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Answering the call: Line9 partnership puts pharmacy school to action

As soon as Bayli Larson hung up the phone, it rang again. She closed her eyes. It rang again. On the third ring, Larson took a deep breath, exhaled slowly and picked up the receiver.

Larson, a fourth-year graduate student in the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, wasn’t facing a harassing caller. A firm believer in the benefits of volunteering, Larson was staffing the phones for Pharmacist Line9.

Although the 90-minute phone marathon can offer a crash course in stress control and mental cleansing, it provides CU, volunteers and Channel 9 viewers so much more, participants say.

“It gave me a sense of the needs of the community members, and it helped me learn how to think on the spot,” Larson said. “As a pharmacist, it’s really important to be able to communicate effectively and respond accurately in a way that the patients understand. It was great practice.”

Fulfilling a growing need

Because of the popularity of the service (no volunteer’s phone ever sits quiet) coupled with serious medical matters taxing the community, Channel 9 recently boosted the airings, making Pharmacist Line9 a monthly event, said Lynne Valencia, Channel 9 vice president of community relations.

Many of the questions I answered I felt really made a difference in their lives, whether it was preventing drugs from falling into the wrong hands or averting a serious health event. — Briana Williams

From an opioid-addiction crisis gripping the state to a severe flu season lingering on, critical issues have heightened the need for the partnership, said Valencia, an alumna of CU Denver. “CU students and faculty members supply the expertise that people are looking for, and we provide the platform. They offer our viewers sound advice and a great service.”

Volunteering ranks high on the priority list of CU’s pharmacy school, recently named the recipient of the 2017 Lawrence C. Weaver Transformative Community Service Award from the American Association of College of Pharmacy (AACP). While fulfilling unmet needs in the community, volunteer events move CU students’ education beyond the textbook.

“It really can help supplement what you are learning in class,” said third-year graduate student Briana Williams, an active volunteer, including with Line9, and an intern at University of Colorado Hospital. “You definitely get questions right off the bat that you are like: I have no idea how to answer this. But you have to think on your feet and use the resources that you are taught in pharmacy school.”

Briana Williams on 9Line desk
Briana Williams, left, takes a rare break to smile for the camera. Her colleagues, from left to right: Liza Wilson Claus, Emily Zadvorny and Peter Rice.

Facing tough questions

Armed with Centers for Disease Control guidelines and other medical and prescription directives, Williams and Larson quickly fell into the groove of the call-ins, which generally include two students and two faculty members. Apprehensive her first time, when she was a second-year student, Larson said she remembered a lesson from school: It’s OK to say I don’t know.

Calls can run the gamut from the simple — Where can I get a flu shot? — to the moderate — How do I dispose of addictive medications? — to the complicated — What will I do if I can’t refill my pain-pill prescription?

With new regulations threatening opioid access, many calls relate to the crisis, including from fearful patients who rely on the drugs, Larson said. “I found those questions kind of challenging. A lot of these people have been living with chronic pain for years, and it’s the only thing that can get them out of bed in the morning.”

The anonymity factor can embolden callers to ask more complicated and sensitive questions, Williams said.  “Without having to actually go to a physician or pharmacist and see them face to face, they can ask these questions without thinking in the back of their minds that somebody is judging them,” she said.

Volunteers can confer with their colleagues on the Line9 desk, or, when a question falls outside of their expertise, refer the callers to their physicians, Williams said. “You have to know your boundaries and your scope of practice.”

Educating the pubic

Regardless of whether they can answer the question, the volunteers educate patients and urge them to use their physicians and pharmacists as resources. “I don’t know a pharmacist who wouldn’t provide any patient a phone consultation, but a lot of people don’t know that,” Larson said.

I think it really gets out to the public that pharmacists are not just pill-pushers; that we really have a lot of education that we go through to provide more services. And we are typically one of the more accessible health care professionals. — Briana Williams

Williams, who said she chose the CU Anschutz Medical Campus for graduate school partly because of the state’s progressiveness in the pharmaceutical field and the school’s emphasis on multidisciplinary teamwork, said taking part in events like Line9 also helps educate people about her profession.

“I think it really gets out to the public that pharmacists are not just pill-pushers; that we really have a lot of education that we go through to provide more services. And we are typically one of the more accessible health care professionals.”

‘A greater purpose’

A lot of people don’t know where to go for help, Williams said. “Many of the questions I answered I felt really made a difference in their lives, whether it was preventing drugs from falling into the wrong hands or averting a serious health event.”

In today’s competitive world, volunteering can also boost student’s chances at jobs and residency programs, said Williams and Larson, who both work in pharmacies and have their eyes on residencies post-graduation. Larson recently learned that she matched to a PGY1 residency with UCHealth Memorial in Colorado Springs.

Residencies are not required, but they can help set pharmacy students up for careers in hospitals and clinical settings after graduation. This year’s residency numbers for CU Pharmacy are on par with previous years, with 64 percent of those who applied matching, tying the national average.

“I just can’t stress it enough how important work and volunteering is,” Larson said.  It also helps students stay focused on what comes at the end of their heavy college load. “I remember going to work after an exam and being grateful to see there’s a lot to look forward to,” she said. “It’s all for a greater purpose.”

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Military nursing program graduates first master’s degree student

Some people just like finishing first. For Allison Boyrer, a University of Colorado Anschutz Medical Campus faculty member in the College of Nursing (CON), that means everything from a Master of Science program to a stint on the “Wheel of Fortune.”

Boyrer, MS, MA, BSN, RN, recently became the inaugural master’s degree graduate of a first-of-its-kind CU Anschutz program centered on the military and veteran population.

Launched in 2015 by CON Professor Mona Pearl Treyball, PhD, RN, FAAN, the Veteran and Military Health Care (VMHC) program covers a breadth of unique needs in the veteran community, whether it’s dealing with the traumas of war, enduring deployment of family members, or quieting suicidal thoughts.

“I have family and friends who are military members and first-responders,” said Boyrer, CON coordinator of strategic partnerships. “Seeing the physical and psychological issues that they were experiencing made me realize I needed to understand it better.

Boyrer with her dogs
Allison Boyrer shows off her canine “family members.”

Offering a firsthand look

That understanding came easier with Pearl Treyball at the helm, Boyrer said. The retired U.S. Air Force colonel worked from the ground up during a 22-year-military career, living the dynamics of military life that she now teaches.

While in the Armed Forces, Pearl Treyball did everything from caring for wounded warriors as a flight nurse, to serving as a unit commander, to working with top military officials at the Pentagon. Also in the military, her now ex-husband served often on the frontline in Special Forces.

“He had a lot of PTSD (post-traumatic stress disorder), and it eventually broke up the family,” said Pearl Treyball. “I know firsthand the impact on family and the traumas of war. So I made it my next mission to try to create leaders for a better system.”

Students learn the culture, dynamics and consequences of military and veteran life, with classes on everything from mental health first aid to women in the military. “There are so many issues that women have to deal with that you would never think about,” Boyrer said, using breastfeeding or finding a restroom during combat in the male-centric military environment as examples.

The curriculum also focuses largely on veteran and military health care delivery and ways of improving the systems, another area Pearl Treyball brings experience to both as provider and patient.  A three-time cancer survivor, she has been a patient in military and VA settings.

A program with impact

Boyrer, a wife and mother of two, said Pearl Treyball’s design of the online program also made it more doable and impactful. By using both synchronous and asynchronous models, students can work at their own pace, but also have face-to-face time with online discussions, Boyrer said.

Boyrer at Broncos
Allison Boyrer, posing with her daughter, quickly adopted Colorado life after clinching her job with CU Anschutz.

“You get to meet your cohort of fellow students, and you kind of go through the program with them, even though we’re from all over the country,” she said, adding that she could not have taken the program with her full schedule if it were not online.

VMHC also emphasizes personalized assignments, making it more useful for students, Boyrer said.  “My topics were relevant to my area of interest and practice, which is community engagement and homeless veterans, whereas somebody else might focus more on traumatic brain injury,” she said.

“And the assignments are something you can actually take with you when you’re done to make a difference in veteran care,” said Boyrer, who was recently accepted into the Leadership for Educational Equity Program (EdD) at CU Denver.

CU in the community

For instance, during her clinical training, Boyrer worked with the nonprofit Soldiers Angels in creating a project aimed at feeding, educating and joining together the veteran community. Once a month, Boyrer organized a dinner at Valor Point, a VAMC-Denver domiciliary.

“She did an outstanding job enlisting different resources from the community,” Pearl Treyball said, adding that Boyrer would also recruit volunteer educators, such as nutritionists, for the dinner event. “It’s something that is going to be longstanding in the community. And she made it educational and fun for veterans.”

Meals were provided by veteran-friendly or veteran-owned restaurants or from famous area chefs and were often therapeutic. “If you can get the military members together, and they can talk about similar experiences, then a lot of them open up more,” Boyrer said.

Bringing it all together

Veteran-focused programs are rife in the Denver area and on the CU Anschutz and CU Denver campuses, recently named top university campuses for veterans, Boyrer said. “But I don’t think people know all of what’s available out there,” said Boyrer, whose sister is director of Canines Providing Assistance to Wounded Warriors (C-P.A.W.W.), a CON Health Research Initiative for Veterans.

So for another assignment, Boyrer created a resource guide highlighting everything from fundraising events for veterans to alternative care for military and ex-military, such as canine, equine and yoga therapies.

Now the team of a newly organized Veteran and Military Health Area of Excellence on the CU Anschutz campus, which includes CON’s Lori Trego, PhD, CNM, retired Army colonel, plans to expand Boyrer’s guide and use it as a springboard in becoming a premier resource, Pearl Treyball said.

Boyrer will also transfer some of her new military knowledge to her job, which is largely focused on increasing nursing presence on the CU South Campus. “We’ve created the first CU mini-nursing program, set to launch in March, with one course focusing solely on military health care.”

 

‘It can help anyone gain more of an appreciation of our servicemen and women so that we can all join together in improving their well-being. And the experience Mona brings to the textbook is just priceless.’ -Allison Boyrer  

 

Boyrer on Wheel of Fortune
Allison Boyrer crushed her competition during a holiday “Wheel of Fortune” episode in 2015, during which she gave a “shout out” to her then-new employer, the University of Colorado Anschutz Medical Campus.

Advocating for CU and veterans

Boyrer, a Florida transplant who quickly grew to love Colorado and CU, spends free time skiing and hiking with family (which includes two dogs), volunteering in her kids’ classrooms, and (at least one time) playing “Wheel of Fortune.”

“I auditioned when I first moved here for my job,” said Boyrer, who ultimately found herself standing next to Pat Sajak at the prize wheel. “I gave a big shout out to CU and the College of Nursing,” said Boyrer, a self-described dedicated CU advocate, who now has more fodder for her promotional pitches as the VMHC’s first master’s graduate. “It’s neat. I kind of helped pave the way.”

The curriculum is up-to-date, powerful and informative, Boyrer said.”It can help anyone gain more of an appreciation of our servicemen and women so that we can all join together in improving their well-being. And the experience Mona brings to the textbook is just priceless.”

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Honor Society: A small dose of compassion goes a long way

In the end, his patient died. But as Ajay Major, MD, MBA, then an intern, flipped through the old veteran’s medical record, he found comfort in the memories the notes inspired.

Now Major, a second-year internal-medicine resident on the University of Colorado Anschutz Medical Campus, calls up those memories of the witty old man with terminal cancer who always asked for bourbon (and his devoted wife who always rolled her eyes in response) as a continual reminder of the importance of compassion in health care.

“Medicine is hard,” Major said. “We see a lot of patients with a lot of difficult medical issues, and I think burnout stems not just from feeling overworked, but also from feeling that we’re not truly caring for our patients on a human level.”

Major, co-president of the CU Anschutz School of Medicine (SOM) Resident Chapter of the Gold Humanism Honor Society, spread his message during the society’s annual Solidarity Week Feb. 12-16 by encouraging his colleagues to take part in the week’s centerpiece program, Tell Me More (TMM).

Changing the conversation

Dr. Griff with Cory
Megan Griff, MD, chats with University of Colorado Hospital patient Frances Cory as part of a program aimed at teaching the value of compassion in medicine.

Armed with a TMM questionnaire and a smile, second-year internal-medicine resident Megan Griff, MD, entered her patient’s room, finding Betty Redwine, 77, wrapped in a light blanket and relaxing in a chair. “Is it OK to talk and find out about your life?” Griff asked, after explaining the program and introducing Major and attending physician, Jeannette Guerrasio, MD.

“OK,” Betty Redwine said, returning her doctor’s smile. “But it’s nothing exciting,” she said, grinning up from beneath a black-suede, shower-like cap she informed her guests was taming her unruly hair.

Prompted by four TMM questions, Redwine soon was sharing pieces of her past. Topics of capillaries and high blood pressure gave way to children’s feats and life’s treasures, sounding more like tea-time chatter than hospital-room discussion. When Redwine let a little secret slip, the room exploded in utterances of disbelief.

“What?” Guerrasio said, after Redwine revealed she worked as a registered nurse for 35 years. “Why didn’t you tell us?” asked Griff. “My mom is a nurse, too,” Griff said, when the commotion subsided. “You guys are hard-workers,” she said, patting Redwine’s hand.

Staying centered on the cause

While it might seem miniscule, a small dose of compassion can result in an array of benefits, Major said.  “It allows the patient to feel that the care team really cares about them, but it also brings some catharsis for providers. Just finding out a little bit more about our patients’ lives outside of the hospital can help re-center us in the work that we are doing as physicians and, I believe, help prevent burnout.”

On the patient side, studies show compassionate healthcare results in higher patient satisfaction, a higher pain threshold, reduced anxiety and better outcomes, according to the Gold Foundation, which cites supporting studies on its website.

TMM team meets with nurse
Ajay Major, MD, MBA, left, and Jeannette Guerrasio, MD, right, talk with Anne Marie Fleming, RN, about the Tell Me More program.

“People develop diseases for lots of reasons, and everyone’s lives really affect the way they respond to health problems,” said SOM Chair of Medicine David Schwartz, MD. It makes sense that trusted patient-provider relationships result in better care, he said. “We need to know how their lives might be contributing to the development of disease, and how their lives might contribute to our ability to effectively treat their disease,” he said.

Remembering: ‘I’m a person’

Looking up from her bed as the TMM trio walked into her room, Frances Cory, 79, had them laughing before even agreeing to chat. “You want to talk beyond my medical condition? You mean you don’t care about my medical condition anymore?” said the mother and grandmother, who later responded to a question about her biggest strength: “My sense of humor.”

Cory, who shared with her visitors that she had served more than 5,000 volunteer hospital hours during her lifetime, said she thought the program was important. “It’s nice to know that you take the time to talk to your patients. I’m a person.”

The TMM program offers a valuable reminder for medical students that their patients are people, and not just medical mysteries to solve, Guerrasio said. “I actually, as a doctor, find these conversations really helpful. And it’s what makes me come to work every day.”

Notes about the patient-doctor chat are jotted down on the TMM questionnaire, which is then displayed on the wall so that everyone involved in that patient’s stay, from therapists and nurses to doctors and janitors, can use it as conversation fodder, Major said.

‘The more passionate individuals are about their profession, and the more they enjoy what they are doing, the more engaged they become. These things feed on each other in very positive ways.’   ̶   David Schwartz, SOM Chair of Medicine  

Seeing nothing as too small

By getting to know his end-stage cancer patient and his wife as an intern, Major learned not just about his patient’s bourbon routine, but that he was a strong war veteran who had “always been a fighter.” That helped Major, when the man opted for a late chemo-treatment that was questionable at his stage and age. While the patient fared well through therapy, he developed an infection afterward that ended his fight.

When his patient was transferred to hospice, Major told his palliative caregivers about the bourbon. As he looked through his patient’s medical record after learning of his death, Major was jolted by one caretaker directive: Bourbon, one ounce at bed time as needed.

“It seems like such a small detail,” said Major, who published an article in JAMA Oncology about the patient experience. “But when his fighting wasn’t working anymore, he started thinking about things he really enjoyed in life. And having his little bit of bourbon was kind of important to him. So we made sure he could have that to the end.”

 

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Poverty simulation helps dental students gain compassion

In under an hour, Margaret, 57, a grandmother who suffered a stroke and is partially paralyzed, lost her foods stamps, faced eviction from her home and was robbed of her jewelry and valuables. These events left her and her son, Miles, 36, his wife, Melinda, 36, and their daughter, Mandy, 15, confused, frustrated and worried.

This was no ordinary family. First-year CU School of Dental Medicine students took on these roles during the first-ever Poverty Simulation, a three-hour session in which they experienced the same struggles as real low-income families. Having the time and money for dental and health care was often last on the list as these families worked to pay rent, buy food and take care of their children.

“My family is out working or looking for work and it’s kind of frustrating because I’m paralyzed and I have to stay here and can’t help more,” says dental student Rebecca Ryan, 24, who played Margaret, the family matriarch. “But that’s the reality of life – it can change in a second and that’s what happened to Margaret.”

The Poverty Simulation is part of Community Engagement I, a fall class that introduced 81 first-year dental students to public dental health, says William D. Bailey, DDS, MPH, CU School of Dental Medicine Chair, Department of Community Dentistry and Population Health.

“We want our students to be aware of the barriers and inequities in accessing dental and health care,” says Bailey, adding that the hands-on Poverty Simulation experience is more powerful than any lecture.

The goals of the simulation were to raise students’ awareness of the realities of poverty, while helping them understand stereotypes and misconceptions about low-income families, says Deidre Callanan, RDH, DC, MPH, a CU School of Dental Medicine Clinical Instructor, Community Engagement.

“The hope is that students now understand some of the barriers and frustrations to accessing services, including health and dental care for those with limited resources,” Callanan says. “We want our students to graduate with a deeper understanding, respect and compassion for their patients while they are out in the community, in the school clinics and when they become practicing dentists.”

How the simulation works

At the start of the Poverty Simulation, students received packets and worked in groups as makeshift families. The packets provided them descriptions of family members, their ages, employment situation, health status, income and monthly bills. Some families owned vehicles; others could only use bus passes to get where they needed to go.

Their tasks? They had to provide food, shelter and basic necessities for a month. They also received information on resources that would help them survive. About 20 community volunteers represented various agencies that could provide services for these families – from food and rent assistance to childcare. Each 15 minutes of the simulation represented a week in their lives.

There also was a bank, an employer, a juvenile detention center, utility and mortgage companies, a pawnshop, and a health care clinic, among other businesses and agencies.

Poverty simulation at CU School of Dental Medicine
Dr. Deidre Callanan hands out fake money, bus passes and other materials to dental students participating in the poverty simulation.

The students represented four different types of families during the simulation. They included a family of four or five; some had two parents and others were single parents with children. Some students posed as elderly single people with health issues and little family support.

Dental student Ryan Koster, 22, was surprised to find out he was a pregnant 16-year-old girl.

“I’m due in two months, we just got evicted and I’m not doing too hot,” says Koster, adding that he’s had no access to health care. “It’s crazy, it’s eye-opening. It’s a lot more interactive than I thought. This experience has helped me understand different people and situations. This will make me a better dentist.”

A family in crisis

For the family of Margaret, Miles, Melinda and Mandy, the struggles resonated with the dental students who played their parts.

CU dental school student Rebecca Ryan
Dental student Rebecca Ryan played the role of “Margaret,” the family matriarch, in the poverty simulation.

“It definitely gives you a different perspective of how people live,” says Hassanain Zaheer, 23, who was15-year-old Mandy. “This simulation helps us understand the hoops people have to go through. This is the first time I’ve done anything like this – it’s a unique experience.”

Stanford Smith, 29, who represented Miles, the father, said he gained new insight as the only wage earner in a large family.

“I didn’t know what we were going to do – it was hard to get things done and you had to learn to work the system,” he says. “It was so frustrating because you’re trying to do everything, but the lines were long and you couldn’t get stuff done.”

He says the experience helped him understand the complexities low-income families face every day.

“This is a great program – it really made me see what it’s like to live on minimum wage,” he says. “It makes me want to do more and help the people I see as patients.”

While her “family” faced challenging life situations and tough decisions, Messay Ibrahim, 25, said she didn’t realize life could be so difficult.

“As Melinda, I’m unemployed and I tried to get a job, but I couldn’t,” she said. “It was just so hard trying to pay our bills and we still got evicted. We just had so many things thrown at us.”

She says the experience will make her a better dentist.

“It helps us to know where our patients are coming from and all the emotions and stress that comes with living in poverty,” she says. “The one thing I did like was that our family did try to work together to overcome all our challenges – and I’m thankful for that.”

 

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Four generations of one family receive MDs at CU

The line of physicians in the Kenagy-Vance family stretches across states, continents and generations. For centuries, these medical men have guided the health of communities from Switzerland to Pennsylvania to Idaho and beyond.

And most of their skills were acquired in the same place – the University of Colorado School of Medicine (SOM). Four generations of the family received their MDs here. Dr. John Brough (JB) Kenagy started it all when he graduated from the SOM – located in Boulder then – in 1906.

The family’s next two physicians – Drs. Fayre H. Kenagy (class of 1920) and J. Corwin (Corky) Vance (class of 1971) – attended the medical school in Boulder and then the CU Health Sciences Center in Denver. Corky’s father, Edward Pershing Vance, who married Barbara Eloise Kenagy, took a different path: He enjoyed a successful career in natural resource stewardship in the Pacific Northwest. Dr. Karl Kenagy Vance, son of Corky and Karen Vance, extended the family’s black-and-gold legacy into the 21st century by attending medical school at the CU Anschutz Medical Campus from 2005 to 2009.

Fayre Kenagy at Denver General Hospital
Fayre H. Kenagy, center, is pictured at the old Denver General Hospital circa 1917. Fayre was the second member of the Kenagy family to receive his MD from the CU medical school.

Karl applied to about 10 medical schools, but chose CU. “The combination of the high-quality education at the medical school and the lifestyle of being in Colorado factored in,” says the avid cyclist and skier. “Also, it was something I thought would be cool – that I would be the fourth generation of my family to go to the CU School of Medicine.”

Swiss start

The family history of physicians goes back to Bern, Switzerland, where Corky’s sixth great grandfather, Hans Gnage, practiced medicine before fleeing the country over religious persecution of Mennonites. “Family legend has him seeing a patient when the police came to arrest him for draft evasion,” Corky says. “His wife had the policeman sit down to wait for him and offered food and drink, but then sent their son to tell his father to leave the country instead of coming home. His family joined him later.”

Hans arrived in Pennsylvania in 1742 and joined the Amish community, where he resumed work as a physician. It would be several generations later when JB Kenagy, born and raised in a Mennonite community in Ohio, would leave his career as an educator and move from Gunnison to Boulder. After graduating from CU medical school in 1906 he moved to Rupert, Idaho, to practice internal medicine.

His son, Fayre Kenagy, aspired to become a doctor just like his father. He was drafted into World War I but received a deferment to finish his medical degree.

Keeping the CU tradition going

It was Fayre who delivered J. Corwin Vance in August 1945, starting a lifelong bond with the boy who went by the nickname Corky. “I was in awe of my grandfather and wanted to follow in his footsteps. I therefore also attended the CU medical school,” Corky says. “When Karl was born, we named him Karl Kenagy Vance, after his grandfather. He later decided to attend the CU medical school as well, having heard how great it was.”

Drs. Vance sip cappuccinos in Italy
Drs. Corky and Karl Vance take a break from cycling to enjoy cappuccinos during a family vacation in Italy last fall.

The elder Dr. Vance is now retired, but Karl worked with his father during the final year of his practice in Minneapolis. Karl now works with several of Corky’s longtime staff members, though in a different dermatology practice. The Twin Cities are a fitting home for the Vances as twin interests abound in father and son, including a shared love of fine food and wine. When they aren’t pursuing culinary interests, you can find Corky and Karl on their bicycles or in planes traveling the world. Sometimes they’re globetrotting and cycling – as they did on a recent family trip to Italy.

Incidentally, they both met their wives while attending the CU medical school. Corky met Karen while she was a lab technician, and Karl hit it off with Pamela while out on the town with classmates.

Karl and Corky Vance in the CU School of Medicine
On Karl’s graduation day in 2009, Drs. Karl and Corky Vance stand in front of the photos of CU School of Medicine classes of 1919 and 1920 in the SOM. Corky was inspired to pursue medicine by his grandfather, Fayre H. Kenagy, who is pictured in the class of 1920.

Just as Corky was inspired to pursue medicine by his grandfather, Karl looked up to his father, who became the first dermatologist in the Twin Cities to perform Mohs surgery – a micrographic procedure that removes skin cancers. “He found it rewarding. Growing up around medicine, you get an understanding of the process, the responsibilities and the ups and downs of it,” Karl says. “Mostly, it’s a fulfilling career because it’s a daily opportunity to help people.”

Camaraderie with CU classmates

Excellence in clinical care

“If you want to get clinically grounded, the CU School of Medicine is as good as any,” says Dr. Corky Vance, who attended the SOM from 1967 to 1971. “I got to see acute and emergency care at Denver General, and at University Hospital I got to see the rare cases you heard about from your professors. We also went out to the Fitzsimons Army Hospital (as it was known then) and saw cases and procedures that you were going to see in your own practice. There was a real advantage to having that much exposure to clinical practice.”

The retired physician says the SOM is even better since moving to the CU Anschutz Medical Campus. “Having everything together – with the hospitals on campus, as well as the VA – it really makes it even easier to get clinical exposure.”

Unlike the camaraderie he enjoyed at CU Anschutz, Karl struggled to connect with his pre-med classmates as an undergraduate at Stanford University. But he excelled in chemical engineering, and it wasn’t long before he connected that discipline to his burgeoning interest in wine. After graduating from Stanford, he became an assistant wine maker in Northern California and Australia. A few years later, however, he realized that winemaking couldn’t quite match the fulfillment of medicine.

At CU Anschutz, Karl loved his classmates – “It was hard to find people who weren’t into skiing and biking,” he says. And he was influenced by Dr. J. Ramsey Mellette, the faculty member who trained him on Mohs surgery. Back in the 1970s when Corky first performed Mohs, it was a new and innovative procedure. “Now, this procedure is pretty widespread,” Karl says. “I like it because of the precision in which we take the cancer out, and I enjoy the creativity involved in the reconstruction (of the tissue).”

Mohs is usually performed on a patient’s face, so the reconstruction of the skin requires utmost precision to minimize scarring.

Finding a mentor in the SOM

Corky was inspired to pursue dermatology by Dr. Robert Goltz, who in the late 1960s served as head of the Dermatology Department in the medical school. Corky so enjoyed Goltz’s teaching that he took the professor’s early-morning class on public health. “Dr. Goltz noticed that I was a hard worker, that I liked dermatology and was good at it,” Corky says. “I was good at visual learning, and that’s why dermatology appealed to me. You have to be able to memorize what rashes and other conditions on the skin look like.”

Goltz proved to be the catalyst for Corky’s career in Minnesota. Goltz, who had just accepted a job as chair of dermatology at the University of Minnesota, suggested Corky pursue his residency in the Land of Lakes.

Drs. Vance at CU medical school graduation
Drs. Karl and Corky Vance at Karl’s graduation from the CU School of Medicine in 2009.

Now, as Corky and Karen settle into retirement, they watch their progeny carry on the Kenagy-Vance caregiver tradition. Karl has established his own thriving practice in Minneapolis, while his sister Chardonnay, who attended medical school at Wake Forest University, is a family practice doctor. The life in medicine has made for a full, satisfying ride for the elder Vances – and a lasting family legacy that’s anchored in CU’s SOM.

“The most important thing is your job,” Corky says. “If you have a miserable job, you’ll be miserable wherever you are. If you have a rewarding job – as we are lucky enough to have – you’ll be happy.”

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Our students don chefs’ hats to further their education

Students from the Culinary Medicine/Culinary Dentistry present a meal they prepared
Students from the Culinary Medicine/Dental Medicine present a meal they prepared

On a recent Friday, Gabriela Andrade, a second-year dental student from the CU Anschutz School of Dental Medicine (SDM), was putting the finishing touches on a group project. She stacked sandwiches on a platter, and her group lined up to explain to their instructors and classmates about an extra ingredient they added to the hummus: chipotle peppers.

Because of a program funded by Delta Dental of Colorado to support interdisciplinary education among health professionals, called the Frontier Center, the classmates, 17 CU dental and medical students, join culinary nutrition chefs side-by-side each week in a Culinary Medicine/Dental Medicine elective course. The class is a venture of the School of Medicine (SOM), the SDM and the College of Culinary Arts at Johnson & Wales University (JWU). Every Friday the students gather in JWU’s production kitchen to talk about and taste food—for academic credit.

As Andrade’s group described how the peppers contributed a pleasing heat and flavor, as well as added nutritional benefits, their instructor chimed in with suggestions for ingredient substitutions. Then the class heard the words they had been waiting for all afternoon: “let’s eat.”

Gabriela Andrade, a School of Dental Medicine student, practices her knife skills
Gabriela Andrade, a School of Dental Medicine student, practices her knife skills

An interdisciplinary education in nutrition

The class, which will meet for eight Fridays, consists of a two-hour discussion and quiz on nutrition, followed by hands-on training in cooking techniques, including knife skills, working with fresh produce, and making healthful substitutions in recipes. Students work in small groups to produce different parts of a complete meal: appetizers, salads and a main course. Clinical nutrition students from JWU are on hand to provide guidance and experience.

Tamanna Tiwari, a clinical instructor at the School of Dental Medicine
Tamanna Tiwari, a clinical instructor at the School of Dental Medicine

The interdisciplinary focus of the course is one of its primary benefits, according to Tamanna Tiwari, MPH, MS, BDS, a clinical instructor at the SDM. “As the first School of Dental Medicine to offer an elective for Culinary Dentistry, we are adding to our innovative, interdisciplinary curriculum,” she said. “Our dental students work as a team with medical students. They take ownership of projects together.”

The course aims to fill a gap in medical education by providing students with the latest research on clinical nutrition and instruction on how to communicate lessons about nutrition to their future patients. “Diet has a huge effect on the whole person,” said Mark Deutchman, PhD, SOM professor. “This class fills in a knowledge gap. It will make our students better practitioners and help them to address all aspects of a patient’s health.”

Adding tools to their toolkits

For medical student Nick Stephanus, the class is an opportunity to add more tools to his toolkit. “In primary care, many illnesses are chronic, and can be managed by careful monitoring of one’s diet,” he said. “This class teaches us how to give good advice to future patients, so that physicians can say more than just ‘manage your calorie intake.’”

Mark Deutchman, professor at the School of Medicine
Mark Deutchman, professor at the School of Medicine

Andrade, too, plans to use the skills she gains in the class to help her future dental patients. “I plan to work with Hispanic populations and with patients with a lower socio-economic status,” she said. “They may not have had a lot of education about nutrition, and this class will help me to better communicate tips for a healthier lifestyle and oral health.”

Although the Culinary Medicine/Dental Medicine course focuses on skills that students can use to help their future patients, the class agrees that they are already benefiting by taking their work home. The skills they are learning have allowed them to cook meals that are more nutritious for themselves. They’ve also cultivated camaraderie with the nutrition students from JWU, who will go on to work in the medical field as dietitians and clinical researchers.

“The JWU students enjoy the interchange of information with CU,” said Marleen Swanson, RD, the department chair of the JWU Culinary Nutrition program. “They glean a better understanding of the medical world through case studies that they review with CU students.”

School of Medicine students like Nick Stephanus learn cooking skills and how to communicate nutrition tips to their patients
School of Medicine students like Nick Stephanus learn cooking skills and how to communicate nutrition tips to their patients

Following their taste buds

With a growing awareness of the important role nutrition plays in preventive care, and the lack of nutrition education in medical and dental schools across the country, the Culinary Medicine/Dental Medicine course will make a significant contribution to medical education. The interdisciplinary approach at CU Anschutz, along with the partnership with JWU, are producing medical and dental professionals who are knowledgeable and enthusiastic about healthy eating.

For good reason. The smells wafting from the kitchen classroom every Friday are mouthwatering, and the energy in the room is contagious. Both Andrade and Stephanus look forward to the class each week. “Cooking is an experiment,” Andrade said. “I’m learning as I go, but I’m also following my taste buds.”

 

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A grad’s journey from Cuba and conflict zones to CU Anschutz

One cold afternoon, Ivan Quintana Hijano walked through the University of Colorado School of Dental Medicine. The chilly temperature brought back memories of the first time he visited Colorado.

It was nothing like his native Cuba, where Quintana Hijano was an oral and maxillofacial surgeon before emigrating to the U.S. in 2011. Or East Timor, where he spent two years operating on patients injured during the county’s struggle for independence. He was the nation’s only oral and maxillofacial surgeon and was on call 24/7.

Ivan Quintana Hijano
Ivan Quintana Hijano in the CU Anschutz School of Dental Medicine. Quintana Hijano is a Cuban immigrant and graduated with honors from the Advanced Standing International Student Program.

On Friday, Quintana Hijano, a student in the School of Dental Medicine’s Advanced Standing International Student Program, will graduate near the top of his class. He’ll earn his Doctor of Dental Surgery degree, which is necessary for Quintana Hijano to practice in the U.S.

It also sets up his next step—getting into a four-year residency program for oral and maxillofacial surgeons. That would allow Quintana Hijano, 39, to restart a career that he has loved as long as he can remember.

“I remember I was playing on the street one day and there was a car accident. I saw this guy bleeding all over the place,” Quintana Hijano said. He wondered what doctors would do to save and heal the man, and it was the start of a career. “Since I was a kid, I wanted to be a facial surgeon. I told my mom when I was 5, ‘when I grow up, I want to do that.’”

Now, after putting on hold a career that has spanned oceans and continents so he could start a new life in America, Quintana Hijano is a big step closer to performing surgeries and helping patients. Again.

“Nothing comes without effort”

The Advanced Standing International Student Program offers dentists who have earned their degrees in foreign countries the opportunity to earn a Doctor of Dental Surgery degree at the University of Colorado School of Dental Medicine. Graduates of the two-year accelerated program are able to take any state or regional board exam, and thus are eligible for licensure to practice in the U.S. This program accepts 40 students each year.

“It was really tough decision,” Quintana Hijano said.  “I’m really attached to my folks. I didn’t know when I was going to see them again, because I would be banished for leaving Cuba.”

Quintana Hijano said Cuba produces well-trained dentists, doctors and surgeons—just not many of them, especially in the past few decades, because spots in Cuba’s top universities and medical schools are limited. Students have to compete for top scores each step of the way to have a shot at getting the few specialist jobs available each year. The path included multiple “make-or-break” national exams, where elite students are ranked and get to pick their profession.

“I said, ‘I have to excel to do this,’” Quintana Hijano said.

Quintana Hijano was ultimately accepted into the oral surgery and maxillofacial program at the Cienfuegos General Hospital, affiliated to the Higher Institute of Medical Sciences of Villa Clara, Cienfuegos’ Campus. He trained and practiced in Cuba, before its government sent him on a humanitarian mission to East Timor, a nation on an island between Indonesia and Australia. East Timor had just won independence from Indonesia after a long-running guerrilla war that ended a brutal occupation.

Quintana Hijano was the only oral and maxillofacial surgeon in East Timor. He performed reconstructive surgeries on people injured in the war or in accidents. He also trained medical students and translated the Ministry of Health’s national guidelines into Spanish to be used by the Cuban medical personnel and to help educate 1,000 new East Timorese doctors.

Additionally, he attended weekly meetings with the Minister of Health and other staff to discuss the nation’s health care strategies.

Coming to America, finding Colorado

Quintana Hijano would return to Cuba and practice for a few years before going to Venezuela in 2010 on another humanitarian mission. Over time, a feeling began growing that his future would not be in Cuba. The strain of not being able to say what you think and other stresses were taking a toll.

“It was really tough decision,” Quintana Hijano said.  “I’m really attached to my folks. I didn’t know when I was going to see them again, because I would be banished for leaving Cuba.”

The decision also could have ended his career.

“I had to put aside what I loved, doing surgeries. I didn’t know if I’d be able to do it again,” Quintana Hijano said. “But I was ready to come here, roll up my sleeves and do whatever [it took].”

In October 2011, Quintana Hijano made the stressful 40-hour trip, which took him through several countries before he arrived in the U.S. Quintana Hijano declined to give details, because Cubans still make that voyage and the authorities watch. He also declined to discuss the relationship between his new home and his old one and what the future might hold.

But Quintana Hijano is clear about his love for the people of Cuba and the beauty of the country.

“It’s a really nice society and a beautiful country. The people are friendly, people are really willing to help you at any time, and anywhere,” Quintana Hijano said.

Beginning anew at Anschutz

Quintana Hijano ended up in the Phoenix area. Although unable to practice as a doctor or dentist, he was able to help patients, working as a dental assistant and in a dialysis clinic. But he still wanted to be a surgeon and decided to restart his education. That would mean going through dental and medical school all over again. That also meant more high-stakes tests competing against other experienced professionals for admission.

But Quintana Hijano kept it in perspective. “I always look way ahead into the future. It doesn’t happen in one day, it takes forever.”

The only program for international students Quintana Hijano applied to was at the CU School of Dental Medicine. He says finding the program was a lucky break. While other dental schools have similar programs, by the time Quintana Hijano was ready to apply in 2013, CU Anschutz was the only school still taking applications. The wait since 2011 had been long enough, so he sent in his application.

“[I] was shocked and very flattered,” he said about getting admitted. “I thought there were people more prepared than me.”

“It was something random,” Quintana Hijano said. “But when I got here, I realized it was God’s will. This is a really, really good school.”

Going back to school didn’t seem to be a problem for Ivan, said Professor Elizabeth Towne, DDS. She directs the Advanced Standing International Student Program and worked closely with Quintana Hijano.

“Though he was an oral surgeon with an admirable career, he became a student again and eagerly embraced the basic level tasks of working on plastic teeth, and treating all the minor maladies we encounter in general dentistry,” Towne said. “He is supremely humble. He has been open to critique and criticism, and eagerly sought it out.”

Quintana Hijano said his classes have been a great way to learn the American system. Faculty members have been approachable and ready to offer professional and personal guidance. He also likes that American dentists are able to see patients from the start, develop a treatment plan and relationship, and see their progress.

That’s not a surprise.

“He has a big heart, and feels great empathy for all his patients,” Towne said. “He is a very kind, gracious and compassionate person.”

Colorado provided one shock, though. A life in hot climates and then Phoenix didn’t prepare him for Colorado winters. The day he came to Aurora to interview and visit was cold and snowy, which was the only downside, at least at the time.

But now, as Ivan awaits “match day” on Jan. 30 to find out where he’ll go for a residency program, he relaxes by skiing. He’s getting better, and he said he has even survived a few runs down the black diamond trails he went down “by mistake.”

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Students envision solutions to opioid epidemic

Opioid abuse is one of the nation’s most severe public health crises. The problem strikes close to home, with nearly 900 Coloradans dying of intentional or unintentional drug overdoses in 2014. Many of those deaths came from misusing prescription medications such as Vicodin, Percocet and OxyContin, three of the most prescribed opioid painkillers. Addiction to those drugs also is leading to a surge in heroin use.

2016 public health case competition winners
The winners of the 2016 competition, along with Colorado School of Public Health dean David Goff.

Public health experts, health care practitioners and lawmakers are among those working hard to find solutions to the epidemic, and recently teams of University of Colorado Denver | Anschutz Medical Campus students joined the cause. About 55 students competed in this year’s Rocky Mountain Region Public Health Case Competition, competing to find innovative solutions that could alleviate the crisis. The annual event was hosted by the Colorado School of Public Health (ColoradoSPH) and run by its students.

Inventive ideas were not in short supply—including one proposal that would create specially equipped buses and design smartphone apps that could give addiction sufferers an accessible and discreet way to receive help recovering.

The proposal, named “Heals on Wheels” by the team, would use the vehicle to take back drugs, screen patients and give them referrals for treatment, educate and train people about drugs that stop overdoses and exchange needles.

Christy Colalancia, a student getting a master’s degree in public health, was a member of the winning team. She said a model for the idea was mobile mammography clinics, and the team considered the challenge of creating effective outreach strategies.

“We were thinking about what has worked and what didn’t work in the past. Our idea was as original as we could make it, but by taking into consideration evidence-based approaches,” Colalancia said.

Inventive ideas

Competition was stiff, with the panel of judges impressed by each of the proposals.

“We had a real belief that if any one of them were implemented, it would improve the public health of Colorado,” said ColoradoSPH Dean David Goff, MD, PhD, one of the judges.

Finishing second was a team with an idea to improve the rehab system in southeast Colorado by adding case managers who would work to educate and support patients. The case workers also would become liaisons between patients and doctors.

The third-place team proposed developing a drug takeback program that would allow people to return unused medication any day of the year by dropping the medications in secured bins at pharmacies around the state. Currently, some communities, government agencies and others including the Skaggs School of Pharmacy and Pharmaceutical Sciences will collect drugs for disposal, but most programs are one-day events. Additionally, many rural areas, where the opioid abuse problem is most severe, do not have those programs.

A growing problem

Colorado is one of the states hit hardest by the opioid epidemic, according to the Centers for Disease Control and Colorado Health Institute. In 2014, Colorado had 899 deaths related to drug overdoses. That works out to 16.3 deaths per 100,000 residents, which is up 68 percent since 2002. Colorado’s fatality rate is above the national average of 14.7 drug-related deaths per 100,000.

Twelve counties, including Denver and Adams counties, had rates of more than 20 deaths per 100,000 residents, making them among the highest in the nation.

Research also shows that prescription pain killers are a gateway drug, with 75 percent of heroin users saying they abused painkillers before switching drugs, according to nationwide stats from the CDC.

Real-world challenges

The goal of the annual competition is to give students across varied disciplines the experience of working as members of interdisciplinary teams, Goff said. It also gives them the chance to design innovative solutions to real-world health problems. Up to six students had to research the problem, develop a proposal, craft a presentation and answer questions from judges. They also needed to ensure their ideas could be implemented for less than $3 million and address challenges to implementation.

“I think one of the greatest parts of the program is getting a real-world scenario to try to solve in a limited amount of time, using limited funds and resources, and having an integrated approach,” Colalancia said.

The teams also had to beat the clock—students had 24 hours before their presentations were due. It led to some bleary eyes at the awards ceremony.

The competition was open to students from the ColoradoSPH, the School of Medicine, College of Nursing, Graduate School and the pharmacy school, among others. Students from CU Boulder, Colorado State University and the University of Northern Colorado also participated.

Representing CU Anschutz on the judges’ panel for the final round were Goff and Robert Valuck, PhD, a professor in the pharmacy school and director of the Colorado Consortium for Prescription Drug Abuse Prevention. Colorado Department of Public Health and Environment Executive Director and Chief Medical Officer Dr. Larry Wolk, state Sen. Jim Smallwood and state Senator-elect Dominick Moreno also were judges.

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High school girls seek health care careers

In early June, over 50 high school girls from around Aurora and Denver had the extraordinary opportunity to get an inside look at several centers operating on the University of Colorado Anschutz Medical Campus. The one-day program, “Exploring Careers in Health Care,” is hosted by the Center for Women’s Health Research and UCHealth. Its goal is to expose a diverse group of young women to careers in health care that they may not know about and to connect them with mentors who can share insight into their own career paths.

Girls-Career-Day-2016-OR-training2-588x668

Participants test out medical instruments for surgery.

The participants toured the Gates Biomanufacturing Facility, learning about stem cell therapy and personalized medicine. The Gates researchers explained how following a path of biology, chemistry or engineering could lead to unique careers in health care to treat and cure various cancers, skin and muscle diseases, and type 2 diabetes. One participant was particularly interested, noting, “This is a field that you don’t hear about on a regular basis, but has the potential to change the world of medicine and the future.”

At the Skaggs School of Pharmacy and Pharmaceutical Sciences, the girls heard from students about their varied paths into pharmacy and the rewarding careers for which they are training. The Skaggs students guided the girls through activities to make their own lip balm and to experiment with drink flavoring. They also had an interactive discussion with Laura Borgelt, PharmD, FCCP, BCPS, associate dean for administration and operations at Skaggs School of Pharmacy and Pharmaceutical Sciences, about the complications, challenges and opportunities in medical marijuana research.

A visit to the University of Colorado Eye Center allowed the girls to learn about eye health, diseases of the eye, and the state-of-the-art treatment and surgery happening at CU Anschutz. Using blindfolds and special glasses to simulate visual impairments, the girls helped each other through common tasks such as pouring water into a cup and typing on a keyboard. They could momentarily experience how a patient interacts with the world, and how a caregiver helps guide them through treatment.

The highlight of the day was the visit to the Center for Surgical Innovation where the girls got to try their hand at suturing and experimenting with medical instruments for surgery. One participant said, “I loved it. I came home excited and ready to learn more. It opened up my mind to medical professions I had never heard of.”

Surgical training at CWHR Girls Career Day, 2016

Surgical training at CWHR Girls Career Day, 2016

As they interacted with doctors, pharmacists, research assistants and ophthalmologists, the girls had smiles on their faces and asked thoughtful questions. “We were delighted to welcome these young women to campus. We know the importance of helping young people learn about careers in science and also connecting them with leaders and mentors in the field to help them navigate various career paths in healthcare and research,” said Judy Regensteiner, PhD, director of the Center for Women’s Health Research, professor of medicine, and holder of the Judith and Joseph Wagner Chair in Women’s Health Research.

The program is in its second year and was a tremendous success. With such high demand, the Center for Women’s Health Research and UCHealth plan to make this an annual activity.

Guest Contributor: Sarah Westmoreland, MPH, Public and Community Education Liaison, Center for Women’s Health Research

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Surgery workshop will offer skills to doctors in low resource areas

Despite the dangers, more and more physicians are drawn to working in impoverished or strife-torn areas where medical care is rudimentary yet the needs are overwhelming. But few possess the skills to operate under such harsh conditions.

On June 4 and 5, a dozen doctors from around the country take part in the Colorado Humanitarian Surgical Skills Workshop at the Center for Surgical Innovation on the University of Colorado Anschutz Medical Campus.

The Center for Surgical Innovation is a multi-disciplinary training center dedicated to promoting education courses for surgeons around the world. From 2015-2016, it trained over 4,000 surgeons.

Dr. David Kuwayama, a vascular surgeon, has worked with Doctors Without Borders and other humanitarian groups worldwide.

This unique program will teach senior surgical and obstetrics residents how to perform surgery in low-resource environments without high-tech surgical tools. They will learn how to do a craniotomy with a handsaw, hernia repair without mesh and skin grafts using hand blades rather than electrical ones.

“This is the only humanitarian training course for surgical residents in the country,” said David Kuwayama, MD, MPA, a vascular surgeon at CU Anschutz and director of global health in the department of surgery. He has also worked with Doctors Without Borders and other humanitarian groups in developing countries, disaster zones and areas of conflict.

The work is often dangerous. Last October, 30 people were killed at a Doctors Without Borders/ Médecins Sans Frontières hospital in Kunduz, Afghanistan when an American AC-130 gunship opened fire at what they thought were Taliban fighters. Other hospitals supported by the group have been attacked in Idlib, Aleppo, and Hama governorates in Syria, forcing at least three to close down.

But it’s done nothing to quell enthusiasm for humanitarian medical work.

“There is a wellspring of interest now in global health despite the often difficult situations,” Kuwayama said. “More and more people want to make it part of their careers but there are few training opportunities.”

Kuwayama held a pilot program last year with just four senior surgical residents to gauge outside interest. This year, they have increased that to 12 residents. The workshop will be taught by attending physicians from CU Anschutz and will cover general surgery, vascular surgery, orthopedic surgery, neurosurgery and OBGYN.

“While working abroad, I found that American doctors often lack the skills to work in these often tough environments,” Kuwayama said. “Our goal is to provide those skills so they are prepared for whatever the situation calls for.”

What:  The Colorado Humanitarian Surgical Skills Workshop

Where: The Center for Surgical Innovation, University of Colorado Anschutz Medical Campus, Aurora, Colo.

When:  June 4 & 5 from 7:30 a.m. – 5 p.m.

More information: Interested media are invited to attend the lectures. For more information please contact David Kelly, 303-503-7990, david.kelly@ucdenver.edu

 

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