LGBTQ Training Opportunity

UCLA Health and the David Geffen School of Medicine are proud to offer a LGBTQ Healthcare Fellowship designed to train future primary care physicians to be sensitive, comfortable, clinically knowledgeable and culturally competent in delivering healthcare to sexual and gender minority patient populations.

This one-year fellowship beginning on July 1, 2022, is a junior academic appointment as a Clinical Instructor in both general primary care and LGBTQ subspecialty and specialty care. The fellow will have yearlong longitudinal clinical rotations in a variety of UCLA and affiliated clinical sites, with some flexibility in tailoring the experiences to the learning environment and career goals of the fellow.

These experiences include:

  • Primary Care for MSM
  • Primary Care for WSW
  • Transgender Care and Hormone Management
  • Urology, Gynecology and Gender-affirming Surgery
  • Hepatitis B & C
  • HIV Treatment and Management
  • High Resolution Anoscopy
  • Substance Abuse and Drug Addiction
  • Mental Health including LGBTQ Adolescents and Young Adults in Transition
  • Mental Health in HIV+ Patients
  • Behavioral health coursework and workshops spanning a variety of topics including human sexuality, bisexual identity, affirmative psychotherapy, and LGBTQ domestic violence.

Successful applicants are U.S.-trained MDs and DOs with a strong interest in caring for LGBTQ communities and have completed or will be completing their residency training by June 30, 2022 in Internal Medicine, Family Medicine, or Internal Medicine/Pediatrics combined specialties. Applicants should also have a passion for leadership, teaching, research and a motivation to expand the current field of LGBTQ medicine.

Please visit www.uclahealth.org/lgbtq/fellowship-program for more information.

HC Owen MTC 2/25: DLBCL and transgender medicine

Today our excellent R2, Dr. Kevin Wang, presented a case of a middle aged transwoman who presented with lower extremity swelling and L groin pain who was found to have new onset heart failure and also generalized lymphadenopathy. We used this case to discuss a few issues surrounding HIV patients:

a) Heart failure: patients with HIV are more likely now to suffer and pass away from chronic medical conditions such as heart failure than from complications of HIV given the success of current anti-retroviral therapies. Patients with HIV have about a 3 fold increase risk of developing CAD and also heart failure, due to the pro-inflammatory state of their HIV, their increased likelihood of co-morbid tobacco and stimulant abuse, and the side effects of older ART, specifically protease inhibitors.

b) We were able to break into groups and then go over possible differentials for generalized lymphadenopathy, using the MIAMI mnemonic (provided by the AAFP, see figure above from 2016 article on work-up of generalized lymphadenopathy) as one diagnostic schema. Our patient was ultimately diagnosed with having DLBCL and had to get modified DA-R-EPOCH regimen given she could not get doxirubicin due to her pre-existing heart failure.

c) We also spent some time discussing the nuances of caring for our transgender patients and how we can work to create a welcoming, inclusive environment that would best build a therapeutic relationship.

Special thanks to our expert discussant, Infectious Disease fellow, Dr. Stephen Rawlings for sharing his expertise on these topics!

Great case, Dr. Wang!

Clinical Pearls:

  1. The first step to avoid mis-gendering patients is to introduce yourself and your pronouns to all your patients. For additional tips consider viewing this website from UCSF: https://transcare.ucsf.edu/guidelines/clinic-environment.
  2. Transgender HIV patients are at greater risk of med nonadherence and inability to achieve viral suppression due to a number of psycho-social barriers and stigmas they face in the health care setting. To better understand their needs please read the following NEJM article: https://www.nejm.org/doi/full/10.1056/NEJMcp1903650
  3. DLBCL is one of the most prevalent malignancies in HIV patients as HIV infection can lead to chronic antigen stimulation and polyclonal B-call expansion, promoting emergence of monclonal B-cell lines. Remember to get excisional biopsies if possible (or multiple cores) in order to best preserve the lymph node architecture.

Medicine in Motion: Advancing Medicine Through Equity—Nov 15 6-9pm

As part of our Advancing Women in Medicine Initiative and Health Equity, Advocacy, & Diversity Interest Group, we are pleased to invite you to attend a special event held by the ACP on Friday, November 15th.

“Medicine in Motion: Advancing Medicine Through Equity,” will bring together distinguished leaders, practicing physicians and future physicians for networking, collaborative problem-solving, and sharing best practices on issues related to diversity and inclusion, well-being, leadership and gender equity. Topics of discussion will highlight shifting patient demographics, physician workforce needs, designing inclusive work environments and ensuring access to high quality care.

Our keynote speaker for the evening will be Dr. Darilyn Moyer, Executive Vice President and CEO of the American College of Physicians. She will speak on “Creating a Inclusive Health Care System.” 

Mark your calendars, RSVP now and plan on attending this informative and enriching event!

Where: UCSD MET Auditorium
When: Fri, Nov 15, 2019 6-9pm
Cost: FREE for up to 10 residents who respond first and PROMISE to attend—contact the chiefs ASAP!

$5 for ACP members; $20 for non-members (Dinner and drinks are included)

To register, click on the following link: Medicine in Motion: Information and Registration

Program

6-6:30 pm – Networking

6:30-6:45 pm – Introduction

6:45-7pm – Keynote by Dr. Darilyn Moyer, ACP EVP/CEO on “Creating an Inclusive Healthcare Environment”

7-7:30pm – Gender Equity Panel

  • Moderator: Sima Pendharkar, MD, MPH FACP

  • Panelists: Doug DeLong, MD, FACP, Chair, ACP Board of Regents; Chwen-Yuen Angie Chen, MD, FACP, FASAM, Stanford University

7:30-8pm – Diversity, Equity & Inclusion Panel

  • Moderator: Tiffany I. Leung, MD, MPH, FACP, FAMIA
  • Panelists: Susan T. Hingle, MD, MACP, Professor of Medicine, SIU School of Medicine, former Chair, ACP Board of Regents; Tracey Henry, MD, MPP, FACP – Assistant Professor at Emory University and member of the ACP Council of Early Career; Amy Bellinghausen, MD – UCSD Pulmonary, Critical Care, & Sleep Medicine Fellow

8-8:45pm – Breakout groups on Gender Equity and Diversity, Equity, and Inclusion with a chance to connect with senior leaders in these areas, the opportunity to form and participate in “work affinity groups,” and to engage in projects (publications, podcast, book, videos, or other audience generated ideas) with sponsorship by leaders and experts in these areas. Fantastic chance to get your name on a work product and to engage with more senior leaders and experts in the process!

8:45-9pm – Reports from the breakout groups & Conclusion

After 9pm – Networking and conversations to continue…

Owen MTC: Starting PREP

This morning’s Owen conference at UCSD covered PREP therapy for HIV prevention. A young adult male presented to primary care clinic, completed appropriate screening labs (see below), and started Truvada. For a great overview of recent guidelines, the CDC 2017 PREP guidelines are a great place to start! Many thanks to Dr. Kadakia and Shaun Giancaterino for putting together a great case discussion

Friday School: statistical process control charts, osteoporosis and transgender health

Today we had a perfect combination of sessions to round out the end of the Endo, Gender Health and QI block! We started with a hands-on session, creating our own SPC charts to learn how easy and useful these can be. This was lead by our very own Dr. Jack Temple. Remember these graphs/charts help you see visually how a process changes over time. This is easy to understand when you think about graphing someone’s blood pressure: you can see average ranges and when it goes high vs low. This was followed by a case-based session on osteoporosis with Dr. Kado. The groups went through various cases to discuss when and how to treat osteoporosis and when to stop. Take a look at this single slide for a nice guide:   The interns joined us for the rest of Friday school which consisted of a lecture on LGBT health by Dr. Jill Blumenthal and followed by a transgender panel. Below

read more Friday School: statistical process control charts, osteoporosis and transgender health

Upcoming Events! March 8th and 9th

There are two upcoming conferences that we wanted to share with you: March 8th, 2019: Human Trafficking Conference  For more information: click here March 9th, 2019: UCSD Transgender Healthcare symposium DATE/TIME: Saturday March 9th, 2019   7:00 am- 1:00pm  LOCATION: UC San Diego School of Medicine campus, T. Denny Sanford Medical Education and Telemedicine Center, lower level auditorium  MEALS: Breakfast, coffee, and light snacks REGISTRATION: Free On behalf of Dr. Ankita Kadakia with support from the Vice Chancellor for Health Sciences Office,  the Academy of Clinician Scholars Kaiser Award and collaboration from Pacific AIDS Education and Training Center.   The goal of this half day symposium is to increase provider awareness to transgender health care issues by education geared towards primary care providers and those interested in transgender health care.  Topics include gender neutral terminology, hormone therapy and gender confirmation surgeries, mental health issues in transgender health care, as well as primary care health issues for transgender patients, fertility and reproduction, and

read more Upcoming Events! March 8th and 9th

Friday School: SPC, Osteoporosis, and Transgender Health!

Today’s Friday School was quite diverse: everything from Statistical Process Control charts to cosmetic, catastrophic silicone buttock injections. I (Jack, He/Him/His) started off the afternoon with a presentation on Statistical Process Control charts–not as boring as they sound! They’re very helpful to determine if your Quality Improvement actually led to significant change. As a reminder, PDSA + SPC = the Model for Improvement. These two are like peas and carrots. Our residents created their own SPC charts and identified that yes, in fact, the interventions at “The Center Medical Center” improved the overall community A1c. For more info, check out the SPC page on this blog! Then the wonderful Dr. Kado taught us about the nuances of Osteoporosis care with six interactive case studies. We ended the afternoon with a fantastic overview of Transgender Health by Dr. Davey Smith. His slides are a great resources and posted below. Some key points: Remember the Gender Unicorn: birth sex is different than

read more Friday School: SPC, Osteoporosis, and Transgender Health!