Posts from the ‘education’ category

What secrets lie in the hearts of our ancestors? Signs of cardiovascular disease, for one, as a Brigham team of cardiovascular imaging experts recently helped discover.

Through a collaboration with an international team of researchers and anthropologists, Brigham faculty and staff performed CT scans on five mummies from 16th-century Greenland in the Shapiro Cardiovascular Center early last year. The team was looking for evidence of plaque in the arteries—also known as atherosclerosis—to see if the leading cause of death in the U.S. today was also prevalent centuries ago.

Sure enough, high-resolution scans of the mummified remains—belonging to four young adults and one child from an Inuit community—revealed telltale signs of the disease: hardened calcium deposits in various blood vessels in the chest.

“It’s always fascinating to look at humans who lived hundreds of years ago and see if learning about the past could teach us more about the present and future,” said Ron Blankstein, MD, associate director of the Brigham’s Cardiovascular Imaging Program, director of Cardiac Computed Tomography and a preventive cardiology specialist.

Blankstein was among the experts who scanned the mummies and interpreted the images last January, an event featured on National Geographic’s “Explorer” series this month. Other faculty and staff who helped conduct the scans included Kristen Burke, CT technologist; Marcelo Di Carli, MD, director of the Cardiovascular Imaging Program and chief of the Division of Nuclear Medicine; Abe Haboub, RT(R)(CT), cardiac CT manager; and Michael Steigner, MD, director of Vascular Imaging.

The effort was part of a broader project, led by a group of external researchers, to scan mummies from hunter-gatherer and preindustrial civilizations worldwide to search for signs of heart disease. The Brigham is one of several institutions to have participated and was approached based on the prestige of its cardiovascular imaging program, Blankstein said. 

Searching the Past

From Egypt to Mongolia and now Greenland, mummies throughout the ages have shown evidence of atherosclerosis. The Greenland mummies were particularly of interest due to their diet, which would have primarily consisted of fish and sea mammals.

While increased fish consumption is commonly touted as a heart-healthy diet—which may make the findings of atherosclerosis seem surprising—Blankstein emphasized that scientists still have much to learn about its exact relationship to cardiovascular health. For example, although it is known that consuming fish rich in omega-3 fats has benefits, some types of fish can also be high in cholesterol and, in the current era, contain toxins such as mercury or polycholrinated biphenyls (PCBs) that may pose some risk, he said.  

There could also have been lifestyle factors, such as exposure to cooking smoke in their dwellings, that contributed to the mummified individuals developing cardiovascular disease during their lifetimes, Blankstein explained.

With all that in mind—and the small sample sizes of these mummy scans—he noted that the team’s findings shouldn’t be taken too much to heart, so to speak.

“The question of whether fish is good or bad for you is still open-ended, and it would be unrealistic to think that we could provide a definitive answer by scanning a small number of mummies for plaque,” Blankstein said. “Our team found it fascinating that there was evidence of atherosclerosis despite the mummies’ estimated young ages, but this also doesn’t mean cardiovascular disease is inevitable. In fact, the majority of cardiovascular disease events that we see in patients is preventable with appropriate diet, weight control and lifestyle changes, such as regular exercise; at times, medication can also be used to treat various risk factors.”

A Different Kind of Patient

Although the mummies needed to travel only a few miles from a museum in Cambridge to Longwood, bringing them to the Brigham was no small feat logistically. Working closely with the hospital’s Police and Security team, Brigham faculty and staff members spent countless hours coordinating with museum officials and the researchers on how to safely transport these extraordinarily rare, delicate remains.

Once inside Shapiro, scanning the mummies wasn’t too different from work the cardiovascular imaging team normally does. In fact, they were a little easier to scan than a living patient; normally, the CT scanner must account for the movement of a beating heart.

Interpreting the images required a different perspective, however, Blankstein explained.

“This is not the same as scanning a [living] human. All of the organs are decomposed—in fact, you don’t see much of the heart at all,” he said. “The major plaque we saw was not necessarily in the arteries of the heart but in some other blood vessels in the chest, such as the aorta or some arteries of the neck.”

In addition to satisfying the team’s intellectual curiosity, Blankstein hopes their findings will inspire people to learn more about atherosclerosis and how to reduce their risk.

“It was certainly an exciting and interesting experience, and I hope we can use it to promote awareness of this mostly preventable disease,” he said.

Leave a comment

s Stan Ashley, MD, of the Division of General and Gastrointestinal Surgery, and Marshall Wolf, MDCelebrated medical educators Stan Ashley, MD, of the Division of General and Gastrointestinal Surgery, and Marshall Wolf, MD, emeritus vice chair for Medical Education, reflected on their decades of experience training the next generation of physicians during an event at the Brigham Education Institute (BEI) Knowledge Center on Dec. 21. The fireside chat—complete with a digital display of a crackling fireplace—was moderated by BEI Executive Director Erik Alexander, MD, who asked Ashley and Wolf to share their thoughts on the evolution of medical education, their advice for today’s educators and more.

Leave a comment
Aidan Chen

Aidan Chen displays one of the books donated to the NICU.

Ever since Aidan Chen was a young child, he’s had a love for reading. Wanting to share his passion for literature and the written word with others, he recently collected and delivered a large donation of children’s books—600, to be exact—to the Brigham’s Neonatal Intensive Care Unit (NICU) for our tiniest patients and their families to enjoy.

“Even very small babies need books,” said Chen, 16, a junior at Weston High School. “I love that through my donation I am able to help one baby at a time build their first library.”

His visit last month marked the second time Chen has contributed to the unit’s Brigham Baby Academy—a program introduced in 2016 that seeks to improve neurodevelopment of NICU babies and help families bond with their babies by reading, talking and singing to them every day. During their hospital stay and upon discharge from the hospital, NICU babies and their families are gifted new books for parents to continue reading with their infants at home.

Carmina Erdei, MD, medical director of the NICU’s Growth and Development Unit and neonatologist in the Department of Pediatric Newborn Medicine, who oversees the Brigham Baby Academy, explained that babies in the womb are listening to their mother’s voice and other family members for many hours a day. For most healthy, full-term newborns, that practice continues without interruption after birth and plays a notable role in the rapid brain development that occurs in infancy and early childhood.

On the other hand, babies who require acute care in the NICU—and need to remain hospitalized for several weeks or months—have significantly less exposure to that form of auditory stimulation. Through the Brigham Baby Academy, the NICU is creating the opportunity for some of these therapeutic experiences to occur for its littlest patients.

“We do think that reading and meaningful auditory exposure is medicine,” Erdei said.

For Chen, who hopes to be a doctor when he’s older, his latest donation to the program is just one chapter of a bigger story. As a research intern at the Brigham in 2017, he learned about the NICU and its commitment to ensuring each infant is read to at least once a day by staff or a family member.

To support the program, Chen created the GoFundMe fundraiser “Books for the Babies.” He continues to collect donations to purchase books for Boston-area NICUs and military families through events sponsored by the March of Dimes.

Sarah Wood and baby Hayden

Erdei said Chen’s latest donation couldn’t have come at a better time.

“Our shelves were getting quite bare, and we are incredibly grateful for Aidan’s efforts and donations,” Erdei said. “Because of him, we are able to spread the literacy message to so many families. He’s incredible.”

During his latest visit to the NICU, Erdei introduced him to two families and their babies who received books through the Brigham Baby Academy.

Sarah Wood was reading a book to her infant daughter, Hayden, a patient in the NICU, when Chen stopped by for a visit. An educator, Wood said she’s thrilled the Brigham created the reading program because not only does it help babies and their families bond, but it also sets infants up for success later in life. She began reading to her daughter before she was born. Some of Wood’s favorite books to read to Hayden are Corduroy, Polar Express and Goodnight Moon.

“As a teacher, I am always trying to instill the importance of reading to children,” Wood said. “The more language and the more words that your child hears in these formative years, the more effective communicators they will become. Having books available in the NICU is wonderful.”

Leave a comment

PCAs preparing to go to nursing schoolMany of you have already heard about the four amazing Brigham patient care assistants (PCAs) who received the inaugural Neskey Educational Opportunity Fund Scholarships, which provide full-tuition support to University of Massachusetts (UMass) Boston for PCAs who aspire to have a career in nursing. David and Sharon Neskey established the fund to honor the extraordinary care they received from a PCA here. As it turns out, the day we announced those four recipients was just one piece of what would become my One Shining Moment this year.

Weeks earlier, I had the pleasure of attending an information session about the scholarship. Considering that this was a new program, I set my expectations accordingly, thinking six to eight attendees would have been a good showing for our first year. Little did I know how incredible the response would really be. About 40 PCAs came to the session, brimming with enthusiasm about the next potential step in their careers. I was also amazed that attendees were at all stages of thinking about their future as nurses—some had completed all the academic prerequisites and were ready to start at UMass, while others who had never taken any formal steps for continued education viewed this potential scholarship as the push they needed.

Linda S. Thompson, DrPH, MPH, RN, FAAN, dean of UMass Boston’s College of Nursing and Health Sciences, was so inspired by the program that she attended the information session and spoke of how her own professional beginnings looked very similar to those in the room. The most moving part of the event, though, was that when I looked at that group of PCAs, I saw the future nurses of the Brigham, who will one day inspire the next generation that follows them. I can’t wait to see the amazing things they will do in the years to come.

Ron M. Walls, MD
Executive Vice President and Chief Operating Officer, Brigham Health

Leave a comment
Bernard Jones headshot

Bernard Jones

“Great Friday news!!!” At first glance, it seemed that was the entirety of the email from Paula Squires, MBA, SHRM-SCP, SPHR, our senior vice president of Human Resources. But as I scrolled down to read what she had forwarded, I clearly saw why she was so excited. After a lot of hard work with a great team (Ron M. Walls, MD, executive vice president and chief operating officer; Shelita Bailey, director of Workforce Development; Carmen Santos, Workforce Development specialist; and Paula, among others), we had hired the first person through our Brigham Health SUCCESS Program.

SUCCESS is designed to increase employment opportunities at the Brigham for those members of our local communities whose life trajectories would be most transformed by them, whether due to incarceration for nonviolent offenses, past challenges with substance use disorder or simply the broad spectrum of life’s personal challenges that anyone can encounter. The program’s initial partnership is with STRIVE, a Dorchester-based organization that provides an intensive five-week training on workplace readiness, responsibility and professionalism, along with career-specific skills training. We work with STRIVE to identify graduates with career potential and an interest in health care and then help guide those graduates through our employment process.

It all sounded great in theory and it was a program we loved working on and describing to others, but it didn’t feel real until I got that Friday afternoon email. I quickly emailed back an excited response and walked over to Ron’s office. He had seen the news and we shook hands on a job well done, but we also agreed that this had to be the first of many. I’m hoping for many, many more “great news” emails and I doubt they will ever be any less exciting.

Bernard Jones
Chief of Staff to the Executive Vice President and Chief Operating Officer, Brigham Health

Leave a comment
Bruynell and staff

From left: Alyssa Schifano, Sue Warthman, Karen Bruynell, Anna DeCristofaro and Caitlyn DeCastro

Being a new employee at Brigham and Women’s Hospital, my personal shining moment has been the teamwork and camaraderie I’ve experienced here, and it is one of the many joys that make me proud to be part of the Brigham.

As a team in the Brigham Education Institute’s Knowledge Center, our shining moment is working with trainees, faculty, allied health professionals and staff who are creating a community of learning and inspiration. They are producing results, they influence and impact today’s rapidly changing medical education environment and they shape our teaching and learning culture.

Karen Bruynell, MM, C-TAGME
Administrative Director, Brigham Education Institute

Leave a comment

Winter Food Drive Concludes Dec. 20
The Center for Community Health and Health Equity is hosting a winter food drive to benefit the Parker Hill/ABCD Emergency Food Pantry in Mission Hill, now–Dec. 20. Beans, rice, cereal, pasta, soups, peanut butter, jelly and canned goods are most needed. Donations can be placed in the food drive bins outside the Garden Cafe on Tower 2. For questions, or to make a cash or check donation, call 617-264-8750 or email

OHS Episodic Care Clinic for Employees
Occupational Health Services (OHS) offers conveniently located care for upper respiratory infections, sore throats, conjunctivitis, urinary tract infections and back pain. Staff who have a Brigham primary care provider and receive medical insurance through Partners HealthCare can visit the clinic Monday–Friday, 7 a.m.–3:30 p.m. Employees will not be charged a co-pay for their visit; labs, radiology exams and prescription medications are billed to insurance. The clinic is hosted at OHS’ mid-campus clinic on the Lower Pike. To schedule an appointment, call 617-732-8501.

Professional Development Series
The Professional Development Series (PDS) is available to help Brigham staff and teams gain new skills through self-led resources and classroom learning. PDS has a spring and fall semester, with spring courses beginning in February and fall courses starting in September. Class offerings include: Behavioral Interviewing; Communication Skills; Delegation; Presentation Skills; Time Management; Running Effective Meetings; Role of the Manager and more. To learn more, visit

BEI Yoga: Winter Series
The Brigham Education Institute (BEI) will host its winter series of 60-minute vinyasa yoga classes in the BEI Knowledge Center (located in the Thorn building, first floor, room 127D). The class is designed for all levels of experience, from beginners to more advanced yogis. Attendees should wear appropriate workout attire and bring their own yoga mat. Upcoming classes will be held 5:30-6:30 p.m. on Wednesday, Jan. 9, and Wednesday, Jan. 16. View a full schedule and register. 

Leave a comment

Gift-Wrapping Fundraiser to Support the NICU

The Brigham Young Professionals group is hosting a gift-wrapping fundraiser outside of the Shop on the Pike throughout December. Bring your unwrapped holiday presents and a volunteer will wrap them for you. Donations will benefit the NICU Friends of BWH, a group that support the families of the Neonatal Intensive Care Unit (NICU). Hours of operation will be Tuesday, Dec. 11–Friday, Dec. 14 and Tuesday, Dec. 18–Thursday, Dec. 20, 11 a.m.–1 p.m.

Shop on the Pike Holiday Sale, Dec. 13-14

The Shop on the Pike will celebrate its 10th birthday by offering 20 percent off most items, including select Brigham apparel, during a holiday sale on Thursday, Dec. 13, and Friday, Dec. 14. The discount does not apply to flowers/plants, balloons, candy, food, magazines, greeting cards, website orders, phone cards, gift cards or paperback books. Call 617-732-7878 for more details.

‘Flooded: Lessons Learned from a Major Hospital Flood,’ Dec. 13

The Department of Quality and Safety hosts “Flooded: Lessons Learned from a Major Hospital Flood” as part of the Quality Rounds. Ronald Iverson Jr., MD, MPH, of Boston Medical Center will present. Attendees will learn about planning and practice for a large-scale flood, as well as the use of outside resources during a response to such an event. Thursday, Dec. 13, noon-1 p.m., in Bornstein Amphitheater. Learn more.

Holiday Reminder: Personal Package Policy

With the holidays fast approaching, the Receiving & Distribution and Office Services teams remind employees that personal package deliveries cannot be accommodated. The priority of these departments is delivering items directly related to patient care and hospital business. Due to the large volume of these deliveries alone, the added responsibility of processing personal packages delays the turnaround time on products that may directly affect patient care. Please make alternate arrangements for the delivery of personal packages. For questions, contact Jonathan Santiago at

Leave a comment
Nahall Rad (left) and Anish Mehta (right) simulate caring for a patient, played by Herrick “Cricket” Fisher, who has fallen in her kitchen.

Nahall Rad (left) and Anish Mehta (right) simulate caring for a patient, played by Herrick “Cricket” Fisher (center), who has fallen in her kitchen.

While home-based hospital care yields considerable benefits for patients, it also poses unique challenges for care teams as they monitor and treat patients outside the controlled environment of a hospital.

Members of the Brigham’s Home Hospital team recently collaborated with experts at the Neil and Elise Wallace STRATUS Center for Medical Simulation to transform the center’s space in Neville House to mimic a home setting. They practiced responding to events the clinical team might encounter in a patient’s house or apartment—running the gamut from emergency to end-of-life scenarios.

The Home Hospital program provides hospital-level care to select acutely ill adults in the comfort of their home. Eligible patients, who must live within five miles of the Brigham’s main campus or BWFH, are enrolled via the Emergency Department upon seeking care for issues such as infections and exacerbations of heart failure, asthma and chronic obstructive pulmonary disease. If inpatient care is needed, the Home Hospital team will discuss the opportunity with the patient to receive care at home instead of through a conventional hospital admission.

The recent exercise with the Home Hospital team was a first for the simulation experts at STRATUS, who usually set up their facilities to look like traditional hospital settings, such as an operating room or patient room. For this training, STRATUS staff created a mock foyer, kitchen, bedroom and living room.

Seeing the Team Come Together

During the exercise, the nine-person Home Hospital clinical team went through six scenarios, including caring for a patient who has fallen in his or her kitchen; what to do when a dementia patient has forgotten to turn off the toaster, leading to a small fire; and speaking with a cancer patient about end-of-life and goals of care. With assistance from STRATUS, they acted out each scenario and reviewed the appropriate protocols and procedures for handling each situation.

“Our team was phenomenal,” said David Levine, MD, MPH, MA, a physician and researcher in the Division of General Internal Medicine and Primary Care who oversees the Home Hospital program. “To see our clinical team come together to enhance their home-hospital skills and learn from each other was beautiful. I am very proud of our team and look forward to organizing more simulated training experiences with STRATUS in the future.”

Home Hospital nurse Nahall Rad, BSN, RN, said taking part in these types of simulations is critical because it prepares the team for the challenges of delivering care outside the hospital.

“The dynamic nature of patient care in the field requires you to be as best prepared as possible for managing unforeseen and emergency scenarios,” Rad said. “The training we received at STRATUS was crucial in allowing our clinicians to be exposed to these types of experiences in a controlled environment to receive feedback on what was done well and what could have been done better. This allows us to have the highest level of patient care and improves our patients’ outcomes that much more.”

Also participating in the training was Gregory Goodman, MD, a Home Hospital attending physician. He appreciated the opportunity to work through the different cases with the team and learn about ways to improve patient care in the home setting.

“This was a powerful opportunity to work with our Home Hospital colleagues to improve our approach to care in a real-life way,” Goodman said. “It was great to see our team work together to collaborate to deliver exceptional and innovative care.”

Preparation Is Key

Planning and organizing such a course takes a lot of preparation behind the scenes—one year to be exact, Levine said. From writing the curriculum to ordering the furniture and equipment for the simulation, both teams wanted to ensure the course was as authentic as possible.

Michael Sampson, CHSOS, senior medical simulation specialist at STRATUS, enjoyed working with Levine and the entire Home Hospital team to create the course and operate the computerized simulation manikins during the training. He said seeing their passion for continued learning was inspiring.

“It is truly a team effort to put on simulation programs at STRATUS,” Sampson said. “It requires extensive planning and dedication from our staff and faculty members.”

Jamie Robertson, PhD, director of Education at STRATUS, also worked closely with the team to create the curriculum for the course. She said it was an exciting opportunity to think creatively about how to simulate the most realistic experience possible for Home Hospital providers.

Charles Pozner, MD, executive director of the STRATUS Center, said the course is another example of how STRATUS continues to contribute to the transformation of care delivered by Brigham Health providers. “This unique interprofessional program not only enables the Home Hospital staff to stay current with procedural care, but it also provides an excellent opportunity to strengthen the team-based care that is crucial in making this program such an overwhelming success,” Pozner said. “STRATUS takes pride in ‘pushing the envelope’ in health care education and research.”

Leave a comment
children participating in family day at the hospital by trying out simulation items.

PACU nurse Kaitlyn Fredrickson (third from left), RN, demonstrates for “Family Day” attendees Gianni and Kelis Wilkinson (first and second from left) how to place intravenous lines, while their mother, PACU nurse Teyarnna Straughter, RN, snaps a photo.

More than 500 children, parents and siblings of staff from the Brigham’s Operating Rooms (ORs), Post-Anesthesia Care Unit (PACU) and Perioperative Services received a glimpse of what their loved ones do each day during an inaugural “Family Day” event, held in partnership with the Neil and Elise Wallace STRATUS Center for Medical Simulation, on Nov. 17.

In addition to providing tours of the ORs, PACU and Peri-op areas, staff hosted family-friendly educational activities. Interactive stations around the three areas provided hands-on opportunities for young visitors to use simulation tools to try out laparoscopy, intubation, CPR, ultrasound and more. Using models of bones, children also learned surgical skills used in orthopaedic surgery and how joint replacements are performed.

1 Comment

On Nov. 10, the American Heart Association (AHA) held its annual Scientific Sessions meeting in Chicago, featuring the latest advances from major cardiovascular trials with the potential to transform clinical practice. Investigators from the Brigham led some of the most highly anticipated trials and presented their results at the conference.

Insights into Omega-3s, Vitamin D

The benefits of omega-3 fatty acids – a “good” fat largely found in fish, nuts, flax seeds and leafy greens – have been touted in recent years. But just how protective are they in cardiovascular health?

JoAnn Manson shares findings from the VITAL study.

JoAnn Manson shares findings from the VITAL study.

Deepak L. Bhatt, MD, MPH, executive director of Interventional Cardiovascular Programs in the Division of Cardiovascular Medicine, presented results and insights from the clinical trial REDUCE-IT, which tested whether icosapent ethyl (a medication derived from an omega-3 fatty acid found in fish oil) could reduce the risk of cardiovascular events in at-risk patients. Participants were defined as “at risk” if they fell into one of two categories. Either they had atherosclerosis – a disease in which plaque builds up in the arteries – or they had diabetes plus at least one other cardiovascular risk factor along with elevated triglyceride levels, despite taking statins.

Participants who took the medication saw a 25 percent risk reduction in cardiovascular events and a 20 percent reduction in death due to cardiovascular causes, a result Bhatt described as “remarkable.”

“This may be the biggest development in cardiovascular prevention since statins,” he said. “The REDUCE-IT trial sets a new standard of care for these patients.”

In another presentation, JoAnn Manson, MD, DrPH, chief of the Division of Preventive Medicine, unpacked results from the VITamin D and OmegA-3 TriaL (VITAL). VITAL also examined whether omega-3 fatty acids affected a person’s risk of experiencing cardiovascular events, but Manson and colleagues studied them among a general, racially diverse population and used a lower-dose supplement that contained both of the major forms of marine omega-3s. VITAL also examined effects on cancer occurrence.

The team found that omega-3s reduced the risk of heart attacks but did not reduce stroke, major cardiovascular events or cancer. VITAL also tested the effects of taking a vitamin D supplement, which did not reduce cardiovascular or cancer outcomes except for a signal that cancer deaths were lower over time.

Diabetes Drug Lowers Heart Failure Risk

A new class of diabetes drugs known as SGLT2 inhibitors can help lower blood glucose levels in patients with diabetes. Investigators are finding mounting evidence that the inhibitors may also lower cardiovascular risk.

Stephen Wiviott, MD, of Cardiovascular Medicine, shared findings from the DECLARE–TIMI 58 trial. The multinational trial tested an SGLT2 inhibitor known as dapagliflozin. Wiviott highlighted reductions in risk of adverse heart and kidney outcomes for patients.

Separately, Elisabetta Patorno, MD, DrPH, of the Division of Pharmacoepidemiology and Pharmacoeconomics, presented initial results from the real-world EMPRISE study, which found that another SGLT2 inhibitor reduced the risk of hospitalization for heart failure in routine care.

Inflammation and Heart Disease: A Roadmap for the Future

Brigham cardiologists have been at the forefront of basic, clinical and translational research linking inflammation and heart disease for decades and presented the next chapter in the ongoing story of the inflammatory hypothesis at this year’s meeting.

Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention, delivered results from the Cardiovascular Inflammation Reduction Trial (CIRT), a large-scale trial that tested whether low-dose methotrexate – an inexpensive, generic drug widely used to treat inflammatory diseases – was effective in reducing cardiovascular risk.

Last year, the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS) showed that the high-cost drug canakinumab targeted a specific inflammatory pathway and consequently lowered rates of heart attack and cardiovascular death. By contrast, the findings from CIRT showed that low-dose methotrexate neither inhibited that same pathway nor did it reduce major adverse cardiovascular event rates.

“The results from CIRT and CANTOS, when considered together, tell us something critically important: Not all inflammation is the same, and not all drugs that target inflammation are the same,” said Ridker. “While it is disappointing that an inexpensive drug like methotrexate did not have the effects we previously saw in CANTOS, the results from CIRT shed crucial light on the underlying biology that connects inflammation with cardiovascular disease. The divergent trial results provide a clear roadmap to guide our efforts going forward.”

In a separate presentation, Brendan Everett, MD, MPH, director of General Cardiology Inpatient Service, reported that the interleukin-1β inhibitor canakinumab reduced hospitalization for heart failure and heart failure-related death. These data represent the first-large scale evidence that inflammation inhibition can improve outcomes in heart failure. The results suggest that the role of inflammation reduction in improving heart failure outcomes merits further exploration.

Leave a comment

The Brigham was buzzing with excitement as Discover Brigham drew hundreds of attendees to the hospital’s main campus on Nov. 7.

Through digital poster sessions, hands-on demonstrations, panel discussions, award presentations and more, the event showcased the Brigham’s expertise in several areas of science, medicine and technology. This year’s event highlighted discoveries and insights around lung disorders, sleep medicine, genomics, cancer, women’s health and opioid use disorder.

The day-long event concluded with an awards ceremony that announced the winners of the BRIght Futures Prize and Brigham Research Institute Director’s Transformative Award.

Leave a comment

Bram Wispelwey trains community health workers in Palestine.

Thanks to a new Global Health track in Hospital Medicine, hospitalists have the support they need to practice at the Brigham and work to improve health around the world.

The first cohort of three Global Health track physicians began at the Brigham in July, with projects supporting communities in Ethiopia, Guatemala and Palestine. In 2017, Peter Rohloff, MD, PhD, an attending hospitalist, established the track to expand opportunities for his colleagues to be a part of both the Brigham and the global health community.

“The vision for this track is to help junior faculty with a strong interest in global health take the next steps in advancing their careers,” said Rohloff, who is also the founder of Maya Health Alliance, a nonprofit that addresses the health care needs of Guatemala’s most impoverished communities. 

He added that the track helps clinicians connect with mentorship and development opportunities at the Brigham and have a clinical home at the hospital – a goal shared by the Division of Global Health Equity. Since its founding in 2001, the division has provided an anchor for faculty who wanted to work globally but remain active clinically and academically in the U.S. 

Among those in the first cohort of physicians on the Global Health track is Bram Wispelwey, MD, MS, who completed the Brigham’s Doris and Howard Hiatt Residency Global Health Equity and Internal Medicine earlier this year. When not practicing at the Brigham, Wispelway is caring for Palestinians and helping mend fractured health care systems in Palestinian refugee camps. 

To address the complex issues facing refugees in these camps – which lack dedicated local clinics or consistent access to affordable primary care – Wispelway helped launch and monitor a Community Health Worker program. This work aims to improve relationships and rebuild trust between physicians and patients, strengthen the health care delivery system and improve the health of refugee families. He now divides his time between the Brigham and Palestine.

Jennifer Goldsmith, MS, MEd, administrative director of the Division of Global Health Equity, helped establish the partnership between Hospital Medicine and the division. She described the global health track as “highly customizable to meet the needs and interests of individuals and to offer opportunities for global health research and field work, didactics and career mentorship.” 

“We’re delighted to work together to build on the mentorship and global health opportunities at the Brigham by creating this new career step,” Goldsmith said. 

Leave a comment

Raymond Mak

Raymond Mak, MD, of the Department of Radiation Oncology, was honored with the 2018 Bernard Lown Teaching Award, which celebrates physicians who are outstanding clinical teachers.

In this Q&A with BWH Bulletin, Mak shares his ideas on the field of radiation oncology, effective teaching and the Socratic method.

What drew you to the field of radiation oncology?

RM: I was always interested in cancer care and patients. One of my medical school mentors, Anthony D’Amico, MD, PhD, happened to be a radiation oncologist. He introduced me to the field of radiation oncology, serving as a mentor and teacher. The field combines procedural/interventional aspects of medicine, technology and imaging, with an academic, evidence-based and patient-centered focus, which was very appealing to me.

What is the key to being an effective instructor?

RM: From my perspective, it’s about trying to put yourself in trainees’ shoes. You need to understand where they are coming from, their level of knowledge and their experience. Using this information, you need to tailor your teaching style accordingly. I focus most of my efforts here when designing a lecture or lab for trainees.

Additionally, I try to make the material as interactive as possible. Using the Socratic method, I ask a lot of questions, both rhetorical and direct, to gauge the level of understanding in the classroom or clinic. As an instructor, this is the key to understanding the needs of the learner.

Whose teaching style has influenced your own?

RM: My dad was a college professor, so growing up, I often observed him teaching and tailoring material to the needs of different people, and much of my approach now comes from him.

In the past, I considered myself somewhat of an introvert and did not really think I would be a good teacher. It was in speaking to and learning from my mentors in medical school and throughout residency that I was able to hone my craft and come out of my shell.

At Harvard Medical School, the problem-based learning curriculum set the stage for my own teaching style. Going into residency, the teaching model was Socratic as well, with the emphasis on direct questioning and audience participation. This emphasis combined with the many great teaching role models in my department and at the Brigham greatly influenced my own teaching.

How has working with trainees influenced your work as a physician-scientist?

RM: Residents teach me a lot. They have great ideas, and they don’t follow the assumptions and orthodoxies that those who have been in the field for a long time do. Between the teacher and the trainee, it’s a two-way street. I ask them questions to help them learn, and in return, they ask me questions that challenge my own thinking and customs. I always tell my residents when they’re on service with me to make sure they continually ask why I’m doing a procedure or approaching a patient’s situation in a particular way. I encourage my trainees to challenge my conventions and methods as much as possible.

Our department is an environment with such an emphasis on teaching; everyone is pushed to improve, from residents to junior faculty. There was no doubt to me that one of the most important things that I could do as a physician was to be a great teacher for residents and medical students. This has always been a primary focus for me. When everyone you’re surrounded by is focused on effective teaching and trying to do their best, you have to bring your A-game.

Brigham Health’s Strategy in Action: Teaching and Training
Learn more about our strategic priorities at

Leave a comment

Interactive demonstrations at the ‘iHub Turns 5’ celebration showcase digital health innovation at the Brigham.

On Sept. 12, more than 200 clinicians, scientists, staff and entrepreneurs commemorated the fifth anniversary of the Brigham Digital Innovation Hub (iHub) during a celebration of innovation and digital advancement at BWH and beyond.

The half-day event, “iHub Turns 5,” featured panel discussions with BWH innovators, iHub alumni and senior leaders from the Brigham and Partners HealthCare in the Hale Building for Transformative Medicine.

Since 2013, iHub has helped innovators launch and advance projects focused on using technology to streamline hospital operations, improve care delivery and enhance the patient and employee experience. One example is the Brigham’s online wayfinding tool, which provides step-by-step directions for navigating the hospital. iHub members have also worked with Medumo, a startup co-founded by Internal Medicine and Dermatology resident Omar Badri, MD. The company’s flagship application – in use at the Brigham’s Endoscopy Center – delivers precisely timed reminders via email and text message to patients for various purposes, such as preparations for procedures.

“We are aspiring to drive the safest, most patient-centered and efficient care through the use, development, evaluation and commercialization of digital health solutions,” said Adam Landman, MD, chief information officer of Brigham Health.

Improving Lifesaving Care Through Innovation

During a panel highlighting current and former BWHers’ journeys from ideation to innovation, YiDing Yu, MD, shared her experience of working with iHub to grow a startup company from a single idea.

When she was a second-year Internal Medicine resident, Yu attended iHub’s inaugural hackathon five years ago wanting to solve a problem she had encountered firsthand, specifically the communication challenges care teams encounter when a patient is arriving via ambulance.

Due to privacy concerns, emergency medical service (EMS) responders can only transmit limited information about an incoming patient to hospital care teams over public radio channels. Yu wanted to develop a tool to bridge this gap – a technology that would provide emergency departments with timely information while protecting patient privacy.

Yu was determined to solve this problem, despite the fact that she had no experience starting a tech company. “All of us were first-time entrepreneurs. We had no idea what we were doing,” said Yu.

Yu’s application, Twiage, is now used by over 50 hospitals in 12 states. Its secure digital platform enables first responders and emergency departments to accelerate lifesaving care by sending real-time clinical data and location updates directly to hospital care teams. Yu said that while it was daunting to pivot her career path to focus on Twiage – she also practices medicine at Atrius Health a few hours a week – she believes in her startup.

Yu attributes part of her success to the support she has received from iHub and the larger Brigham community. “I came to the Brigham to train because of the culture here,” said Yu. “I think you have to be surrounded by people who support your passion – I have bosses and mentors who do that. They help ignite that fire in your belly.”

Yu was joined on the panel by Karen Fasciano, PsyD, a psychologist at BWH and Dana-Farber Cancer Institute, who discussed her work on banYAn, an app that helps young adults coping with cancer; Alexander Lin, PhD, director of the Center for Clinical Spectroscopy in the Department of Radiology, who launched a company called BrainSpec to make virtual biopsies a reality; and Scott Weiner, MD, MPH, of the Department of Emergency Medicine, who is working on several digital health projects related to the opioid crisis.

In addition to the speaking program, the celebration was a homecoming for many iHub alumni, including Lesley Solomon, MBA, who helped create iHub and was honored that evening with the inaugural Disrupting Medicine Award for her contributions and leadership.

Reflecting on iHub’s early days, Solomon said the Brigham had to chart new territory to get iHub off the ground: “You just have to go for it. You just have to start doing things.”

Leave a comment

From left: Aaron Berkowitz works with Roosevelt François, inaugural graduate of Haiti’s first neurology fellowship.

The Brigham has more than a hundred neurologists on faculty, each with their own subspecialties. Yet until recently, Haiti, a country of nearly 11 million people, had only one. Aaron Berkowitz, MD, PhD, hopes to change that.

Following the island’s devastating 2010 earthquake, Berkowitz, director of the Brigham’s Global Neurology Program, was deeply moved by what he learned from his colleagues who had traveled to Haiti to assist with medical relief efforts. The disaster magnified how the country, especially its rural areas, was in dire need of specialized care.

“Most doctors in Haiti are general practitioners because there are no specialty training programs,” said Berkowitz. “If you go to medical school in a country with few or no neurologists, you have very minimal training in neurology to help patients with neurologic conditions.”

Six years ago, Berkowitz and his colleagues, including Michelle Morse, MD, MPH, assistant program director of the Internal Medicine Residency Program and associate physician in the Division of Global Health Equity, resolved to remedy this shortage. They worked with global nonprofits Partners In Health and EqualHealth to teach neurology courses for internal and family medicine practitioners and trainees.

Following this, Berkowitz, Morse and their Haiti colleagues developed a four-week neurology rotation for five internal medicine residents at the Hôpital Universitaire de Mirebalais (HUM). Their subsequent success inspired Berkowitz and colleagues to start a new, more intensive program – thus, Haiti’s first neurology fellowship was born.

One applicant is chosen each year for the two-year fellowship, and the program is rigorous; the fellow cares for all neurology inpatients and outpatients at HUM and receives mentorship from about a dozen U.S.-based neurologists, each of whom spends one to 12 weeks teaching in Haiti annually.

Last year, the first fellow, Roosevelt François, MD, graduated from the program. He recently joined the hospital’s faculty and became director-in-training of the neurology clinical program and educational fellowship. With the second fellow set to graduate this fall and a third next year, the program is on track to reach its goal of a 500 percent increase in neurologists – from one to five – within five years.

The need for neurology care is especially critical in Haiti, Morse explained. The country has a disproportionately high rate of hypertension, which is a key risk factor for stroke, in addition to a high burden of epilepsy from neurologic infections.

Building a Pipeline

Berkowitz and Morse hope their latest milestone ignites a fast-growing, self-sustaining fellowship led by HUM faculty.

“This program is going to have an enormous impact on the next generation of health care professionals because it has this faculty pipeline built into it,” Morse said. “And, more importantly, it’s a step toward achieving what citizens of Haiti deserve: health care as a human right.”

Berkowitz expects the program will not only expand access to high-quality neurologic care in Haiti, but will also train a cohort of clinician-educators who will teach neurology to their peers and train more neurologists in Haiti. More broadly, he hopes it becomes a model that other health professionals in resource-poor settings can replicate to develop specialty training programs in partnership with visiting faculty.

“Haiti is just one country,” he said. “Around the world, patients who need specialized care often can only see their general practitioner, who has no one they can refer the patient to for specialized expertise. The need is endless, and we hope our program can inspire other clinician-educators to expand their teaching efforts beyond borders.”

Morse, who has worked on health equity initiatives in Haiti and beyond for more than a decade, said Berkowitz’s passion and dedication has positioned the project for long-term success.

“Aaron is one of my heroes for being so committed to this program,” she said. “No matter what challenge comes along, he never gives up.”

Brigham Health’s Strategy in Action: Teaching and Training
Learn more about our strategic priorities at

Leave a comment

Rich Joseph leads a class about creating a personalized health plan at Brigham and Women’s Center for Community Wellness.

When Christina Meade, MD, was invited by a fellow resident to give a talk about kidney health – one of her clinical interests – to people in the local community, she jumped at the opportunity.

“I love medicine, specifically preventive medicine, and to educate people in our local communities about their health and wellness is what makes my job so wonderful and exciting,” said Meade, a second-year resident in the Department of Medicine. “After I participated in the talk, my passion for primary care was rejuvenated.”

Last year, Rich Joseph, MD, MBA, a third-year resident in Primary Care and Population Medicine, approached Paul Ridker, MD, MPH, director of the Center for Cardiovascular Disease Prevention, about possibly launching an ongoing health and wellness series led by residents at Sportsmen’s Tennis and Enrichment Center in Dorchester. Ridker, who at the time was the board chair of Sportsmen’s, said he instantly loved the idea, knowing the series could benefit both Brigham residents and community members.

Ongoing since September 2017, the “Wednesday Wellness” series takes place twice a month at the Brigham and Women’s Center for Community Wellness, Dorchester, located within Sportsmen’s. Each course focuses on a different health- and wellness-related topic, with more than 20 sessions held to date. Courses have covered diabetes and hypertension, dementia and arthritis, among other topics.

Opened in 2015, the goal of the Brigham and Women’s Center for Community Wellness Center at Sportsmen’s is to advance health and chronic disease prevention in underserved communities of Dorchester, Mattapan and Roxbury. The facility includes both classroom space for educational activities and a full gym, free to anyone living in the area.

For Ridker, the center has been a “terrific way for the Brigham to have a positive impact on preventive health in underserved neighborhoods where so many of our patients live and work.”

Wanda McClain, MPA, vice president of Community Health and Health Equity, agreed, adding the “Wednesday Wellness” program shows the power of collaboration. “Bringing together health care providers, community residents and Sportsmen’s is a perfect trifecta for improving community health,” she said.

Toni Wiley, Sportsmen’s executive director, has seen firsthand how valuable the courses have been for attendees.

Attendees of a recent “Wednesday Wellness” course gather for a photo with Brigham resident Rich Joseph (back row, center).

“I’ve heard many success stories from our members who’ve attended the ‘Wednesday Wellness’ sessions,” Wiley said. “Some have lost a few pounds, and others have come to understand how their medications truly work. It has been truly gratifying to hear people talk about how attending these sessions has been life-changing for them.”

The series has a loyal following. William Mitchell, of Mattapan, has attended nearly every “Wednesday Wellness” session, even inviting friends to join him. A retired firefighter, Mitchell said he appreciates the residents’ thoughtful, insightful presentations.

“To me, it’s a great thing to bring health and wellness education into the local community,” he said. “I’m grateful that the Brigham and Sportsmen’s came together to bring this goodness to our community, which is helping many of us live a better life.”

The series has also benefited Brigham trainees by providing opportunities to “get outside one’s comfort zone” and talk about health and wellness in a setting other than the hospital, Joseph explained.

Since the series launched, Joseph has heard from many resident colleagues who are interested in getting involved.

“It feels good knowing our work is helping others,” said Joseph, noting the series is a collective effort and would not be possible without the support of his resident colleagues.

BWH Emergency Medicine residents and Boston Children’s Hospital pediatric residents are among those involved in the series. Since Sportsmen’s offers programs for all ages, Joseph said it has been valuable to have residents from different specialties share their expertise.

Joseph, along with a handful of other Brigham residents, including Joshua Lang, MD, MS, a third-year resident in Internal Medicine, are also teaming up with Sportsmen’s to launch related programs, including community health fairs and an educational series for children attending summer camp at Sportsmen’s. Lang said it has been wonderful to participate in this work. “I feel pretty lucky to have found out about it,” he said.

Joseph added: “Partnering with Sportsmen’s has been one of the best decisions I’ve made as a resident. For me, this is the type of work that keeps me going – it’s very motivating. I love showing people the process of discovering their own health and taking care of themselves.”

Brigham Health’s Strategy in Action: Improve Health
Learn more about our strategic priorities at

Leave a comment

Buprenorphine is widely considered one the most effective medications available to treat opioid use disorder. It blocks the effects of opioids and suppresses cravings and withdrawal symptoms – “tricking” the brain into believing an opioid like heroin or oxycodone has been ingested without producing a drug-induced high.

But there’s one big catch: It can be difficult for patients to access, primarily because clinicians must undergo a specialized, eight-hour training to prescribe it to patients with opioid use disorder.

The time commitment alone is a significant barrier for many providers. Additionally, access to the buprenorphine waiver training course is limited in many areas of the country.

Mia Lozada, MD, an internal medicine physician at Gallup Indian Medical Center in Gallup, N.M., and her colleagues are all too familiar with these challenges. Serving residents of the Navajo Nation, the U.S. Indian Health Services (IHS) hospital is about a two-hour drive from the nearest city, Albuquerque, where waiver training is occasionally offered.

“In addition to the time and distance, we typically don’t hear that these trainings are available until a month or two ahead of time. By then, our clinics are already scheduled, so the logistics are even more complicated,” she said.

That’s why Lozada and her colleagues jumped at the chance to remotely attend an online waiver training last month led by Joji Suzuki, MD, director of BWH’s Division of Addiction Psychiatry, organized in collaboration with the Brigham and Women’s Outreach Program. The course was scheduled several months in advance, enabling 38 Navajo-area IHS clinicians from multiple disciplines across five sites to attend without affecting patient care.

Since 2009, BWHers have collaborated with the IHS – the U.S. government agency responsible for delivering medical and public health services to members of federally recognized Native American tribes. Through the Outreach Program, BWH faculty, nurses, trainees and other providers volunteer their time and expertise to offer specialized care and training on the ground at IHS hospitals in rural New Mexico and Arizona and through remote teaching opportunities.

Providing waiver training remotely and offering it to IHS clinicians were firsts for Suzuki, who has led waiver training courses for prescribers across the Brigham, Greater Boston and New England for more than 10 years.

“The clinicians out there in Navajo Nation are doing amazing work with such limited resources, and I’m happy to do anything I can to help them,” Suzuki said. “Since we already had this relationship established through the Outreach Program and the technology to provide the training remotely, it was a great opportunity to lower some of the barriers they face in accessing waiver training.”

Joji Suzuki

Joji Suzuki provides buprenorphine waiver training to Indian Health Services clinicians based in New Mexico.

A Valuable Resource

Many patients with substance use disorder are reluctant to seek care from an addiction medicine specialist due to social stigma. They may be more open to discussing treatment options with a clinician with whom they have an existing relationship, such as a primary care provider or gynecologist, underscoring the importance of expanded waiver training.

But because those providers typically haven’t received more specialized training in treating substance use disorders, they often report not feeling confident prescribing medications such as buprenorphine. Lozada, who completed the waiver training in 2011 during her residency at the University of California, San Francisco, was thrilled to have an opportunity to retake the course with Suzuki for this exact reason.

“The training reviewed a lot of areas in which we sometimes feel a little uncertain and would otherwise push some of us away from prescribing buprenorphine,” she said. “Hearing from an expert such as Dr. Suzuki was really valuable and reassuring. It gave me a lot more confidence in how to care for patients with opioid use disorder.”

Lozada noted that not only did the recent training help IHS clinicians increase their roster of buprenorphine prescribers, but it also expanded the range of specialties where patients can now access the medication. In addition to internal medicine practitioners, Navajo-area IHS clinicians representing inpatient care, obstetrics/gynecology, pediatrics and pharmacy services attended, as well.

“Having that diversity in expertise is important because it gives us the opportunity to provide this treatment to more patients, regardless of age or condition,” Lozada said. “It’s also a chance to cross-collaborate between our departments in a way we haven’t been able to do before.”

Another benefit is that having so many colleagues take the same training together will result in more consistent practice across multiple sites and disciplines, Lozada added.

“It puts us all on the same page,” she said. “Rather than attending different waiver trainings across the country, we all have a common foundation as we prescribe medications to treat opioid use disorder.”

While the number of clinicians receiving waiver training across the country is increasing, Suzuki noted it is one piece of a far bigger, more complex puzzle in responding to the opioid crisis.

“There’s a huge educational gap that’s going to take an entire generation to close,” he said. “You have several generations of physicians and health care providers who never received any substantial training around addiction treatment. One eight-hour course is not going to solve that problem. But it’s part of the solution.”

1 Comment

Seniors from SSJP’s class of 2018 celebrate with Center for Community Health and Health Equity staff.

Kaman Hau never thought she’d get hands-on experience in a research laboratory as a high school student.

After friends and family encouraged her to apply to the Student Success Jobs Program (SSJP), Hau was overjoyed to achieve exactly that. Upon her acceptance into the program, she was placed in the Division of Endocrinology, where she met her mentors, principal investigator Ann Marie Zavacki, PhD, and research technician Colleen Carmody, who supervised her.

“Never in a million years would I have imagined myself being this far in my career in high school,” Hau said, adding that many college students never even step foot inside a lab. “I grew as a student because Colleen and Ann Marie challenged me to leave my comfort zone – I created bonds with individuals who motivated me to strive toward my goals.”

A program of the BWH Center for Community Health and Health Equity (CCHHE), SSJP partners with select Boston-area high schools to match students with mentors and paid internships across the Brigham. The program is focused on fostering the next generation of talented, diverse health care workers.

Joined by their families, colleagues and SSJP underclassmen, this year’s seniors were honored during a graduation ceremony held at the Joseph B. Martin Conference Center on June 4.

Attendees heard from fellow students, keynote speaker Ricalder A. Valentine, MPH, MBA, director of Ambulatory Clinical Operations in the Department of Medicine, and SSJP alumna Angela Vu, RN.

In addition to her ongoing mentorship with Zavacki and Carmody and learning practical techniques, such as how to properly handle mice and genotype their DNA for research, Hau worked closely with SSJP on the college application process, including SAT preparation, essay writing and career planning. The Boston Latin Academy senior begins college at her dream school – Tufts University – this fall.

“It was this experience that pushed me to go into the medical field,” said Hau, who aspires to become a physician. “I can confidently say that SSJP is the best internship that any high school student could have.”

Overcoming Obstacles Together

More than 60 departments host SSJP interns. In a survey of SSJP alumni, more than 70 percent of program participants are first-generation college students, and more than 90 percent felt that the opportunity to work in a professional environment while in high school greatly assisted them in their college and career pursuits.

As part of her alumnus address at the recent graduation ceremony, Vu reflected on how the support network she found here helped her overcome personal challenges later in her college career.
During her junior year at the College of the Holy Cross, Vu unexpectedly needed to take a leave of absence for medical reasons. Shortly after she made this difficult decision, she received an email from SSJP asking alumni for an update on how they were doing.

“I didn’t want to reach out because I was embarrassed to tell them I was no longer in college,” Vu said. “A few days later, I found myself in the Longwood Medical Area speaking to SSJP staff about everything I was going through. After many tears and hugs, and a lot of encouragement, we came up with a plan.”

After taking the remainder of her junior year off to focus on her health, Vu and SSJP staff worked together on her application to University of Massachusetts Boston’s nursing program, to which she was accepted the following fall.

Today, she is a registered nurse at the Charles River Community Health Center and is applying to a family nurse practitioner program at Simmons College.

“The love from SSJP is enormous,” Vu said. “I can’t emphasize enough that the SSJP staff truly care about their students and support them in every way – they taught me resilience and to never give up on my dreams, no matter how impossible the situation may seem.”

Leave a comment
Training class for staff at Gillette Stadium

This tourniquet training class for staff at Gillette Stadium was one of many conducted by BWH researchers last year.

In the immediate aftermath of an accident or attack, can bystanders help save the life of someone who has experienced a traumatic injury? Brigham researchers recently sought to answer this question by studying how well different training methods prepared laypeople to apply tourniquets to stop uncontrolled bleeding, finding that those who underwent in-person training were most likely to successfully perform and retain this skill.

Traumatic injuries are the leading cause of death for Americans under 46, and uncontrolled bleeding is the most common cause of preventable death following a traumatic injury. Since the Boston Marathon bombings in 2013, several national initiatives, including the White House’s “Stop the Bleed” program, have emerged to empower laypeople to act as immediate responders until emergency personnel arrive on scene. These efforts have led to the development of different training methods, but it was previously unknown which type, frequency and format of training would competently prepare nonmedical personnel to conduct hemorrhage control.

To determine the best training method for tourniquet education, BWH researchers completed the PATTS Trial (Public Access and Tourniquet Training Study). The study was funded by The Gillian Reny Stepping Strong Center for Trauma Innovation and conducted in partnership with Gillette Stadium and the New England Patriots.

In total, 465 Gillette employees, who had no prior training in this area, participated in the study. The trial was designed to not only train staff in responding to uncontrolled bleeding, but also to test whether, and under what conditions, such training was effective. The results were published in JAMA Surgery this month.

Participants were randomly assigned to one of four groups. The first was provided instructional flashcards to learn about proper tourniquet application. The second group used flashcards and audio kits. The third received in-person training through the Bleeding Control Basic (B-Con) course, led by BWH instructors. The final cohort was asked to apply tourniquets with no training or instructions. Participants in the first, second and fourth groups later received in-person training.

Researchers found that in-person training, via the B-Con course, was the most effective instructional method and resulted in 88 percent of participants correctly applying a tourniquet. By comparison, participants who received no training applied a tourniquet correctly only 16 percent of the time, and participants who had access to instructional flashcards or an audio kit with flashcards experienced only small gains in effectiveness.

Looking at skill retention, researchers discovered that only about half of the participants could correctly apply a tourniquet three to nine months later, emphasizing the need for refresher training.

“Before the PATTS Trial, we didn’t know what was the best way to train the public in bleeding control,” said Adil Haider, MD, MPH, a trauma surgeon and Kessler director of the Center for Surgery and Public Health. “Now that we know, we can be more effective in creating training programs, public awareness campaigns and tools to empower people.”

Researchers stress that most external hemorrhages, or bleeds, can and should be controlled by direct pressure. While bystanders were critical first responders following the Boston Marathon bombings, subsequent research indicated that all 27 improvised tourniquets administered at the scene were applied incorrectly.

Looking ahead, Eric Goralnick, MD, MS, medical director of Emergency Preparedness and lead author of this study, said clinicians and public health investigators will convene to define a common research agenda for laypeople and bleeding control.

Meghan McDonald, MSN, RN, nurse director of the Trauma Program in the Division of Trauma, Burn and Surgical Critical Care and co-author of the study, said intervention from bystanders in any situation, not just mass-casualty events, can help save lives.

“Some people hesitate, especially when it comes to tourniquets, because they are afraid of causing more harm,” McDonald said. “Educating laypeople on hemorrhage control, be it direct pressure or tourniquet application, is not only the responsible thing to do as a trauma center – it is also the right thing to do.”

Brigham Health’s Strategy in Action: Scalable Innovation
Learn more about our strategic priorities at


Elizabeth Buzney demonstrates how phototherapy is performed at the BWH Phototherapy Center.

After topical treatments failed to heal a patient with a rare form of skin cancer, family physician John Mohs, MD, carefully evaluated the patient’s next steps.

Mohs practices at Northern Navajo Medical Center in Shiprock, N.M., a rural hospital operated by the U.S. Indian Health Services (IHS), which provides health care for American Indians living on or near their native homeland. Patients in this remote region of Navajo Nation are at higher risk for many diseases, yet specialty care is scarce. Northern Navajo Medical Center serves approximately 30 inpatients per day and approximately 600 outpatients per day, according to the IHS.

Diagnosed with cutaneous T-cell lymphoma – a form of lymphoma that affects the skin – Mohs’ patient was a good candidate for phototherapy, which exposes targeted areas of the body to ultraviolet light to reduce skin inflammation. Also known as light therapy, phototherapy has been proven to be safe, effective and affordable in treating a number of inflammatory skin conditions. 

For Mohs and his patient, the challenge was access. Until recently, Mohs had neither the training nor equipment to provide phototherapy at his small dermatology clinic in Shiprock. The nearest phototherapy center was about 200 miles away, and his patient would need to go there three days per week for several months. The combination of barriers made it infeasible for the patient to obtain the specialized care he needed. 

Ironically, the solution to their problem would be found more than 2,000 miles away – in the BWH Department of Dermatology. 

Thanks to a clinical collaboration between BWH faculty volunteers and IHS clinicians through the Brigham and Women’s Outreach Program, Mohs developed and launched a phototherapy service for his patients in Shiprock based on guidance he received from BWH experts in the field.  

He worked closely with Elizabeth Buzney, MD, director of the BWH Phototherapy Center, and Margaret Cavanaugh-Hussey, MD, MPH, director of Public Health and Community Outreach Programs in BWH Dermatology, who Mohs said both played a significant role in helping him get this new clinical service off the ground.

“I probably would not be using phototherapy without the guidance and assistance they provided. Dr. Buzney willingly shared many resources so that I wouldn’t have to reinvent the wheel,” Mohs said. “Thanks to all of this support, my patient was treated right at Northern Navajo Medical Center and is now in remission.” 

Buzney was delighted she could help to expand access to this treatment – a cause she says is close to her heart.

“I felt like I did something that was so small – I shared resources and knowledge I already had – and Dr. Mohs has since been able to care for so many people as a result,” Buzney said. “As physicians, we typically treat patients one-to-one. To play a part in assisting many patients who are so far away is immensely gratifying.” 

A Helping Hand

From left: Toby Crooks, Margaret Cavanaugh-Hussey and John Mohs

The project represents one of many collaborations established over the years between IHS clinicians and BWH faculty volunteers through the Outreach Program. Building on their latest momentum in phototherapy, Mohs and his physician assistant colleague, Toby Crooks, PA-C, visited the outpatient Dermatology clinic at 221 Longwood Ave. last month for a weeklong shadowing opportunity to observe and learn from BWH clinicians in action.

Mohs and Crooks were assigned to various specialty clinics, ranging from advanced wound care to cutaneous lymphoma – an experience that enabled them to broaden their dermatologic knowledge and strengthen relationships with experts in the field, said Cavanaugh-Hussey. In return, she added, BWH faculty had the chance to learn firsthand about the important work their IHS colleagues are doing in Shiprock. 

“The BWH Outreach Program is a model for how forming meaningful relationships with primary care providers in underserved communities can dramatically increase access to high-quality specialty care,” said Cavanaugh-Hussey. “This is particularly important in dermatology, where access to care is limited in many areas of the country.”

While the Outreach Program may be best known for sending BWH faculty volunteers to Shiprock to train IHS clinicians and help care for patients, providing shadowing and observation opportunities at the Brigham are equally important to its work and mission, said Thomas Sequist, MD, MPH, medical director of the Outreach Program, a primary care physician in the Phyllis Jen Center for Primary Care, and chief quality and safety officer at Partners HealthCare. Since 2009, the program has hosted training opportunities at the Brigham for 18 IHS clinicians.

“The delivery of highly specialized, complex care is crucially needed within the IHS. However, the number of patients that require such care on a day-to-day basis is relatively low, so if we send a BWH specialist to New Mexico, it is quite likely that there will be no training opportunity with actual patients the week they are there,” Sequist said.

Mohs agreed that observing the BWH Dermatology team in person was enormously beneficial. 

“We were able to see a large volume of more rare and complex conditions that we don’t see often enough to feel confident managing,” he said. “Being able to see these cases with BWH attendings and ask questions – and receive extensive answers from the experts – in real time was invaluable.”

Brigham Health’s Strategy in Action: Improve Health
Learn more about our strategic priorities at

Leave a comment

Growing up in Zimbabwe, Tracy Makuvire witnessed the difficulties people faced in accessing health care and how those challenges affected many families, including her own.

Determined to become a doctor so that she could help heal others, Makuvire came to the United States seeking an education in medicine. She graduated from Stanford University in 2013 and is now just months away from receiving her medical degree from Harvard Medical School (HMS).

On March 16, Makuvire said her dream came true when she found out she was one of the 76 incoming interns selected for BWH’s Internal Medicine Residency Program on Match Day. She, along with several other newly matched interns, celebrated their acceptance into the program with current BWH residents, faculty and staff during a reception in the Zinner Breakout Room.

“This is the culmination of my studies since high school,” said Makuvire, who completed a rotation in the Department of Surgery as a fourth-year medical student. When she opened the envelope and saw it contained the words Brigham and Women’s Hospital, Makuvire was overjoyed to know she would soon begin her journey as a physician at this world-class medical institution.

“I immediately contacted my family in Zimbabwe and told them I had matched at the Brigham,” Makuvire said. “I’m counting down the days until I will put on my white coat and say to a patient for the first time, ‘Hello, I am Dr. Makuvire, and I’ll be taking care of you today.’ That is going to be a very special moment for me.”

Classmate and fellow incoming intern Enrico Giuseppe Ferro echoed Makuvire’s excitement. He was thrilled to video chat with his family back home in Italy as he opened his envelope earlier in the day. Ferro said he’s proud to continue the family tradition of caring for patients, just as his parents have done for so many years as physicians.

“Having the honor to enter patients’ lives and help them feel better – that is a privilege that will stay with us forever as doctors,” said Ferro, who completed an elective rotation in the BWH Division of Cardiovascular Medicine during medical school. “Matching at the Brigham is hard to beat. The community here is filled with such supportive people who want to help you succeed.”

Fellow HMS student David Wang enjoyed the Match Day festivities with his family, who was visiting from Texas. While he said they weren’t enthusiastic about the snowy weather, they were ecstatic about Wang’s match news. Recently having completed a rotation in the Department of Anesthesiology, Perioperative and Pain Medicine, Wang said he was very grateful to join an academic medical center so renowned for clinical training, constant support and a sense of family.

Thinking back to his Match Day experience a year ago, Zachary Hermes, MD, MPH, a resident in the Department of Medicine, attended this year’s celebration and congratulated his soon-to-be colleagues. He said it “feels like yesterday” when he found out he matched at the Brigham.

“The past year here has been more than I could have imagined,” Hermes said. “I hope the newly matched residents come to work with open minds and hearts and ready to learn. This is an experience unlike any other.”

Diana Bartenstein, of Tufts University School of Medicine, and Sally Tan, of HMS, gave each other a big hug when they arrived at BWH on Match Day. Bartenstein and Tan, who both plan to pursue a career in dermatology, recently met and became close friends after working as counselors at a camp for children with dermatologic conditions. They’re thrilled to spend this next chapter in their careers together at the Brigham.

During the Match Day celebration, Joel Katz, MD, director of the Internal Medicine Residency Program and vice chair for Medical Education in the Department of Medicine, welcomed the new interns into the Brigham family and congratulated them on finding their match.

“Today is a banner day for our hospital,” Katz said. “It’s wonderful to be able to welcome so many talented, hard-working and enthusiastic students to the Brigham. I hope our new residents enjoy the experience and focus on becoming the best doctors possible.”

Leave a comment

From left: Hanni Stoklosa, Mardi Chadwick, Annie Lewis-O’Connor, Jacqueline Savage Borne and Jessica Loftus

For several BWHers, including Srini Mukundan, MD, PhD, of the Department of Radiology, being able to work with care providers at Northern Navajo Medical Center in Shiprock, N.M., and Gallup Indian Medical Center in Gallup, N.M., through the Brigham and Women’s Outreach Program with Indian Health Service (IHS) has been an educational and transformative experience they will always cherish.

Mukundan, who has trained IHS staff on-site in Shiprock and remotely from BWH, said his experiences with the program provide an antidote to burnout and remind him why he chose this path in medicine.

“The Outreach Program opportunities have been one of the greatest rewards of being a BWHer,” Mukundan said. “After meeting the wonderful patients and witnessing firsthand the work of our remarkable colleagues at Shiprock, it is clear how important the essence of the physician-patient relationship is, especially in light of the limited resources available in Shiprock.”

Since 2009, BWHers have collaborated with the Navajo Area IHS – the federal agency responsible for delivering medical and public health services to members of federally recognized Native American tribes in the region. Through the Brigham and Women’s Outreach Program with IHS, BWH faculty, nurses, trainees and other providers volunteer their time and expertise to provide specialized care and training – on the ground at IHS hospitals and through remote teaching – in rural New Mexico and Arizona.

Advancing Care

Over the past year, BWHers across multiple disciplines have helped establish critically needed and sustainable services that would have otherwise been unavailable in these resource-poor areas.

Earlier this year, a BWH team traveled to Shiprock to teach IHS staff about human-trafficking in addition to screening and intervention strategies for domestic violence in the health care setting. Because of that visit, a BWH/IHS Trauma-Informed Care working group has been established with the goal to implement a trauma-informed care model in Shiprock by late 2018.

“During our time there, I learned new things from my Brigham colleagues as well as from the IHS staff. The whole experience challenged me to think more broadly about my interactions here with patients in the Emergency Department,” said Hanni Stoklosa, MD, MPH, an attending physician in the Department of Emergency Medicine and a member of the Division of Women’s Health, who trained IHS staff in human-trafficking awareness.

Annie Lewis-O’Connor PhD, MPH, NP, director of the C.A.R.E. Clinic and a member of the Division of Women’s Health, provided staff with techniques for incorportating trauma-informed care into practice, emphasizing the need for self-care, patient autonomy and meeting patients where they are at.

Also on the team was Jacqueline Savage Borne, LICSW, hospital program manager for the Passageway program in the Center for Community Health and Health Equity, who said working with the program was a professional dream fulfilled.

“The providers at Shiprock are so deeply committed to holistic, trauma-informed care for their patients,” Savage Borne said. “The resiliency in this community and its network of care providers is nothing short of inspiring.”

The collaboration between BWH and IHS providers results in dramatic, lasting improvements in care. Because of the radiology training provided by Mukundan, a neuroradiologist and medical director of Magnetic Resonance Imaging at BWH, along with other faculty members and house officers from the Department of Surgery, Shiprock providers are now able to screen patients for stroke based on head CT scans. Prior to this, they had no ability to provide this service.

Also in the works is a live, interactive remote video-training program to license IHS clinicians to be able to administer buprenorphine, a medication to treat opioid use disorder. Joji Suzuki, MD, director of the Division of Addiction Psychiatry, provides the same training in Boston and will lead the new remote course. Such support is needed to help IHS clinicians combat the opioid crisis in their remote and resource-poor communities.

“I have a lot of respect for the clinicians in IHS. I have visited and taught remotely, and I’ve seen firsthand how they work under very difficult conditions due to their limited resources,” Suzuki said. “I’m pleased we’ll be able to help them have access to training that would have otherwise not been readily available.”

Thomas Sequist, MD, MPH, a primary care physician in the Phyllis Jen Center for Primary Care and medical director of the Outreach Program with IHS, said he believes the Outreach Program is a vital resource for the region.

“Access to specialty care services is particularly challenging in more rural parts of the country, often limiting the treatment options for patients in these areas,” said Sequist, who also serves as chief quality and safety officer at Partners HealthCare. “We are extremely proud of the work of our BWH clinical community – physicians, nurses and other staff working together to fill important gaps in care. This work is built on the premise of establishing long-lasting relationships that represent a sustainable approach to delivering advanced and high-quality care in these native communities.”

Brigham Health’s Strategy in Action: Improve Health
Learn more about our strategic priorities at

Leave a comment

Stephanie Caterson (center) with her husband and “number one supporter,” E.J. Caterson (left), MD, PhD, and Dennis Orgill (right), MD, PhD, who presented her award.

Stephanie Caterson, MD, director of the Perforator Flap Breast Reconstruction Program in the Division of Plastic Surgery, received the 2017 Bernard Lown Teaching Award, which celebrates BWH physicians who are outstanding clinical teachers.

In this Q&A with BWH Bulletin, Caterson shares her thoughts on her career in plastic surgery and her education style.

What drew you to the field of plastic surgery?

SC: I was an aerospace engineer as an undergraduate, and when I went to medical school, I was not even considering surgery. I was seeking a higher-level degree so that I could apply for the astronaut program. I thought I would study emergency medicine because it would be applicable in space. But as I started my clinical rotations, I fell in love with the technical aspects and challenges of surgery.

Plastic surgery stood out to me due to the parallels to engineering. You have a set of “tools,” and you must solve the problem, which is different for each patient. During my formative years as a medical student, the most inspiring role models I came across were plastic surgeons. They loved what they did, and it was contagious.

As I completed my surgical residency, I began to question my path to the astronaut program because, as an astronaut, I wouldn’t practice any clinical medicine. In the end, the pull of plastic surgery won. I applied for a fellowship and I was lucky enough to match.

What is your education style when working with trainees?

SC: I try to teach using encouragement instead of intimidation. I gauge my audience for their level of training and prior clinical exposure, then go from there. For instance, the complexity will be different when teaching a first-year medical student versus teaching an instructional course at a plastic surgery conference. I enjoy the challenge of tempering my style for the audience, and I like to provide a comfortable but stimulating atmosphere in which to learn.

I would say the most intensive teaching takes place in the operating room, but there’s a lot that goes into the pre- and post-operative stages. I think you would be remiss in just teaching trainees how to do the operation, but not teaching them how you get the patient to the operation.

What nonclinical skills do you also reinforce in your teaching?

SC: The doctor-patient relationship is something that I try to emphasize. Dr. Bernard Lown is famous for teaching the doctor-patient relationship and its importance in healing and care. I place a special emphasis on practicing empathy. Every patient responds differently to their diagnosis, and it is our responsibility as caregivers to be respectful and supportive.

In addition to teaching medical trainees, I am also passionate about patient education. Recently, our deep inferior epigastric perforator (DIEP) flap program started a preoperative education class for patients who are preparing for DIEP flap surgery, as well as their families. We host the class in the hospital on the floor where the patients will be staying post-operatively. They get a tour of the facilities and a demonstration of the medical equipment we will be using during their care. Patients gain a better understanding of recovery and meet surgical team members who will be caring from them and other patients about to undergo the same procedure. At the same time, I am learning what concerns patients have pre-operatively, which allows me to improve my consultations. The response has been tremendously positive for patients and caregivers alike.

How do you think medical training could be improved?

SC: I think personalized mentorship is much more powerful than teaching in large group settings. The more we can do to center the instruction around the learner, the more effective we can be. Additionally, I think early exposure to specialties is important for students. Often these areas of medicine are competitive and difficult to pursue, so starting off on the right track is important.

Lastly, I am a strong believer in collaborative interactions improving the field of medicine. The DIEP flap program is an example of a multi-disciplinary team – including office staff, physician assistants, nurses and nurse practitioners, OR staff, anesthesiologists, plastic surgeons, physical therapists, staff from radiology, surgical oncology and medical oncology and the patient – all working together with the common mission of optimizing patient care.

Leave a comment

National Physician Assistant (PA) Week is held every October to honor physician assistants’ substantial role in improving health. PAs are involved in nearly every facet of care at BWH.

Chioma Tomlinson

Chioma Tomlinson, MMS, PA-C II, who practices Internal Medicine and Primary Care at Brigham Circle Medical Associates, is one PA making a difference in the lives of patients, colleagues and trainees.

“Having had the good fortune of watching Chioma practice and teach medical trainees, I’m struck by how effective she is at immediately establishing rapport,” said Charles Morris, MD, MPH, associate chief medical officer and an attending physician at Brigham Circle Medical Associates. “She was the first PA in our practice, so she often was introducing not only herself in the exam room but also her profession. Her ability to quickly forge a connection is a skill at which she excels and then leverages to provide a superlative level of care.”

In this Q&A, Tomlinson shares why she loves her job and her commitment to helping educate the next generation of PAs.

What’s your favorite part of your work?

CT: Our team-based approach. It’s a pleasure for me to get to know many of our patients almost as well as their physician does. This dynamic helps us provide better continuity of care. It’s a privilege to be there as someone who can step in and is as invested in the patient’s overall health as their physician when issues arise that need immediate attention or that require frequent visits.

Why did you choose primary care?

CT: I value the relationships we have with our patients in primary care. Our ability to consistently provide quality care for any number of medical and/or psychosocial issues is often tethered to our ability to establish caring and trusting relationships. One example is management for illnesses such as hypertension and diabetes. Staying healthy for these patients often requires not only regularly taking medication but also making significant lifestyle modifications. I try to find common ground and talk to patients about how we can help them live their best lives.

You’re also a preceptor. What do you enjoy about educating PA students?

CT: I love what I do and enjoy sharing that fulfillment with students. I’m fortunate in that I teach students from a few local programs. It’s a nice opportunity to give back to the community that has given me so much. It’s inspiring to remember how much we learn during those didactic years and how stressful – but exciting – that time can be. I also like challenging students to think through the many ethical and professional issues in medicine and how they impact our practice as PAs.

What’s your advice for new PAs and PA students?

CT: It’s important for all of us to make sure our profession stays strong by honoring those who came before us, supporting those around us and fostering those who come after us. I encourage PAs to find a meaningful way to stay active in our community. Teaching, publishing, advocacy or trailblazing new opportunities are just a few examples of ways to stay engaged. Lastly, take pride in the fact that we’re part of a larger medical community with the common goal of providing the best care for our patients.

Leave a comment

Compared to many of my colleagues, I am a relative newcomer to the Brigham, with just 13 years of service. I have been very fortunate to be surrounded by nursing and allied support colleagues who took the time to answer my many questions, share their knowledge and collaborate. It was these frequent interactions that led me to not only become a better critical care nurse, but also to challenge myself in ways I had not considered.

My most moving memory is from almost 12 years ago – when I saw the confidence my nurse director, Shaun Golden, had in me after I applied for the nurse educator position.

To prepare, I read the professional literature daily and discussed cases with the experts around me. At BWH, we have complex, challenging and interesting patients as well as clinical situations that were like what I was reading about in the literature. From that realization, I tried my hand at writing for professional nursing journals, and submitted abstracts for local, regional and national nursing conferences. I was fortunate enough to find some success there.

I will always treasure my colleagues in the Neuroscience Intensive Care Unit, my fellow nurse educators, all the incredible nurses I’ve had the privilege to work with over the years from all departments for their confidence in me and faith in what I could achieve. Most especially, I will remember that any success I’ve enjoyed as a nurse educator would not have been possible without the confidence and support that Shaun gave me, and for that I will always be grateful.

Vince Vacca, MSN, RN, CCRN, Clinical Nurse Educator, Neuroscience Intensive Care Unit

Leave a comment

Pablo Uribe Lietz (center) demonstrates for Harvard Medical School students how to properly apply a tourniquet.

Even if you have no medical training, you might be able to save the life of someone experiencing a heart attack if there’s an automated external defibrillator (AED) nearby. Designed to be used by those with minimal or even no training, these devices automatically detect an abnormal heart rhythm and administer an electrical shock after sensors are applied.

Now, a group of BWHers plans to develop a similar kit for treating uncontrolled bleeding that anyone can use during an emergency before medical personnel arrive. The project is part of Stop the Bleed, a national awareness campaign about how to stop life-threatening bleeding.

In this Q&A, Eric Goralnick, MD, medical director of Emergency Preparedness, discusses the innovative ways BWH is contributing to Stop the Bleed in partnership with The Gillian Reny Stepping Strong Center for Trauma Innovation, Gillette Stadium and several local partners.

What gave rise to this initiative?

EG: Stop the Bleed was started in the wake of the Sandy Hook shootings by a group of clinicians, the Hartford Consensus, whose goal was to find what we can do as a society to minimize preventable deaths after mass shootings or other mass-casualty events.

To do that, they looked at the success the military has had in preventing deaths from extremity injuries by training many ground forces in trauma combat casualty care. The focus is on teaching lay individuals to recognize life-threatening bleeding and intervene – either applying pressure to a wound, packing a wound and then applying pressure or, if it’s an extremity, applying tourniquets. From this, the Hartford Consensus recognized the need to empower laypersons to intervene.

How is the Brigham contributing to the campaign?

EG: Where we think Brigham can particularly add value is in innovation, education and operationalizing the concepts of Stop the Bleed.

We’re working to identify the equivalent of the defibrillator for hemorrhage control, starting with trials of a few commercial “just-in-time training” kits for bleeding control. Potentially, we may design our own.

We’re also developing training programs. When we look at these horrible events, they have traditionally occurred in places like stadiums, public transportation hubs, schools and shopping malls. We want to work with these organizations to train their staff in bleeding control.

This program’s success is possible thanks to our collaboration with the Department of Emergency Medicine and Trauma Service at BWH and Massachusetts General Hospital, the Center for Surgery and Public Health, Fallon Ambulance, South Shore Hospital and Boston MedFlight.

Tell us more about the research and training.

EG: At our first event, we trained more than 50 health care professionals, followed by a series of similar events in the community.

We also launched a randomized study at Gillette Stadium, where we’ve enrolled more than 560 staff, including security officers, vending station operators, parking attendants and others. Each staff member was randomly assigned to one of four groups comparing the effectiveness of tourniquet application after receiving traditional training, “just-in-time training” kits with audio or diagrams or no advance training.

Through focus groups, we’re learning how to design a more intuitive kit. Roughly 90 percent of the people got it right after in-person training, and we think we can develop a kit that’s equivalent.

In addition, Stepping Strong and Gillette purchased 525 first-aid kits that will be worn by personnel who have been trained. They’ve also purchased public-access tourniquet kits that are hung next to AEDs.

Next, we will retest and reevaluate these individuals to gauge how often they should be retrained. Finally, we’ll describe best practices for training a stadium’s workforce, as this is the first Stop the Bleed program in a professional sports stadium that we’re aware of.

This is an opportunity for science to guide us, and the science we have is from the battlefield – and the many soldiers, sailors, airmen and Marines whose lives have been saved because of tourniquets.

‘Stop the Bleed’ at HUBweek

BWH is participating in HUBweek, a weeklong festival celebrating innovation in Boston. On Wednesday, Oct. 11, 3-5 p.m., explore innovation at Brigham Health through an interactive scavenger hunt, which includes a training session with BWH’s Stop the Bleed project. The event is free to attend and open to all staff. Register and learn more here.

Brigham Health’s Strategy in Action: Scalable Innovation
Learn more about our strategic priorities at


Kate Marra interned in a BWH lab studying the same cardiovascular condition from which she recently recovered.

In addition to her naturally warm demeanor and educational background, nursing student Kate Marra possesses another quality that made her uniquely suited for a summer internship in the Division of Cardiovascular Medicine. She has an innate empathy for cardiovascular patients, having been one herself.

Marra, a junior at Linfield College in Oregon, recently worked under the guidance and mentorship of investigators in the MacRae lab, where researchers are striving to unravel the mysteries of cardiovascular disease. She worked directly with investigators who are trying to pinpoint the earliest signs of impending cardiovascular issues long before symptoms appear. They hope to intervene as early as possible to prevent cardiovascular events from ever occurring. Marra spent much of her summer internship speaking with patients in the Watkins Cardiovascular Clinic about the lab’s research projects and opportunities for them to participate in clinical trials.

“I was surprised so many people said yes when I asked them if they’d like to participate in a research study,” she said. “Most people in the waiting room are enduring very stressful situations. And yet, patients told me, ‘I want to help others,’ and ‘I want to contribute to research.’”

Marra can certainly relate to their sentiments.

One of the conditions the MacRae lab is studying is a rare disease of the heart muscle known as arrhythmogenic right ventricular cardiomyopathy (ARVC). Although Marra’s work this summer was not related to ARVC, she is very familiar with the condition. At the age of 15, she was hospitalized and diagnosed with it. She has since recovered, but the experience shaped her goals and interests.

“I knew I wanted to give back,” said Marra. In addition to pursuing a nursing career, Marra, along with her father, began searching for labs that were researching ARVC. That’s how the family came across the work of Calum MacRae, MD, PhD, chief of Cardiovascular Medicine.

Marra and her family have been fundraising for the MacRae lab for several years. Marra’s father competes in long-distance running and cycling events, and Marra does everything from teaching swimming lessons to helping organize garage sales to raise funds for the lab’s research.

Last year, the Marras came to the Brigham to visit and tour the MacRae lab and the zebrafish facility where most the lab’s ARVC research was being conducted. During that visit, Marra had the opportunity to see zebrafish lines with the same cardiovascular condition she had been hospitalized for not long ago.

Marra and MacRae talked about her burgeoning interest in nursing and about the possibility of coming back to the Brigham for a summer internship. After her application was accepted, she returned to the MacRae lab in June and worked with Cardiovascular Medicine fellow Sunil Kapur, MD, helping to recruit participants for a research study using innovative biomedical devices.

Marra, who completed her internship in August, said she loved being a part of the research team and seeing the work that goes on behind the scenes to collect and interpret data, publish papers and polish presentations. But, above all, her favorite part of the internship was the opportunity it gave her to interact with patients.

“The patients I talked to were wonderful. I loved learning about them, and they were so supportive,” said Marra. “One of them told me, ‘You’re going to make a great nurse.’ I have lots of good memories from the summer, but that one is my favorite.”

Leave a comment

This slideshow requires JavaScript.

As a shy and unsure high school sophomore beginning her BWH internship through the Student Success Jobs Program (SSJP) three years ago, Laureen Chalumeau froze when her supervisor instructed her to make her first phone call to a patient for an appointment reminder.

“I’m not ready for this,” she thought. But after a few months of working closely with her supervisor and mentor, Caroline Melia, BSN, RN, nurse care coordinator at Brigham and Women’s Advanced Primary Care Associates, South Huntington, something shifted for Chalumeau.

One day, a patient who only spoke Haitian Creole arrived for an appointment, but an interpreter was not immediately available. Chalumeau, who speaks Haitian Creole as well, jumped in to help translate without hesitation. Looking back now as one of this year’s 31 graduating SSJP seniors, she remembered how pivotal that moment felt and how surprised she was by her confidence.

“I don’t think I would ever speak Haitian Creole to anyone outside my family before that,” said Chalumeau, 18, who was recently awarded a six-year, full scholarship to attend Northeastern University, where she will study pharmacy. “SSJP just shook my world. I was so shy and introverted. Now I’m more outgoing and ready to challenge myself because SSJP supported me and put me in situations where I felt I could push myself.”

A program of the BWH Center for Community Health and Health Equity (CCHHE), SSJP matches Boston-area high school students with mentors across the Brigham for paid internships. The program is focused on fostering the next generation of talented, diverse health care workers. More than 40 departments host SSJP interns. All students who have completed the program enroll in college, and 75 percent study health or science.

Joined by their families, colleagues and SSJP underclassmen, this year’s seniors were honored during a graduation ceremony held at the Joseph B. Martin Conference Center on June 19. Attendees heard reflections from SSJP alumna Nakia Ellies, their peers in the program and keynote speaker Cheryl Clark, MD, ScD, director of Health Equity Research and Intervention at CCHHE and a hospitalist in the Division of General Medicine and Primary Care. Clark advised graduates to find strength in community, believe in themselves and “take the long view” on what they seek to achieve or change.

Donell Rankins Jr., a sophomore at the John D. O’Bryant School of Mathematics and Science in Roxbury, told the audience how valuable his first year interning with inpatient Radiology has been.

“I was able to truly see that teamwork really does make the dream work,” he said. “Not only have I had the pleasure of being on the Radiology team but also the SSJP team. I have made so many friends from a plethora of different backgrounds and experiences that all come together and form a diverse SSJP community.”

Mentorship Builds Bonds

Reflecting on her three years in the program, Chalumeau said the most important component for her has been her relationship with her mentor.

“Caroline has always been there for me. No matter what issue I have, I could easily come to her,” said Chalumeau, who graduated from the Urban Science Academy in West Roxbury this month. “I look up to Caroline and aspire to be as great as she is. She’s a one-woman army in my eyes.”

At South Huntington, SSJP interns are treated like any other team member, whose ideas and contributions are all valued, Melia said. Last year, Chalumeau led an effort to create a team newsletter to better communicate information from staff meetings.

“They’re not just students. They’re people with great ideas, and they add a lot to the patient experience,” Melia said. “This program is really important not only for the students as a learning opportunity but also for the community, the hospital and the future of health care.”

Melia said it has been rewarding to see Chalumeau grow as a person and professional over the past three years and take the next steps in her studies and career.

“I’m so proud of Laureen and so happy for her. She’s such a special person,” Melia said.

SSJP is actively seeking departments and enthusiastic staff members to support its efforts. To learn more about how to become a mentor and host an SSJP intern, contact Pamela Audeh at 617-264-8740 or

Brigham Health’s Strategy in Action: Teaching & Training
Learn more about our strategic priorities at

Leave a comment

Channel De Leon (center) chats with pharmacy students Hannah Kwon and Ryan Fan on Shapiro 8W before seeing patients.

When Channel De Leon, PharmD, BCGP, joined the Integrated Care Management Program (iCMP) four years ago as a senior pharmacist – and the program’s only pharmacist – one thing quickly became apparent to her. There wasn’t a way she could manage 3,000 medically complex patients on her own, especially given that an average iCMP patient takes 17 medications.

De Leon realized the best way to expand the breadth of the program and enhance patient care was to bring pharmacy students on board and teach them about enhancing transitions of care. In partnership with BWH Pharmacy Services, she began training students from Northeastern University and the Massachusetts College of Pharmacy and Health Sciences in 2014.

Since then, dozens of pharmacy students have completed rotations with De Leon. The students have contributed to improving medication reconciliation and adherence, helping patients save thousands in out-of-pocket costs and resolving hundreds of medical discrepancies at critical transitions of care.

For patients with complex medical conditions or multiple co-morbidities, navigating the health care system can be a challenging experience. The goal of iCMP is to help patients stay healthy through proactive care coordination and interdisciplinary support. In addition to a pharmacist, the iCMP team includes registered nurse care coordinators, social workers, community resource specialists and community health workers – all of whom work closely with a patient’s primary care physician.

“Having students as part of the program means there is more time to provide education directly to patients about their medications, and this is also a great learning experience for students before graduating,” De Leon said.

Lower Medication Expenses, Better Health

Pharmacy students on the team have a lot of face-to-face conversations with patients about medication management. Students counsel patients about their medications and assess barriers to medication adherence.

“A big factor is the cost of certain medications. We teach patients about insurance deductibles and look for resources that will help patients access the medications they need,” De Leon said.

If a patient goes home from the hospital on a new medication, the student ensures it’s affordable for the patient and, if not, works to resolve the issue prior to discharge. This process avoids gaps in treatment and unexpected out-of-pocket costs upon discharge. One student recently helped a patient save more than $10,000 in out-of-pocket costs by identifying a different insurance plan with better coverage for the patient’s specific medications.

The program is mutually beneficial to students and patients. Magie Pham, PharmD, who completed a rotation with De Leon last fall and graduated from Northeastern’s pharmacy program in May, said the skills she learned at BWH were invaluable to her training.

“While you’re in pharmacy school, you think to yourself, ‘I have to study and memorize all of these drugs,’ but communication is an equally key skill on a day-to-day basis,” Pham said. “Channel gave us guidance on everything from how to appropriately email someone to how to best communicate with patients. I never felt lost.”

Pham was among the group of pharmacy students who helped host a Medicare Part D Fair at BWH last fall. During the event, patients were paired with a student who walked them through the various Medicare D plans and identified the most affordable options based on the patient’s medication list and pharmacy preferences. By the end of the fair, students had helped patients collectively save nearly $7,000 in out-of-pocket costs.

De Leon hopes to offer the fair again this year and send students into community settings, such as senior housing complexes, which are more convenient to many patients.

Incorporating pharmacy students into iCMP has enabled the program to extend the reach of its pharmacy services, which are vital to safety and quality of care, said Lisa Wichmann, MS, RN, ACM, NC-BC, nursing director of Ambulatory Care Coordination.

“In some of our specialized programs, such as the End-Stage Renal Disease Program, Channel and her students review the medications for opportunities to reduce polypharmacy (the use of multiple drugs or more than are medically necessary) and enhance medication safety,” Wichmann said. “They’ve been able to make recommendations about simplifying the medication regime taken by some of our high-risk patients.”

Leave a comment

Incoming interns from the Boston area, joined by Joel Katz (far right), celebrate their BWH match during a recent reception.

When Wilfredo Matias (pictured above: back row, second from left) and his family immigrated to the U.S. and settled down in New York, he was troubled by the inequities facing underserved residents in the city, particularly around health care quality and access.

He thought often of his grandfather, a physician serving the local community back in their home country, the Dominican Republic. Those two sources of inspiration – a desire to help those in need and a role model for doing so – led Matias to pursue a career in medicine and landed him at Harvard Medical School.

Now, Matias looks forward to continuing his training and helping care for patients in local communities the Brigham serves as one of the hospital’s 74 incoming interns selected for BWH’s Internal Medicine Residency Program on Match Day, March 17.

“The mission of the hospital is fantastic, and the community we serve is incredibly diverse,” said Matias, who completed a rotation at BWH as a third-year medical student. He had especially enjoyed the opportunity to interact with patients from Brazil, the Dominican Republic and Haiti.

“When I opened the envelope and saw the words ‘Brigham and Women’s Hospital,’ I went from feeling super stressed to thinking, ‘Yes, I get to be part of a place that truly invests in their people and has a culture I really admire,” he added. “Everyone here wants to help you figure out the kind of doctor you want to be, the impact you want to have and the means to accomplish that. That is pretty exceptional.”

Feels Like Family

Those feelings of welcoming and support were echoed by other newly matched interns who celebrated their acceptance into the program with BWH residents, faculty and staff that evening during a reception in the Zinner Breakout Room.

“What distinguishes the Brigham is the sense of family you feel here, which is truly unique,” said Aaron Cohen, who also graduates from HMS this spring. “When I’m here, I feel like I am part of a strong community that’s supportive and loving. That’s what has struck me most.”

Friend, classmate and fellow incoming intern Chijioke Nze, MPH, agreed that while BWH is a large hospital, he was moved by how it feels like a tight-knit community.

“There’s something very genuine about the family feeling I get from here,” said Nze. “A lot of my mentors are at the Brigham, most notably Dr. Fidencio Saldaña, so I’m very excited to work somewhere he calls home.”

Similarly, Ellen Nagami, of Tufts Medical School, said she couldn’t stop smiling when she learned she had matched to BWH.
“I’m really excited to work with the Brigham residents and attendings,” Nagami said. “I was able to rotate at BWH and BWFH, and I really loved the people with whom I worked and the experiences I had here.”

Jennifer Yeh, of HMS, who will begin her preliminary medicine residency at the Brigham this year, was elated to be matched to BWH, her top choice during the selection process.

“Medical education is a strong priority here, and this feels like an environment where I could develop my own skills at becoming a good teacher,” Yeh said. “This was my first choice because I liked working with all of the residents here as a medical student. Not only are they great physicians, but they’re also incredibly intelligent and caring people.”

Joel Katz, MD, director of the Internal Medicine Residency Program, has welcomed interns to the Brigham on Match Day for the past 17 years. He says seeing so many talented, enthusiastic and altruistic people who want to pursue a career in medicine is an inspiring experience each year.

“It’s an incredible privilege to be a doctor, and we matched 74 people who will be great doctors,” Katz said. “My advice for them is to concentrate on the unique, intimate learning experiences possible in the intern year: Accept it, embrace it, devote yourselves to the well-being of your patients, find what’s good, pass over what’s bad and turn to colleagues and friends for help when needed. Medicine is very much a team sport. We’re like family.”

Leave a comment
Monica Bharel speaks at the first Opioid Grand Rounds at BWH.

Monica Bharel speaks at the first Opioid Grand Rounds at BWH.

The number of opioid-related deaths in Massachusetts has increased fourfold over the past decade, with data showing that five people in the state die every day due to an opioid overdose. Behind these staggering statistics are patients, families and communities struggling to get the help they need, and clinicians have an opportunity to help fill that gap, said Monica Bharel, MD, MPH, commissioner of the Massachusetts Department of Public Health, during BWH’s inaugural Opioid Grand Rounds on Feb. 2.

The event, sponsored by the Brigham Comprehensive Opioid Response and Education (B-CORE) program, kicked off a bimonthly speaker series about issues around the prevention and treatment of opioid use disorder.

Data is playing an important role in how the state is responding to the opioid epidemic, with the goal of analyzing it in a way that provides specific guidelines for frontline clinicians, said Bharel.

Getting to that point involves pulling information and seeking out experts from multiple sources, ranging from hospitals to law enforcement. Among the more revealing findings has been the overlap between a sharp increase in opioid-related deaths since 2014 and the presence of fentanyl at the time of death. Fentanyl is a powerful synthetic opioid that is 50 to 100 times more potent than morphine. Nearly three out of four people who died from an opioid overdose in Massachusetts between 2015 and 2016 had fentanyl in their system.

“We’re talking about the numbers in a big picture today, but it’s important to know that behind each one of these is an individual, family and community, and this disease has such profound impacts,” Bharel said.

This is not the first opioid-related epidemic the country has endured, but it has been the deadliest, mainly due to the widespread presence and potency of fentanyl, Bharel said. Another difference this time: Most people who die were introduced to opioids through the use of prescription painkillers, she said.

Focusing on Prevention, Education and Treatment

Prevention and education – for patients and prescribers – are key to turn those trends around, Bharel said. At the Brigham, B-CORE recently developed guidelines and best practices to educate prescribers about new laws related to prescribing, ways to help prevent addiction and where to direct patients seeking treatment.

Another major focus statewide has been removing the stigma associated with addiction and  changing the way it’s viewed, by the public and providers alike, “from a choice or moral decision somebody makes to a medical illness” that should be properly treated, Bharel said. If communities and health care providers regarded opioid use disorder the same way as other life-threatening illnesses, it would change patient outcomes, she added.

“I would really urge us, in terms of what we can do within the medical system, to take a deep look at why we treat substance use disorder so differently,” Bharel said.

One example of that is the proactive distribution of naloxone, a fast-acting medication that reverses an opioid overdose. New laws have made it available more broadly – at BWH, it can now be obtained without a prescription from the Outpatient Pharmacy and is carried by Security officers – but Bharel’s hope is that it’s also provided to patients at the same time they’re prescribed an opioid.

Even if the patient isn’t at risk for developing an addiction – most opioids are prescribed to people over 50, whereas most opioid-related deaths occur in people under 44 – the patient may live with someone at higher risk who has access to those painkillers, she said.

“When we start to decrease the number of deaths, individuals suffering from substance use disorder can get an opportunity to receive treatment and recovery. And unlike something like chronic alcoholism, we have an antidote when someone is acutely at risk for fatal overdose,” Bharel said. “If this was a blood pressure medicine, we would all be using this all the time, so I urge us to think about ways we can enhance the use of naloxone throughout our communities.”

The next Opioid Grand Rounds is March 23, 8-9 a.m., in Carrie Hall. David Kelly, RN, a nurse who developed opioid use disorder and underwent recovery, will share his story.

Leave a comment
From left: Edward Boyer, Peter Chai, Timothy Erickson and Susan Farrell

From left: Edward Boyer, Peter Chai, Timothy Erickson and Susan Farrell

Traditionally, when a patient arrives at the BWH Emergency Department (ED) with a possible poisoning or overdose, the care team calls the Regional Center for Poison Control and Prevention based at Boston Children’s Hospital. A clinical toxicologist – a health care professional with specialized knowledge of the adverse effects of drugs and other chemicals – provides guidelines and advice to the care team on how to best treat the patient.

This year, the Brigham will bring its own medical toxicologists directly to the bedside to share their expertise and care for patients facing adverse effects from medications, drug overdoses and substance abuse issues, thanks to a new division within the Department of Emergency Medicine: the Division of Medical Toxicology.

“Toxicology has been a well-known subspecialty for 20 years or more,” said Michael VanRooyen, MD, MPH, Emergency Medicine chair. “We’re taking a new twist on it through the addition of biotechnology and oncology toxicity research. The division will provide an innovative and unique way of looking at emergency toxicology.”

In addition to providing direct clinical care in the ED and inpatient units, the team will also educate clinical teams and trainees, provide staffing for the Regional Center for Poison Control and Prevention at Boston Children’s Hospital and pursue a variety of toxicology research, including biotechnology research that can share insights on medication compliance.

BWH emergency medicine physician, educator and medical toxicologist Susan Farrell, MD, EdM, is part of the new division, as well as medical toxicologists Edward W. Boyer, MD, PhD, and Peter Chai, MD, MMS, who both recently joined BWH from UMass Medical School in Worcester. Their expertise includes adverse drug events, toxicity, drug interaction and poisoning, and drug overdose. Medical toxicologist Timothy Erickson, MD, who joined BWH last September, serves as division chief. His areas of interest include the study of environmental toxins, venoms and the development of poison control centers in low-resource settings globally.

Once the new clinical service is up and running, medical toxicologists will follow and discuss the management of patients, says Chai. Not only will the bedside service provide personalized care for patients who are poisoned, but it will also help to reduce length of stay and decrease costs. Two examples of how medical toxicologists can achieve this: identifying which patients need to be observed, rather than admitted, and recognizing a poisoning early enough to provide an effective antidote.

Medical toxicology also encompasses opioid abuse, and clinicians have an important role to play in combating the opioid epidemic, says Boyer. “In general, we have to be much more cognizant of how we prescribe medications,” he said. “Research shows that writing somebody an extra handful of medications can have downstream effects on patients and families for decades. Understanding how patients use medications and the ways in which they take them has become ever more important in last few years.”

As director of Academic Development for Emergency Medicine, Boyer is also charged with growing the academic pipeline of new research in the department, toxicology-related and otherwise.

The expansion of Emergency Medicine into toxicology also includes plans to support cancer patients who are dealing with toxicity issues from chemotherapy and other medications. The initiative, which is expected to launch next year, will provide emergency care for cancer patients, as well as care coordination and palliative care for all cancer patients with toxicologic issues.

“We have a personal mission to help cancer patients, and our relationship with DFCI puts BWH at the cutting edge of how to care for them quickly and compassionately,” said Erickson.

Leave a comment


Our shining moment is highlighting our partnership with nurse colleagues from Haiti who are pursuing master’s degrees at Regis College and completing clinical work with BWH nurses, including Michaelle Renard, MSN, RN; Cherlie Magny-Normilus, MSN, RN; and Nadia Raymond, MSN, RN.

It is a shining moment for Nadia, Michaelle and Cherlie, as they have engaged in the theory-based and clinical education of the nurses from Haiti. It is also a shining moment for me as the director of the BWH Global Nursing Program and International Nurse Visitor Program in welcoming the Haitian nurse visitors to BWH!

Patrice Nicholas, DNSc, MPH, RN, FAAN
Director of Global Health and Academic Partnership

Leave a comment
From left: SAGE team members Arjun Rangarajan, Joshua Lakin, Adam Schaffer, Rebecca Berger, Rachelle Bernacki, Catherine Arnold and Rebecca Cunningham

From left: SAGE team members Arjun Rangarajan, Joshua Lakin, Adam Schaffer, Rebecca Berger, Rachelle Bernacki, Catherine Arnold and Rebecca Cunningham

Death is an uncomfortable topic, even – and often especially – for clinicians, whose first priority is to improve health.

But avoiding discussions about goals and preferences in serious illness is a disservice to patients. An innovative program at BWH aims at improving the quality of care for such patients by encouraging earlier conversations about their personal goals and values, as well as fostering a better understanding of their prognosis.

“We recognized that some patients were dying without ever receiving the palliative care services they needed,” said Joshua Lakin, MD, a physician in the Division of Adult Palliative Care at Dana-Farber/Brigham and Women’s Cancer Center. He believes this was largely due to the fact that conversations between providers and patients about long-term care goals were happening too infrequently, and when they did occur, they were often very late in the illness course.

In response to a need to promote these “goals of care” conversations, an interdisciplinary leadership team representing Social Work, Palliative Care, the Hospitalist Service and Population Health Management formed the Speaking About Goals and Expectations (SAGE) program. The team used the Serious Illness Care program, originally created by Ariadne Labs – a joint initiative of BWH and Harvard Medical School – as a framework for a training program to help physicians engage hospitalized patients in discussions around their goals and values, and incorporate patients’ wishes across all aspects of care. The program earned a 2016 Success Story Award from Press Ganey last month.

“The idea is to get doctors to ask patients about their goals in a big picture view of their illnesses,” said Lakin, a member of the SAGE team.

“What are their worries? If their conditions worsen, what can they not live without? We strive to help patients receive long-term care that aligns with their values and preferences, and ensure that all providers involved with their care are part of these conversations.”

The SAGE team has trained 83 percent of the 35 hospitalists it initially identified as eligible for training. The team plans to complete more trainings within that group and expand the program to other departments.


The two-and-a-half-hour group training sessions cover communication skills and best practices for talking with patients about long-term goals related to their care. Participants have the opportunity to practice these discussions with medical actors who play the roles of patients. SAGE instructors provide feedback and offer ways for trainees to better promote and talk about goals of care.

Adam Schaffer, MD, a hospitalist in the Division of General Internal Medicine and Primary Care, completed the training and is now a champion for the program.

“The simulation with the actors is incredibly valuable,” Schaffer said. “Having these types of conversations can be intimidating because it’s something physicians often receive minimal training for. Practicing with an actor really helped me gain confidence.”

Physicians who complete the training continue to receive support from SAGE’s interdisciplinary leadership team, including clinical social worker Catherine Arnold, MSW, LICSW. Arnold lends her expertise to doctors who may experience difficulty in keeping these conversations moving forward. She also ensures information is shared across transitions of care so that ambulatory and post-acute providers understand patients’ goals for their treatment after discharge or upon readmission.

“Some cases can be more challenging than others, which really emphasizes the importance of an interdisciplinary approach. Our physicians know they can always come to me for support interacting with patients and their families,” Arnold said.

Leave a comment
A sample evidence kit used in the Sexual Assault Simulation Course for Healthcare Providers (SASH) at the STRATUS Center

A sample evidence kit used in the Sexual Assault Simulation Course for Healthcare Providers (SASH) at the STRATUS Center

More than one-third of women and more than one-fourth of men in the U.S. experience rape, physical violence or stalking by an intimate partner during their lifetimes.

To help lessen the health consequences associated with violence, trauma and abuse, a group of BWHers developed a training program for care providers, the Sexual Assault Simulation Course for Healthcare Providers (SASH).

SASH, which is the first nurse-led simulation at BWH, allows providers to gain hands-on experience in a safe environment and understand their roles as members of an interprofessional sexual assault response team.

Meredith Scannell, RN, MPH, of the Department of Emergency Medicine and the Center for Clinical Investigation; Annie Lewis-O’Connor, PhD, NP-BC, MPH, FAAN, a nurse scientist and founder and director of the Coordinated Approach to Recovery and Empowerment (C.A.R.E.) Clinic at BWH; Amanda Berger, MSN, SANE-A, and Andrea MacDonald, BSN, both forensic liasons in Emergency Medicine; and Ashley Barash, a former medical simulation specialist at BWH, began offering the course at the Neil and Elise Wallace STRATUS Center for Medical Simulation in 2013.

Scannell identified a need to improve care for sexually assaulted patients who arrive in the Emergency Department (ED). Her first priority became developing an enhanced, comprehensive education for ED nurses. After seeking out the expertise of fellow forensic nurses and nurse scientists, Scannell and others ultimately developed SASH for nurses, physicians and physician assistants. The team received BWH’s Mary Fay Enrichment Award in 2012, which funded the course’s development.

The four-house course, offered to clinical teams working in the ED, focuses on the medical, psychological and forensic needs of patients who have been sexually assaulted. It is divided into four sections: didactic teaching, evidence-collection skills acquisition, simulation (with a standardized patient actor) and debriefing. Participants learn how to collect components of the sexual assault evidence collection kit, perform a forensic examination and provide effective care for patients who have experienced intentional violence.

The course uses a trauma-informed framework, which helps providers understand how a patient’s exposure to intentional violence and trauma may influence care.

“Historically, this patient population has experienced disproportionate gaps in the delivery of their care in emergency departments and once they leave,” Lewis-O’Connor said. “This kind of intentional violence – sexual assault, domestic violence or human trafficking – is a serious public health epidemic in the U.S. and worldwide.”

Scannell, Lewis-O’Connor and Barash published a paper on SASH in the Journal of Forensic Nursing, “Sexual Assault Simulation Course for Healthcare Providers: Enhancing Sexual Assault Education Using Simulation,” which received the journal’s Article of the Year award this fall and now serves as a blueprint for other institutions to follow.

“Our goal is for every ED nurse to go through SASH,” said Scannell. “Each year at BWH, we see about 60 to 70 patients treated for an acute sexual assault – meaning the assault occurred up to five days prior – in the Emergency Department. It’s critical at least one member of a care team, and hopefully more, is trained in a comprehensive, quality care approach for this particular patient population.”

In the future, Scannell and her colleagues hope to offer training to participants from other disciplines, such as social workers and pharmacists, who may interact with patients who have been sexually assaulted.

“I am so proud of the program we’ve created,” said Scannell, who credits the course’s success to the passionate support it received from clinical staff across the hospital. Those supporters include Dorothy Bradley RN, MSN, program director in BWH’s Center for Nursing Excellence; and Patti Dykes RN, PhD, MA, a senior nurse scientist in the Center for Nursing Excellence; Janet Gorman, RN, BWN, MM, nurse director for Emergency Medicine; Nancy Hickey, MS, RN, former associate chief nurse, who passed away last year; and Charles Pozner, MD, medical director at the STRATUS Center.

In addition to the gaps in care that SASH is addressing in the ED, Lewis-O’Connor’s C.A.R.E. Clinic provides post-ED support to men and women who have experienced intentional violence. Through a trauma-informed care model, the C.A.R.E. Clinic helps patients create an individualized plan of care that is based on their unique needs.

Lewis-O’Connor said she also appreciates the partnership between the C.A.R.E. Clinic and BWH clinicians such as Hanni Stoklosa, MD, MPH, an emergency physician in Emergency Medicine and an internationally recognized expert in human trafficking.

“Partnerships are so important to ensuring that patients who present with intentional violence in the ED receive the highest-quality and safest care possible, both while they are here and after they leave,” Lewis-O’Connor said. “My work is dependent on others. It’s all about collaboration and doing what’s best for the patient.”

StrategyIcon_WordpressBWHC’s Strategy in Action: Highest-Quality, Safe Care
Learn more about our strategic priorities at

Leave a comment
U.S. Surgeon General Vivek Murthy meets with Sheri Talbott.

U.S. Surgeon General Vivek Murthy meets with Sheri Talbott.

Physician Assistant Week is held Oct. 6–12 each year to honor physician assistants’ substantial role in improving health. PAs are involved in nearly every facet of the care at BWH.

Sheri Talbott, MS, PA-C, chief physician assistant for Renal and Pulmonary Transplant Medicine, says that learning medicine is akin to being handed a glass and asked to drink an entire lake.

“You’re never done drinking,” said the Army National Guard captain, who first joined BWH as an Emergency Department EMT in 1995 when she was a pre-med biology student at Tufts University. “There’s always more to learn, and I am really passionate about it and do it willingly.”

This passion for learning is clear in the variety of roles Talbott has taken on in service to patients at BWH and beyond, including her work at the state level to combat opioid addiction.

“Sheri embodies the very essence of what a PA represents in the health care community,” said Jessica Logsdon, MHS, MHA, PA-C, director of PA Services. “She has been a tremendous influence to the profession at the local, state and national levels.”

In February, Talbott was asked to join Massachusetts Gov. Charlie Baker’s task force on the opioid epidemic. As then-president of the Massachusetts Association of PAs, Talbott was charged with bringing together all PA program directors in the state to establish a set of core competencies for educating future PAs about recognizing, treating and preventing opioid addiction. Talbott says that the program directors and deans embraced this work from the beginning.

“How do you go after something so large?” she asked. “You start in lots of places, one of which is to teach clinicians who are going to be prescribing opiates how to do it thoughtfully and responsibly and how to talk to patients about it.”

The governor and other state leaders, including Health and Human Services Secretary Marylou Sudders and Department of Public Health Commissioner Monica Bharel, met again this August with Talbott and others to announce the finalized education program. The new curriculum will reach Massachusetts’ 900 enrolled PA students and 2,000 nurse practitioner students, according to State House News Service.

“I hope this work reduces the stigma associated with opioid addiction and brings it out of the shadows so it becomes something we’re able to look at in the light,” said Talbott. “Once we start having open conversations with patients about opioids, we can treat them more effectively. The more aware we are and the more we’re talking about it, the more successful we can be.”

Leave a comment
From left: Charles Pozner and Michael VanRooyen

From left: Charles Pozner and Michael VanRooyen

Praised as an innovator in medical education and for his warmth and sincerity as a mentor, Charles Pozner, MD, medical director of the Neil and Elise Wallace STRATUS Center for Medical Simulation at BWH, was honored with the Bernard Lown Teaching Award earlier this month.

Pozner led the development of the Simulation, Training, Research and Technology Utilization System (STRATUS) Center in 2004 as a single-specialty simulation center in the Department of Emergency Medicine. More than a decade later, it has grown into a multidisciplinary hub for hands-on training for thousands of physicians, nurses, physician assistants, residents, fellows, students and other clinicians across 14 departments throughout the hospital and beyond.

In addition to providing clinical training, STRATUS has also been used for assessment, process improvement and research purposes. More than 100 peer-reviewed studies have been published using data obtained in STRATUS; among those was the first simulation-based paper in the New England Journal of Medicine.

Pozner received the Lown Award on Sept. 12 during the 2016 Daniel D. Federman Teaching Awards Ceremony in the Carl W. Walter, MD, Amphitheatre at Harvard Medical School.

Through his work in the STRATUS Center and involvement in other projects, Pozner has redefined medical education at BWH, wrote Michael VanRooyen, MD, MPH, chair of Emergency Medicine, in a letter nominating Pozner for the award.

“I can honestly say that there are few clinicians whose contributions have affected as many learners, in as many disciplines and areas of clinical importance, as have the contributions of Dr. Pozner,” VanRooyen wrote. “His pioneering work has greatly improved the quality and safety of patient care in the entire hospital and beyond.”

The Lown Award was established in 2009 and named after Bernard Lown, MD, to celebrate physicians who are outstanding clinical leaders and recognize the significant role that education plays in BWH’s mission. Lown is a renowned senior physician at BWH, professor emeritus at Harvard School of Public Health and a Nobel Peace Prize recipient.

Pozner, named Clinical Innovator of the Year at BWH in 2008, said he was deeply moved to receive the award.   

“The fact that I’ve been recognized as a teacher is so unbelievably rewarding,” he said. “I love the interaction involved in teaching, and I love learning with the students.”

Simulation offers a safe space for clinicians to practice, learn and—perhaps most importantly, Pozner says—to make mistakes.

“No one comes to work to make mistakes, but we’re human, and humans have flaws,” he said. “In this environment, mistakes don’t hurt anyone—we can always just reboot the computer—so you should feel comfortable making them here because we’re going to use the mistake as a means to improve your practice.”

The supportive atmosphere in STRATUS is emblematic of Pozner’s passion for teaching and exceptional mentorship, wrote Andrew Eyre, MD, of Emergency Medicine, in a nomination letter.

“I cannot think of a clinician more deserving of this award,” Eyre wrote. “While I and others have learned a huge amount of information from him directly, nearly every provider at Brigham and Women’s has had their education and practice enhanced indirectly by Chuck’s leadership of STRATUS.”

Leave a comment
Elizabeth Stanley and Collin Brady

Elizabeth Stanley and Collin Brady

Collin Brady, MBA, MEng, and Elizabeth Stanley, MBA, BSN, RN, CCRN, may have diverse interests and backgrounds, but there’s one thing they have in common: a passion to improve health care.

This year, the pair will serve as BWH’s newest Deland Fellows. The Deland Fellowship in Health Care and Society is a one-year administrative experience at BWH and BWFH that prepares early-career professionals to be leaders of health care institutions.

Throughout the fellowship, Brady and Stanley will work closely with senior leaders at BWHC. Brady’s mentor is Rich Fernandez, MBA, BWH’s senior vice president of Ambulatory Services. Stanley is working with Julia Sinclair, MBA, senior vice president of Clinical Services at BWH. Both Sinclair and Fernandez are former Delland Fellows.

Just a few months into the program, Brady and Stanley say they have already developed a great appreciation for the opportunities available to them at BWH.

“My parents always instilled in me to leave something better than I had found it,” said Brady. “The people I have met here all share this same ambition. I plan to learn as much as I can from the Brigham community so that I can add to the current transformation taking place in health care.”

Brady earned his MBA from Northwestern University’s Kellogg School of Management and a Master of Engineering from the Massachusetts Institute of Technology. He received dual bachelor’s degrees from Pennsylvania State University.

Brady says he is looking forward to working on several different projects, including helping teams and departments transition into the new building at 60 Fenwood Road. He’s also interested in learning more about how the hospital will develop its physician network, interacting with the Brigham Innovation Hub and Brigham Research Institute, and understanding how strategic decisions are evaluated financially.

“My family has been personally affected by neurological diseases,” he said. “I believe that the Brigham is a leader in innovation in these areas, among others, and I am proud to be a fellow here.”

For Stanley, she looks forward to working with BWH’s new Gillian Reny Stepping Strong Center for Trauma Innovation to further develop its organizational strategy and growth.

The more experiences Stanley has in health care, the more she realizes how interested she is in hospital operations. She enjoys exploring how and why things are done certain ways in hospitals.

Wherever she might land in her career, Stanley says she’s certain the fellowship experiences will serve her well.

“The Deland Fellowship adds to my nursing foundation for a career in health care leadership and affords me an opportunity to accelerate my professional development,” Stanley said. “The comprehensive mentorship and engaging project work allows me to distinguish myself in a rapidly changing health care environment.”

Stanley received her MBA, with a focus in health care administration, from the University of Colorado, Denver and her bachelor’s from Northeastern University.

The fellowship honors the memory of former board President F. Stanton Deland, Jr., a key figure during the merger of BWH’s predecessor hospitals.

Leave a comment

From left: Paul Farmer and Ira Magaziner

Traumatized by years of civil war and a devastating act of genocide in the early 1990s, Rwanda used to be a place where hope was in short supply.

Over time, however, the country came back stronger than ever—investing in education, infrastructure and regional trade—and Rwanda’s economy enjoyed one of the largest growth rates in the world last year. Still, one critical resource remained scarce: health care.

In 2010, the World Health Organization reported that Rwanda had one of the lowest rates of physicians per capita in the world. A country of nearly 11 million people, Rwanda was home to about 600 physicians at that time. Most were concentrated in large cities like Kigali, leaving rural areas underserved, especially in terms of specialists.

Now that picture is changing, thanks in large part to the Human Resources for Health Program, a collaborative, seven-year project with Brigham and Women’s Hospital and Harvard Medical School (HMS), the Rwandan Ministry of Health and more than 20 other academic institutions in the United States.

Currently in its fifth year, the program sends physicians and faculty from multiple specialties to Rwanda to train the country’s next generation of clinicians, researchers and medical instructors. BWH is the lead institution for clinical faculty for all Harvard affiliates from the Boston area, and it has recruited and deployed more than 50 specialists and sub-specialists over the last four years. To date, more than 340 clinicians have participated in the program.

“This partnership was forged by something very powerful: shared convictions about health equity,” said Paul Farmer, MD, PhD, chief of the BWH Division of Global Health Equity and co-founder of the nonprofit Partners In Health. The Human Resources for Health Program was the result of partnerships that Farmer helped establish in Rwanda.

When the program concludes in two years, its organizers hope to see significant increases in the total number of care providers in Rwanda and bring more specialists to rural areas. By 2018, the number of physicians is expected to reach 1,182—nearly double the physician census in 2011. Organizers expect to see the number of nurses grow by about 34 percent, with the goal of reaching 11,384 nurses by 2018.

Representatives from across the HMS-affiliated hospitals involved with the program—including BWH, Massachusetts General Hospital, Boston Children’s Hospital and Dana-Farber Cancer Institute—shared milestones and challenges over the past year at the “Symposium on Rwanda Human Resources for Health Program: A Success Story of a True Partnership” on June 10.

Capping off the half-day event at HMS’ Joseph B. Martin Conference Center was a panel discussion with Farmer and Ira Magaziner, CEO and vice chairman of the Clinton Health Access Initiative. Agnes Binagwaho, MD, PhD, Rwanda’s Minister of Health, joined via video conference.

“After the 1994 genocide against the Tutsi, almost no one believed in the future of Rwanda,” Binagwaho said. “We created a future that was defined by innovation—doing what nobody expected of us—because we believed that each and every person deserves the best future.”

The HRH program aims at replacing a culture of foreign aid with one of self-sufficiency. The expectation is that greater access to high-quality health care will improve the country’s economy—whether that means ensuring children’s physical and intellectual growth isn’t stunted by malnutrition, or by creating an environment that attracts biotech companies, Magaziner said.

“What we’re aiming for is sustainability,” he said. “We want to work ourselves out of a job, ultimately.”


Leave a comment
Jill Lanahan

Jill Lanahan

Training residents in anesthesiology is not only about teaching them the medicine behind the specialty, says Jill Lanahan, MD, of the BWH Department of Anesthesiology, Perioperative and Pain Medicine. It’s also about sharing a passion for the profession to inspire them to join the field.

Lanahan has done exactly that at the Brigham since March 2014, and for the next year she will share that same expertise and enthusiasm for anesthesiology with the next generation of physicians in Rwanda as part of the Human Resources for Health (HRH) Program, a collaborative, seven-year project between the Rwandan government, BWH, Harvard Medical School and more than 20 other academic institutions in the U.S. The program recently began its fifth year.

Lanahan—who relocated with her family to the Rwandan capital, Kigali, on Aug. 2—will spend one day each week doing didactic training with her new crop of residents. The other four days will consist of clinical training in the operating room. During her year-long position, she will offer three months of training in cardiac anesthesia, her primary area of clinical interest.

Although she has long had a desire to get involved in global health, Lanahan says HRH piqued her interest after chatting with two BWH colleagues in her department who were alumni of the program: Stewart Chritton, MD, PhD, and Ramon Martin, MD, PhD. She felt compelled to participate after learning just how scarce anesthesiologists are in Rwanda.

“There are fewer than 20 anesthesiologists in the whole country, and we have more than 100 in our department at the Brigham,” she said. “There’s a critical need for anesthesiologists in Rwanda.”

In Rwanda, there may only be one anesthesiologist per hospital, Lanahan explained. In addition, anesthesia is often administered by technicians—whose highest level of education is typically a high school diploma—rather than physicians or nurses, she said. In comparison, only licensed anesthesiologists and nurse anesthetists may provide anesthesia to a patient in Massachusetts.

The lack of specialized training can be deadly, Lanahan said.

“People fear anesthesia in Rwanda, and part of it is because there’s a higher morbidity and mortality rate associated with it,” she said. “By training specialists in anesthesia, we can increase the likelihood that it will be administered safely to patients.”

As part of its broader goal to build a more self-sustaining health care system in Rwanda, the program has gradually sent fewer U.S. clinicians each year to train residents.

Lanahan is one of a handful of anesthesiologists in attendance this year.

“The idea is that if a resident from a country such as Rwanda goes elsewhere to train, they might not come back to their home country,” Lanahan said. “So by bringing doctors to Rwanda, you can train them in their own environment and expand the number of physicians there.”

Leave a comment

BWHC Strategic Priorities Slide 2016 v4

Strategic Priorities

We have prioritized these seven objectives to ensure that we are a high-performance health care organization that meets patient needs and remains competitive in the marketplace. The examples listed below are meant to illustrate one instance—not a comprehensive review—of how we meet these goals. For more examples of how we achieve these priorities, visit As our strategic priorities evolve in fiscal year 2017, read BWH Bulletin for the latest updates.

Scalable Innovation

The remarkable discoveries and innovations at BWHC improve our understanding, prevention and treatment of diseases.

BWH researchers were the first to study the long-term effects of multivitamins, discovering in 2012 that men over 50 who take a daily multivitamin reduce their risk of cancer, but not cardiovascular disease—a finding that affects millions.

Advanced, Expert Care

Patients from around the world seek out the expertise of our highly specialized clinical and research staff, who pioneer medical breakthroughs and provide individualized care.

Launched  as an initiative of the Dana-Farber/Brigham and Women’s Cancer Center, serves as a hub for physicians and patients looking for resources, including clinical trials, to help pinpoint therapeutic agents designed to precisely target and treat an individual’s cancer.

Improve Health
Global healthcare

Healing and caring for patients locally and globally means not only treating disease, but also preventing it and improving a patient’s quality of life.

The Center for Community Health and Health Equity works with community partners to reduce health care inequities and increase access to care for vulnerable populations. Our primary care and specialty services enable us to help patients sustain good health and prevent disease.

Timely Access
Medical register

Our ongoing efforts to optimize operations, productivity and efficiency mean we can help more patients in need of BWHC’s expert care and in their preferred timeline.

Our Epic system helps make scheduling for appointments and procedures easier for patients and families. We also aim to assign patients to a room as quickly as possible and ensure we can rapidly accept direct transfers of patients who need our care.

Exceptional Experience
Environmental Services4

BWHC is committed to providing patients and families with the best possible care experience—from their first interaction with BWHC to follow-up care they receive after leaving the hospital.

This includes valet services when patients or family members arrive, a seamless registration process, clean inpatient rooms, high-quality meals, compassionate and highly skilled care, among many other elements.

Highest-Quality, Safe Care
Close up of nurse caring for a senior patient

Our patients and families deserve the best possible care, which means the right diagnosis and treatment, coordinated communication with care teams, transparency and prevention of harm.

We are improving patient safety by fostering a Just Culture, where staff feel comfortable reporting errors so that we can prevent them from reoccurring. Our Safety Matters initiative encourages transparency and sharing stories about mistakes we made, what we learned from them and the improvements we are making as a result.


The effective use of clinical, research and administrative resources and processes helps reduce the cost of care.

As part of a hospital-wide effort to reduce costs and improve efficiency, the BWH Audiovisual Service team began providing furniture moving assistance last year for internal events. The hospital had previously relied on an outside vendor. Using our in-house staff is expected to save the Brigham $60,000 this year.

Areas of Focus: Fiscal Year 2016

These areas of strategic focus position BWHC to achieve the seven objectives outlined above. Included with each description are examples of how we’re bringing these to life. For a full list of objectives, visit

Discovery & Innovation
8977_©Maglott_BWH_010509 copy

BWHC will continue to build on our rich legacy as pioneers in patient care and research.

FY ’16 goals: Brigham Building for the Future will be completed this fall on time and on budget. Increase our number of invention disclosures from 200 in 2015 to 210 this year to advance academic, clinical and financial progress.

Leading-Edge Care Redesign
BWH Buildings_100815_1991

We never stop looking for ways to improve patient care.

FY ’16 goal: Implementing an initiative called “Active Asset Management,” focused on improving the effective utilization of surgical, procedural and inpatient resources; improved transfer of patients; more efficient and supportive discharge processes; and improved referral management and ambulatory access.

Business Development
Stock market price display

Sustaining our mission requires an ongoing commitment to revenue growth and financial stability.

FY ’16 goals: Partnering with Bermuda Cancer and Health Centre to construct the island’s first radiation oncology facility. The business development team has also identified opportunities in China to lend Brigham expertise to new health systems there, greatly benefiting both organizations. Locally, we will meet our target of providing primary care for more than 200,000 patients in Greater Boston and Southeastern Massachusetts.

Our Foundation

People, Education, Skills and Capabilities
Longwood Primary Care

We seek to attract and retain the best staff, whose talents make our work possible.

FY ’16 goal: Strengthen the newly launched Brigham Education Institute—a central, cross-department organization launched earlier this year to coordinate medical education opportunities for our health care providers and trainees.

Financial Strength
stock graphy on screen

Without a solid financial foundation, our work in carrying out our mission and achieving our vision simply isn’t possible.

FY ’16 goal: Use our existing assets wisely to generate margin and operate within our budget so that we can continue to provide exceptional, leading-edge care, regardless of external challenges.



Leave a comment
Betsy Nabel discusses BWHC’s institutional strategy with Medicine residents.

Betsy Nabel discusses BWHC’s institutional strategy with Medicine residents.

As health care institutions navigate an increasingly complex environment, it is imperative that we, as an organization, continue to differentiate ourselves through discovery, innovation and excellence in patient care. Having a clear strategy with specific goals will ensure our organizational strength for generations to come.

BWH Bulletin sat down with BWHC President Betsy Nabel, MD, to talk about our strategy and what it means for the BWH community.

Could you briefly summarize why having a strategy is important?

Our strategy articulates what we believe in as an organization, who we want to be in the future and what we need to accomplish today in order to realize our goals over the next five years.

Walk us through the framework image.

BWHC Strategic Priorities Slide 2016 v4

The image resembles the exterior of the historic Peter Bent Brigham entrance at 15 Francis St., emphasizing that our values are the same today as they were more than a century ago when our predecessor hospitals were established. You’ll see our vision at the top of the framework—that is who we aspire to be—and our mission is underneath, describing what we do and why we’re here.

The seven boxes below represent our strategic objectives—in other words, what we need to do to achieve our mission and vision. Three pillars underneath those boxes outline the priorities that we will focus on to meet our strategic objectives. Our people and our financial strength are at the foundation, as we cannot accomplish any of our goals or carry out our precious mission without continued development of our talented, dedicated staff and a strong financial foundation.

Why is it important for all employees to know our institutional strategy?

Our people have a deep-seated connection to our mission of patient care, research, teaching and community engagement. It’s equally important that they connect with our strategy. If all 18,000 of us understand the big picture and the goals, we’re better positioned to achieve them. Having conversations with each other about what the goals are and how we contribute to achieving them reaffirms our sense of engagement, unity and commitment.

Is having a strategy new for us?

We have always set strategic goals, but this framework gives us a way to make difficult choices based on where the Brigham should be in five years, not just this year or next. This builds on the strategic commitments we laid out in 2011. Once everyone understands the strategy and feels connected to it, we can all work together to ensure that we succeed.

Can every staff member have an impact?

Absolutely. Our clinicians are among the best in the world and can ensure every patient receives the advanced, expert care that sets us apart by working and communicating as a team to deliver truly patient-focused care. In addition, we all can have an impact on affordability, for example. You can be more efficient in your work, regardless of your role, and look for cost-savings ideas to share with your manager or submit to Bold Ideas, Big Savings at

Exceptional experience is another goal where we all can contribute. Each one of us can be on the lookout for patients who are lost and offer to help them. Offering words of encouragement, empathy and kindness, providing support to patients and families, and going above and beyond what is expected—these are the things that profoundly affect how our patients feel about their care and their experience at the Brigham.

Not every role or department has a direct impact on every area of the strategy, but we can all affect some of these areas. I encourage everyone to use the worksheet in this issue to think through how you connect to our strategy and talk with your colleagues about it.

Will this change how we do things?

Yes, our strategy will guide us as we consider new initiatives and programs. We realize that we can’t do everything and, going forward, this approach will help us determine what new things we will take on and also what we will discontinue or decide not to do. These decisions, guided by our strategy, will also help us set priorities during our budgeting process.

Can you elaborate on how changes in the budgeting process will affect us?

We know every year that our expenses are higher than our revenue, so each year we begin with a gap that we need to close. We want to be more strategic and thoughtful as we consider what we should be doing more or less of in order to differentiate ourselves in the market, rather than just focusing on the numbers for one year. We need to think about the big picture so that we can be successful for years to come.

Where does the education component of our mission fit into the strategy?

Education is a vital part of our mission. The newly formed Brigham Education Institute is mapping out our strategy for education and training programs. As that matures, we will be able to set specific objectives in this critical area as well.

At Town Meeting, you discussed the strategic priorities that differentiate us. Can you elaborate on that?

As you look at the strategy framework, you’ll see that two of the seven boxes below the mission are shaded: “Scalable Innovation” and “Advanced, Expert Care.” In the other five boxes are goals we know we must achieve to be competitive, but they don’t necessarily distinguish us. All hospitals must ensure safe care, for example. But scalable innovation and advanced, expert care are what make us different from many other hospitals in the nation.

People come to the Brigham from all over the world because of the outstanding, highly specialized care they receive here—we take care of many patients whose cases are too complex for other hospitals. And our research community continually innovates and makes discoveries that we can rapidly translate to the bedside and the clinic to improve care for many patients at the Brigham and beyond—that’s scalable innovation.

We have always excelled in these two areas, and we know that they need to be a focus of our strategy going forward.

Does focusing more on these initiatives mean we’re focusing less on others?

Yes. As ideas or proposals for new initiatives and programs come to us, we will look to our strategy to guide us. That means there are some things we will discontinue or downsize and new projects we will implement.

How will we measure our success relating to strategy?

Strategy constantly evolves and adapts to the environment. As we set our strategic objectives, we are also committing to consistently measuring our progress in these vital areas and the performance of the hospital as a whole. That way, we will know if we have selected the right programs and priorities, and whether we are moving in the right direction. If we don’t see the progress we anticipated, we will course-correct.

How will these efforts benefit our patients?

Patients are at the center of everything we do, and articulating our strategy is no exception. Our strategy is designed to help us be successful for generations to come, which will ensure that we can continue to provide patients with care they simply can’t receive anywhere else. In addition, our focus on discovery and innovation will help accelerate the prevention, treatment and, ultimately, cures for many of the health concerns that those who depend on us face. The strategy not only positions the Brigham for success; in doing so, we believe that it will also improve the health of patients around the world for generations to come.

Leave a comment
Filming an NOTSS training video in Rwanda

Filming an NOTSS training video in Rwanda

All physicians want to provide the best possible care to their patients, but clinicians in parts of the world where resources are limited can face many challenges in doing so.

Recognizing this challenge, John Scott, MD, MPH, a general surgery resident and research fellow at the Center for Surgery and Public Health, teamed up with surgeons in Rwanda to improve surgical care for patients through the Non-Technical Skills for Surgeons (NOTSS) training program. This program—originally designed in Scotland by a team of psychologists, surgeons and anesthesiologists—was created to assess and improve surgeons’ non-technical skills, such as situation awareness, decision-making, communication, teamwork and leadership.

With the help of his mentors Robert Riviello, MD, MPH, of Trauma, Burns and Critical Care, and Steven Yule, PhD, of the STRATUS Center for Medical Simulation, Scott redesigned the NOTSS program to be used in a resource-limited setting for the first time. Additionally, they collaborated with students at the KWETU Film Institute in Kigali, Rwanda, to produce an on-location video series to complement the curriculum.

“Surgery is very technical, but expert performance takes more than just cutting and stitching,” said Scott. “Before the NOTSS program, we didn’t have a reliable way to teach these critically important non-technical skills.”

Having training in skills like situation awareness, leadership and decision-making makes it easier for doctors in resource-limited settings to resolve problems that may be specific to their operating rooms, Scott says. For instance, surgeons in Rwanda see variability in the equipment they use, the personnel and assistance they receive, and the support systems they work within. This makes it difficult for surgeons to plan ahead, and they must think creatively and deal with changes very rapidly, as their access to these medical resources can change quickly.

“The long-term goal is to improve the surgical service in Rwanda so that resource variability is no longer an issue,” said Scott. “But NOTSS enables us to improve patient safety and surgical performance here and now, without waiting around for more money and technology.”

For more information about BWH’s global health initiatives, visit

Leave a comment
Adelina Peña

Adelina Peña

Adelina Peña had been interested in working in health care for years, but it wasn’t until learning about the Partners in Career and Workforce Development program at a job fair a few years ago that she discovered how to make it happen.

PCWD is a free eight-week training program designed to help local residents prepare for, obtain and succeed in entry-level employment at Partners institutions, including BWH. The training program includes four weeks of classroom instruction and a four-week internship in a clerical or support staff position at a Partners hospital.

In addition to invaluable training related to résumé writing, interviewing skills and medical terminology, the program also focuses on other professional skills, including communication, problem-solving, customer service, attitude, and professional dress and appearance.

Graduates of the program have been matched in positions such as office assistant, unit coordinator, patient service coordinator, practice secretary, laboratory aide, medical records clerk and operating room assistant at BWH and Massachusetts General Hospital.

After applying to the program and completing a screening and testing process, Peña was accepted into the July 2013 PCWD class. Her internship was spent working as an anesthesia technician in BWH’s Department of Anesthesiology, Perioperative and Pain Medicine, where she was offered a full-time job after completing the program. She says that her BWH internship was the first step in a long journey of personal and professional growth.

Today, Peña is a BWH anesthesia technician and nursing student at Lawrence Memorial/Regis College in Medford. She is also the mother of 3-year-old Amelia.

“The PCWD program jumpstarted everything for me and enabled me to go to the next level,” she said. “It opened up job opportunities and networking relationships I had never thought would be available to me. I have received incredible coaching from BWH career coach Amy Zydanowicz, who helped me brainstorm the types of career paths I might want to explore.”

Working as an anesthesia technician has exposed Peña to different career growth opportunities. She is pursuing her associate’s degree in nursing, which she expects to earn next May. From there, Peña plans to enroll in a bachelor’s degree nursing program and aspires to become a certified registered nurse anesthetist at BWH someday.

Peña says her proudest accomplishment was getting accepted into nursing school and surviving the first year, especially with the intense clinical work.

“It was extremely difficult to balance school, work and being a mom, but I am very grateful to have an incredibly supportive manager and supervisor who have been very accommodating with my work schedule, especially around exam times,” said Peña. “In addition, I never could have done this without the support of my mother, who helps me take care of my daughter.”

Leave a comment
From left: Michael Givertz, Arnold Ketchum, Nicolette McDermott-Ketchum and Lynne Stevenson

From left: Michael Givertz, Arnold Ketchum, Nicolette McDermott-Ketchum and Lynne Stevenson

At Northern Navajo Medical Center in Shiprock, New Mexico, physician assistant Nicolette McDermott-Ketchum, PA-C, cares for patients who are part of Navajo Nation, the largest Native American tribe in the U.S. at about 175,000 people.

About 37 percent of Navajos live in poverty. Access to specialty and preventive medical care is limited, with patients often having to travel a long distance to obtain medical services. Adding to these challenges is a lack of primary care physicians and specialists in New Mexico, Arizona and Utah, where Navajo Nation is based.

Clinicians like McDermott-Ketchum, who are part of the Indian Health Service (IHS)—a federal agency within the Department of Health and Human Services—provide care to nearly 2 million Native Americans at 35 hospitals and more than 300 health centers across the country. In 2008, the BWPO formed the Brigham and Women’s Outreach Program with the Indian Health Service. The outreach effort enables BWH clinicians to provide ongoing training and up-to-date clinical knowledge to IHS clinicians, with the goal of expanding IHS clinicians’ expertise in managing a spectrum of conditions.

McDermott-Ketchum and her husband, Arnold Ketchum, PA-C, a fellow IHS physician assistant, visited BWH last month to sharpen their cardiac care skills and heart disease knowledge in service to their patients in New Mexico. Many of their patients suffer from diabetes, high blood pressure and high cholesterol.

“I married into the tribe, and I love serving the Navajo people, who are kind, patient, resilient and family-oriented,” said McDermott-Ketchum.

During their visit, the couple shadowed Lynne Stevenson, MD, director of the Cardiomyopathy and Heart Failure Program, and Michael Givertz, MD, medical director of the Heart Transplant and Mechanical Circulatory Support Program.

“It was an amazing opportunity to observe Drs. Givertz and Stevenson in the Watkins Clinic and see the compassion and skill they demonstrated in every patient encounter,” said McDermott-Ketchum. “It is one thing to hear didactics about how clinical cardiology practice is supposed to operate, but viewing the interactions between BWH staff and their patients reinforced the knowledge with a human element. This is something I will keep in mind during my patient sessions.”

As part of the three-pronged Outreach Program, more than 100 Brigham clinicians have traveled to the Navajo Reservation in Shiprock and Gallup, New Mexico, and Chinle, Arizona, to care for patients and teach members of the local medical staff. Dozens more lead remote teaching and patient consultation sessions by video conference or volunteer to host IHS visitors here in Boston for more focused learning, says Ellen Bell, MBA, MPH, senior project manager for the Brigham and Women’s Outreach Program.

During the past seven years, 14 IHS clinicians have visited BWH to shadow clinicians across a wide range of specialties, including Emergency Medicine, Dermatology, Gynecology, Radiology and Cardiology.

“The Brigham and Women’s Outreach Program is the perfect reflection of the core values of the hospital in that we have been able to apply the expertise of our senior clinicians to improve the health of the community through teaching and clinical care,” said Tom Sequist, MD, MPH, medical director of the Brigham and Women’s Outreach Program. “Most importantly, this is not a one-way street, as our clinicians have been very vocal in expressing that they gain as much, if not more, from their experience volunteering in the program. In many ways, our program offers a life-changing experience.”

To learn more about the Outreach Program and how you can participate, visit

Leave a comment

Dr.TylerBWH and the Department of Neurology mourn the loss of H. Richard Tyler, MD, former chief of the Division of Neurology and BWH’s first full-time neurologist. He passed away May 9 at the age of 88.

“Known as a brilliant clinician and memorable teacher, Dr. Tyler made enormous contributions to the Brigham community, its patients and the field of neurology,” said Martin Samuels, MD, chair of the Department of Neurology.

Dr. Tyler, who lived in Brookline, is credited with building BWH Neurology from the ground up, serving as chief from 1956 to 1988. Under Dr. Tyler’s leadership, the department added a major basic research program in 1985, led by Dennis Selkoe, MD, and Howard Weiner, MD, co-directors of the Ann Romney Center for Neurologic Diseases. The Neurology Division at BWH became an independent department in 1995.

Dr. Tyler received his MD from Washington University School of Medicine in 1951. He interned at the BWH predecessor Peter Bent Brigham Hospital in 1951, followed by a neurology residency at Boston City Hospital. He then spent two years abroad at The National Hospital for Neurology and Neurosurgery, Queen Square in London and at the Pitié-Salpêtrière Hospital in Paris. He later worked at The Johns Hopkins Hospital before returning to BWH in 1956. He was appointed professor of Neurology at Harvard Medical School in 1974 and became emeritus professor in 1999.

During his time as chief, Dr. Tyler helped to develop the field of renal neurology, based on his experience with early dialysis and organ transplantation. He also characterized the physiological basis of asterixis, one of the cardinal signs of metabolic encephalopathy, also known as brain disease, damage or malfunction. He was an expert in the neurological aspects of congenital heart disease in adults and the neurological aspects of alcohol and malnutrition.

He always felt that his greatest contribution was not his personal work but rather the generations of medical students, residents and faculty he trainedmany of whom went on to assume major leadership positions in neurology, locally and throughout the nation.

After stepping down as chief in 1988, Dr. Tyler continued to maintain a busy neurology practice until 2015, and he remained a valued consultant for internists and neurologists. He continued to develop one of the great modern collections of books related to neurology and neuroscience.

Samuels said generations of Harvard Medical School students have vivid memories of Dr. Tyler’s prodigious teaching skills. He was one of the founders of the Harvard Longwood Neurology Training Program and recruited a group of distinguished neurologists to join him at BWH, including Selkoe and Weiner.

“Rick Tyler was the single most influential teacher in my quest to become an academic neurologist and to develop my career at BWH,” said Selkoe. “I will greatly miss his remarkable depth of insight into how brain diseases work and how to humanely care for those suffering chronic neurologic illnesses.”

Weiner said he learned neurology from Dr. Tyler at a time when all doctors had to work with were a patient’s medical history and physical exam.

“He was a master clinician who made neurology come alive for me,” Weiner said.

He is survived by his wife, Joyce; children Kenneth Tyler and wife, Lisa; Karen Tyler; Douglas Tyler and wife, Donna; and Lori Spisak and husband, Ken; 12 grandchildren; eight great-grandchildren; brother-in-law, Edward Colby; nephews David and Geoffrey Colby; and many friends and colleagues.

Kara Burge (center), a staff nurse in Orthopaedic Surgery, with two Operation Walk Boston patients

Kara Burge (center), a staff nurse in Orthopaedic Surgery, with two Operation Walk Boston patients

year had passed since a young man came to the clinic with severe joint disease in his hips that left him unable to stand up straight, his torso pitched forward about 45 degrees as he steadied himself on a crutch.

But thanks in part to a group of volunteer clinicians from the Brigham, he was now running laps up and down a hallway at a hospital in the Dominican Republic, where he had received bilateral hip-joint replacement surgery through Operation Walk Boston—an orthopedic medical mission founded by Thomas S. Thornhill, MD, former chair of the BWH Department of Orthopaedic Surgery.

The program partners with Hospital General de la Plaza de la Salud in Santo Domingo to perform hip- and knee-joint replacements for patients who can’t afford the procedures. It completed its ninth mission last month.

Seeing that young man run down the hall when he came back for a follow-up visit was an unforgettable moment—one that illustrates why BWH volunteers give their time to give back, said Judith Nagle, MSN, RN, CNOR, nurse-in-charge in the Orthopaedics Operating Room who has gone on every Operation Walk Boston mission since its launch in 2008.

“When people come back and show you what they can now do that they couldn’t do last year, it just overwhelms you,” said Nagle, who took on the role of scrub nurse in the Operating Room during the trip. “I only did my job; these patients did the hard work.”

The latest mission served 37 patients and resulted in 56 replaced joints over five days. To date, Operation Walk Boston has provided 380 people with joint replacements. Clinicians perform the procedures pro bono, and all supplies are donated.

Each year, the mission takes about 50 volunteers, including surgeons, anesthesiologists, nurses, physical therapists, pharmacists and Operating Room staff. That group also includes residents from Orthopaedic Surgery, the Department of Anesthesiology, Perioperative and Pain Medicine, and Pharmacy. Additionally, the team trains about 70 medical students in the Dominican Republic to help support local care providers.

Daniel Tobert, MD, a third-year resident in Orthopaedic Surgery, went on his first Operation Walk Boston mission this year. Although the days were long, often starting at 4:30 a.m., he says the experience was fulfilling both personally and professionally.

“Everyone on the trip is giving up their free time to do hard work—and, in some respects, harder work than we’d do in a normal week—but it’s an incredibly rewarding experience,” said Tobert, who will be the mission’s chief medical officer next year.

Sarah Kelly, PT, DPT, a senior physical therapist in the Department of Rehabilitation Services, also joined Operation Walk Boston for the first time and says she was humbled by not only how grateful the patients were, but also how hard they worked during recovery. Because the volunteers are there for such a short time, they have to get patients walking as soon as possible, sometimes within a few hours of surgery. 

“It’s one of those trips that reminds you why you wanted to be a physical therapist in the first place,” Kelly said. “Patients who haven’t walked in years can finally get up and sit at the edge of the bed, stand on two feet or bend their knee a little more. To help somebody do that for the first time is unbelievable.”

Julia Rodriguez, RN, a staff nurse in the Post-Anesthesia Care Unit who has gone on several Operation Walk Boston missions, says she enjoys connecting with the patients and the Dominican clinicians and medical students. She also appreciates having the opportunity to speak her second language, Spanish.

“It appealed to me: going to a country that had fewer medical services than we have and being able to do mission work for patients who can’t afford this surgery on their own,” Rodriguez said.

This slideshow requires JavaScript.

Taking the Lessons Home

Volunteers say the mission also provided learning experiences they wouldn’t normally be exposed to and fostered a deep sense of teamwork. Nagle appreciated the opportunity to attend a grand rounds-style meeting where doctors discussed their plans for surgery that week.

“You get to hear their thought process, which adds a whole other dimension to my practice here at home,” Nagle said.

Learning is also a two-way street, she said. Over the years, BWH volunteers have trained hundreds of medical students in Santo Domingo and helped local practitioners improve their quality of care. 

The limited resources during the mission can be challenging, but volunteers say they enjoyed having the chance to think critically and creatively to find solutions.

“It presents a situation we don’t normally have here, where you have an isolated opportunity to intervene surgically,” Tobert said. “This gives me experience in how to deal with more complex care decisions, which is something they don’t teach you in medical school.”

Leave a comment
From left: Mark Lipman, Grace Dammann and Helen Cohen

From left: Mark Lipman, Grace Dammann and Helen Cohen

On April 19, BWHers attended a screening of the documentary film “States of Grace” and had the pleasure of meeting the subject of the film, Grace Dammann, MD, along with the film’s directors.

The film shares the story of Dammann, an HIV specialist in San Francisco who was seriously injured in a head-on collision on the Golden Gate Bridge in 2008.

“The film is one of the most honest, informative and inspiring documentaries about illness and recovery that I have ever seen,” said Carolyn Becker, MD, of the BWH Division of Endocrinology, Diabetes and Hypertension, who saw the film at a conference in Portland, Oregon, last year. “When I first saw it, I knew it could carry great appeal for our housestaff and faculty, showing how a severe and sudden life event can lead to disability, family tensions, loss of sense of self and ultimate healing and renewal.”

Thanks to the generous financial support of Marshall Wolf, MD, emeritus vice chairman for medical education at BWH, and his wife, Katie, the film was shown at the hospital. Wolf believed the film was especially important for medical students and residents to view and learn from because it includes many lessons about caregiving and recovery.

Following the screening, Dammann and directors Helen Cohen and Mark Lipman answered questions from the audience about the documentary and Dammann’s journey.

BWH chaplain Monique Cerundolo, of Spiritual Care Services, said it was an honor to learn more about Dammann’s story as she responded to questions.

“The program was greatly pertinent to the work we do at the Brigham every day, portraying through Grace’s story the feelings, challenges and needs of patients and caregivers,” said Cerundolo. “Her journey is as profound, painful and inspiring as her strong spirit. Her presence was a gift.”

Abbie Engelstad, also a chaplain in Spiritual Care Services, meets patients and their families at particular moments on their journey, whether it’s just after experiencing trauma, returning to the hospital following a setback or during a routine check-in that has become part of a patient’s daily life.

“Watching Grace move through all of those moments in the film, and the huge range of emotions she and her caregivers felt along the way, reminded me of the deep reserves of strength and resilience our patients and their families need in order to move through each day, much less thrive,” Engelstad said. “Most inspiring of all was witnessing Dr. Dammann transform when she went back to practicing medicine. This strengthened my conviction that a sense of purpose is vitally important for the dignity, healing and well-being of all of our patients.”

To learn more about “States of Grace” and view the trailer, visit

Leave a comment
Jeffrey Golden, left, announces the award winners, including Matthew Rose, right, at the Department of Pathology’s annual research celebration.

Jeffrey Golden, left, announces the award winners, including Matthew Rose, right, at the Department of Pathology’s annual research celebration.

The Department of Pathology recognized several young investigators at its 10th annual research celebration for their basic, clinical and translational research being conducted both in the department and in collaboration with other departments. In total, more than 30 posters were presented at the April 15 event.

Dozens of clinicians and investigators gathered in the Miller Atrium to listen to Jeffrey Golden, MD, chairman of the Department of Pathology, as he announced the Posters of Distinction Awards, including the first to be chosen by using a crowd-sourcing app developed in the department specifically for scientific meetings.

The event is an exciting opportunity to recognize trainees and junior faculty, Golden said.

“The annual Department of Pathology Research Celebration accentuates the extraordinary depth and breadth of research that is conducted in our department each year,” he said. “Every year, I am awed and impressed by what is done in this tremendous department.”

Lori Ramkissoon, PhD, Matthew Rose, MD, PhD, and Gurpanna Saggu, PhD, received the Posters of Distinction Awards. Saggu’s poster was chosen through the crowd-sourcing app. Distinguished guests Thomas J. Gill III, MD, and Simon J. Simonian, MD, ScD, were also in attendance to present the Thomas J. Gill III, MD, and Simon J. Simonian, MD, ScD, Prize for Research Excellence to Sankha Basu, MD, PhD, and his mentor Scott Lovitch, MD, PhD. This award recognizes the accomplishments of young investigators and how their relationships with mentors have influenced their success.

“This was a remarkable showcase of the cutting-edge nature of the research activities ongoing in our department,” said Michael Gimbrone, MD, former department chairman and the director of the Center for Excellence in Vascular Biology.

Leave a comment