Grand Rounds

"The good physician treats the disease; the great physician treats the patient who has the disease."

- William Osler

  • Worlton, Tamara

    Worlton, Tamara

    M.D., Commander

    CDR Worlton completed her surgical residency at the former NNMC, completed her Bariatric fellowship at Cleveland Clinic, and returned to WRNMMC to run the bariatric program. She was Chief of the Division of MIS and Bariatric Surgery from 2011 to 2019. Her interests are more focused globally on prevention and treatment of obesity, with lectures in India, Philippines and Sri Lanka.

    Bariatric Surgery and Me

    CDR Worlton discusses bariatric surgery work up, treatment, and results with a specific focus on post operative mental health.

  • Altstatt, Carol

    Altstatt, Carol

    LCSW-C

    Ms. Altstatt been a social worker in the Washington area for 35 years, and with WR for over half of that period. Early career spent with child protective services and as a therapist with community clinics. Mid-career she conducted psychiatric evaluations in Suburban Hospital’s emergency department and assisted with the management of a longitudinal study of trauma with the National Institute of Mental Health. She was one of a team of social workers who served the thousands of combat casualties evacuated from Iraq and Afghanistan to WR. In 2008, she deployed under the State Department to Iraq for one year as the Foreign Service Social Worker, U.S. Embassy, Baghdad. Ms. Altstatt had missions throughout Iraq interviewing and assessing personnel under the Chief of Mission. She is now Service Chief, Inpatient Social Work, WR. Her yoga studies began 35 years ago, she has instructed locally as well as abroad, and maintains a varied home practice.

    Pack Firearm, Carry Mat: A Yogi in Afghanistan

    A civilian clinical social worker’s narrative of her one year deployment as an Advisor to the Afghan National Defense and Security Forces. With the perspective of a behavioral health professional, she describes the environment, community, and mission over the course of her tour. Despite the volatility of security, politics, threat levels, and force mobility, she managed to offer regular yoga instruction to her NATO community in Kabul.

  • Mucklow, Lacy

    Mucklow, Lacy

    MA, ATR-BC, LPAT, LCPAT, ATCS

    Lacy is an art therapist who has been practicing in the Washington, DC area since 1999, working in various sites, including home-based counseling, school, private practice, partial hospitalization program, and inpatient hospitalization settings.  She has worked for the Department of Defense since 2002, first working with military dependents at Fort Belvoir and currently working with active duty service members at Walter Reed.  Lacy obtained her Master's Degree in Art Therapy from The George Washington University and holds a Bachelor's Degree in Psychology with a Studio Art Minor from Oklahoma State University. A nationally Registered and Board Certified Art Therapist, she is a Licensed Clinical Professional Art Therapist and Approved Art Therapy Supervisor in Maryland, and is a Licensed Professional Art Therapist in Kentucky.  Lacy is also an Art Therapy Certified Supervisor, and has supervised graduate art therapy students as well as ATR and licensure candidates since 2006.


    In addition to her passion and devotion to providing art therapy, Lacy is a New York Times bestselling author and National Bestseller with her coloring book series for adults (Color Me Calm, Color Me Happy, Color Me Stress-Free, Color Me Fearless, Color Me to Sleep, and Color Me Grateful) and has also authored an art journal for mothers and their children to communicate through art in response to prompts in Mom and Me: An Art Journal to Share, Connect, and Create Side-by-Side.  She has also released a relaxation double album with original music and guided imagery called “Lavender Dreams,” with a second album currently in the works, to help people reduce stress and practice mindfulness.

    Featured on “CBS Sunday Morning,” Lacy was also a presenter with the Smithsonian Resident Associate Program and was the Keynote Speaker for the First Born Girls Social Club's 10th anniversary program on the phenomenon of adult coloring and how it can be helpful for people on a psychological and neurological level. She has interviewed with magazines, newspapers, and podcasts around the world and was featured locally in The Washington Post Express.  She has presented art therapy in-services for colleagues and trainees as well as to mental health providers in the community since 1999, and will be a presenter at the American Art Therapy Association National Conference in 2020.  She looks forward to more opportunities such as this to make art therapy better known and understood within the behavioral health community.

    Introduction to Art Therapy

    What is art therapy? Many people have not heard of the field of art therapy and would respond to that question in a variety of different ways. So what is it, really? This introduction to art therapy will cover what art therapy is and what it is not, its history, how one becomes an art therapist, who art therapy serves and where it is practiced, the benefits of art therapy, art therapy assessments, common art therapy directives, and examples of artwork from art therapy.

  • Ritchie, Elspeth & Preston, Samuel

    Ritchie, Elspeth & Preston, Samuel

    M.D., M.P.H., Colonel (retired), & D.O., Lieutenant Colonel (promotable)

    Dr. Ritchie is a forensic psychiatrist with especial expertise in military and veteran’s issues. She is currently Chief of Psychiatry at Washington Hospital Center. Recent jobs have included Chief of Mental Health for the Community Based Outpatient Clinics at the Washington DC VA and Chief Clinical Officer, Department of Behavioral Health, for the District of Columbia. She retired from the Army in 2010, after holding numerous leadership positions within Army Medicine, to include the Psychiatry Consultant. She trained at Harvard, George Washington, Walter Reed, and the Uniformed Services University of the Health Sciences, and has completed fellowships in both forensic and preventive and disaster psychiatry. She is a Professor of Psychiatry at the Uniformed Services University of the Health Sciences, Georgetown University and George Washington University School of Medicine. An internationally recognized expert, she brings a unique public health approach to the management of disaster and combat mental health issues. Her assignments and other missions have taken her to Korea, Somalia, Iraq, and Cuba.  She has over 250 publications, mainly in the areas of forensic, disaster, suicide, ethics, military combat psychiatry, and women’s health issues. Recent volumes include: “Forensic and Ethical Issues in Military Behavioral Health”, “Women at War”, “Post-Traumatic Stress Disorder and Related Diseases in Combat Veterans”, “Intimacy After Injury: Restoring Sexual Health on Return from Combat”; “Psychiatrists in Combat, Clinicians Experience in the War Zone”, “Gay Mental Healthcare Providers and Patients in the Military: Personal Experiences and Clinical Care”, and “Veteran Psychiatry in the US”.

    Military Behavioral Health: Focus on Accession Standards

    This presentation will give a personal history of COL (Ret) Ritchie's military experience and will emphasize the importance to behavioral health providers of accession standards while assessing military service members.

  • Santiago, Patcho

    Santiago, Patcho

    M.D., M.P.H., Captain

    I think most everyone in the audience knows Dr. Santiago, but I imagine some of our new interns and others new to the command might never have met him.


    Dr. Santiago was our residency program director until last summer when he PCS'd to the medical school to join the Dean's Staff as the Associate Dean for Diversity and Inclusion.


    People are sometimes surprised to find out that Dr. Santiago is neither a graduate of USU or the NCC psychiatry residency. He was an HPSP student at Jefferson and then completed residency at Balboa. His first utilization tour was at Naval Hospital Camp Pendleton, and from there he deployed to Camp Arifjan, Kuwait in 2005.


    He then completed the Disaster and Preventive Psychiatry fellowship, a two-year program that starts with earning the MPH at USU. He stayed on as billeted faculty at the medical school, where he deployed to Afghanistan as the OIC of the Navy's Mobile Care Team in 2010.


    Dr. Santiago has been invited to serve on a number of national organizations' task forces, including the NBME's Step 1 Standard Setting Panel, the VA/DoD's Suicide Clinical Practice Guideline Working Group, and the ACGME's Psychiatry Milestones 2.0 Working Group.


    At the end of the day though, he'll tell you that he's been most proud of his work with residents. In the six years he was PD, residents contributed 99 poster and 38 podium presentations at regional and national meetings, and published 12 book chapters and 14 articles in peer-reviewed journals.


    He remains committed to our program, and I can tell you he means it when he says he continues to have an open-door (or open-Zoom) policy with us!

    Equity and Inclusion, and You: Diversity Beyond a Number

    Dr. Santiago presents on diversity, equity, and inclusion (DEI), with a focus on turning knowledge into action.

  • Greene, Elizabeth

    Greene, Elizabeth

    M.D., Captain (retired)

    Dr. Elizabeth Greene graduated from the University of Virginia, School of Medicine in 2002 and completed a combined residency in Psychiatry and Family Medicine through the National Capital Consortium in 2007. She maintains board certification in both specialties. She served in the United States Air Force for nine years, deploying in 2008 to support OIF. During her time in the Air Force she served as a residency faculty member at Wilford Hall Medical Center/ University of Texas Health Sciences Center San Antonio (UTHSCSA) Psychiatry Residency program and was Chief of the Psychiatry Consultation Liaison Service at Wilford Hall Medical Center. In 2011 after completing her service commitment to the United States Air Force she transitioned to work as a DoD civilian at Fort Belvoir Community Hospital. She currently serves as one of the Associate Program Directors for the NCC Psychiatry Residency and as the Chief of Education for the Directorate of Behavioral Health at Fort Belvoir Community Hospital while continuing to provide patient care in the Adult Outpatient Behavioral Health Clinic. Throughout her career Dr. Greene has provided care for many medical colleagues and has developed an interest in physician wellness. Her favorite things to do (besides teach psychiatry residents, of course!) are spending time with her family, reading and knitting.

    Psychiatrist Response to Patient Suicide

    Having a patient die by suicide is a common experience for psychiatrists, but one that is rarely discussed in training, leaving psychiatrists unprepared. The goal of this presentation is to discuss both the emotional reactions and the practical actions that can help a clinician after a patient dies by suicide.

  • Wurdeman, Glen

    Wurdeman, Glen

    CH (MAJ), Bioethics Chaplain

    CH Wurdeman earned a B.A. in speech communication from the University of Nebraska in 1983 and an M.S. in college student personnel administration from Indiana University in 1985. After working as the coordinator of student organizations and special projects at the University of Nebraska—Kearney, he attended Concordia Seminary in Saint Louis, receiving the M.Div. in 1990. Following ordination, he served as pastor and mission developer of congregations in Armour, SD; Dakota Dunes, SD; and Zionsville, IN.


    Chaplain Wurdeman attended Chaplain Basic Officer Leader Course at Fort Jackson, SC.  After graduation, he served as squadron chaplain at 1-4 CAV at Fort Riley, KS, deploying to Iraq in 2009 and Afghanistan in 2012. He then served as battalion chaplain at 1-6 Infantry at Fort Bliss, TX. He completed the Chaplain Captains Career Course in June 2016, receiving the Francis P. Duffy Award as the distinguished honor graduate. He served as the battalion chaplain at 242D OD (EOD) at Fort Carson, CO until his selection for Advanced Civilian Schooling in the area of bioethics. He received an M.A. in bioethics and medical humanities from Case Western Reserve University in May 2019.


    Chaplain Wurdeman’s awards and decorations include the Bronze Star Medal, Meritorious Service Medal (4th award), the Army Achievement Medal, National Defense Service Medal, the Afghanistan Campaign Ribbon, the Iraq Campaign Medal, the Global War on Terrorism Service Medal, the Army Service Ribbon, the Army Overseas Service Ribbon, and the NATO Medal.


    Chaplain Wurdeman is married to the former Gala Joy Rolofson of Cairo, NE. Their family includes Anna; David, his wife Shaina, and their son Joseph; and Andrew and his wife Lauren.

    Moral Injury: Toward Definition, Diagnosis, and Treatment

    The presentation will discuss the concept of moral injury, its prevalence among military personnel, and the importance of military medical personnel understanding its significance. We will discuss current attempts to treat moral injury and efforts to measure their success.

  • Hoge, Charles

    Hoge, Charles

    M.D., Colonel (retired)

    Charles Hoge, MD, Colonel (retired), is a graduate of Sarah Lawrence College (BA) and University of Maryland School of Medicine (MD).  He received specialty training and board certification in internal medicine, infectious diseases, and psychiatry, and served a total of 20 years in the U.S. Army (1991-2009) and U.S. Public Health Service (1989-1991).  He directed psychiatry and neuroscience research at Walter Reed Army Institute of Research (WRAIR) from 2000-2009.  Since 2009 he has served as a Senior Scientist and Neuropsychiatry Consultant at the Office of the Army Surgeon General and WRAIR, and as an attending psychiatrist at Walter Reed National Military Medical Center.  He deployed to Iraq in 2004 and Afghanistan (as a civilian) in 2011.  Out of his more than 200 publications, more than 30 have been published in New England J of Medicine, JAMA Network, or Lancet Network journals.  His articles on post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are the most cited of all medical articles from the wars in Iraq and Afghanistan.  He has testified to U.S. congressional committees on several occasions, and is also author of a self-help book for combat veterans titled, Once a Warrior Always a Warrior: Navigating the Transition From Combat to Home.

    Suicide Reduction and Research Efforts in Service Members and Veterans: Sobering Realities

    This talk will provide a critical look at current clinical health care policies and practices for the assessment and management of patients at risk for suicide, including review of evidence summaries in the latest VA/DoD clinical practice guideline and key studies relevant to VA and DoD populations.

  • Flinton, Christopher

    Flinton, Christopher

    M.D., CAPS Fellow

    MAJ Christopher Flinton hails from upstate New York.  He graduated from the Honors Program at Boston College, becoming the first in his family to earn a college degree, before earning his M.D. from the F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences.  Dr. Flinton graduated from the National Capital Consortium Psychiatry Residency Program in 2018 before continuing Graduate Medical Education training as a Child and Adolescent Psychiatry Fellow.  He has been honored with local and national awards including First Prize in the inaugural Washington Psychiatric Society Case Conference Competition, the Artiss Recognition Award, and the Anne Alonso PhD Memorial Award.  Dr. Flinton is a Past Fellow of the American Psychoanalytic Association and the Group for the Advancement of Psychiatry.  He is highly motivated to assume duties as the Division Psychiatrist for the 4th Infantry Division based at Fort Carson, Colorado, but not before presenting to beloved colleagues at Walter Reed National Military Medical Center one last time.

    Video Gaming and the Behavioral Health Provider: What You Need to Know

    This presentation aims to identify American video gaming trends, differences in generational perspectives on video games, delineate features associated with pathological video gaming, and create a framework for approaching patients and families dealing with problematic gaming behaviors.

  • Bowes, Reid

    Bowes, Reid

    D.O., CAPS Fellow

    I have a unique life in that I have lived in 11 states and waited tables in 3 different time zones. After conducting an exhaustive google search, I can proudly say that I the only person in history to be part of a chess club in elementary school, middle school, high school, college, and medical school. I enjoy literature, piano, camping/hiking, and sitcoms from the 80s and 90s. I am supported by my lovely wife, Ashley and my three children, Aly, Cece, and Jack.

     

    Professionally I am very interested in writing and research. I am first author on one published article and have submitted a systematic review to another journal and am finalizing a paper on this grand rounds topic. I graduated from Johnson County Community College in 2005, then subsequently went to a couple of other schools, and have been in NCC residency/fellowship since 2015.

    What Big Interpretations You Have! Fairy Tales' Psychodynamic

    In this presentation we go into detail about fairy tales, their underlying meanings, and how they can connect to therapy work. We go into many different psychodynamic theories as well as examples of fairy tales and contemporary children's books.

  • Mestrovich, Janee

    Mestrovich, Janee

    D.O., PGY-4 NCC Psychiatry Resident

    Dr. Janee Noel Mestrovich was raised in Idaho and is proud to be from the Pacific Northwest. She chose to attend a small college in her hometown, Northwest Nazarene University, in order to be near her younger brothers, Derek and Cooper. Since then, she has somehow managed to move farther and farther away from her family; however, plans to move closer to them as soon as she is able. She attended Michigan State University College of Osteopathic Medicine prior to residency and will be moving to Ft. Wainwright in Fairbanks, Alaska in just a few short months. She is engaged to the sweetest and most supportive person she knows, Sam Lyons, and is very excited to marry him. She has two cats, Delilah and Beau, and is a proud auntie of three precious little beings.

    How to Slay Giants: A Guide to Building Therapeutic Alliance

    The therapeutic alliance is one of the best predictors of psychotherapeutic outcomes, as well as premature discontinuation of treatment (Horvath et al., 2011; Martin et al., 2000). Bordin (1979) speculated “the effectiveness of therapy is a function, in part, if not entirely, of the strength of the working alliance.” Likewise, dropping out of care is one of the most important predictors of treatment failure. This presentation will review the origins of alliance theory and its evolution into modern therapeutic alliance concepts. Additionally, it reviews evidence-based practices that have been shown to build therapeutic alliances and minimize premature dropout from therapy.

  • Hart, Daniel

    Hart, Daniel

    M.D., PGY-4 NCC Psychiatry Chief Resident

    Dr. Hart was raised in the Navy, graduated from West Point in 1997 with a BS in Chemistry and Life Sciences, married Joanna 6 months later and spent 15 years as an Infantry Officer before returning to USUHS to pursue his MD. He joined the NCC Psychiatry Residency in 2016 and is starting the Child and Adolescent Psychiatry Fellowship in July. He enjoys being a husband, father, psychiatrist, teacher and takes pleasure in making stuff. In the words of Dr. Bradley Ray, “Dan, you really like coming up with ideas.” His love of ideas and figuring things out led to this grand rounds.

    The Economy of Distress

    Dr. Hart describes a cognitive model that relates ego strength to distress management. It discusses how a therapist can approach a patient with an eye on defense mechanisms as a means to better understand the patient. Equipped with that understanding, the therapist and patient are better able to judge appropriate next steps in therapy.

  • Horotan, Ioana

    Horotan, Ioana

    D.O., PGY-4 NCC Psychiatry Resident

    Dr. Horotan-Enescu immigrated to the US from Transylvania, Romania when she was in her 20’s. She moved to Boston, MA where she attended Bunker Hill Community College and graduated from the University of Massachusetts with Suma cum Laude in Biology. Then she went to the University of New England College of Osteopathic Medicine where she obtained her DO degree. She started her NCC Psychiatry Residency in 2016. She always had a keen interest in ancient wellness practices and, while in medical school, worked on a pilot study at Brigham

    and Women’s Hospital in Boston, MA investigating novel treatment modalities of PTSD including yoga. Currently she is interested in forest medicine and its possible application in Psychiatry.

    Forest Therapy - Re “turning” to Nature for Wellness and Stress Reduction

    The presentation will describe Shinrin-yoku/Forest Therapy as a specific type of Nature Therapy. It aims to provide of framework for understanding current investigative techniques and to review current literature in supporting its beneficial role in improving wellness and reducing stress.

  • Heilmann, Tim

    Heilmann, Tim

    D.O., PGY-4 NCC Psychiatry Resident

    CPT Heilmann started his healthcare career in alternative medicine. He received a doctorate from the University of Western States; College of Chiropractic Medicine in Portland, OR in 2009. Wanting to expand his ability to help patients he applied to and was accepted to Rocky Vista University; College of Osteopathic Medicine in Parker, CO. After his graduation in 2014 he completed his internship at Eisenhower Army Medical Center in Augusta, GA. He then went on to train as a flight surgeon in Ft. Rucker, AL then served as a Flight Surgeon for the 3rd Squadron of the 17th Cavalry regiment at Hunter Army Airfield in Savannah, GA. He reports having decided on pursuing psychiatry at the end of his internship which was then solidified while treating his fellow soldiers as a flight surgeon/battalion surgeon. He joined the NCC Psychiatry residency as a PGY-2 in 2017.

    Shame: What does it do for us and what are we doing with it?

    Exploration of ideas behind the evolutionary developments of shame, how shame is used in modern society, and what can be done to help people who are experiencing shame.

  • Cederberg, Joseph

    Cederberg, Joseph

    D.O., PGY-4 NCC Psychiatry Resident

    Dr. Cederberg was raised in rural central Virginia. He was an Army ROTC cadet and graduated from Liberty University with a B.S. in Biology, minoring in Psychology. He continued his education at Edward Via College of Osteopathic Medicine in Blacksburg, Virginia, where he earned is DO. He has a passion for rural, underserved care settings and dreams of becoming an old-timey traveling “country doc,” little black bag and all. Outside of his psychiatric training, he enjoys all types of games, sports, weightlifting, sarcasm, clowning around, and spending time with his wife and three young boys.

    Emotional Labor: Deep Acting to Develop Alliance

    Topics covered will include theory of therapeutic alliance, Freudian versus Rogerian perspectives of patience alliance, the Emotional Labor model, and deep versus surface acting.

  • NCC Psychiatry Residency Network

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