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Advancement of my academic position should be approved because among other contributions, I have worked for and represented the University well by making significant improvements to the rheumatology fellowship program and through my research, have played a part in the improved understanding of the psychosocial factors of patients with rheumatic diseases. The research I am involved in reflects my views of patient care. I believe in helping people address their psychological as well as their physical well-being, which is consistent with Loma Linda’s Mission to make man whole.   In addition, the volunteer work I have done through my participation in professional societies have supported my goal to improve the physical as well as the psychological aspects of our patients’ lives. Overall, I have represented Loma Linda University well in my professional life thus far.  

 

I have been an active member of the PATROL (Patient Reported Outcomes in Lupus ) research group, which is a partnership of rheumatology academic centers in Southern California interested in studying patient reported outcomes in Lupus patients. One of the published PATROL studies demonstrated that depression in lupus patients and not disease activity or damage is the significant mediator of a patient’s quality of life. Prior studies in the literature found a positive correlation between disease activity and quality of life measures, but these studies did not analyze the contributions of psychosocial factors in a meaningful way. In another published PATROL paper, we documented that patients determine their disease activity based on emotional and psychological determinants rather than symptoms or physical signs that their physicians discover. Research like this has implications for a physician’s practice because it demonstrates the need for physicians to attend to patients’ psychosocial needs. In this relatively new age in medicine, which focuses on outcome measures as proof that physicians are practicing quality care, these studies indicate that a patient’s perception of good health may be determined by psychological characteristics rather than physical ones. This is why quality of medical care may depend on addressing the psychological as well as the physical aspects of our patients.

 

My current research has been supported through a $270,000 grant sponsored by Forest Laboratories to determine if milnacipran, an FDA approved medication for the treatment of fibromyalgia, can improve fatigue in lupus patients and therefore their quality of life. Thus far, this has the potential of being the first published interventional drug study to determine if a medication can directly impact fatigue and therefore a lupus patient’s quality of life. This study may also determine if such an impact is mediated by psychological factors such as depression.

 

In addition, I have been committed to improving the educational experience of our rheumatology fellows. Since becoming assistant program director in 2005, I introduced a formal clinically-based didactic lecture series, and added more specific evaluation tools to provide feedback of a fellow’s progress on all of our rotations and to reflect all of the core competencies. Since becoming a fellowship director in 2009, I have helped expand the fellowship from two to four fellows to better meet the demands of the Inland Empire, and organized an in-house orthopedics rotation. I have also added a quarterly rheumatology-nephrology conference, added a musculoskeletal ultrasound workshop, and organized an in-house pediatric rheumatology rotation. Also I initiated a mini-in service rheumatology exam that the fellows take in the fall.  I have helped expand clinical research opportunities, as well. Our fellowship is in good standing with the ACGME and we have received full accreditation for the maximum amount of time.

 

Involvement in the Arthritis Foundation’s Pacific Region’s Public Health Committee reflects my commitment to my patients’ wellbeing beyond the physical aspects of their disease. The Public Health Committee oversees the aquatics, exercise and tai chi programs, support programs and juvenile arthritis camps. All of these programs improve a patient’s physical well-being, improve self esteem and empower our patients. They are vital tools for patient care. As Chairman of the Pacific Region’s Public Health Committee, I have helped expand participation of the Walk with Ease Program, which is an evidence-based walking program aimed at improving a patient’s overall fitness, ease the symptoms of arthritis and improve quality of life. The expansion included Loma Linda, where four-hundred employees have signed up as participants.  In addition I have been an active participant in the “Arthritis in Prime-Time,” which is a weekend event for young adults with arthritis. Workshops and lectures at “Prime-Time” help patients and their families understand rheumatic disease and help them cope with its sequelae.

 

In addition, I have made contributions to the medical and educational community of Loma Linda through committee participation, which ultimately improves patient care and the educational experience on this campus.  I was an active participant on the Operations Committee of Loma Linda University Physicians Medical Group, have participated in the Internal Medicine residency’s mentorship program and have worked on thesis committees of postdoctoral psychology ÁÔÆæÖØ¿Ús.

 

In general, I should be considered for promotion because I have made contributions to my profession in a way that is consistent with my philosophy of patient care and have worked hard to improve the education of our fellows.  I intend to continue defining psychosocial characteristics of our rheumatology patients, and plan to test treatments that can measurably affect quality of life outcomes. I will further strengthen our fellowship program by expanding educational and research opportunities for our fellows. My participation with the Arthritis Foundation will be ongoing, and I look forward to continuing another year as the Pacific Region’s Public Health Committee Chair, where I plan to offer more work-based programs to help prevent and mitigate the affects of arthritis while promoting a sense of well-being.  I hope that you will agree that I have represented Loma Linda University well, and my prior work and future plans are consistent with the accomplishments of an associate professor of medicine.