Melissa R Partin

University of Minnesota Duluth, Duluth, Minnesota, United States

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Publications (67)313.76 Total impact

  • No preview · Article · Mar 2016 · Clinical Gastroenterology and Hepatology
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    [Show abstract] [Hide abstract] ABSTRACT: We examined whether pain outcomes (pain interference, perceived pain treatment effectiveness) vary by race and then whether opioid use moderates these associations. These analyses are part of a retrospective cohort study among 3,505 black and 46,203 non-Hispanic, white Department of Veterans Affairs (VA) patients with diagnoses of chronic musculoskeletal pain who responded to the 2007 VA Survey of Healthcare Experiences of Patients (SHEP). We used electronic medical record data to identify prescriptions for pharmacologic pain treatments in the year after diagnosis (Pain Diagnosis index visit) and before the SHEP index visit (the visit that made one eligible to complete the SHEP); pain outcomes came from the SHEP. We found no significant associations between race and pain interference or perceived effectiveness of pain treatment. VA patients with opioid prescriptions between the Pain Diagnosis index visit and the SHEP index visit reported greater pain interference on the SHEP than those without opioid prescriptions during that period. Opioid prescriptions were not associated with perceived treatment effectiveness for most patients. Findings raise questions about benefits of opioids for musculoskeletal pain and point to the need for alternative treatments for addressing chronic noncancer pain. © 2016, Rehabilitation Research and Development Service. All rights reserved.
    Full-text · Article · Jan 2016 · The Journal of Rehabilitation Research and Development
  • [Show abstract] [Hide abstract] ABSTRACT: Cancelled and missed colonoscopy appointments waste resources, increase colonoscopy delays, and can adversely affect patient outcomes. We examined individual and organizational factors associated with missed and cancelled colonoscopy appointments in Veteran Health Administration (VHA) facilities. From 69 facilities meeting inclusion criteria, we identified 27,994 patients with colonoscopy appointments scheduled for follow-up, based on positive fecal occult blood test results, between August 16, 2009 and September 30, 2011. We identified factors associated with colonoscopy appointment status (completed, cancelled, or missed) using hierarchical multinomial regression. Individual factors examined included: age, race, sex, marital status, residence, drive time to nearest specialty care facility, limited life expectancy, comorbidities, colonoscopy in the past decade, referring facility type, referral month, and appointment lead time. Organizational factors included: facility region, complexity, appointment reminders, scheduling, and prep education practices. Missed appointments were associated with limited life expectancy (odds ratio [OR], 2.74; P=.0004), no personal history of polyps (OR, 2.74; P<.0001), high facility complexity (OR, 2.69; P=.007), a dual diagnosis of psychiatric disorders and substance abuse (OR, 1.82; P<.0001), and opt-out scheduling (OR, 1.57; P=.02). Cancelled appointments were associated with age (OR, 1.61; P=.0005 for 85 y or older and OR, 1.44; P<.0001 for 65-84 y old), no history of polyps (OR, 1.51; P<.0001), and opt-out scheduling (OR, 1.26; P=.04). Additional predictors of both outcomes included race, marital status, and lead time. Several factors within VHA clinic control can be targeted to reduce missed and cancelled colonoscopy appointments. Specifically, developing systems to minimize referrals for patients with limited life expectancy could reduce missed appointments, and use of opt-in scheduling and reductions in appointment lead time could improve both outcomes. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Aug 2015 · Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association
  • [Show abstract] [Hide abstract] ABSTRACT: Methods: We identified 74,104 patients with FOBT+ results from 98 Veterans Health Administration (VHA) facilities between August 16, 2009 and March 20, 2011, and followed them until September 30, 2011, for completion of colonoscopy. We identified patient characteristics from VHA administrative records, and organizational factors from facility surveys completed by primary care and gastroenterology chiefs. We estimated predictors of colonoscopy completion within 60 days and six months using hierarchical logistic regression models. Results: Thirty percent of patients with FOBT+ results received colonoscopy within 60 days and 49% within six months. Having gastroenterology or laboratory staff notify gastroenterology providers directly about FOBT+ cases was a significant predictor of 60-day [odds ratio (OR), 1.85; P = 0.01] and six-month follow-up (OR, 1.25; P = 0.008). Additional predictors of 60-day follow-up included adequacy of colonoscopy appointment availability (OR, 1.43; P = 0.01) and frequent individual feedback to primary care providers about FOBT+ referral timeliness (OR, 1.79; P = 0.04). Additional predictors of six-month follow-up included using guideline concordant surveillance intervals for low-risk adenomas (OR, 1.57; P = 0.01) and using group appointments and combined verbal-written methods for colonoscopy preparation instruction (OR, 1.48; P = 0.0001). Conclusion: Directly notifying gastroenterology providers about FOBT+ results, using guideline-concordant adenoma surveillance intervals, and using colonoscopy preparations instruction methods that provide both verbal and written information may increase overall follow-up rates. Enhancing follow-up within 60 days may require increased colonoscopy capacity and feedback to primary care providers. Impact: These findings may inform organizational-level interventions to improve FOBT+ follow-up.
    No preview · Article · Dec 2014 · Cancer Epidemiology Biomarkers & Prevention
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: To inform the VA Office of Health Promotion and Disease Prevention we conducted a systematic review to examine the effects of cancer screening shared decision making (SDM) interventions. Method: We searched MEDLINE, CINAHL, PsycINFO, and relevant journals from 1995 through 2013 for randomized controlled trials (RCTs) of cancer screening SDM interventions in adults in clinical settings. We extracted key study population and intervention characteristics and the effect of SDM on three outcomes of interest. Outcomes of interest drawn from the Ottawa Decision Support Framework included: (1) Decision Quality (informed, values-based, patient involvement), (2) Decision Action (screening preference/intention, screening behavior), and (3) Decision Impact (decisional conflict, health services use, decision satisfaction). Result: We identified twenty-two eligible RCTs evaluating SDM interventions for: breast (k=2), colorectal (k=3), and prostate (k=17) cancer screening. More than half of all SDM interventions included a values clarification exercise (k=15), but few used a theoretical framework (k=7). SDM intervention effects on outcomes varied. For Decision Quality, knowledge was assessed in the majority of studies (n=19), and in all cases SDM increased knowledge. Studies measured values and patient involvement less often (k=5 and k=11, respectively) and found no consistent effect. Eleven studies assessed Decision Action with no consistent SDM effect of SDM. Screening intention was evaluated for breast (k=2) and prostate cancer (k=9). Three studies assessed screening preference, all colorectal cancer. Screening behavior was assessed in 16 studies, ranging from 2 weeks to 1 year. SDM enhanced Decision Impact as measured by a consistent decrease in decisional conflict (k=12). However, SDM had no consistent effect on health services use (k=6) or decision satisfaction (k=2), though outcomes were infrequently reported. Conclusion: SDM interventions for cancer screening consistently increase patient knowledge and often decrease decisional conflict. However, there have been varying intervention effects on Decision Action or Decision Impact. Research is needed to guide future SDM intervention development to enhance the effect on decision action and impact.
    No preview · Conference Paper · Oct 2014
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    [Show abstract] [Hide abstract] ABSTRACT: Background Anonymous survey methods appear to promote greater disclosure of sensitive or stigmatizing information compared to non-anonymous methods. Higher disclosure rates have traditionally been interpreted as being more accurate than lower rates. We examined the impact of 3 increasingly private mailed survey conditions—ranging from potentially identifiable to completely anonymous—on survey response and on respondents’ representativeness of the underlying sampling frame, completeness in answering sensitive survey items, and disclosure of sensitive information. We also examined the impact of 2 incentives ($10 versus $20) on these outcomes. Methods A 3X2 factorial, randomized controlled trial of 324 representatively selected, male Gulf War I era veterans who had applied for United States Department of Veterans Affairs (VA) disability benefits. Men were asked about past sexual assault experiences, childhood abuse, combat, other traumas, mental health symptoms, and sexual orientation. We used a novel technique, the pre-merged questionnaire, to link anonymous responses to administrative data. Results Response rates ranged from 56.0% to 63.3% across privacy conditions (p = 0.49) and from 52.8% to 68.1% across incentives (p = 0.007). Respondents’ characteristics differed by privacy and by incentive assignments, with completely anonymous respondents and $20 respondents appearing least different from their non-respondent counterparts. Survey completeness did not differ by privacy or by incentive. No clear pattern of disclosing sensitive information by privacy condition or by incentive emerged. For example, although all respondents came from the same sampling frame, estimates of sexual abuse ranged from 13.6% to 33.3% across privacy conditions, with the highest estimate coming from the intermediate privacy condition (p = 0.007). Conclusion Greater privacy and larger incentives do not necessarily result in higher disclosure rates of sensitive information than lesser privacy and lower incentives. Furthermore, disclosure of sensitive or stigmatizing information under differing privacy conditions may have less to do with promoting or impeding participants’ “honesty” or “accuracy” than with selectively recruiting or attracting subpopulations that are higher or lower in such experiences. Pre-merged questionnaires bypassed many historical limitations of anonymous surveys and hold promise for exploring non-response issues in future research.
    Full-text · Article · Jul 2014 · BMC Medical Research Methodology
  • [Show abstract] [Hide abstract] ABSTRACT: Prior research has examined clinical effects of performance measurement systems. To the extent that non-clinical effects have been researched, the focus has been on negative unintended consequences. Yet, these same systems may also have ancillary benefits for patients and providers-that is, benefits that extend beyond improvements on clinical measures. The purpose of this study is to identify and describe potential ancillary benefits of performance measures as perceived by primary care staff and facility leaders in a large US healthcare system. In-person individual semistructured interviews were conducted with 59 primary care staff and facility leaders at four Veterans Health Administration facilities. Transcribed interviews were coded and organised into thematic categories. Interviewed staff observed that local performance measurement implementation practices can result in increased patient knowledge and motivation. These effects on patients can lead to improved performance scores and additional ancillary benefits. Performance measurement implementation can also directly result in ancillary benefits for the patients and providers. Patients may experience greater satisfaction with care and psychosocial benefits associated with increased provider-patient communication. Ancillary benefits of performance measurement for providers include increased pride in individual or organisational performance and greater confidence that one's practice is grounded in evidence-based medicine. A comprehensive understanding of the effects of performance measurement systems needs to incorporate ancillary benefits as well as effects on clinical performance scores and negative unintended consequences. Although clinical performance has been the focus of most evaluations of performance measurement to date, both patient care and provider satisfaction may improve more rapidly if all three categories of effects are considered when designing and evaluating performance measurement systems.
    No preview · Article · Feb 2014 · BMJ quality & safety
  • [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study was to investigate possible racial differences in opioid prescriptions among primary care patients with chronic, non-cancer pain receiving care in the Veterans Affairs (VA) healthcare system. This was a retrospective cohort study of 99,903 veterans with diagnoses of low back, neck, or joint pain, selected to participate in the VA Survey of the Healthcare Experiences of Patients (SHEP) in Fiscal Year 2006. The outcome was prescription of opioids in the year following the first pain diagnosis, obtained through electronic medical record data. Analyses incorporated fixed effects for race, most recent pain intensity rating, new or established primary care patient status, and an interaction between race and most recent pain intensity rating, together with random effects for healthcare facility and race within facility. The association between patient race and prescription of opioids was moderated by baseline level of pain intensity scores (assessed on a 0-10 scale) and patient age. Among patients under 65 years of age, blacks with moderate (4-6) or high levels (7-10) of pain were less likely to receive opioids than whites (p = 0.0025; p = 0.0011); however there were no significant differences between black and white patients with low levels of pain intensity (1-3) and those with pain intensity ratings of 0 (no pain). Among patients 65 and older with pain intensity ratings of zero, blacks were more likely than whites to receive opioid prescriptions (p = .0087), but there were no significant racial differences in opioid prescriptions in those with low to high levels of pain. Among veterans under age 65 reporting moderate to high levels of chronic, non-cancer pain, blacks were less likely to be prescribed opioids than whites, even after controlling for clinical and system-level factors. Results underscore the challenges of eliminating racial differences in pain treatment, despite comprehensive system-wide improvement initiatives.
    No preview · Article · Jan 2014 · The journal of pain: official journal of the American Pain Society
  • [Show abstract] [Hide abstract] ABSTRACT: This study assessed whether postal follow-up to a web-based physician survey improves response rates, response quality, and representativeness. We recruited primary care and gastroenterology chiefs at 125 Veterans Affairs medical facilities to complete a 10-min web-based survey on colorectal cancer screening and diagnostic practices in 2010. We compared response rates, response errors, and representativeness in the primary care and gastroenterology samples before and after adding postal follow-up. Adding postal follow-up increased response rates by 20-25 percentage points; markedly greater increases than predicted from a third e-mail reminder. In the gastroenterology sample, the mean number of response errors made by web responders (0.25) was significantly smaller than the mean number made by postal responders (2.18), and web responders provided significantly longer responses to open-ended questions. There were no significant differences in these outcomes in the primary care sample. Adequate representativeness was achieved before postal follow-up in both samples, as indicated by the lack of significant differences between web responders and the recruitment population on facility characteristics. We conclude adding postal follow-up to this web-based physician leader survey improved response rates but not response quality or representativeness.
    No preview · Article · Dec 2013 · Evaluation & the Health Professions
  • Melissa R Partin · Adam A Powell
    [Show abstract] [Hide abstract] ABSTRACT: To the Editor The study by Pignone and colleagues,1 which found that the relative importance patients assign to specific prostate cancer screening outcomes depends on the method used to summarize them, provides sobering documentation of how sensitive patient opinions can be to differences in presentation. Given previous research documenting that less can be more in communicating complex risk information to patients,2 the authors appropriately limit the number of outcomes presented in their values clarification exercises to 4. However, it is not clear why they selected these particular outcomes over other potentially relevant outcomes. We recognize that the focus of the study by Pignone et al1 was not to identify which outcomes to highlight in a decision aid, but rather to evaluate whether the type of values clarification exercise used affects the judgments derived from this process. However, the selection of outcomes highlighted may have had a large effect on the overall preference for screening observed and may very well be the most critical issue to address in applying the findings from their study to the design of future decision aids. If presenting all the potential outcomes would be overwhelming for patients, we believe that the most critical outcomes to present are those relating directly to morbidity and mortality. In the study by Pignone et al,1 2 of the outcomes included in the values clarification exercises meet this criteria (the chance of developing impotence and incontinence as a result of screening and the chance of dying of prostate cancer). The remaining 2 outcomes do not (the chance of being diagnosed as having prostate cancer and the chance of requiring a prostate biopsy). For these outcomes, patients must infer the morbidity and mortality implications of each state. In a recent review of the literature, the US Preventive Services Task Force estimated that the number of men who will avoid a prostate cancer death through screening is between 0 and 1 per 1000 men screened.3 However, they found no evidence of an all-cause mortality benefit and estimated that 5 men in 1000 would experience a life-threatening complication (ie, blood clot, myocardial infarction, infection-related hospitalization) from follow-up procedures. If less is more, we believe future decision aids should find ways to incorporate information on these serious complications. Although less prevalent than some of the more commonly highlighted harms of prostate cancer screening (eg, false-positive biopsy results, treatment-related impotence and incontinence), they are more serious and more likely to occur than a survival benefit from screening.
    No preview · Article · Sep 2013 · JAMA Internal Medicine
  • Adam A Powell · Melissa R Partin
    [Show abstract] [Hide abstract] ABSTRACT: To the Editor In their recent Viewpoint, Drs Shaw and Elger1 argued that persuasion plays an important role in communication with patients. They proposed that it is appropriate for physicians to use persuasion when it reduces preexisting biases but inappropriate when it creates bias. Although we also believe that persuasion is a critical component of communication, we disagree with the assertion that bias necessarily adversely affects the decisions made by patients and should therefore always be minimized. A large body of research has demonstrated that biased strategies in some contexts, such as choosing the most easily recognized option (recognition heuristic) or choosing based on one important attribute (take the best heuristic), lead to better decisions than more systematic unbiased approaches.2
    No preview · Article · Aug 2013 · JAMA The Journal of the American Medical Association
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    [Show abstract] [Hide abstract] ABSTRACT: Primary care providers frequently recommend, administer, or prescribe health care services that are unlikely to benefit their patients. Yet little is known about how to reduce provider overuse behavior. In the absence of a theoretically grounded causal framework, it is difficult to predict the contexts under which different types of interventions to reduce provider overuse will succeed and under which they will fail. In this article, we present a framework based on the theory of planned behavior that is designed to guide overuse research and intervention development. We describe categories of primary care provider beliefs that lead to the formation of intentions to assess the appropriateness of services, and propose factors that may affect whether the presence of assessment intentions results in an appropriate recommendation. Interventions that have been commonly used to address provider overuse behavior are reviewed within the context of the framework.
    Full-text · Article · Aug 2013 · Medical Care Research and Review
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    Melissa R Partin · Adam A Powell · James F Burgess
    Full-text · Article · Mar 2013 · Journal of General Internal Medicine
  • [Show abstract] [Hide abstract] ABSTRACT: OBJECTIVES:: To determine whether black patients are less likely to be screened for pain than white patients. PARTICIPANTS:: A sample of 25,382 black and 220,122 non-Hispanic white Veterans Affairs (VA) patients was identified among the panel surveyed in the ambulatory care module of the 2007 Survey of Health Care Experiences of Patients. DESIGN:: This was a cross-sectional analysis of documentation of a pain score in the electronic medical record at the patient's Survey of Health Care Experiences of Patients index visit. Hierarchical logistic regression analyses were used to examine the association between race and documentation of pain screening. RESULTS:: After accounting for site and whether the patient was a new or established primary care patient, black VA patients were significantly less likely than their white counterparts to be screened for pain, odds ratio: 0.79, P<0.0001, with estimated screening rates of 78% and 82% for black and white established primary care patients at a typical VA site, respectively. Further adjusting for demographics, medical and psychological comorbidity, prescription of pain medication, and health care utilization reduced the odds ratio to 0.86, P<0.0001). Additional analyses revealed that this reduction in odds ratio was primarily explained by higher rates of outpatient visits to the VA in the previous 2 years among black patients, which was associated with lower rates of screening at the index visit. CONCLUSIONS:: Rates of screening were lower among black patients. The magnitude of this disparity was small and was explained, in part, by racial variation in prior health care utilization.
    No preview · Article · Nov 2012 · The Clinical journal of pain
  • [Show abstract] [Hide abstract] ABSTRACT: BACKGROUND: Policy-makers have called for efforts to reduce overuse of cancer screening tests, including colorectal cancer screening (CRCS). Overuse of CRCS tests other than colonoscopy has not been well documented. OBJECTIVE: To estimate levels and correlates of fecal occult blood test (FOBT) overuse in a national Veterans Health Administration (VHA) sample. DESIGN: Observational PARTICIPANTS: Participants included 1,844 CRCS-eligible patients who responded to a 2007 CRCS survey conducted in 24 VHA facilities and had one or more FOBTs between 2003 and 2009. MAIN MEASURES: We combined survey data on race, education, and income with administrative data on region, age, gender, CRCS procedures, and outpatient visits to estimate overuse levels and variation. We coded FOBTs as overused if they were conducted <10 months after prior FOBT, <9.5 years after prior colonoscopy, or <4.5 years after prior barium enema. We used multinomial logistic regression models to examine variation in overuse by reason (sooner than recommended after prior FOBT; sooner than recommended after colonoscopy, barium enema, or a combination of procedures), adjusting for clustering of procedures within patients, and patients within facilities. KEY RESULTS: Of 4,236 FOBTs received by participants, 885 (21 %) met overuse criteria, with 323 (8 %) sooner than recommended after FOBT, and 562 (13 %) sooner than recommended after other procedures. FOBT overuse varied across facilities (9-32 %, p < 0.0001) and region (12-23 %, p < .0012). FOBT overuse after prior FOBT declined between 2003 and 2009 (8 %-5 %, p = .0492), but overuse after other procedures increased (11-19 %, p = .0002). FOBT overuse of both types increased with number of outpatient visits (OR 1.15, p < 0.001), but did not vary by patient demographics. More than 11 % of overused FOBTs were followed by colonoscopy within 12 months. CONCLUSIONS: Many FOBTs are performed sooner than recommended in the VHA. Variation in overuse by facility, region, and outpatient visits suggests addressing FOBT overuse will require system-level solutions.
    No preview · Article · Jul 2012 · Journal of General Internal Medicine
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    [Show abstract] [Hide abstract] ABSTRACT: Multilevel intervention research holds the promise of more accurately representing real-life situations and, thus, with proper research design and measurement approaches, facilitating effective and efficient resolution of health-care system challenges. However, taking a multilevel approach to cancer care interventions creates both measurement challenges and opportunities. One-thousand seventy two cancer care articles from 2005 to 2010 were reviewed to examine the state of measurement in the multilevel intervention cancer care literature. Ultimately, 234 multilevel articles, 40 involving cancer care interventions, were identified. Additionally, literature from health services, social psychology, and organizational behavior was reviewed to identify measures that might be useful in multilevel intervention research. The vast majority of measures used in multilevel cancer intervention studies were individual level measures. Group-, organization-, and community-level measures were rarely used. Discussion of the independence, validity, and reliability of measures was scant. Measurement issues may be especially complex when conducting multilevel intervention research. Measurement considerations that are associated with multilevel intervention research include those related to independence, reliability, validity, sample size, and power. Furthermore, multilevel intervention research requires identification of key constructs and measures by level and consideration of interactions within and across levels. Thus, multilevel intervention research benefits from thoughtful theory-driven planning and design, an interdisciplinary approach, and mixed methods measurement and analysis.
    Full-text · Article · May 2012 · JNCI Monographs
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    Melissa R Partin · Diana J Burgess
    Full-text · Article · May 2012 · Journal of General Internal Medicine
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    No preview · Dataset · Apr 2012
  • Melissa R Partin · Adam A Powell · Sean Nugent · Diana L Ordin
    [Show abstract] [Hide abstract] ABSTRACT: Using data from an improvement collaborative, we examined whether facility-specific conclusions regarding the success of efforts to improve timely access could vary depending on the type of measure used. The sample was drawn from 21 Veterans Health Administration (VHA) medical facilities participating in a collaborative on timely diagnostic evaluation following positive fecal occult blood tests (FOBT+). We identified FOBT+ cases from participating facilities between September 2004 and August 2005 (precollaborative), and September 2006-August 2007 (postcollaborative). Dates of FOBT+ results, colonoscopy, and death were extracted from VHA medical records. We estimated the cumulative proportion receiving colonoscopy within 2 months of the FOBT+ (target measure established by collaborative), and compared facility-specific results regarding improvement on this measure to results from measures of the cumulative proportion receiving colonoscopy within 12 months, and average time-to-colonoscopy. In 12 facilities (57%), all measures suggested consistent results regarding pre-post collaborative changes in colonoscopy rates. In four facilities (19%), the target measure suggested less favorable change, and in five (24%), more favorable change than one or both other measures. Because conclusions drawn about the success of QI efforts can vary by the measure used, multiple measures should be employed to track progress toward timeliness goals.
    No preview · Article · Dec 2011 · Journal for Healthcare Quality
  • Timothy J Wilt · Melissa R Partin
    [Show abstract] [Hide abstract] ABSTRACT: In their article appearing in this issue of the Archives, Welch and Frankel1 critically evaluate the common claim among cancer survivors that their “life was saved” by screening. After providing convincing evidence that this claim is markedly exaggerated, the authors express concerns that overly inflated perceptions of the benefits of mammography may lead to a self-perpetuating cycle of unwarranted demand for screening, overdiagnosis, overtreatment, and a continually growing population of breast cancer survivors who advocate mammography. The demographics of survivorship suggest that their concern is legitimate.
    No preview · Article · Dec 2011 · Archives of internal medicine

Publication Stats

1k Citations
313.76 Total Impact Points


  • 2003-2012
    • University of Minnesota Duluth
      • Medical School
      Duluth, Minnesota, United States
  • 2008-2010
    • Minneapolis Veterans Affairs Hospital
      Minneapolis, Minnesota, United States
    • University of Minnesota Twin Cities
      • Department of Medicine
      Minneapolis, Minnesota, United States
  • 2007
    • University of California, San Francisco
      San Francisco, California, United States
  • 2006
    • Spokane VA Medical Center
      Spokane, Washington, United States