Thank you to all department members for your incredible dedication and hard work and achievement of excellence.
Download ReportTranscript Thank you to all department members for your incredible dedication and hard work and achievement of excellence.
Thank you to all department members for your incredible dedication and hard work and achievement of excellence. Assert yourself as a leader: Everyday and with every opportunity Vision • Clinical Care: Perfect outcomes; Complete patient satisfaction with care and communication; Leaders of innovations in care • Education/Training: Most sought after graduates; Leaders of innovative education approaches; Most competent and up-to-date faculty and staff • Research/Scholarly work: Well funded, translational and clinically-oriented research; Consistent culture of Discovery • Administrative core: Perfect, transparent processes that assures a strong financial and administrative foundation Mission • Recruit and retain talented members of our team, from diverse backgrounds, who are driven to achieve • Provide appropriate financial/administrative resources to allow everyone on the team to be successful. • Provide educational/training resources to allow all members of the team to be successful in their position • Foster a culture of collaboration, respect, innovation and scholarship. The way I think Education of our trainees and faculty/Staff Infrastructure excellence Excellence in Patient Care Personal integrity and dedication (leaders and Heroes) Discovery: Research Just to be clear: what really matters? • Outstanding care for our patients • Well-being of our team members • Building the foundation of knowledge in anesthesiology (research) • Educating the next generation within anesthesiology, with the appropriate tools for clinical care, leadership and scholarship. OHSU Investment in the department during recovery from 2008/2009 economic downturn • OPEX/LEAN: reduces waste and improves structure to allow more efficient work, with less frustration • Hospital support to offset burden of weekend call. • Salary stability for full-time scientists • Work-environment improvement for staff (better printers, computers, lighting) • Expansion of clinical staff to better support academic days and break help. • Growth in compensation for all department members New Leadership Responsibilities •Ansgar Brambrink - Vice Chair for Faculty Development and Advancement •Michele Noles – Director of Quality Management •Ines Kroener – Medical Director of NeuroICU CRNA Contributions • Implementation of LC4 position • Development & Implementation of break shift – Cortney Blakemore – Danielle Freeman – David Bullock • EP/Cath Lab Team • LVAD Team • Committee Members – CQI: Diane Knapp – CME: Jim Hilliard • Kaizen – Michelle Livingston – Kendall Snow – LaDawn Reid Pediatric Anesthesia • Awards – Michael Seropian - The Presidential Citation from The Society for Simulation in Healthcare for Significant Contributions to Healthcare Simulation – Angela Kendrick - Clinical Service Award at the Women in Academic Medicine Conference • Promotions – Kirk Lalwani – Professor – Berklee Robins – Associate Professor Pediatric Anesthesia • Planning clinical growth – Increased presence in cardiac cath lab – Outpatient surgery at CHH – Intraoperative MRI OR being built – opens 10/2015 • Clinical research – Perioperative experience of autistic children; participation in national databases for sedation, regional, cranialfacial surgery; acupuncture and postop nausea; intraop neuromonitoring in infants; post spinal fusion pain management Vascular Anesthesia Ann Bingham Ryan Anderson • We have increased interdepartmental communication • Our team is involved in exciting treatment techniques: Peripheralartery.n et – Endovascular advancements, Angiovac thrombectomy device • Practice suggestions are in the works: – collaborating on perioperative K+, Aspirin • Regional anesthesia team co-produced helpful suggestions for your reference • We welcome your collaborative ideas for improvement in safety and efficiency Vascular Surgery Team http://www.ohsu.edu/xd/health/services/heart-vascular/services/vascular-surgery/our- 8C-ICU Process Improvement Projects • SOR – ICU Transfer of Care – Expansion of cardiac surgery admission standard to all direct to ICU admission in all adult ICUs – Partnering with PICU staff to adapt similar process • Vocera for ICU providers on CSI team (pilot) • OPEX: Implementation of several Management Standards (including): – TAVR: mandatory team huddles (post admission, 4h, 8h, twice daily) – Use of renal replacement therapy for volume management in acute RV failure – AM huddle (next slide) pilot (now expanding to all Adult ICU AY 2015: OHSU future concept Knight CVICU CCU (all ICU needs) • Advanced heart failure • Adult Congenital cardiology • Interventional cardiology • Complex heart disease Vascular surgery Surgical Subspecialties CTS • Adult cardiac surgery • Adult congenital cardiac surgery • Thoracic surgery CVICU CVICU (primarily cardiovascular co-morbidities) •ENT •Plastics •Urology •Ortho (none spine) •OMFS •OB/GYN • Majority requires ICU admission due to advanced cardiovascular comorbidities • Patient with EGS involvement will be admitted to SICU • Ortho Spine has already been merged with NSICU to group all spine surgeries New CVICU – Collaboration between Anesthesiology, Surgery and Cardiology • CVICU Leadership: Matthias Merkel • Teams: – 2 day teams – 1 night team • 26 ICU beds • Faculty changes: – APOM: • 7 MD faculty members • APP: additional 3.5 FTE (total 8.5 FTE – Pulmonary Critical Care: • 5 Faculty members – Cardiology: • Planned 3 additional FTE • 1 ICU fellowship trained cardiologist recruited Regional Anesthesia 2013-2014 Year in Review Glenn Woodworth, MD Director Regional Anesthesia Department of Anesthesiology and Perioperative Medicine 2013-2014 Regional Anesthesia Projects • Improve team communications • regional service, primary anesthesia team, surgical service, nursing • Improve Patient Care • Evaluation in the PACU before handoff to APS • Better intraoperative management of catheters • First case starts • Coordination with preop nursing, regional service and primary anesthesia team to facilitate on-time first case starts 2013-2014 Regional Anesthesia Projects • Develop, Refine and Implement Clinical Care Pathways (Perioperative surgical home?) • • • • Vascular surgery Bariatric surgery Total Joints Patients with potential peripheral nerve injury • Handling of home pump telephone calls • Evaluation of the efficacy of a new drug (Exparel: bupiliposome suspension) against standard care in a clinical or translational model 2013-2014 Regional Anesthesia Projects • Develop and Implement an organized curriculum for regional anesthesia training • Core Regional Rotation • Advanced Regional Rotation • Regional Fellow • Research • Validation of an Ultrasound Skills assessment • Validation of a Needling Skills assessment • Evaluation of the effects of Tens stimulation on PNB onset 2014-2015 • Faculty Development • Recruit additional regional faculty • Encourage and support research in regional anesthesia and acute pain medicine • Establish OHSU as a National Leader in Regional Anesthesia Education • Better Collaboration with our Surgical Colleagues Clinical Education Research Pain Medicine • The Pain Division continues to be busy both in and outpatient. • New efforts to increase clinical and research collaboration with Knight Cancer Center. • Research ~ 7 papers: fibromyalgia and light sensitivity assessed with fMRI, new spinal cord stimulation device, Yoga and cancer. Presentations at American Pain Society, American Academy of Pain Medicine, and American Society of Regional Anesthesia, with Andrei Sdrulla winning the Best of Meeting award for his abstract. • Future move Adult Inpatient Anesthesia Properly Prepared Patient (patient is ready for surgery and OHSU is ready for the patient) Surgical Patient Flow & Experience Improvement Events (Kaizen) - completed Surgical Practice Clinic O.R. Scheduling Preoperative Medicine Clinic PreOperative Unit South Operating Room Perianesthesia Recovery O.R. Turnover Time Recovery duration Information to patient & family Properly prepared patient 2.0 Properly prepared patient 1.0 PMC capacity On-time 1st case start Intra-op documentation Procedure card Inventory Management Work place organization future Standard Work and Daily Management Systems (DMS) Level loading across the week Level loading within the day Tray replenish. Consolidate instrum. In room to Anesth Ready Anesth Ready to Proc Start Proc Start to Close Close to patient out SOR/PACU Accomplishments • Opex Kaizen events complete: – – – – – Turnover time First case start time PACU phase 1 and 2 time Properly prepared patient (scheduling) Procedure cards, item file (equipment) • Events launched – In room to anesthesia ready – Anesthesia ready to cut SOR/PACU Accomplishments • Improved SCIP performance metrics (antibiotic administration, patient warming/temp, beta blocker administration) • Improved patient satisfaction metrics • Improved first case start times • Improved OR/ICU transfer process • Expanded specialized care teams (VAD patients) • Restructured weekend staffing model • • Standard Work for First Case Starts: Patients, 6A Staff, SOR RNs Anesthesia, and Surgeons Consistently monitor and countermeasure Highlights: • • • Daily Huddles leading to interdisciplinary communication and collaboration Daily Management Systems trending and addressing abnormalities Focus on evaluating standard work and workarounds SOR/PACU Goals • Launch further Opex Kaizen events: – Cut to close – Close to out of room – Other patient and equipment prep projects • Further metrics to tackle: – Reduce ambulatory volume in SOR from 15% to 10% – 10% reduction in case cost – Smooth the schedule: ‘level load’ – Better impact on turnover time • Standard work for eight different roles • Initial improvement, sustained • Larger barriers had specific work to: • – Address gaps in schedule – Signaling for the next patient Next steps to address “longer” delays Be a Leader Initiate the TEAM HUDDLE SOR/PACU Goals • Better socialize standard work from Kaizen events- emails, grand rounds, direct feedback • Streamline clinical care pathways and create easier online accessibility to this information • Extend patient education and preparation to PMC Perioperative Pacemaker Program: 2013-2014 Accomplishments • Ongoing expansion of program – We are currently training our 6th team member (Ryan Anderson) – In collaboration with EP, ICU and palliative care, developed new protocol for PM deactivation for end of life care • The program now provides near 100% of periop. coverage, average >2 consults per day • Ongoing funded clinical research study • Completed several associated publications, internal and external presentations Out of OR: 2013-2014 Accomplishments • New collaborative agreement with GI to improve efficiency • New collaborative agreement with Cardiac Cath. Lab to increase block time, improve efficiency • New INR activation protocol – APOM now only mobilized when actually needed • Improved compliance with deep sedation policy & developed “rescue sedation” protocol for cath lab Out of OR: 2014-2015 Goals • Cont. to work to improve efficiency and processes of care at OOR sites, especially in light of significant growth in OOR volume that is anticipated over coming year • Develop more defined protocols (systems based care) for OOR cases • Improve OOR experience for residents: expand and improve OOR rotation curriculum • Complete MRI improvement project (PI=Doug Arditi) Center for Health & Healing Ambulatory Surgery Center Accomplishments for the past year • Installed High Definition Nu Boom in OR # 5 to expand Urology capability. • Initiated Opex huddle to improve facility administration. • Reduced work hours to realign staffing with actual surgical volumes. Goals for the Coming Year • Continue to recruit new surgical volume • Improve efficiency of care delivery and facility through-put • Expand and improve team-building through didactic and clinical training • Participate in long-range planning for expansion of Ambulatory Surgery Services at OHSU by participating in the planning and design of CHH2 (CHH South). NOR Goals • Improve patient experience by: – Distributing patients between A and D pods to enhance patient privacy – Additional training for DayStay nurses • Maintain 18 month record of best on-time, first-case starts. • Install new privacy curtains for all patient bays. • Upgrade monitors in B and C pods Portland VAMC Dept of Anesthesia - Highlights 2013-2014 Personnel changes: Grace Chien stepped down as Chief of Anesthesiology in Nov 2013. Mini Dogra currently the Acting Chief. PVAMC Anesthesiology Residency Site Director and Director of CBY: David Wilson took over from Linda Wylie Access and Backlog reduction in Operative Care • Prior to recent allegations, PVAMC approved for staged expansion from 9 to 11 ORs/day and additional out-of-OR anesthesia resources • Will be able to add 1600 cases per year with increasing to 11 rooms by 2015 • Restructuring of the Pre-Operative clinic: Added a new pre-op clinic specific to certain cases to increase throughput . • Expansion of out of OR Anesthesia care in sites e.g. GI for endoscopy VA Research • Research protocol for rotator cuff surgery and Acupuncture for post-operative pain submitted. • Diane Miller:Feasibility and Acceptability of Group Acupuncture in Veterans with Hepatitis C:A Pilot Study: • Drew Oken: Aliskiren: A New Harbinger of Hypotension? • Eric Schnell: 4 publications related to mechanisms of injury from head trauma VA Education • Interns: David Wilson has developed a curriculum to help interns study for their intraining examination. • Drs. Wilson and Mitchell have mentored Dr. Vega in developing a curriculum for “perioperative surgical home models” within the peri-operative rotation. • Faculty continue to be resident advisers APOM CQI Committee 2013 Highlights Dr. L. Michele Noles • • Joined the CQI team in February 2014 as Chief Quality Officer and Chair of CQI Committee Goals – Improve turnaround times for CQI case reviews – Work with Education Office to involve residents in educational Quality Improvement Projects – Create Quality ASPIRE track – Work with hospital QEC and national data to ensure APOM’s standing as a quality leader – Identify, measure, improve and publish Quality initiatives. Grand Rounds: Value assessment by attendees Measure 2011-2012 2012-2013 2013-2014 Content 4.48 4.16 4.18 Quality of presentation/Effectiveness 4.52 4.19 4.19 AV Materials 4.42 4.09 4.12 Relevance to Practice 4.46 4.16 4.17 Scale of 1 (poor) to 5 (excellent) 2013-14 Committee Productivity Committee Members: Michele Noles, MD (Chair) Ed Kahl, MD Glenn Woodworth, MD Julio Gonzalez, MD Karen Hand, MD Lars Hegnell, MD Mark Zornow, MD Mary Blanchette, MD Matthias Merkel, MD Andi Orfanakis, MD Rebecca Hall, MD Diane Knapp, CRNA Jamie Eastman, PhD Matt Schreiner • 229 Cases reported, reviewed and logged for CQI between July 1, 2013 and May 1, 2014 • 41 Grand Rounds featuring 30 internal speakers and visiting professors from Universities such as Stanford, Columbia, and Michigan Accomplishments and Goals Research Research – Accomplishments • Made important scientific advances related to: • Understanding mechanisms of stroke (N. Alkayed) • Biomarker discovery in Alzheimer’s Disease (J. Saugstad) • CSF dynamics in Traumatic Brain Injury (J. Iliff) • Neuro-inflammatory mechanisms after cardiac arrest (I. Koerner) • Anesthetic effects on the developing brain (A. Brambrink) • Mechanism of epilepsy after traumatic brain injury (E. Schnell) • Acute Kidney Injury (M. Hutchens) • Airway Management (M. Aziz) • Cardiac implantable electronic devices (P. Schulman) • Anesthesia Educational Research (G. Woodworth) • Anesthetic effects in the aging brain (K. Schenning) Research – Accomplishments • Received more than 3 million dollars of grant funding • Published more than 40 original peer-reviewed research articles • 2 patents • Developed an innovative process and accounting system to support use of shared core resources • Fostered interdisciplinary collaborations throughout OHSU Research – Strategic Goals • Develop APOM as a center of excellence in clinical and biomedical research – FY15: Recruit two new faculty to support animal models and clinical outcomes research • Develop a self-sustained research program – FY15: Foster junior faculty research career development and grant applications • Strengthen collaborations with the KCVI and the neuroscience community – FY15: Develop APOM facilities into a shared resource core model • Engage and support clinical anesthesiologists interested in research and other scholarly activities – FY15: Work with other APOM divisions to formalize the faculty development program HOPE 2013-2014 Humanitarian Overseas Physician Education Resident Trips 2013-2014 • Cindy Hwang/Dean Lao – Vietnam, funded by SEA/HVO • T. Trinh/Berklee Robins – Peru (Cleft lip and palate) • Katie Schenning/Judy Freeman – India (General surgery) • Katrin Post-Martin/Grace Chien and Linda Wylie – Ethiopia (Gyn) Peds Anesthesia Fellow Trips • Amy Opilla/Kelly Ryan and Becky Hall – Vietnam (Cleft lip and palate) • Christine Martin/Jerry Tanner with Rachel Wood – Equador (pediatric orthopedics) Thank you • To those of you who financially support the Stevens, Thompson or Stewart Funds in our Department • Aspire Global Health core faculty: – Bingham, Freeman, Gonzalez-Sotomayor, Lao, Robins • To those faculty who donate their time and money to work very hard overseas • Our amazing education staff, especially Debi Stabler Administration New Administrative Staff • Jenny Baker, ICD-10 Program Technician • Maria Heruela, Administrative Coordinator – Research • Karl Koenig, Financial Analyst II Research • Molly Malone, Research Assistant I • Julie Wright, Coding Specialist Jenny Baker Jenny started at OHSU in 1997 with the Professional Services Coding department. She received her core coding certification in 2002, and her sub-specialty certification in OB/GYN in 2007. In 2008, she earned her coding teaching certification. For the past 17 years she has been specializing in OB/GYN coding and reimbursement here at OHSU and she enjoys the teaching environment here at the University. She is very excited to have the opportunity to move to APOM, and is looking forward to learning a new specialty. . She has been married to her husband for 14 years and they have two little Chihuahua’s. In her time away from work she enjoys getting outdoors. They love to go camping, hiking and motorcycle riding. In her quiet time she enjoys reading, listening to music, cross-stitch and doing logic problems Maria Heruela Maria Heruela, Administrative Coordinator, joined the APOM Research Division on May 27, 2014. Maria has most recently been with the Patient Experience and Language Services departments here at OHSU. Maria was born in the Philippines and moved to Portland as a child. She is fluent in Tagalog as well as Bisaya (a dialect of Tagalog). In her spare time, Maria enjoys hiking and cooking. Karl Koenig Karl Koenig, Financial Analyst II joined the APOM team in October 2013. He assists with the billing, reporting and costing activities related to the research division. Prior to joining OHSU, Karl worked for 25 years at Regency BlueCross BlueShield in a variety of accounting and finance positions. Away from work, Karl spends time with his wife and two children and enjoys exercising, as well as working on home improvement projects. Molly Malone Molly Malone, Research Assistant I, joined APOM officially in June, 2014, but has been working as a volunteer in the molecular biology labs since March. She works in the molecular core under Dr. Julie Saugstad genotyping the various mouse colonies. Molly is a recent PSU graduate who began as a volunteer with us in April of this year. She was married in February 2014, and has 1 child and 4 stepchildren. Julie Wright Julie is a long time OHSU employee, most recently working for the Urology department as their full time coder for 23 years. She has also worked for other Surgical Divisions over the years, including ENT and General Surgery. At the beginning of her OHSU career in 1989 she worked in both Orthopedics and the mailroom, so she has an extensive history here at OHSU. She is enjoying learning Anesthesia coding; even with her extensive coding knowledge, Anesthesia coding/compliance is totally new for her. Julie has one adult son who works for Union Pacific Railroad. In her spare time she enjoys doing crafts with beads and wire, and enjoys other crafty things. She also loves shopping! Changes w/ Administrative Staff • Ron Pleas, transitioned to a joint appointment with the Healthcare Decision Support team. Ron now has closer ties with ITG but still supports APOM projects. • Debi Stabler, now manages two admin coordinators and is the facilitator for the admin coordinator team meetings. • Annie Riley, received her lean certification and will be heading up the department’s lean process improvement initiative. Website and Intranet Updates • Website Content Updated Regularly • New Intranet Launching Soon! “Like Us” on Facebook! Administrative Strategic Plan Completed • Vision – To be recognized by the entire OHSU Institution for teamwork and excellence in all administrative and financial processes that lead to a high level of employee job satisfaction. • Mission – To provide administrative and financial support in order to meet the goals of all departmental missions while keeping everyone motivated to achieve excellence. Administrative Strategic Plan Completed • Themes – Enhance Human Resources – Strengthen Financial Structure – Strengthen Culture of Teamwork – Develop and Implement Transparent Compensation Processes – Build Relationships with OHSU Leadership Administrative Strategic Plan: Completed & Current Tactics Develop an enhanced human resource program that will serve as a best practice for OHSU: Lead by Kay Koestler 1. Conduct Exit Interviews & Utilize Feedback Completed 2.Conduct Regular Employee Satisfaction Surveys & Respond to Feedback - Completed 3.Create Formal Cross Training Program – Started 4.Develop Competencies and Staff Development Started Administrative Strategic Plan: Completed & Current Tactics Strengthen the culture of teamwork with a focus on continuous improvement. 1. Implementation of Administrative “Self Managed Teams” • APOM Managers - Completed • APOM Administrative Coordinators - Started 2.Implement Lean Methodology across all mission areas • “Train the trainer” to be lead by Annie Riley - Started Administrative Strategic Plan: Completed & Current Tactics Develop and implement transparent compensation processes and tools that will be identified as best practice at OHSU. 1.Design template that allows employees to understand the salary and pension components of their total compensation - Started 2.Design training material that further describes and links each pay element to the compensation plan Started Other Completed Projects Employee Recognition Committee – Lead by Debi Stabler • Birthday Cake Days (quarterly) along with employee bios • Fall Event – Autumn Social, October 24th, SAVE THE DATE! • Look for future announcements about APOM social activities! Financial Results FY 14 (April YTD) • Patient Revenue: 1.1% better than budget and better than FY13 • Expenses: 2.3% better than budget • Payer Mix: Commercial better than budget • Net Income: Expect a positive variance to budget at year-end Education Accomplishments • • • • Recruited a group of 12 accomplished incoming residents. All graduates were successful in attaining positions to achieve their personal career goals. Postgraduate placement of residents and fellows includes 15% going on to fellowship training, 40% to academic practice and 45% to community practice. Submitted three education papers to peerreviewed journals. Received OHSU and ACGME approval to add 1 additional pediatric fellow. Education Accomplishments • Fostered resident scholarship, resulting in multiple publications, presentations/abstracts, awards & honors. • Peer reviewed articles: 11 • Presentations/abstracts: 6 • Posters: 9 • Awards/honors: 3 • Co-developed and led an all GME Education Day about diversity recruitment including leading the development of a tool for programs to use to help align GME wide diversity efforts and resources. Education Accomplishments • • • • Expansion of the “mock oral” program into the formal curriculum of subspecialty rotations such as peds, ob and regional. Grew our highly rated MOCA training program which draws participants from across the country and Canada. Introduced additional ASPIRE modules including Risk Management and Acupuncture. Over 75% of residents attended at least one ASPIRE session. Added an Assistant PD and a Director of Educational Technology to our leadership team. Education Goals • • • • • • • Develop strategies to help facilitate patient centered teaching and learning experiences. Integrate educational technology into our training and assessment methods. Complete rollout and implementation of Milestones and revised assessment tools in residency training. Start to incorporate Milestones into fellowship training. Continue to expand our MOCA program to offer additional course dates. Refine and expand the ASPIRE program. Continue to support and facilitate trainee and faculty scholarly work. Interns Dr. Immaculeta Achilike Immaculeta Achilike was born and raised in Dallas, Texas. She attended Baylor University for her undergraduate degree in Biology and The University of Texas School of Public Health, San Antonio for her combined M.D./M.P.H. Her interests include cooking, practicing yoga, watching and playing basketball, as well as running and half-marathon training. She enjoys spending time with family and friends and taking walks with her dog. Dr. John Meyer John Meyer was born in Kansas City, Missouri. He attended the University of Idaho for his Bachelor’s degree and Colorado State University for his Master’s. John attended medical school at the University of Kansas School of Medicine. In his spare time, John enjoys fly fishing, upland bird hunting, pointing dogs, river travel, and stand-up paddling. Dr. Joanna Olsen Joanna grew up in Brooklyn, New York. She went to Williams College and then the MD/PhD program at the University of Rochester, where her graduate work was in immunology and HIV transmission. In her free time, she enjoys running, hiking, yoga, cooking (and eating), and spending time with her husband and two little boys, ages 3 and 1. She is looking forward to integrating her training in anesthesiology and critical care through the Oregon Scholars Program. Dr. Jay Robinson II Jay Robinson is from Detroit, Michigan. He graduated with his Bachelor’s in Neuroscience before attending medical school at the University of Michigan, Ann Arbor. He enjoys drawing and painting, with a little sculpture on the side. He enjoys playing and watching basketball. Reading is a pretty cool activity (graphic novels) and so is playing video games. Dr. Remigio Roque Remigio Roque grew up in rural Western Maryland, the youngest of five. He went to undergrad at North Carolina State University. He has spent the last six years in Baltimore, Maryland – first as an IRTA at NIH and then as a medical student. Professionally, he is interested in critical care and medical education. Personal interests and hobbies include reading, trying new restaurants, traveling, climbing, and going to movies or the symphony. Dr. Nicholas Saenz Nicholas Saenz is from McAllen, Texas and went to medical school at the University of Texas Health Science Center in San Antonio. During his spare time, he enjoys working out, being outdoors, playing many intramural sports, keeping up with a couple of TV shows, and attempting to cook. He’s recently grown to love live music concerts of all types. He also follows the San Antonio Spurs religiously and looks forward to becoming an obligatory Portland Trailblazers fan. Dr. Andrew Slupe Andrew Slupe grew up in Caldwell, Idaho and completed undergraduate training at Boise State University. While at Boise State, he had the opportunity to conduct basic science research and found that he really enjoyed the process. This led him to combined training in clinical medicine and research through the University of Iowa MSTP. When not engaged in work or schoolrelated activities, Andrew enjoys spending time with his family. He married his high school sweetheart, Meghan, and they have two children, Calvin and Hazel, and one dog, Paige. They enjoy playing at the park and going to the zoo. Dr. Julia Stokes Julia Stokes has lived in the greater Seattle area for fifteen years. She completed her undergraduate and medical degrees at the University of Washington. She absolutely loves the Pacific Northwest and is excited to explore the Portland area. Most of her free time is spent hanging out with her husband, their 90-pound chocolate lab mix, and most recently her one year old daughter, Audrey Marie. She is a hiking enthusiast, avid gardener, and general fan of anything she can do outdoors. Dr. Evan Thilo Evan Thilo is originally from Seattle, WA (Go Hawks!) and is returning to the Pacific Northwest after attending medical school at Wake Forest University SOM. Originally more of a city-boy from Seattle, he found peace in the Appalachian mountains during medical school and discovered rock climbing and mountain biking are his passions. He is coming here with a new appreciation for the outdoors and hopes to explore all that the cascades have to offer. Dr. Amber Tucker Amber Tucker was born and raised in Long Island, New York. However, her parents are from Bermuda and Jamaica so each island is like a second home to her. She went to medical school at VCU Medical College of Virginia. She loves traveling and experiencing new cultures, enjoys the beach, and loves the adrenaline rush of roller coasters and extreme adventures. She has recently increased her talents to cooking gourmet dishes. Lastly, she has dedicated a great portion of her free time in serving underserved communities – nationally and internationally.