics at SLU School of Medicine. “My eldest daughter often came to Kenya with me and would triage patients prior to their physical exams. On one of our earlier trips, she borrowed a scale from the local market and hung it from a tree limb to weigh the children.”

Sugarbaker saw patients with mumps and measles for the first time in her career. She also saw children with malaria, severe malnutrition and HIV. At the end of her first two-week stay, Sugarbaker realized there was no one trained to use the equipment or medica-tions she brought, no one to follow the children’s growth and development or to admin-ister immunizations.

Sugarbaker felt the need for a permanent clinic was so urgent that she decided to leave her private practice and devote her time to establish-ing one.

“I love my patients here in St. Louis, but I thought I would have a far greater

impact on this world if I could help the Kenyan children and their families than I would in my day-to-day private practice,” she said.

Within a few years of Sugarbaker’s first visit to Kenya, and with support from many partners including the Outreach Foundation, Medical Benevolence Foundation and the Everett D. and Geneva V. Sugarbaker Foundation, ground was broken for a three-story clinic a short distance from the Tumaini Children’s Home.

“Part of our sustainability planning was to employ local residents to do the construc-tion,” Sugarbaker said. “If we built the clinic, it empow-ered no one. If they built the facility, it’s different. They are empowered and proud. They are personally invested in a more meaningful way.”

The clinic is the first and only community-based, specialized pediatric clinic in the Nyeri District. It offers free medical care to at least eight orphanages and provides affordable medical care to chil-dren and adults living in the surrounding areas. The clinic offers preventive medical care, including vision and hearing exams, immunizations, testing for communicable diseases, education programs, rural out-reach and health advocacy.

When the Kenyans placed the first cornerstone in 2005, they named the clinic the Sugarbaker Memorial Clinic for Children and Families in honor of Sugarbaker’s neph-ew, Everett M. Sugarbaker, M.D. (’00). He was a fourth-year SLU medical student who died of melanoma before he could receive his diploma. The clinic also stands as tribute to Sugarbaker’s father, Everett D. Sugarbaker, M.D. He was a surgical oncologist in Mis-souri who spent six-to-eight weeks a year relieving medical

missionaries abroad so they could visit their families in the United States.

“The continent my father never reached was Africa,” Sugarbaker said. “So when they dedicated the clinic, the Kenyan people said, ‘Your father is here now. He did make it.’”

Also honored in 2009 when the clinic opened was Sugarbaker’s eldest brother, Everett V. Sugarbaker, M.D. He donated the entire con-tents of his medical office to the clinic upon retiring from his surgical practice. He died suddenly as he was preparing for his first trip to Kenya.

On the first floor, the Sugarbaker clinic has outpatient services, a lab and pharmacy. The second floor offers housing accommodations for visiting medical providers from throughout the world. The third floor is equipped with Wi-Fi and seminar facili- ties to provide educational opportunities for local medical providers, nurses and childcare workers.

Elizabeth Sugarbaker travels to Kenya annually to care for the children, but she also spends time building partnerships with governmen-tal health agencies; medical schools; hospitals in Nairobi and in the Nyeri District; local medical officers; and interna-tional medical volunteer organizations. Last year, she took a group of School of Medicine residents with her to work in the clinic and learn about common illnesses in the area. This year, the Everett D. and Geneva V. Sugarbaker Foundation established a scholarship program for fourth- year students at the School of Medicine who are interested in global medicine. The scholar-ship allows them to travel to developing countries and build this type of service into their medical careers.

19 Grand Rounds Saint Louis University School of Medicine

As my 45th medical school reunion approached this fall, I found myself reminiscing about our class coming together late in the hot summer of 1963. We faced the initial trials of gross anatomy

and histology, and the further challenges of our pre-clinical years. But those long days and late nights studying were inter-spersed with some fun. Who can forget the fraternity houses, Frank’s on Lafayette, The Pelican, Uncle Bill’s Pancake House,

Hodak’s, Rigazzi’s, Laclede Town, Gaslight Square, Firmin Desloge and City Hospital? (To name just a few iconic haunts.) What a great time! And then there were the class skits. Well, that’s for another issue of Grand Rounds.

We had less time for socializing during our clinical years. We were busy being exposed to various specialties and to the challenges that came with that exposure, including night call. Finally, the big decision about how we would spend our futures culminated at graduation in May 1967.

And what a future that turned out to be! Think about your career. Think about the opportunity Saint Louis University gave you and every other graduate with that diploma. That future began at graduation when we became members of the Medical School Alumni Association. At this time we are almost 10,500 members strong, including medical school and residency program graduates. In addition to our numbers, we have grown in outreach efforts, including enhanced reunion events each year. I had the privilege of organizing my class events for our ninth gathering since graduation. The friendships I have formed with classmates over the years are priceless and keep me connected.

I urge all of you to stay connected and involved with your respective classes as well. Volunteer as a class representative or organizer, assist with reunion events or become a class caller. You have a great resource, as our Medical Alumni Office stands ready to assist your class at anytime, reunion year or otherwise.

Memories of medical school are different for each class. No matter what year you graduated or what experiences are etched in your memory, remember that Saint Louis University School of Medicine gave all of us these memories and opportunities.

From Your Alumni Association President EDWARD J. O’BRIEN JR., M.D. (’67)

“I would love for SLU students to come to Kenya to see the clinic because the clinic established a model that is helping our Kenyan partners grow toward self-sustainabili-ty,” she said. “This model can be reproduced anywhere they see a need or anywhere they may be asked to help in the future. It’s about partnering with people, giving them a sense of ownership and empowering them through education to uphold high standards of health care in their own country.”

AlumniPulse

O’Brien

left | Sugarbaker speaks to Kenyan attending physicians and pediatric

residents at Gertrude’s Children’s Hospi-tal in Nairobi about the different etiologies of hyperbilirubinemia.

Sugarbaker and her School of Medicine pediatric residents attended morning

rounds at various pediatric hospitals in Nairobi and in the Nyeri District during

their visit last spring.

top | Laura Waters, M.D, School of Medicine pediatric resident, with a

patient outside the Sugarbaker clinic.

middle| Sugarbaker and School of Medicine residents Laura Waters, M.D.,

and Austin Dalrymple, D.O., attended morning rounds at Tumutumu Hospital

in Karatina. The Sugarbaker clinic has established a partnership with the

hospital to provide care for families in the area.

bottom| The three-story Sugarbaker clinic.

Join us for Med Reunion 2013: Oct. 17-19

In Memoriam

FACULTY OBITUARIES

Denis Cavanagh, M.D. 1924-2012 Denis Cavanagh, M.D., SLU’s first full-time chairman of the department of obstetrics and gynecology, died in July at the age of 88.

A gynecologist who specialized in cancer care, Dr. Cavanagh chaired the department from 1966-1971

and from 1973-1975. Robert Blaskiewicz, M.D. (’75), pro-fessor of obstetrics, gynecol-ogy and women’s health, was a student and resident when Dr. Cavanagh was department chairman.

“I consider him to be one of the giants of our medical school heritage. He was a role model in many ways,” Blaskie-wicz said. “He was beyond a doubt the best pelvic sur-geon I ever worked with. Dr. Cavanagh was an internation-

ally recognized gynecologic oncologist and was a staunch pro-life physician.”

Dr. Cavanagh was rec-ognized for his expertise in septic shock and developed a primate model used to study preeclampsia. A prolific writer and researcher, Dr. Cavanagh wrote or was the co-author of four textbooks, 40 textbook chapters and about 240 articles in medical journals.

Matt Backer, M.D., profes-sor emeritus of obstetrics,

gynecology and women’s health, credited Dr. Cavanagh with helping to build a stellar department.

“He contributed to the teaching program and brought in world renowned specialists. In this city, beyond question, he was the top gynecologic oncologist,” Backer said. “He would regale you with jokes and stories and loved to sing.”

Dr. Cavanagh was born in Scotland and received his medical degree from the

John Schweiss, M.D. 1925-2012John Schweiss, M.D. (’48), a retired professor of surgery and pediatrics and the first chair-man of the anesthesia section in the department of surgery at the School of Medicine, died in May at the age of 86.

After graduation from SLU School of Medicine, Dr. Schweiss completed his internship at St. Mary’s Hospital in St. Louis and residency at Columbia Presbyterian Hospital in New York City. In 1952, Dr. Schweiss

joined the SLU faculty in the department of surgery, where he taught until his retirement in 1996. In addition, he was the chief

of anesthesiology at SSM Cardinal Glennon Children’s Medical Center until his retire-ment. He also was a physician with the U.S. Navy during the Korean War.

During his more than 40 years at the University, he was a professor of surgery and pediatrics in the anesthesiology section, where he served as the first chairman of the group.

“He was greatly loved and highly respected because of his intellect and commitment to the department of anesthesiol-ogy and our specialty,” said Gary Haynes, M.D., Ph.D., chairman of the department of anesthesiology and critical care medicine. “He was a giant among giants when it came to doctors who made SLU an outstanding place.”

DECEASED ALUMNI

Michael Buckley, M.D. (’37)

Sam Rabinovitch, M.D. (’39)

Eugene Dmytryk, M.D. (’41)

Wilfred Guerra, M.D. (’41)

Louis Kraemer, M.D. (’42)

Arthur Daniel, M.D. (’43)

Otto Stegmaier, M.D. (’43)

William Fitzpatrick, M.D. (’45)

Raymond LaDriere, M.D. (’45)

John McGonigle, M.D. (’48)

Leo Strutner, M.D. (’48)

George Brennan, M.D. (’49)

Paul George, M.D. (’49)

Charles Hoffman, M.D. (’49)

Robert Stevens, M.D. (’49)

Myron Szczukowski, M.D. (’49)

Michael Beirne, M.D. (’51)

James Foster, M.D. (’51)

Mitchell Harkins, M.D. (’51)

Edwin Neville, M.D. (’51)

Peter Kinsella, M.D. (’52)

William Byrd, M.D. (’54)

George Russo, M.D. (’54)

John Waldhausen, M.D. (’54)

John Lynch, M.D. (’55)

David Beato, M.D. (’56)

Paul Babcock, M.D. (’58)

James Kilway, M.D. (’58)

Robert Bregant, M.D. (’59)

Ronald Turner, M.D. (’59)

Donald Adams, M.D. (’60)

Joseph Emmite, M.D. (’62)

Norman Chernik, M.D. (’65)

Roger Doak, M.D. (’65)

Lawrence Leff, M.D. (’67)

George Viamontes, M.D. (’90)

University of Glasgow in 1952. Other than his time at Saint Louis University, he spent most of his medical ca-

reer in Florida. Before coming to SLU, he was a professor of obstetrics at the University of Miami. He left SLU to serve as director of gynecologic oncology at the University of South Florida from 1977 to 1999, and later became the chief of gynecologic oncology for Tampa General Hospital and the H. Lee Moffitt Cancer Center.

Robert E. Olson, M.D. 1919-2011Robert E. Olson, M.D., for-mer Alice A. Doisy Professor and chairman of the depart-ment of biochemistry and molecular biology, died in August 2011. He was 92.

After his Ph.D. studies in the biochemistry department at the School of Medicine, Dr. Olson spent two years in the Navy during World War II. Upon returning from the war, Dr. Olson was awarded an instructorship in biochemistry

and nutrition at Harvard Medical School, where he earned his M.D. in 1952. While at Harvard, Dr. Olson studied the effects of

vitamin deficiencies on cardiac metabolism, which became a major theme of his research.

Dr. Olson left Harvard to become professor and chairman of biochemistry and nutrition at the University of Pittsburgh School of Medicine. In 1965 he returned to the SLU to chair the department of biochemistry and is credited with significantly expanding

the department by recruiting 28 faculty members during his 17-year tenure.

“He was known for his irascibility in championing causes that he viewed as important to the teaching and research interests of his department,” said Carmine Coscia, Ph.D., professor of biochemistry and molecular biology. “He was a charismatic leader and an excellent educa-tor.”

Dr. Olson published 222 papers and 89 books chapters on experimental and clinical nutrition, cardiac metabolism, lipid transport and the bio-chemistry of isoprenoid lipids. From 1967 to 1977, he served as director of the Anemia and Malnutrition Center in Chiang Mai University, a center he help found to study protein-calorie malnutrition in children of northern Thailand.

Dr. Olson received nu-merous awards for his work including the E.V. McCollum Award for original nutrition research from the American Society of Nutrition, the Joseph B. Goldberger Award in Clinical Nutrition from the American Medical Association and the School of Medicine’s highest teaching honor, the Golden Apple, in 1972.

Although Dr. Olson left SLU in 1982 to serve at other medical schools, he frequently returned to the school to attend the annual lecture series named in his honor and was an eager participant in discussions of the research presented.

School of Medicine Alumni Events

March 19 American Academy of Orthopaedic Surgeons – Chicago

April 5 Missouri State Medical Convention – Kansas City

May 2 John H. Gladney, M.D., Diversity Award Reception

May 4 American Urological Association Annual Meeting – San Diego

Continuing Medical Education

Oct. 31 - Nov. 1 Topics and Case Studies in Advanced Pediatric Sleep Medicine

Nov. 9 Midwest Pediatric Trauma Conference 2012

Nov. 30 - Dec. 2 Craniofacial Surgery and Transfacial Approaches to the Skull Base

Dec. 1 The Best of the American Association for the Study of Liver Disease

Feb 1 - 2 St. Louis Hip Skills Course: Hip Arthroscopy and Hip Impingement Procedures

Feb. 8 - 10 Fundamentals and Advanced Techniques in Cosmetic Blepharoplasty and Non-surgical Periorbital Rejuvenation Techniques

Feb. 21 - 23 6th Annual Cervical Spine Research Society Hands-on Cadaver Course

Feb. 28 - March 2 5th World Congress on Cerebral Revascularization and 12th Annual Hands-on Workshop: EC-IC Bypass and Microanastomosis Techniques

March 4 - 8 Microsurgery of Aneurysms: Recent Advances

March 9 Resident Update in Rhinology

For information on alumni events, please contact the Alumni Relations Office at 314-977-8335 or visit medschool.slu.edu/alumni/.

For information on the CME programs, please call the SLU School of Medicine continuing medical education office at 314-977-7401.

See updates and details about Practical Anatomy and Surgical Education Workshop programs at medschool.slu.edu/cme/.

Cavanagh

Olson

Schweiss

20 Grand Rounds Saint Louis University School of Medicine

Show your school colors www.clubcolors.com/slu

MARK

CALENDARYOUR

Breakfast with Santa Dec. 2 Wicked at the Fox Theatre Dec. 16 Easter Egg Hunt March 30

...and many many more, visit slu.edu/alumni/.

Don’t miss these upcoming SLU alumni events, in St. Louis.

View of the Joan and Joseph Lipic Cloister Walk photographed from the top floor of the Edward A. Doisy Research Center. At more than 300 feet, the brick and concrete structure is the longest covered walkway on Saint Louis University’s campus.

Giving really does change lives.Though the amounts and the reasons may vary, there’s one thing all gifts have in common: Together they make a world of difference to Saint Louis University.

Make your gift by using the envelope enclosed in this issue of Grand Rounds or online by visiting giving.slu.edu.

If you’ve already made a gift to SLU, thank you.

Please visit giving.slu.edu/igive and tell us your reason for giving.

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St. Louis, MO 63103

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PAIDSt. Louis, MOPermit No. 134

“It’s in my blood! As a third generation SLU

MD, I want to make sure the School of Medicine continues to train great doctors for the future.”

DR. TOM LIEB (’82)