Authors often compare publishing a book to birthing a baby – a metaphor that is even more apt when the book in question is THE medical textbook on high-risk pregnancy, delivery, and fetal health.

At 1,494 pages, the 9^th edition of Creasy & Resnick’s Maternal-Fetal Medicine: Principles and Practice weighs in at 9.79 pounds – a good two pounds heftier than the average newborn baby. Clad in a glossy purple cover, it is a book that demands attention on any shelf.

“I should have warned you guys to bring a wheelbarrow for your books,” joked Dr. Judette Louis, professor and chair of Obstetrics and Gynecology (OB/GYN) at the USF Health Morsani College of Medicine and one of seven co-editors of the newest edition.

The department celebrated the publication of the new edition with a book-signing breakfast Wednesday for its trainees: 24 OB/GYN residents and four fellows in Maternal-Fetal Medicine (MFM). Both Dr. Louis and Dr. Charles J. Lockwood, dean of the Morsani College of Medicine and executive vice president of USF Health, were on hand to sign each copy. The publisher describes the book as “the definitive reference in the field for more than 35 years.”

“I am incredibly honored that Drs. Creasy and Resnik honored me as the new chief editor,” said Dr. Lockwood. He noted that the book would be 400 or so pages longer if it included all the references, which are only listed online.

“It’s definitely a great weight-bearing exercise,” joked Dr. Lockwood about the textbook’s heft.

Jokes aside, the residents said the book signing was a nice recognition that the physicians they are learning from are among the nation’s top experts.

“Knowing that we have some of the best mentors in the field as we go on to our careers – I think it’s inspiring,” said resident Dr. Rachelle Price, who will start her MFM fellowship next year.

“It’s amazing,” said Dr. Danielle Hardman. “I went to medical school here, so Dr. Lockwood’s been here during all my time here. It’s an honor” to have her textbook signed by him.

Resident Dr. Brittany Manobianco said one of her friends, who is going into MFM, was especially excited to get her copy.

“This is her Taylor Swift tour,” she proclaimed.

Perhaps fortunately, Ticketmaster did not work on the books – but the editors definitely did. Each editor was assigned a different section of the book, which includes chapters by a variety of authors who are experts on a variety of maternal and fetal high-risk conditions, such as premature labor and pregnancy-related hypertension. Editors conducted multiple levels of review and fact checks to ensure that each chapter reflects the latest science, evidence and best practices.

And then they proofed it all over again.

“I read every word in this book,” Dr. Lockwood said. “Every. Single. Word.”

Just how familiar is Dr. Lockwood with Creasy & Resnick?

Back when he was an MFM fellow himself, Dr. Lockwood studied the textbook’s first edition.

Photos by Allison Long, USF Health Communications.

For the first time, the exercise brings together students from all USF Health colleges.

Living in the moment is a way of life that countless people strive to achieve, but for those living in poverty, the concept takes on a much more somber meaning. If someone is struggling to make ends meet, their daily life is so stressful that they’re probably not thinking about or planning for the long term.

Every day, health care professionals come face-to-face with patients in poverty and in order to teach students empathy and an understanding of these barriers, USF Health Morsani College of Medicine Office of Student Diversity and Enrichment hosts poverty simulations. This training is in its sixth year, but this year is the first with an interprofessional mix of athletic training, medical, nursing, public health, pharmacy, physician assistant, and physical therapy students, as well as residents, and fellows. At the end of 10 sessions provided in the 2018-19 academic year, about 840 people will have participated.

The local American Legion Post donated its community hall to accommodate the large groups of students and volunteers.

Based on a simulation activity from Central Missouri Community Action, participants have the opportunity to experience life in the shoes of a fixed, limited-income family.

Shirley B. Smith, MA, Director of the Office of Student Diversity and Enrichment for MCOM, begins the activity by instructing the group to take it seriously because, “these are real people who have lived this experience.”

The students were assigned to fill various family roles, with identities ranging from seniors living alone to single-parents and blended families. Each family struggles with barriers such as unemployment, disabilities, and transportation. Over the course of a simulated four weeks, the families’ priorities are shelter, electricity, food, and keeping the family together.

The assigned identities range from single seniors living alone to single parents and blended families. Some are recently unemployed or struggling with disabilities.

A variety of resources are offered to the families by volunteers stationed around the community center room.  The volunteers simulate the roles of bankers, grocery store clerks, hospital staff, social service workers, and a pawn broker. Over the course of the activity, participants may run out of time or money, or even just forget to pay rent or buy groceries. One family was visited by law enforcement after she forgot to pick up her child from day care. Another family pawned their furniture for extra money. At least three families were evicted.

“This experience gives insight to health care workers, because sometimes we don’t know what is going on in a patient’s life and how it’s affecting their treatment or compliance,” said Brolivia Harvey, an adjunct faculty member in the College of Nursing.

Volunteers staff the resource tables that represent businesses such as banks, groceries, social service agencies, pawn brokers, and quick cash operators.

Participants without private transportation have to budget for public transportation passes needed to get to each resource station.

Just like in real life, when the rent is not paid, families are evicted.

At the end of the interprofessional education simulation, the participants sit down for a debrief. More than half of the students raised their hands when asked if they felt stressed or anxious during the experience. One student shared that she felt a “sense of insecurity” the entire experience and how you don’t realize the mental health strain it’s having on you or your children.

“I think the poverty simulation made everyone more aware of the struggles that people go through. We saw how much had to be accomplished in one day and that someone living in poverty may have to choose to pay rent instead of buy their medication,” said Rumour Piepenbrink, a first-year public health student.

“It was an eye-opening and humbling experience. I felt an array of emotions from frustration to gratitude for what I have,” said Ashley Reed, a fourth-year nursing student.

First-year public health student Rumour Piepenbrink visits the payday advance quick cash station.

Fourth-year nursing student Ashley Reed speaks with the volunteers at the simulated hospital.

During debrief, the group discussed how they can apply the lessons they learned from the poverty simulation to their health care careers:

• Don’t judge your patients.
• You have to consider the situation your patient is coming from to best help them.
• Be aware of local resources to refer a patient in need.
• Besides providing a resource to help a patient right now, empower them for the future.
• Teach patients the importance of long-term health.
• Physician burnout can happen when you do not deal with not being able to help everyone.

“Don’t ever get to the point where you’re numb to the poverty or problems of the people in the community,” said Priscilla Perez, a case manager for Positive Spin, a community-based social service agency that assists children and families to live healthy, and long-time poverty simulation community partner. “Helping a patient is more than just taking care of the reason for their visit,” she added.

Students are not the only ones participating in the poverty simulation. A session in April will include USF Health leadership and faculty.

“At USF Health, we are committed to preparing health professionals who recognize the importance of interprofessional team-based care, not only in the clinical setting but also in working together to address the social determinants of health in the communities we serve. Engaging our faculty in this intensive training will help us be better teachers and encourage us to recognize and emphasize the important role that every member of the team plays, including our patients and our community partners,” said Donna Petersen, ScD, senior associate vice president of USF Health and dean of the College of Public Health.

USF Health students, residents, and fellows debrief after the poverty simulation.

-Multimedia story by Torie Doll.

Participants in the first full USF Health Graduate Medical Education program’s Patient Safety Workshop are searching a simulated patient room for as many safety hazards as possible.

In a standard hospital room lie dozens of potential dangers threatening the well-being of the patient.  It’s up to every member of the health care team to mitigate these dangers to ensure the safest environment possible.

USF Health’s Graduate Medical Education program hosted a Patient Safety Workshop on April 24 to help residents identify possible causes of patient care errors and learn how to effectively communicate those errors, as well as teach protocols and mechanisms that allow all members of the health care team to speak up.

“What this workshop is trying to emphasize is how to address these issues from a systems perspective while continuing the resident’s medical education,” said Cuc Mai, MD, assistant dean for the USF Health Morsani College of Medicine Graduate Medical Education program.  “At the end of the day, patient safety is the most important thing to a health care team.”

Yilmarie Rosado-Acevedo, MD, a pediatrics intern at the USF Morsani Center for Advanced Healthcare, notices an air-tube around a mannequin’s neck during the USF Health GME Patient Safety Workshop.

One highlight of the workshop was the simulated hospital room riddled with patient safety hazards the physicians had to identify.  Many were obvious, like the sharps sticking out of a biohazard disposal bin, and others required much more attention to identify, such as the patient not wearing non-slip socks and latex gloves mixed with non-latex gloves.  While a scenario like that is unlikely, the importance of being able to detect those hazards proved important to the participants.

“The workshop is a very important tool that will be a great help to all of us,” said Arash Naghavi, MD, a USF radiology oncology resident at Moffitt Cancer Center.  “You can never be too safe when it comes to patient safety.”

A patient’s call remote on the floor is a major safety issue in the patient room.

During the workshop, held at the USF Health Center for Advanced Medical Learning and Simulation, the group also discussed methods of effectively communicating patient safety events to hospital administration, patients and families.  When incidents that threaten patient safety get reported, they can be used to identify vulnerabilities within a system and are often drivers to change them, according to Dr. Mai.

To finish, the residents conducted a root cause analysis, often used to understand the causes of an adverse event and identify flaws in the system that can be fixed to prevent medical errors from happening again.  “This is about preventing future events, not blaming or punishing people for what happened,” Dr. Naghavi said.

This first full workshop, with 13 participants from residency training programs in internal medicine, neurosurgery, and radiation oncology, followed a successful pilot workshop in early April.  The Graduate Medical Education plans to schedule more throughout the year to train all incoming residents.

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.