A heartfelt welcome, some good advice for navigating USF Graduate Medical Education program, and a glimpse of the hard realities found in today’s health care system were part of the morning for 225 new resident physicians taking part in their orientation, held June 30 at the Embassy Suites on the USF campus.

The orientation precedes the July 1 start day for when resident physicians across the country begin their training and when USF residents are deployed to the many clinical facilities and hospitals throughout the Tampa Bay area affiliated with the USF Health Morsani College of Medicine.

Setting the stage for the greater demand for providing higher quality care over total costs, residents were urged to be cautious in their expenditures and more cognizant of individual patient outcomes by Charles Paidas, MD, professor of surgery and vice dean for Graduate Medical Education (GME) at MCOM.

“So for 10 minutes we’ve been talking about (improving the use of health care) money, but really we’re talking about culture,” he said. “Transformation of how we take care of patients is no longer ‘I have to see a whole bunch of patients’ but is now ‘each patient that I see has to be a quality, grand slam, homerun hit.”

USF’s residency program has more than 80 residency and fellowship training programs with more than 700 trainees.

This year’s entering group includes 225 physicians, with 145 residents and 80 fellows. Of the residents, about half are entering their first year of residency. Called PGY1s (post graduate year 1), these physicians are experiencing the first day of their medical careers – they just graduated from medical school a few months ago. In residencies, newly graduated medical doctors transition to the next phase of their education. Unlike in medical school, when decision making was ‘virtual’ and practiced in the shadows of the care team, residencies have the responsibility shift to these new doctors.

The other incoming residents are beginning the next step in their residencies, transitioning to a narrower focus within their specialty. Fellows have finished their residencies and are now conducting additional, more specialized training within their specialty. Fellowships are typically highly competitive positions in superior programs. While most of the new resident physicians are from MCOM (41), the rest are graduates of schools and programs from farther afield, including China, India, Japan, South Korea, Spain, and Thailand, among others.

One new resident didn’t have to travel far; Neil Manimala, MD, is an alum of USF Health MCOM and is specializing in urology. He said his choice for USF’s urology residency was easy.

“I chose to stay at USF because I believe it is one of the best urology programs in the country,” Dr. Manimala said. “Our residents are thoroughly trained to be both quality-driven clinicians and effective educators of patients and junior physicians alike.  From the high-tech robots to the more basic tools of the field, we are empowered to deliver what is truly the best urological care that the region has to offer. From TGH to the VA to Moffitt, our faculty are among the best. I’m excited to work with the USF Urology family in the years to come.  Furthermore, in my time in this city, I have been a witness to the unstoppable growth and development in Tampa Bay.  As we move our college to the heart of this city, I’m honored to be a part of that growth.  The sand, sun, and diversity don’t hurt either. I’m looking forward to giving all the people in this community — from my co-residents and our faculty to my patients and their families — my absolute best.”

Dr. Paidas concluded his orientation remarks with three words he asked the room full of new doctors to remember across their residencies, along with the lesson on value from earlier in the morning: Safe, team, and commit.

“These are the three words I want to leave you with besides value,” he said. “We want to graduate as a safe doctor, be able to work in a team, and commit to your obligations of lifelong learning, to your patients, to your peers and students, your department, and the USF Health Morsani College of Medicine.”

This year’s residents and fellows totaled 225. About 45 percent are starting at Tampa General Hospital, 25 percent at the Haley VA Hospital, 15 percent at Moffitt Cancer Center, and the remaining are at various other sites. Internal medicine welcomed the largest number of new residents and fellows, with 86, followed by surgery, with 25.

Here is a breakdown of the entire group:

Dermatology, 5

Family Medicine, 9

Cardiology, 7

Internal Medicine, 86

Neurology, 13

Neurosurgery, 4

Obstetrics and Gynecology, 8

Ophthalmology, 3

Orthopaedics, 7

Otolaryngology, 2

Pathology, 7

Pediatrics, 17

Plastic Surgery, 3

Psychiatry, 9

Radiology, 20

Surgery, 25

Photos by Eric Younghans, USF Health Office of Communications

USF surgeon Dr. Charles Paidas reconstructed Kaitlin Smith’s intestines, fixing a problem that had haunted the teen her entire life

Kaitlin Smith earned great grades and awards in middle school and was at the top of her class – all signs of a smart and driven teen.

Kaitlin Smith, 16

But friends and family of this 16-year-old didn’t realize she managed this success while feeling constantly nauseous, frequently throwing up and, in essence, starving because of an unknown blockage in her intestines.

Stronger clues began to appear as she entered high school – fatigue that bordered on exhaustion and her already-thin body began to look emaciated. With Kaitlin’s struggle intensifying, her family took action.

***

Nearly 16 years ago Kaitlin was born with a blockage in the first portion of her intestine just beyond her stomach. For her first 10 days after being born, she constantly vomited. Using an endoscope, doctors discovered that liquid would not go beyond her stomach – it stayed in her stomach until newborn Kaitlin threw it up. Two emergency surgeries were required to open the blockage (called an atresia), allowing her to keep food down.

Since that neonatal series of operations, Kaitlin’s family watched her grow, thinking that her digestive problems were gone. Across her childhood, Kaitlin thought the same. Sure she still felt nauseous and was always tired. But she didn’t realize that was abnormal – she thought everyone felt that way, too. And she never complained, so her family didn’t realize just how much she was struggling.  Turns out that, despite two attempts at reconstruction as newborn, the opening in her intestine continued to narrow.

//www.youtube.com/watch?v=Gzc-ILUhMpw

How could her mental state stay so strong? That’s the question Kaitlin’s grandmother asks now, looking back.

“It was amazing she was able to survive like this for so long,” said Nita Wombles. “But she’s not a quitter. She never complained of being nauseated and she ate like a bird. She was very thin, but so is her mom and dad.”

As Kaitlin started high school, it became obvious to those around her that her health was deteriorating rapidly. A family doctor in their hometown of Lakeland referred her to a specialist in Tampa, who then directed her to Dr. Charles Paidas, chief of the Division of Pediatric Surgery for the USF Health Morsani College of Medicine.

USF Health pediatric surgeon Dr. Charles Paidas with Kaitlin, who is thriving following the reconstruction of her digestive tract.

***

Kaitlin’s third operation was in June of 2014. She was exhausted but had tremendous hope – the problem that had haunted her for her entire life was very likely fixable. She knew she was in the right place with the right surgeon.

Just before the operation, she told Dr. Paidas how much she believed in him.

“What a great way to go into the operating room,” Dr. Paidas said.

The operative plan was fairly straightforward but, like many procedures, the plan going in isn’t always what ends up playing out.

“Every endoscope and image using a contrast agent had us all convinced she had a dilated stomach and that everything beyond the stomach was fine, that maybe it was residual scar tissue from her previous surgery creating an additional blockage,” Dr. Paidas said.

“But once we were in, we saw that not only was the stomach dilated but also the entire loop of intestine beyond the stomach, called the duodenum, specifically the first and second portions of the duodenum that borders the pancreas. There was only a pinhole for any food and nutrition to pass through and, as a result, the redundant dilated duodenum and stomach was the root cause of her problems.”

According to Dr. Paidas, the procedure involved tapering the enlarged duodenum, narrowing the section that leaves the stomach and re-opening a pathway to the rest of her intestinal tract. The reconstruction required careful navigation to prevent blockage of bile into the intestinal tract from the nearby pancreas and liver ducts that open right where the problem originated.

Dr. Paidas helps explain Kaitlin’s digestive problem with a sketch on examination table paper.

“Once we dissected all the intestine and scar tissue and assessed normal and abnormal organs, we carefully tapered and reconnected,” he said. “The result is that the stomach and duodenum are now the correct size, functioning properly, and in continuity to pass early digested food on to the intestines, like normal children, giving Kaitlin a working digestive tract for the first time in her life.”

Kaitlin’s condition affects one in 4,000 live births and is part of a spectrum of duodenal anomalies that occur in the first 8 to 10 weeks in-utero.

“During pregnancy a classic double-bubble is suspicious for duodenal atresia but we typically do not do any in-utero reconstruction, but rather wait until the baby is born because there may be associated anomalies,” Dr. Paidas said.

So while Kaitlin’s condition is fairly common in neonates, being treated in her teens places her in a very rare category, a point that likely drew added attention from the teams of health care providers making rounds at TGH during Kaitlin’s two-week stay following surgery.

“After a while, we built a bond with everyone,” Wombles said. “We understand it’s a learning process so we didn’t care who they brought around. We want others to have the knowledge, especially because she was a rare case.”

***

Nearly two years now has passed since the procedure. Kaitlin has thrived, is in her junior year of high school, and is getting great grades and awards.

“There are no words to express how thankful we are to Dr. Paidas and his entire surgical team for their professionalism,” Wombles said. “How does one say ‘thank you’ to someone who gave you back your granddaughter?”

And her gratitude goes beyond this one surgeon.

“We are also grateful to Tampa General Hospital, the entire staff, nurses, Kristyn our Pediatric Surgery nurse practitioner, Intensive Care Unit team, everyone!,” Wombles said. “I spent a great deal of time there, day and night, and I was so impressed with the staff. They are very professional and at the same time so thoughtful, considerate and kind. USF and TGH are so very fortunate to have Dr. Paidas here in the Tampa area. May God continue to bless him and his entire team as they strive to save our children and grandchildren.”

***

Throughout interviews Kaitlin remained fairly quiet. Somewhat shy or just a low-key teen, she would offer only a few words, letting her grandmother help tell her story.

But gratitude poured out in a letter from Kaitlin describing her thanks to Dr. Paidas and the USF Health and Tampa General teams:

Before the surgery, it was difficult to function. Hardly a day would go by that I did not get extremely fatigued. Though I maintained “highest honors,” academically it was hard to focus.  However, a few weeks after the surgery, the days passed easier. I could think more clearly and did not get fatigued as easily. To my surprise, on most days I wasn’t even fatigued at all. I am now able to pursue interests that would not have been possible before.

Dr. Paidas, his team, and the staff at Tampa General Hospital were extraordinary throughout the entire surgical process. My expectation was that the experience would be impersonal because of the medical staff’s hectic schedules and the amount of patients that are seen on a daily basis. However, my expectation could not have been further from the truth. I felt a personal connection with Dr. Paidas and his staff and I felt as though they cared, and still do care deeply about my wellbeing.

Sometimes people do things for you that make it hard to think of a way to say “thank you” properly.  Before the surgery my goal was to be a psychologist.  I am now directing my attention to surgery or in forensic pathology so I can help people regain their health or to find out why things go wrong and be a part of the solution. I am currently an intern at the Polk County Medical Examiner’s office.

Thank you Dr. Paidas!

Kaitlin Cierra Smith

Photos and multimedia by Eric Younghans, USF Health Office of Communications

Three words: Safe. Team. Commit. That’s the message Charles Paidas, MD, urged more than 230 new resident physicians to take away from their recent all-day orientation, their official welcome to the USF Health Morsani College of Medicine (MCOM).

“If you remember nothing else about the next 15 minutes, I want you to remember those words,” said Dr. Paidas, professor of surgery and vice dean for Clinical Affairs and Graduate Medical Education at MCOM. “These are your goals for your residency. Graduate as a safe doctor, be able to work in a team, and commit to your obligations of lifelong learning, your patients your peers and students, your department, and the USF Health Morsani College of Medicine.”

The June 30 orientation at the USF Alumni Center and was likely be the only time the entire group will be in the same room together. The next day – July 1, the national start to residency training programs – the new-to-USF residents were deployed to the many clinical facilities and hospitals throughout the Tampa Bay area affiliated with the USF Health Morsani College of Medicine.

This year’s entering group includes 238 physicians, with 147 residents and 91 fellows. Of the residents, about half are entering their first year of residency. Called PGY1s (post graduate year 1), these physicians are experiencing the first day of their medical careers – they just graduated from medical school a few months ago. The other incoming residents are beginning the next step in their residencies, transitioning to a narrower focus within their specialty. Fellows have finished their residencies and are now conducting additional, more specialized training within their specialty. Fellowships are typically highly competitive positions in superior programs. While most of the new resident physicians are from MCOM (40), the rest are graduates of schools and programs from farther afield, including China, Colombia, Taiwan, Bangladesh, Thailand, and Mexico, among others.

The annual influx of new residents and fellows marks a significant moment for these doctors, but probably a bit more so for the PGY1s. It’s when the paradigm shifts, Dr. Paidas said.

“As a medical student, decision making was ‘virtual’ and practiced in the shadows of the care team,” he said. “Now, the responsibility shifts to the intern, or first-year resident. Although not completely in charge, the first-year resident has graded responsibility and team trust is earned and rewarded with more responsibility. The first-year is all about learning the drill.

“And it’s the very first time an office or hospital patient looks at you as one of their docs, begins to develop a relationship with you, and trusts what you say.”

One such resident is Lindsey Ryan, MD, a PGY1 from the University of Louisville in Kentucky. Her first day included making early rounds at Tampa General Hospital with a team from Pediatric Surgery.

Dr. Ryan, who is specializing in otolaryngology, said that USF’s program rose above others when she was interviewing residency programs.

“On interview day, you look for a program you will fit into,” Dr. Ryan said. “That’s a big thing. There are great programs all over, but it’s that extra piece you look for. I loved the program and the faculty here and I felt right at home.”

Fitting right in on rounds at TGH, Dr. Ryan walked in and out of pediatric patient rooms with the health care team that included more seasoned residents, a chief resident, an attending physician, a nurse practitioner, and a USF medical student. These are the first patients she is seeing as a physician, a realization she doesn’t miss.

“I’m having a very good day,” she said.

USF’s residency program has more than 80 residency and fellowship training programs with more than 700 trainees. The program is considered strong, Dr. Paidas said.

“It’s all about the depth and breadth of patient populations,” he said. “The USF affiliates attract a wealth of patients and provide the substrate for the maturation of the resident. Tampa Bay has historically been an attractive geographic locale. In addition, we have a superb clinical faculty able to balance their work with patient care and education. Think about it. Our affiliates include the Number One ranked hospital in the State, level 1 Pediatric and Adult trauma Center, Comprehensive Cancer Center, two VA’s, Family Health Clinics. Our affiliates give us an unbelievable depth of patients.”

This year’s residents and fellows totaled 238. About 45% are starting at Tampa General Hospital, 25% at the Haley VA Hospital, 15% at Moffitt Cancer Center, and the remaining are at various other sites. Internal medicine welcomed the largest number of new residents and fellows, with 73, followed by surgery, with 25.

Here is a breakdown of the entire group:

Dermatology, 5

Emergency Medicine, 10

Family Medicine, 10

Cardiology, 7

Internal Medicine, 73

Medicine / Pediatrics, 6

Neurology, 18

Neurosurgery, 4

Obstetrics & Gynecology, 7

Ophthalmology, 5

Orthopaedics, 7

Otolaryngology, 3

Pathology, 8

Pediatrics, 15

Preventive/Occupational Medicine, 2

Psychiatry, 13

Radiology,20

Surgery, 25

Story by Sarah Worth, and photos by Sandra C. Roa, USF Health Office of Communications.