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PERSPECTIVES: Alumna Weighs in on New Breast Cancer Guidelines

October 30, 2015

RUSM Alumna Nicole Saphier, MD, delivered opening remarks at the American Cancer Society’s Making Strides Against Breast Cancer walk. RUSM was a flagship sponsor for the event which was held in Pennsauken, NJ.

RUSM Alumna Nicole Saphier, MD, delivered opening remarks at the American Cancer Society’s Making Strides Against Breast Cancer walk. RUSM was a flagship sponsor for the event which was held in Pennsauken, NJ.

The American Cancer Society recently released new guidelines for breast cancer screenings. Among the recommendations is that women with average risk should begin annual mammograms at age 45 and then continuing every other year beginning at age 55. There has been tremendous news coverage on the new guidelines and significant public discussion among experts. Weighing in on the subject is RUSM alumna Nicole Saphier, MD, who is a breast imaging radiologist.

RUSM: Do you think women may be confused by the new guidelines?

Saphier: The women of 2015 are an extremely intelligent and courageous bunch. I hope no one begins screening at 40 or 45 because they are told to do so.  Rather, I encourage women to do their own research and discuss with their primary care physician and their radiologist about their individualized breast cancer screening regimen.  There are many factors that go into what age and what methods should be conducted for breast cancer screening. The risks and benefits to breast cancer screening need to be considered and an educated decision needs to be had by the patient and her physicians.

RUSM: Some argue that annual mammograms to screen for cancer can cause more harm than good. What is the rationale for that perspective?

Saphier: There isn’t anything that I’ve read that suggests mammograms are unnecessary. In fact, there is still a general census that mammography beginning at age 40 will save the most lives.

What I think is important to state is that radiological technology has advanced so much that we are now finding cancers at such an early stage there is question as to whether or not these will become invasive in the future.  That is not a failure of screening with mammography, rather the technology surrounding pathology hasn't caught up with these lesions. Currently, there is no literature that tells us cancers won't spread therefore we choose to treat them all because by not treating some of the early cancers, some people will die from advanced disease.

RUSM: What do you say to those who say false positive mammograms cause undue anxiety?

Saphier: In my opinion, patients are coming to me for screening because they are being proactive in their health care and want to give themselves every possibility of catching their cancer at an early, or easily treatable, stage.  Yes, there is anxiety when you receive a letter saying you need more imaging.  Yes, all of the women who I have told need a biopsy have had some sort of anxiety. However, I am upfront and inform my patients that although the majority of biopsies are benign, I cannot tell them with certainty the mass or calcifications I am seeing are benign.

I find in my practice that many women undergoing breast cancer screenings want to be proactive so they choose biopsy.  The short wait for a final pathology may have some anxiety associated with it but the results and knowing they have done everything they can to find their cancer early gives them a sense of pride and strength.


RUSM:
What would you say to women who are ages 55 and older who believe getting a mammogram every other year decreases their ability to detect breast cancer early?

Saphier:  Reducing the number of mammograms beginning at age 55 is derived from the fact that the average age of menopause is 51, plus or minus four years.  Research does show that post-menopausal cancers can be slower growing. In such case, whether or not they are caught in one or two years does not have a significant impact in mortality. However, each patient should be looked at individually, all factors should be considered for a patient, including a woman’s menopausal status.

I do agree that mammography screening on the chronically-ill and those with less than a 10 year life expectancy should not be performed.  The American College of Radiology also agrees with this notion.


RUSM:
Why would self-exams or breast exams by a physician no longer be recommended? Aren't breast exams the best method to determine a change in a person's breasts?

Saphier: It is true that many times the palpable abnormalities found during a breast examination by most clinicians turn out to be positive but I can't say they all do. In fact, if the patient is sent by a specialist such as a breast surgeon or OB/GYN the likelihood of their palpable abnormality significantly increases.

To stop doing clinical breast exams altogether would subject many women to missed diagnosis and cause their cancers to go undetected until at a later stage.


RUSM:
What breast cancer screening options are available to women today?

Saphier:  Presently, we use digital mammography that produce much more accurate and precise images than that used in prior film mammography.  In addition, we now also have 3D mammography (tomosynthesis), supplemental breast ultrasound and MRI that have furthered our ability to detect early invasive malignancy. 


Dr. Saphier is a member of the American College of Radiology and the Society of Breast Imaging and confidently endorse annual screening mammography for average risk women to begin at 40.
 

 

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ACADEMICS: Dr. Iriana Hammel Named RUSM's Assistant Dean for Clinical Sciences

October 26, 2015

Iriana Hammell named assistant dean for clinical sciences
Iriana Hammel, MD, FACP, AGSF, has been named assistant dean for clinical sciences at Ross University School of Medicine.

Iriana Hammel, MD, FACP, AGSF, has been named assistant dean for clinical sciences at Ross University School of Medicine (RUSM). Dr. Hammel, who has been with RUSM since 2011, is based in Miramar, Florida, where she has served as senior program director of the Internal Medicine Foundations program (IMF). She also teaches an elective in geriatrics to clinical students.

A native of Romania, Dr. Hammel earned her medical degree at Carol Davila University of Medicine and Pharmacy in Bucharest, and came to the US for an internship and residency in internal medicine at Westlake Hospital in Melrose Park, IL, followed by a fellowship in geriatric medicine at Loyola University Medical Center in Maywood, IL.

“My lifelong dream was to be a doctor,” Dr. Hammel said. “I planned to practice medicine in Romania, but I wanted to train abroad, in the US,” she said. Then, while working in Michigan, she met her future husband and the plan changed. They are now the parents of two daughters.

“This promotion reflects Dr. Hammel’s sustained contribution to our educational programs,” said Dean and Chancellor Joseph A. Flaherty, MD.

Dr. Hammel has authored and presented many academic papers, and is the recipient of numerous awards and honors. She is board certified in geriatric medicine and in internal medicine.

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ADMISSIONS: New Articulation Agreement with Benedictine University

October 15, 2015

Years of Collaboration Leads to Articulation Agreement between RUSM and Benedictine University

During a recent signing ceremony, Ross University School of Medicine (RUSM) entered an articulation agreement with Benedictine University (Benedictine).  Representatives of both institutions gathered on campus in Lisle, Illinois to acknowledge 10 years of successfully identifying eligible students who have been well-suited to apply to the medical school in Dominica. With the signing of the agreement, there is now a direct pathway for similar applicants to progress through the admissions process.

“The relationship with Benedictine University has been so successful because both institutions are looking for applicants who are well-matched for RUSM,” said Leslie Andersen, Senior Associate Director of Admissions at RUSM. “Benedictine is knowledgeable in RUSM’s requirements and curriculum and we are acquainted with Benedictine’s process and standard for referrals. Benedictine students who are referred generally do well through the admissions process.”

Terms of the Agreement

Under the articulation agreement, Benedictine graduates will be held to RUSM’s standard admissions requirements and will have special opportunities such as: 

  • Waived application fees
  • A guaranteed admissions interview
  • Consideration for scholarships for which they qualify (once an acceptance decision has been made)

Also, RUSM will hold five open seats in each semester class for eligible applicants from Benedictine until 30 days prior to the start of the semester. 

Making the Grade

“Our relationship with Ross University School of Medicine has been a good one,” said Alice Sima, MSN, MBA, RN, Director-Pre-Professional Health Programs at Benedictine. 

Before Sima began recommending students to RUSM, she was committed to learning about the medical school’s academic standards and student experience. She has visited the campus in Dominica, toured the simulation lab and participated in focus groups with Benedictine alumni to hear firsthand about their experience at RUSM.
 
“If I don’t have the information I need, then I won’t recommend a school,” said Sima. “Students and parents are looking to me for guidance. I have to make a recommendation with integrity.”

A Decade of Success

There are currently 12 students enrolled at RUSM who completed their undergraduate education at Benedictine, with five students enrolling in 2014--the greatest number of enrollees from the institution in one year. Over the past 10 years, 24 Benedictine alumni have graduated from RUSM.

 

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ALUMNI VIEWPOINT: 9 Ways Meditation Can Help You as a Med Student (and Future Doctor)

October 15, 2015

Sommerhalder and Veatch, RUSM alumni
RUSM alumna Raheleh Sarbaziha, MD, Class of 2010, is a hospitalist at EmCare, California. She is the author of two books about her experiences in medical school and beyond. Dr. Sarbaziha will begin an integrative medicine fellowship at University of Arizona in 2016.

This article was written by Ross University School of Medicine graduate and internist Raheleh Sarbaziha, MD, Class of 2010. Check further down for more information on Dr. Sarbaziha.

The mind and body are undoubtedly connected. So, is it possible that you can use your mind to affect your body? Clinical research shows that the mind has the ability to shape and change the way you and your body respond to daily stressors and bodily conditions.

Here are 9 reasons why meditation is bliss:

❶ Meditation can help you better deal with various stressors in your life. Things like studying, exams, and living away from home during medical school are immediate stressors in the lives of many medical students. When I first started medical school, the culture shock of moving to a new country was hard enough, but the addition of medical school studies made the process even more daunting. Learning to meditate once or twice daily— for even a minute at a time—can help guide you through these stressors in a more functional manner, thus making your transition to a medical school much quicker and easier. 

❷ Meditation can assist in alleviating chronic and acute pain. This may not necessarily pertain to you as a medical student, but it’s certainly advice you can give to your patients when you’re a practicing physician. Meditation may help patients alleviate their pain and assist to titrate them down or even off their pain medications.

❸ It can improve your concentration, especially during times where your concentration is low! For me, that was during exam season, as you might expect. The times when you need your brain strength the most are also the times when you become the most sleep deprived or perhaps start eating comfort foods (foods that do nothing for brain health)—two things that can ultimately lead to poorer outcomes.

❹ It can help strengthen your immune system, which is both beneficial to you as the medical student and as a future doctor trying to guide your patients through tumultuous times. This will keep you healthy and strong during days where you might not be getting much sleep or are studying around the clock.

❺ You are able to better train and control your emotions, which is a trick we all need to learn at some point in our lives. During my time in medical school, I dealt with some tough things that were related to family and friends. Invariably, many students will experience some hardships that may not be related to their schooling. Having the strength to endure them while also keeping up your grades and attendance in medical school is key to finishing medical school. Medicine is not very forgiving as a trade: You have to learn it all, and if something distracts you—whether it’s “important” or not—it can be the difference between a C and an A, obtaining the clerkships you want during your rotations, or even earning the residency you’ve always wanted.

❻ Meditation can help alleviate depression and anxiety—two conditions that are, unfortunately, not uncommon in medical school students. Learning to meditate can help you as the medical student, and you could even teach tactics to your fellow students to help them reduce their stress and anxiety levels.

❼ It helps you cope with acute or chronic physical illnesses. Again, this may not necessarily apply to you as the medical student but it can be useful for you as a physician when dealing with your patients. Trying to incorporate meditation in your treatment plan could help your patients cope with their illnesses while trying to recover as quickly and as easily as possible. 

❽ It can be used as an adjunctive treatment when attempting to wean off of addictions. This is a more advanced use of meditation, and should you or anyone you know suffer from addiction, you should consult with an addiction specialist prior to proceeding with cessation of the addiction. 

And as for the ninth and final reason?

❾ If practiced well, meditation can lead to decreases in health care expenditures by helping you control your symptoms and even disease progression. This is important to note both as a patient and as a responsible health care practitioner, as healthcare costs in the United States have been estimated to be somewhere above 3 trillion per year. (http://www.forbes.com/sites/danmunro/2014/02/02/annual-u-s-healthcare-spending-hits-3-8-trillion/). 

About the author: RUSM alumna Raheleh Sarbaziha, MD

Raheleh Sarbaziha, MD, graduated from Ross University School of Medicine in 2010. Currently, Dr. Sarbaziha is working as a hospitalist—a type of physician who cares mainly for for hospitalized patients—at EmCare in Southern California. Her residency training was at University of Southern California (internal medicine), and she will begin an integrative medicine fellowship at University of Arizona in 2016. In addition, Dr. Sarbaziha has completed a medical journalism internship with ABC News in 2013.

She's written two books about her experiences with medical school—In the Jungle of Medicine: Journeys Through Caribbean Medical School and US Residency Programs: Guide to Application—and has traveled to Uganda to provide medical care to citizens there.

Dr. Sarbaziha lives in Los Angeles.

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THINK PINK: Alumna Spends Career Advocating for Breast Health

October 14, 2015

RUSM Alumna Nicole Saphier, MD, will give opening remarks at the American Cancer Society’s Making Strides Against Breast Cancer walk on Oct. 25 in Pennsauken, NJ. RUSM is a corporate sponsor for the event.

RUSM Alumna Nicole Saphier, MD, will give opening remarks at the American Cancer Society’s Making Strides Against Breast Cancer walk on Oct. 25 in Pennsauken, NJ. RUSM is a corporate sponsor for the event.

During National Breast Cancer Awareness Month many Americans, particularly women, are reminded about the importance of early detection to win the fight against the deadly disease that, according to the American Cancer Society, will claim the lives of about 40,290 in 2015. Ross University School of Medicine (RUSM) alumna (class of 2008) Nicole Saphier, MD, is a radiologist who is at the forefront of the cause and has spent much of her career advocating for policy changes that will help women, and men alike, make informed decisions about their breast health.
 
Saphier's advocacy for breast health began when she learned about breast density legislation while completing a Women's Oncologic Imaging fellowship at Mayo Clinic in Arizona. Dense breast tissue is comprised of less fat and more connective tissue which appears white on a mammogram. The challenge is that cancerous tumors appear white on a mammogram as well.
 
"The concept really reached my heart," says Saphier. "Many women were obtaining mammograms and when they were told they were normal, they would ignore a lump they subsequently found in their breasts because they had complete faith in their mammograms." 
 
Following her fellowship, Saphier focused much of her career working to help women better understand the risks associated with breast density. She is known for leading the way among physicians to pass the Arizona State Breast Density Notification Law in her home state. The law requires physicians to inform their patients who have undergone a mammography and were found to have dense breast tissue. Currently, 24 states have enacted the law and breast density notification legislation is at the federal level.
 
After relocating to New Jersey, Saphier now sits on the executive committee and legislative subcommittee of the state’s radiological society. She also has been appointed to the New Jersey Department of Health Breast Imaging Work Group where she is working to revise the state’s breast density notification letter that is sent to patients.

Saphier’s commitment to the fight against breast cancer is fueled by her grandmother’s experience. “My grandmother, who I affectionately called 'Mommom,’ did not pursue the lump in her breast because she was embarrassed to get examined by her physician,” says Saphier. “I attempt to see my patients and explain everything to them best as possible so they never feel uncomfortable coming to see me about their breasts. I want them to feel empowered and be in control of their healthcare.”

Although Saphier acknowledges that mammography is imperfect, she states that mammography is still the best screening modality for all types of breast density.  “The addition of ultrasound, MRI and digital tomosynthesis (3-D imaging of the breast using X-rays) can help what mammography misses but mammography itself should not be replaced,” says Saphier. “MRI and ultrasound will not see the subtle calcifications that can indicate early invasive malignancy.”

Being able to detect those subtle calcifications gets to the heart of why Saphier chose to specialize in radiology. “Throughout my clinical rotations it became apparent to me that many of the specialties were based on an opinion, varied from individual to individual, and heavily relied on patient complaints,” says Saphier. “I chose radiology because I like the objective nature of it.  Findings on an X-ray, MRI and through other imaging techniques are factual, so the subjectivity of it all is lessened.”

For students who may be deciding on which specialty to pursue, Saphier advises those who are considering radiology that it’s crucial to stay current on literature and research as “it requires constant reading beyond training.”

You can learn more about Saphier’s experience at www.nicolesaphiermd.com, including information about a book she is in the process of writing. Drawing upon her own experience as a single mom of a four year-old who decided to pursue a medical degree abroad, Saphier will tell real stories about women who chose the path less traveled.
 

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OPPORTUNITY: RUSM’s Class of 2019 Don White Coats in Moving Ceremony

October 12, 2015

Looking for video from the September 2015 White Coat Ceremony? View the video here.

RUSM September 2015 WC“You are the group that said, ‘we’re not giving up,’” said Joseph A. Flaherty, MD, Dean and Chancellor of Ross University School of Medicine (RUSM) addressing the new group of incoming students at the White Coat Ceremony on October 8, 2015 on the Dominica campus. “You’ve gone through a lot just getting here.” He was referring to Tropical Storm Erika and its devastating aftermath on the island in late August.

The widespread destruction caused by the deadly storm also resulted in the airport’s closure, making it necessary for large groups of students, faculty and other colleagues to fly to Guadeloupe and take a ferry from there. “Remember Guadeloupe?” Dean Flaherty asked, eliciting affirmative cheers from the audience. He, too, had traveled that route with them last month. “You showed your commitment. You showed your ability to take on a challenge and move on. There are many challenges in medical school. I think you’re up to them. We selected you because we knew you could make it.”

Vice Dean Peter Goetz welcomed the class of 2019 and said, “We are very proud of our diversity.” He noted that the students were born in 56 countries, although most were born in the US.

“This is a very significant event for us,” said Campus Dean Dr. Stanley White. He introduced the keynote speaker, RUSM alumna Anita Lal, MD, a forensic pathologist. “Our keynote speaker shows new students what our graduates can become,” he said.

Dr. Lal has been a staff forensic pathologist at the Provincial Forensic Pathology Unit in Toronto since 2013 and is also a lecturer in the Department of Laboratory Medicine and Pathobiology at the University of Toronto. The advice she gave to the new students was,  “Ask questions. Be determined. Don’t give up.”

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DEAN'S BLOG: How We Can Help Stressed-Out Students

October 07, 2015

 

By Joseph A. Flaherty, MD
Dean and Chancellor, RUSM
 

Medical school is hard. It’s no wonder that many students feel stressed, especially during exam time or when interviewing for the residency match while completing their clinical rotations. Unfortunately for some students with certain psychosocial and genetic characteristics, there is a higher risk of experiencing a clinical depression and/or turning to alcohol and other substances in order to cope. What can we do to help our students?

There has been copious research on the subject of medical students, physicians, and alcohol-related problems. Together with several co-authors, I have also contributed to this body of scientific literature over the years. What we looked at is: what gets people depressed, who gets depressed, and who has a problem with drinking, in the general population and in medical school and residency.

What we found was that historically, there has been a striking difference between the genders; men have had a four-times higher drinking rate while women have had a two-times higher suicide rate. This gender difference was confounding and led to all kinds of biological, psychological and sociological research to try to shed some light on what’s going on.

We can say with certainty that there are triggers for serious depression, like sleep deprivation, jet lag, or a death in the family. To the extent that life events change and biological rhythms are disrupted and altered, those people who are vulnerable by genetic predisposition may experience such a situation as a trigger.

But, we found that while men and women start medical school with the societal rates for alcohol abuse, six years later the women students’ alcohol-abuse rates had risen dramatically and were equal to those of the men. By-and-large, women physicians adopted more “male” coping behavior, like drinking. This is cause for concern.

Therefore, being able to cope with stress is very important in preventing depression and alcoholism. The best coping mechanisms are active – doing something, like talking to other people, and not keeping feelings to yourself. The best prevention is to have a good support system or at least one close friend with whom to share your life. Other helpful activities are pursuing hobbies and getting involved with social causes. Maintaining good nutrition is also very important.

I’m pleased that at Ross University School of Medicine we have very good resources and options for people who show signs of serious depression or substance abuse. For all of the many challenges in life facing our students, we have a health center on campus and a counseling center which is an independent clinical entity addressing the on-going and emergent mental health needs of students, family members, spouses, partners and significant others. The ASPIRE Student Assistance Program, for clinical students and their families is a free and confidential service that provides support through telephonic counseling or referrals to local providers.  It is available 24 hours a day, seven days a week.  Additionally, students needing help with academic challenges may avail themselves of an array of services through the Center for Teaching and Learning.

We also have more than 50 student clubs and organizations at the school, including those devoted to medical specialties, sports, humanitarian efforts, nationalities, cultural interests, and so much more. For example, there is a Canadian Students club and a Vegetarian Students club. For students seeking to participate in extra-curricular activities that engage them, and offer camaraderie and friendship with peers, they will find a group that is right for them. This may be the best preventive measure of all. Not only is the activity proven to be helpful, but if signs of trouble should arise, fellow students in the group may suggest that a person check out a talk at the counseling center, or another resource that will help.
 

 

 

 

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RUSM Faculty Save a Passenger’s Life on a Plane

October 05, 2015

“Is there a doctor in the house?” is something most of us have heard only in a scene in a movie, but for two Ross University School of Medicine (RUSM) physician colleagues, the urgent announcement, “Is there a doctor on the plane?” was very real. They were flying home from the RUSM Leadership Conference, held Sept. 17-19 in Cancun, Mexico. Sean Gnecco, MD, RUSM Associate Professor in the Internal Medicine Foundations program, and Assistant Dean for Clinical Sciences, Iriana Hammel, MD, FACP, AGSF, heeded the call for a doctor immediately.

“The patient was panicked, shaking, having difficulty breathing, felt swelling in the throat, and had a rash on both arms and legs,” Dr. Gnecco explained. Flight attendants gave him the emergency kit that was onboard the plane and he quickly examined the patient, and administered oxygen.

The combination of symptoms and the patient’s history of allergies led him to a diagnosis of anaphylaxis, a disease that can be fatal within five to 10 minutes, he said. He quickly injected the person with an Epi-Pen® and within 90 seconds the individual began to feel better.

Fortunately, the plane was only a few minutes from its destination, and when it landed, paramedics were waiting at the airport to take the patient to the hospital for observation.

The airline formally thanked the RUSM heroes and, as a token of appreciation, added several thousand miles to their frequent-flier accounts.

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