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The Division of General Internal Medicine continued to play a pivotal role in the teaching, administrative and patient care activities of the Department of Internal Medicine. The division continued to develop its clinical research program in conjunction with The Center for Outcomes Research (SLUCOR). Major responsibility for the teaching program for third and fourth year medical students rests with the Division of General Internal Medicine. Third year medical students have a required 4 week ambulatory Internal Medicine rotation. One half of each third year class of medical students are assigned to General Internal Medicine faculty at the Doctors Office Building and the John Cochran Veterans Administration Hospital (JCVAH). The ambulatory continuity clinics for the Internal Medicine residents are based at both the Doctors Office Building and the JCVAH. Residents and third and fourth year students are assigned to the Acute Care Service at the Doctors Office Building and the VA Prime Ambulatory Clinic at the JCVAH. The outpatient component of the Internal Medicine Consultation Service is based at the Doctors Office Building as well. The faculty also serve as inpatient teaching attendings at both hospitals. The General Internal Medicine faculty at the JCVAH participate in morning report, an ambulatory lecture series and the noon conference lecture series. There is an ambulatory lecture series each day for students and residents assigned to the outpatient rotations at the Doctors Office Building. At both the JCVAH and Saint Louis University Hospital, the faculty serve as junior preceptors on the inpatient service. General Internal Medicine faculty are teaching attending physicians at both hospitals for the inpatient Medicine teams and for the Internal Medicine Consultation Services. Many of the faculty participate in the Physician, Patient and Society Course in Phase I of the Medical Curriculum. These include Physical Diagnosis and Death and Dying. Fourth year medical students have electives in EKG interpretation, cardiac auscultation, interactions with the pharmaceutical industry, ambulatory Internal Medicine and Pediatrics, ambulatory Internal Medicine and consultative Internal Medicine.

Members of the division hold key administrative positions in the department, Medical School and University Medical Group. Dr. Marilyn Maxwell is the Program Director for the Internal Medicine Pediatrics Residency Program. Dr. Thomas Olsen is Associate Program Director for Ambulatory Education for the core program. Dr. Robert Heaney is Associate Dean for Graduate Medical Education for the Medical School. Drs. Nora Porter and Douglas Walden are the Clerkship Directors for the Third Year Internal Medicine rotation. Faculty play important roles in medical school committees. Drs. Drake, Maxwell and Porter are members of the Admissions Committee. Dr. Victoria Cornelius is a member of the Curriculum Management Committee. Drs. Nora Porter and Douglas Walden are members of the Phase III Committee. Dr. Govind Nagaldinne is a member of the Institutional Review Board for the Medical Center. Dr. Olsen is a member of the Appeals Committee. Dr. Olsen is President of the Alumni Association and Chairman of the Dean’s Executive Advisory Board for the School of Medicine. Dr. Erin Bakanas is Chair of the Hospital Ethics Committee. She is Course Director for the Death and Dying Course in Phase I of the Medical Curriculum. Dr. Olsen is a member of the Hospital Ethics Committee as well. Dr. Robert Heaney is Co-Chair of the University Medical Group Clinical Operations Committee. Dr. Rice is a member of that committee as well and Dr. Olsen does practice site visits for the Clinical Operations Committee. Dr. Olsen is a member of the University Medical Group Contract Review Committee.

 

The University Medical Group will be implementing an electronic health record in 2008-2009. The General Internal Medicine group will be among the first practices to utilize the Automated Record Keeping (ARK) system. Dr. Timothy Rice and Dr. Bishnu Devkota have played an important role in preparation for implementation. Dr. Rice is a member of the Electronic Health Record Clinical Advisory Committee. Dr. Bishnu Devkota is a Physician Champion.

Dr. Erin Bakanas has been appointed Associate Director of the Bander Center for Medical Business Ethics at Saint Louis University. The Bander Center, funded by a generous donation by Stephen Bander, M.D., is dedicated to education and investigation of the ethics of business relationships in medicine. Dr. Bakanas will oversee the fellowship program at the Center.

Natalie Brooks, Pharm.D, BC-ADM, continues to develop collaboration between the Division of General Internal Medicine and the St. Louis College of Pharmacy. Dr. Brooks provides consultation for patients in the General Internal Medicine practice. Dr. Brooks sees scheduled patients in a pharmacotherapy clinic at the Doctors Office Building. She precepts sixth year pharmacy students and participates in the ambulatory lecture series. A clinical study of the accuracy of medication histories has begun.

Patient care activities provide opportunities for teaching, clinical income and are a source of patients for clinical studies. Patient visits for 2007-2008 through May 31, 2008 indicate an outpatient total of 22,768. New outpatient visits including consults total through May 31, 2008 indicate at total of 2,000. The division has off-site practices at two locations. In October 2007 a General Internal Medicine practice at the Des Peres Medical Pavilion was developed. Drs. Bishnu Devkota and Thomas Olsen and Mary Keegan, N.P., are working to develop that practice. It is anticipated that third year medical students will rotate there as part of their ambulatory rotation. The division has a practice at the University Club Tower site. Dr. George Griffing has established an active practice at that site. He is joined this year by Drs. Roque Castillo and Govind Nagaldinne. The division has patients scheduled 10 half days each week at that site which continues to grow. It is anticipated that third year medical students will be assigned to that site as part of their clinical ambulatory rotation. The division is projected to finish this fiscal year ahead of budget.

Four members of the division are board certified in Internal Medicine and Pediatrics. These are Drs. Marilyn Maxwell, Nora Porter, Victoria Cornelius and Timothy Rice. Dr. Cornelius is also certified in Adolescent Medicine. This group of faculty supervises the continuity clinics for the Internal Medicine/Pediatrics residency program. In addition to inpatient teaching responsibilities at Saint Louis University Hospital, they teach and supervise patient care at Cardinal Glennon Memorial Hospital.

In 2007-2008, the General Internal Medicine faculty at the St. Louis VA Medical Center continued their teaching, administrative and patient care activities of the Department of Internal Medicine. Faculty provided over one half the months of inpatient attending on the VA Medicine wards. The Ambulatory Block rotation continued to have a full complement of didactic lectures and journal club to augment the clinical teaching. The Internal Medicine continuity clinics at the VA remained busy and resident satisfaction with the VA experience remained high.

Specialty Care and Dr. Coy Fitch is the Chief of the Medicine Service. Dr. Margaret Hochreiter is VA site coordinator for the Physical Diagnosis Course. Drs. Katz, Fitch and Kroupa are members of the VA Affiliated Partnership Council. Dr. Eliot Katz is a member of the Saint Louis University Graduate Medical Education Committee. Dr. William Mootz is the Assistant Dean for Curriculum for the Medical School. Patient care activities are the bedrock of faculty activity at the VA. There were over 17,000 encounters for GIM faculty and there was an overall increase in visits and encounters for all faculty in the last year. For the coming year, the VA faculty has begun an initiative with the residents to improve patient satisfaction in the clinics. Drs. Michael and Warren will also continue their support of patient safety training for residents and students.

Nancy Delaney, M.D. continued to provide patient care to the students of Saint Louis University at the Student Health and Counseling Center. The Center has seen tremendous growth over the past several years. The excellent care provided has been recognized by both students and parents. Services have expanded to include Orthopedic Surgery, Sports Medicine and Physical Therapy.

In the coming year, the division will continue to expand patient care activity at the Des Peres Medical Pavilion site. This is expected to afford opportunities for teaching medical students as well. It is anticipated that continued involvement with SLUCore will allow expansion of the division’s research activities. Dr. George Griffing continues his studies of improvements in existing therapies for patients with diabetes mellitus, as well as, innovative therapies.

 



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