Asmar received the award during the group鈥檚 annual scientific meeting this fall, where one of his residents received first place for research on improving patient access to heart rehabilitation services.

The American College of Physicians is the world鈥檚 largest medical specialty organization and is committed to advancing 鈥渢he science and practice of internal medicine.鈥� The Florida chapter鈥檚 Teacher of the Year is presented to a physician who has demonstrated outstanding leadership and dedication to medical education.

鈥淒r. Asmar has proven to be a most influential teacher. His passion for medicine and lifelong learning is tangible and unwavering, inspiring his residents to strive to be the best they can be,鈥� his award nomination noted.

Board certified in internal medicine and nephrology, Asmar is program director of the . The residency, established in 2014 as 麻豆原创鈥檚 first graduate medical education (GME) program, trains internal medicine specialists at the Orlando VA Medical Center and HCF Florida Osceola Hospital.

Asmar serves as vice chairman of GME for the College of Medicine and also cares for patients at . He earned his doctor of medicine degree at Kaunas Medical University in Kaunas, Lithuania. He did his residency at Cook County Hospital in Chicago, where he was named chief resident. He received his fellowship training in clinical nephrology at the University of Florida.

鈥淚 am thankful, humbled and honored to receive this award,鈥� Asmar says.

The ACP Florida Chapter鈥檚 annual meeting included research presentations. Inman Squires, a resident at the 麻豆原创-HCA Florida Healthcare Internal Medicine Residency Program of Greater Orlando/Osceola won the QI Poster Award for a quality improvement project: Unbreak My Heart: Increasing Cardiac Rehabilitation Referral Rate.

Raj Shah and Richard Henriquez found that gabapentinoids, a family of drugs used to prevent seizures and commonly used for nerve pain, reduced alcohol withdrawal symptoms and slowed the progressions of liver disease better than another FDA-approved drug for alcohol use disorder.

Both physicians have been chief residents at the Orlando VA Medical Center during their Greater Orlando-Osceola Internal Medicine residency training sponsored by the 麻豆原创-HCA Healthcare鈥檚 Graduate Medical Education Consortium. Henriquez now serves as an attending physician at the VA, where he helps run the 麻豆原创 residency and cares for patients. He plans to apply for board certification in addiction medicine this summer and is also a 麻豆原创 undergraduate alum. Shah will graduate in June from 麻豆原创鈥檚 Internal Medicine of Greater Orlando 鈥� Osceola residency and then join the consortium鈥檚 first Gastroenterology fellowship, where he will care for patients at the VA and HCA Florida Osceola Hospital.

Alcohol Misuse, Liver Disease Increasing

Nearly 30 million people in the United States 鈥� ranging in age from 12 to adulthood 鈥� have alcohol use disorder and that number is increasing. So is alcohol-related liver disease, which can lead to death, liver failure and transplantation, and other serious health ailments.

鈥淎lcohol use disorder is a huge public health issue that needs to be brought to the forefront of research,鈥� Henriquez says. 鈥淲e were looking for more ammunition to have in our toolbox and this study might open a path for it,鈥�

The research was presented recently during Digestive Disease Week in Washington D.C. The physicians used the VA鈥檚 extensive patient database to analyze about 49,000 patients who had been diagnosed with alcohol use disorder and were being treated with acamprosate, an FDA-approved drug for alcohol dependency, or gabapentin.

The physicians found that a statistically significant 15.8% of patients on Acamprosate advanced to severe liver disease, including scarring, cirrhosis, alcohol hepatitis or liver cancer, compared with 13.4% of the veterans taking gabapentin. For patients with pre-existing liver disease, 30.4% of those taking acamprosate saw their liver disease worsen, compared with 25.8% of those on gabapentin.

Acamprosate is only used for alcohol use disorder. Because gabapentinoids are used to treat pain from shingles and neuropathy (a common complication from diabetes), they are much more understood and prescribed by primary care physicians. Use of the drug tripled from 2002 to 2015 and it is one of the 10 most frequently prescribed medications nationwide, according to the study. The physician researchers hope that their findings will encourage more doctors to consider using gabapentinoids to treat patients with alcohol use dependency before they suffer significant liver damage. They point to statistics showing that only about 2.2% of alcohol-dependent patients use prescription drugs to help treat their addiction. One of the reasons, they say, is that patients must take two acamprosate pills three times a day and can suffer serious side effects if they drink alcohol while taking the drug.

Gabapentin treats pain by soothing the nervous system. As such, it may address mental health issues such as anxiety that can lead patients to drink heavily and subsequently damage their livers, Shah told media at the national conference.

鈥淚f we鈥檙e able to, with gabapentin, kill two birds with one stone 鈥� able to treat their pains as well as their alcohol use disorder 鈥� then it鈥檚 warranted, using gabapentin versus just using acamprosate,鈥� he says.

Both researchers said more studies are needed to replicate their findings. They emphasize that physicians should not conclude that gabapentinoids are better than other FDA-approved drugs to treat alcohol use disorder, only that it is another option for patients and providers.

鈥淓ach physician should review patients holistically at an individual level, considering their chronic medical problems and preferences while weighing the risks and benefits,鈥� Henriquez says.

How Research Impacts Patient Care

Both physicians said awareness is key to addressing alcohol use disorder and its serious damage to health.

鈥淲hen education and risk awareness of the dangers of alcohol misuse goes up, usage tends to go down,鈥� Henriquez says. 鈥淭hat鈥檚 why we need to put an emphasis on education and treatment.鈥�

Shah wants to become a gastroenterologist to help provide that care. He noted that lifestyle habits are increasing all forms of liver disease. One of the reasons 麻豆原创 and HCA Healthcare created the new gastroenterology fellowship is to address a physician shortage in that specialty. Both physicians said they came to 麻豆原创 for graduate medical education because the Internal Medicine program of Greater Orlando-Osceola offered a family-like atmosphere and emphasized research and other academic pursuits. The opportunity to care for veterans and residents of Osceola County, one of Florida鈥檚 fastest-growing and most complex communities, also allowed them to care for an incredible variety of patients and conditions.

Abdo Asmar has led the Internal Medicine Residency of Greater Orlando- Osceola since 麻豆原创鈥檚 inaugural program began in 2014. Today, the 麻豆原创-HCA Graduate Medical Education Consortium is one of the fastest growing in Florida, with more than 620 physicians training in 39 accredited programs this summer.

Asmar says Shah and Henriquez鈥檚 research shows their commitment to improving health for all.

鈥淭hese physicians are difference makers,鈥� he says. 鈥淎nd through their research, they are demonstrating a commitment to advancing science and patient care. With research, you go beyond the patient who is sitting in front of you. You improve care for patients you will never see.鈥�

Alex Diaz was one of 795,000 people who suffer a stroke every year, and among the 13% whose stroke is hemorrhagic, meaning a blood vessel in the brain ruptures. These strokes can cause serious disability and often death.

A now healthy Diaz and his wife came to the 麻豆原创 College of Medicine this week to thank the emergency medicine physicians who saved him.

Paramedics responding to Lauren鈥檚 911 call originally thought Alex鈥檚 symptoms were from COVID-19, a diagnosis he had received the day before. But Lauren insisted her husband was having a stroke, so the ambulance transported him to HCA Florida Osceola Hospital 鈥� one of 38 HCA Healthcare facilities that partner with 麻豆原创 to train residents and fellows in one of Florida鈥檚 fastest growing graduate medical education programs.

David Lebowitz leads the emergency medicine residency and serves as an associate professor at the medical school. He organized Alex and Lauren鈥檚 presentation as an inspirational experience to show residents the impact of their care. Physician teamwork and Lauren鈥檚 persistence made the biggest difference in Alex鈥檚 recovery, he says.

鈥淵our insistence led to the EMTs setting off a stroke alert, which had our team properly prepared for his arrival and expedited his care,鈥� Lebowitz told Lauren during the presentation.

She spoke first to the physicians, describing the emotions of seeing her husband intubated and watching helplessly in the fast-paced environment of the emergency room. She thanked the doctors for explaining to her what they were doing to stabilize her husband, and for helping her walk outside when she needed fresh air but was too emotional to move.

After being stabilized, Alex had no function of his right leg and little function of his right arm. Lauren says she began preparing for the fact that her husband might never walk again.

After the residents heard from Lauren, Lebowitz invited Alex to speak. He entered the College of Medicine auditorium to a standing ovation. He walked assuredly, his legs fully functional, and shook Lebowitz鈥檚 hand firmly with the right hand and arm that once could not even lift a spoon 18 months ago.

Alex has no memory of the stroke鈥檚 onset and remembers little about his hospital stay except the bacon the hospital served for his meals.

鈥淢aybe the bacon is what helped me heal so well,鈥� he laughed.

After leaving the hospital, Alex began rehabilitation. First, starting on a walker which the physical therapist insisted he did not need after only a few days. Alex and Lauren followed the physical therapist鈥檚 program, doing the exercises every night as Alex began to regain full use of his body. Before long, he was able to walk and use his right arm again.

鈥淧hysical therapy was easier than I expected, but the brain-related side was more difficult,鈥� he says.

He recalled taking mental exams and thinking he had done well before getting his results and realizing his short-term memory had been severely affected. He worked extensively with a neurotherapist who specializes in executive functioning, such as planning, problem solving and adaptation and has recovered tremendously. While he still has difficulties with short term memory, it has drastically improved.

Today, Alex has been back at work for over a year. He is grateful to the paramedics who brought him to the hospital and the HCA Florida Osceola Hospital physicians who cared for him and to his wife. Alex thanked the doctors for fighting for him during every part of his healthcare journey.

鈥淚 think about that night every single day and what could鈥檝e been if not for my wife and the doctors that took care of me,鈥� he says.

This presentation was part of a retreat to remind emergency medicine physicians and residents that while they respond to countless accidents and illnesses, there are individuals and families behind each case.

The two new programs recently received ACGME (Accreditation Council for Graduate Medical Education) accreditation and are seeking applicants to begin training in July 2024. With the additions, the 麻豆原创-HCA Florida Healthcare Graduate Medical Education Consortium has 37 accredited programs from the Florida panhandle to Orlando, making it one of the fastest growing in the state. By July, the consortium will have 600 physicians in training in high-need specialties that include primary care, surgery, OB-GYN, psychiatry, endocrinology, emergency medicine and geriatrics.

Stephen Cico, 麻豆原创鈥檚 associate dean for graduate medical education and the consortium鈥檚 designated institutional official (DIO), says the programs will help improve patients鈥� access to care and address the state鈥檚 physician shortage.

鈥淭he internal medicine residency will fill the great need in Florida for access to primary care physicians especially in the panhandle,鈥� he says. 鈥淭heir clinics and hospital will care for some of those who have the hardest time accessing medical care. The GI fellowship will provide patients in Greater Orlando with additional access to GI physicians and procedures such as colonoscopies while also providing care for GI emergencies.鈥�

The internal medicine residency will accept 12 physicians a year for its three-year program 鈥� training 36 doctors when at full complement 鈥� and will participate in this year鈥檚 National Match Day March 15. The GI fellowship will accept two physicians a year who have completed their internal medicine residency training for its three-year program 鈥� for a total of six at full complement.

Amanda Finley will lead the internal medicine residency. She completed medical school at the West Virginia School of Osteopathic Medicine and later completed residency training at Magnolia Regional Health Center in Mississippi, where she was chief resident and stayed to serve as faculty. She was founding program director and designated institutional official at Henry County Medical Center in Tennessee, where she worked with the Health Resources Service Administration to create a rural residency program.

鈥淥ur commitment to creating a healthy and innovative learning environment make our new residency an amazing place to train,鈥� she says. 鈥淥ur goal is to ensure that residents achieve clinical excellence in a supportive family environment where we focus on giving and receiving feedback that take our professional performance to the highest level.鈥�

Vinay Katukuri will lead the GI fellowship. He completed his medical education in India and then pursued residency training at Wayne State University in Michigan. Following this, he completed his gastroenterology fellowship at the University of Michigan, followed by an advanced endoscopy fellowship at Thomas Jefferson University in Philadelphia. He served as interventional faculty at Henry Ford Health System and actively participated in teaching residents and fellows, including those specializing in advanced endoscopy. While at Henry Ford Health System, he was chosen to participate in the inaugural fellowship program for entrepreneurs in digital health. Katukuri later relocated to Florida, where he established his own practice.

鈥淚n addition to meeting the community鈥檚 need for gastroenterology services, the new fellowship training program aims to improve access to colon cancer prevention, which is crucial given the rising incidence of cancer,鈥� he says.

Graduate medical education programs are key to addressing Florida鈥檚 physician shortage because the majority of doctors locate their practices near where they completed their residency or fellowship training. Medical school graduates cannot practice medicine independently but must complete residency training in their field of specialty.

Raghav Bassi, chief internal medicine resident at the 麻豆原创-HCA residency at HCA Florida North Florida Hospital in Gainesville, Florida, found the correlation using HCA鈥檚 expansive, nationwide research data base of its patients. An analysis of 289,196 HCA colon cancer patients across the United States found that those living in southern states had a higher incidence of the disease than those living in the Midwest or Northeast. And states with the highest incidence of colon cancer also had the nation鈥檚 highest obesity rates.

Raghav Bassi’s findings are especially alarming as obesity rates continue to increase, with estimates that 50% of the U.S. population may be obese by 2030.

The American College of Gastroenterology (ACG) honored Bassi with its Presidential Award for his poster presentation at the ACG鈥檚 annual meeting in Vancouver, Canada. He also received a second award for outstanding poster presentation.

While at the conference, he discussed his findings with University of Tennessee researchers, who have found that colon cancer rates are increasing in young people 鈥� and again attributed the increases to obesity and America鈥檚 heavy consumption of highly processed, high-fat, high-sugar and fast foods. These findings, Bassi says, are especially alarming as obesity rates continue to increase, with estimates that 50% of the U.S. population may be obese by 2030.

鈥淲hat鈥檚 alarming is that colon cancer rates are going up 鈥� including in young people 鈥� because of lifestyle choices,鈥� he says. 鈥淲e are all looking for food that鈥檚 fast and easy. But just because it鈥檚 fast and easy doesn鈥檛 mean it鈥檚 not doing real harm to your health.鈥�

The World Health Organization estimates 1.8 million new cases of colon cancer a year. Risk factors include age, obesity, diets high in red and processed meats, smoking, excessive drinking and physical inactivity.

In examining state-by-state colon cancer rates, Bassi鈥檚 study found the exception to the obesity-colon cancer connection was Colorado, which leads the nation in colon cancer rates. Bassi and his HCA research colleagues aim to do further studies to identify what factors other than obesity may be influencing Colorado鈥檚 numbers. Mississippi and Missouri were second and third nationally in colon cancer rates. The study noted that obesity rates in Mississippi are the second highest in the nation, with 37.3% of the state鈥檚 population diagnosed as obese. Missouri鈥檚 obesity rate is similar 鈥� 37.3% according to the study.

The 麻豆原创-HCA Graduate Medical Education (GME) consortium is one of the fastest-growing in Florida, training almost 600 residents and fellows in programs from Greater Orlando to Pensacola to help address the physician shortage. 麻豆原创 began its first residency in internal medicine in 2014 with HCA Healthcare and the Orlando VA Medical Center. Today, it has programs in high-need specialties including surgery, psychiatry, OB-GYN, geriatrics, emergency medicine, rheumatology and endocrinology.

The 麻豆原创-HCA Graduate Medical Education consortium is one of the fastest-growing in Florida, training almost 600 residents and fellows to help address the physician shortage.

The 麻豆原创-HCA programs emphasize research as an integral part of training young physicians. Matthew Calestino, a 麻豆原创-HCA residency attending physician and mentor, participated in the colon cancer study and calls research by residents 鈥渁 game changer.鈥� Scientific studies allow residents and fellows to advance medical knowledge, Calestino and Bassi says, helping them stay current on the latest findings that can help their patients. Understanding and conducting research also trains young physicians to better critically analyze new discoveries and data, according to them.

As one of the nation鈥檚 leading providers of healthcare services, HCA Healthcare has 182 hospitals and approximately 2,300 sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics in 20 states and the United Kingdom. HCA Healthcare provides 37 million patient encounters a year in those facilities. Data from that care provides extensive opportunities for research into the most successful care protocols. As the 麻豆原创-HCA GME consortium has grown, so has the infrastructure to support resident and fellow research efforts, and Calestino applauded the leadership of Katy Robinson, division director of GME Research for HCA鈥檚 North Florida Division, in increasing opportunities and support for such scientific studies.

Bassi became interested in gastroenterology as a medical student at St. George鈥檚 University School of Medicine as he watched a classmate struggle with ulcerative colitis. He was selected as one of the medical school鈥檚 global scholars, which allowed him to study and conduct research in the United Kingdom, Grenada and New York City. He hopes to enter a gastroenterology fellowship after he completes his year as chief resident. Bassi says the field offers opportunities to develop and use new therapies, and provide both clinical care and surgical interventions. He says his research experience has allowed him to meet other physician scientists and expand his knowledge to help his patients. It has also allowed him to spread the word about 麻豆原创-HCA鈥檚 young GME programs.

鈥淎s a young program we aren鈥檛 as well known,鈥� he says. 鈥淭his experience shows we can compete with the bigger programs. Research allows me to connect with other members of the scientific community, get life-changing lessons and bring those lessons back with me when I return to 麻豆原创 Gainesville.鈥�