Jeff Levy, MD

       “Hello, I’m Bruce Speyer, and I’m with 

.   I’m proud to introduce today Dr. Jeff Levy.  We’ve been working with  Dr. Levy for four years now since the beginning, as long as       

 been around.  Dr.  Levy’s had many ventures but what he’s doing now is called MedCases.com  and he’s the founder of MedCases and also their Educational Director.   MedCases is interactive CME on the Internet.  Dr. Levy, could you  describe what inspired you to do MedCases and take such an interactive  and Internet based approach?”
       
       

 “I’ve been  dealing with medical education now for about the last ten years and in  education there are some significant problems that are occurring.   Number one – our medical students are not having as much of a chance to  have clinical encounters because we’re sending our patients home faster.   Number two – our faculty is not able to teach as much because they  have so many clinical responsibilities.  Those two things coupled  together have really decreased the amount of education that our medical  students and our residents are getting, and it’s been very distressing.   I’ve been a Medical Student Director, a Residency Director, and I’ve  been Director of the National CME program so I really understand the  nuances and what’s happening in medical education.  I’m very disturbed  in what’s happening and what’s occurring, and I want to make a  difference - I want to make a change.  Over the last ten years I’ve also  been involved in medical education in technology in the use of medical  education.  Technology, I think, can enhance the medical education  process.  We’ve worked with areas of laser disk, areas of CD-ROM, and  most recently, and I think most importantly, the Internet is a real  avenue to improve education at all levels.” 
       
       

 “I’ve looked at  some of the MedCases examples and they’re quite impressive both in their  quality and in the use of very interactive technology, plus I know  you’re putting together dozens if not hundreds of these MedCases.  Could  you describe a little bit on how you’re accomplishing all of this?”
       
       

 “Sure, the  biggest advantage that we have is we’ve created an authoring, editing,  and publishing system all over the Internet and really it’s a one of a  kind process right now.  We’ve created all the tools that an author will  need to develop a case but we scaled it so we can have a thousand  authors working simultaneously on different cases or we can have dozens  of authors working on the same case and creating that case but sending  it then through a very tough peer review process.  So we have editors  that are reviewing it that are national and international experts and  making sure that the contents correct before we ever publish it.  With  this kind of process we really have hundreds of people that we’re  working with right now across the country and soon to be across the  world.”
       
       

 “We’re at FIGO,  it’s the International Congress for Gynecology and Obstetrics which only  happens every three years, and typically, at least in the United  States, we think of CME as the credits are only useful for United States  physicians.  Is that the case with MedCases or is this applicable  worldwide?”
       
       

 “It’s very  applicable worldwide and the reason is things are changing dramatically  throughout the world right now.  Today, we need mainly CME’s continuing  medical education credits in the United States but there’s a huge change  going on in Europe, and they’re going to require continuing medical  education credits also for their accreditation process.  So that’s  occurring literally as we speak so things are going to change across the  world very rapidly, and we really want to be at the ground floor in  that change.”
       
       

  and say we’re very impressed with MedCases.  In fact, we have a license  agreement; we were one of the very first licensees of MedCases.  Could  you describe a little bit about how MedCases would appear on OBGYN.net  or other medical sites?”
       
       

 “Sure, our goal  is that medical MedCases is going to be a medical educational solution  that you’ll find literally almost everywhere you go on the Internet.  We  believe very strongly in strategic partners, and       

 has always been a  wonderful strategic partner with us.  What we’re going to do is we’re  going to provide a free case of the month on       

, and you can find a  urogynecology case on the site right now.  Next month we’re putting on a  breast disease case and we’ll go on and on for the next several months  to several years.  We think it’s important for people throughout the  world to be able to try the cases because then I think that they’ll be  more apt to use the products.  Right now we literally have products for  every level of education.  We have products for medical students and  medical student education, we have products for resident education,  products for board review for when a resident is going into a specific  specialty and needs to pass their boards and also the CME product.  The  CME product is what we’re working with you on and we’ve created that so  your constituents can use it.”
       
       

 “I should also  mention that even though Dr. Levy’s background is gynecology, MedCases  are being applied to all different medical disciplines, and perhaps  we’ll be able to use it on some of our other medical disciplines.  It’s  exciting technology because it’s the future of education, and the  Internet is just exciting and this is pretty near technology for the  Internet.”
       
       

“We’re really  going to be in thirty specialties over the next 2 ½ years.  Right now  we’ve already launched our ob-gyn product.  In about three weeks we’ll  be launching a similar pediatric product, three weeks later after that  is family practice.  Three weeks after that is general surgery and then  it’s on and on, every several weeks we’ll be launching a new product.”
       
       

 “That’s possible  because of the publishing tool and the network of doctors and residents  that you put together around that publishing tool.  It’s very  exciting.”
       
       

 “We’re able to  create contents much, much faster than the traditional model.  As you  know, when you write a book it’s usually a 1 ½ to a 3-year process.   When we do a series of cases, even an entire curriculum, we can do it in  weeks to months.”
       
       

 “Best of luck to you and your company.”       

 “Thank you very much.”
       
       

Articles

OBGYN.net Conference CoverageFIGO 2000 INTERNATIONAL FEDERATION of GYNECOLOGY & OBSTETRICS: Washington DC, USA

MedCases

:        “Hi, this is Jim Carter, and I’m here at the AAGL meeting with 

       own Director of their Urogynecology section and one of my favorite       doctors, Dr. Richard Scotti from the Bronx in New York.        Dr. Scotti and I participated in a debate about laparoscopic versus       vaginal surgery for stress incontinence, for pelvic floor dysfunction, and       pelvic floor support problems.  Dr. Scotti again showed us how we should really be doing our       work and I really appreciate it.  I       want to thank you for the absolutely wonderful job you did.  What I want to do right now is introduce my friend to you and       have him tell you what you should look for in a doctor like him who can       help you with your problems with incontinence and support.”              

:        “I think the first thing you want to do is find a doctor who       listens a lot, understands your problems, and also understands that you       have other problems besides pelvic floor support.        For example, someone may be referred to me for urinary incontinence       and I find out in the course of talking and listening that this is not her       major problem, and I’d like to address all of her problems.        So I think finding a doctor who listens and who understands that       you have other problems besides that and then sort of helps you prioritize       what you really want to work on first is, I believe, one of the first       steps in finding a doctor that’s suitable for you.”                            

:        “I recall seeing a statistic, Dr. Scotti, it takes a patient only       thirty-five seconds to tell a doctor their problem but it only takes a       doctor fifteen seconds to interrupt her.        If you are looking for a physician in New York, look for one that       listens and Dr. Scotti is one who listens.        I want you to tell us about what the patient should expect to be       told and also what kind of an evaluation she should expect because       sometimes they come in and they don’t understand that they need a       machine to do a test, for instance.  Can       you tell us a little about what she should expect for a work-up for       incontinence?”              

:        “Urinary incontinence is a multi-foliate, multi-variable kind of       problem and sometimes just listening to symptoms is not enough to arrive       at a diagnosis so often you need other tools to triage and tease out the       various symptoms.  There are       only a few symptoms like frequency, urgency, painful voiding, and       incontinence and these four symptoms are shared by many diagnoses.        So many diagnoses share a common pool of symptoms and, therefore,       you need some instrumentation like urodynamic testing and cystoscopy, etc.       to really arrive at a diagnosis and from that point, of course, formulate       a rational treatment plan.”              

:        “So it’s important for the patient to understand that just       answering the questions may give the doctor the diagnosis but there may be       some further tests like urodynamics that are needed, and you do those       tests in your office.  These are not hospital tests; these are tests you do in your       office.  Before a person is       taken to surgery they really need a proper diagnosis.        Now Dr. Scotti, you do both vaginal approaches and laparoscopic       approaches, would you tell us a little bit about some of your approaches       to this treatment of this problem?”              

:        “Sometime people come with a particular idea; they want it       laparoscopically or they want it done all from below.        The first thing is to let them understand that there are many ways       to skin a cat, and we can probably do it by one approach or another or       perhaps a combined approach of more than one approach.        I think informed consent involves the patient understanding what       the risks and benefits of a procedure are and what the success rate might       be.  There’s a scale that       only they can measure, and I think the choice is up to them.        We’re not talking about emergency surgery, this is elective       surgery that affects someone’s quality of life and, therefore, they have       to make the decision.  Of course, we have to give them the proper information to       make an informed choice.”              

:        “That is so important, Dr. Scotti, the informed consent.        The patient needs to know how this is going to be done, what can be       done, and you brought up yesterday in our debate this issue of intrinsic       sphincter deficiency.  Now       that’s a mouthful but intrinsic sphincter is a weak muscle in the       urethra or weak support in the urethra and you talked about a procedure as       a way of curing that with a transvaginal tape.        You called it the ‘TVT procedure’ that you’re doing.        Can you describe a little bit about that because that sounded so       exciting.”              

:        “Sure, Dr. Carter, this is a new procedure that is minimally       invasive and can actually be done under local anesthesia in about twenty       minutes just for stress incontinence, this is not for other types of       incontinence.  Basically,       it’s a piece of synthetic tape that’s put under the urethra.        My finger represents the urethra and the rest of my hand represents       the bladder, the tape - the other finger - actually supports the urethra.  It’s this way, and small punctures sites are made in the       abdominal wall.  I don’t       know if you can get down about here, and it takes about thirty minutes.”              

:        “So for a patient with loss of urine from coughing and sneezing,       you place this tape in under local anesthesia, they go home that day, and       they usually can void immediately.  In       fact, the success rate on this has been 85%-90%; it’s been very, very       good in terms of skilled operator’s hands.        If you are interested and have problems with incontinence, contact       Dr. Scotti or contact through 

       the doctors who are involved in incontinence surgery.        Check this out, this transvaginal tape procedure which was invented       by a doctor in Sweden has been performed in over 100,000 cases and many,       many cases, over 25,000, in the United States now has really been a       benefit to people.  It has       been produced by one of our major companies, Ethicon U.S.A., and we’re       so excited to have this available.  Thank       you for explaining all of this to us.”              

:        “Thank you very much, Dr. Carter.”                            

:        “We appreciate it.  It’s       my pleasure, thank you.”

OBGYN.net Conference CoverageFrom American Association of Gynecological LaparoscopistsOrlando, Florida, November 2000

Incontinence:  What You Should Look For In Finding A Doctor For Treatment

click             here for RealAudio/Video version

 "Hi, I'm       Jeff Levy, and we're here in Philadelphia, at the ACOG national meeting.       We're at the IMET booth - IMET stands for Innovations in Medical Education       and Training, and we're an education business. We've had several       educational seminars in our booth during the ACOG meeting, and one seminar       was with Skip Sands, who is sitting to my right. Skip is the head of the       Women's Health Care in Pottstown, Pennsylvania. He's a private       practitioner, and he's been working on some fairly innovative programs in       his office setting. He's has recently started an osteoporosis center in       his office, and I'd like Skip to tell us a little bit about that."
       
       

 "Jeff,       it's an interesting process in that osteoporosis is going to become a       very, very important prospect or problem associated with a menopausal       woman. It's expected that probably 13-18% of all post-menopausal women       presently have osteoporosis. Obviously as the aging population increases,       that number is going to increase dramatically, and we need to be able to       take care of those patients because we're the ones who see those patients.       It's far more convenient for the elderly population to come to one       physician than it is to go to a physician then have to go to another       physician, and then have to go to another institution like a hospital or a       radiology center. They're very uncomfortable with that, and that develops       a lot of problems associated with travel and transportation. So we needed       to go through an evaluation specifically in our own practice to see       whether it was financially feasible to develop an osteoporosis screening       center. We went through the steps of evaluating the entire practice just       on the number of patients that we had, trying to decide the percentage of       patients that would be applicable to being screened, and then       simultaneously looking at what their insurance was to see whether or not       there would be an adequate reimbursement to cover the costs. What we found       out was not only would there be more than adequate coverage but that it       would actually turn out to be a profit center. This was not something that       was not needed, it was just something that should be done, and if done       correctly would obviously add to the profit center of the practice, which       was what we were looking for."
       
       

       "Skip, what types of things do you include in your osteoporosis       center?"
       
       

       "Obviously we have a screening facility so we have equipment to do       bone densitometry. We also have significant nutritional counseling and       also exercise programs so that patients can work on the full aspects of       treating their osteoporosis. We're not dealing with just the idea of       developing a profit center, we're looking at the total care of this       post-menopausal population."
       
       

 "If       you had one pearl to give private practice physicians about how to start       an osteoporosis center, what would you say?"
       
       

 "Crash       the numbers - I mean it's very, very important for you to know what your       reimbursements are going to be and simultaneously to know what the volume       in your patient population will be. It's a simple thing to do, we did our       own analysis, and then what we did was we actually kept a record of every       patient we saw for a month that we thought would be applicable. We       realized shortly after the first week that we had more than enough       patients to make this thing profitable, and the last three weeks were just       confirmatory. So I would say to you - do your homework, and it will       work."
       
       

 "Do       you have any specific machine - densitometry machine - that you would       suggest?"
       
       

 "The       argument always exists between whether or not a peripheral machine is       adequate or you need a central piece of equipment. We opted for a central       piece of equipment which was able to do peripheral scans also. I would       tell you that it has to do more so with volume than it did with the issue       of one machine being actually better. We also are involved in a few       pharmaceutical studies, we really did need a central machine, so it was       important for us to do that. But if your practice is small and you don't       have a significant volume, there's less of a cash outlay for the       peripheral machines, and they will get you started. They will also help       the patient population because in a lot of places central machines just       are not available."
       
       

       "Thank you very much, Skip, we appreciate the interview."

From American College of Obstetricians and GynecologistsPhiladelphia, Pennsylvania - May, 1999

Osteoporosis Screening Center

 "I'm       Jeff Levy, and I'm the Director of Medical Education for IMET -       Innovations in Medical Education and Training. We're here at the ACOG       booth, at the 47th annual ACOG meeting, and we've just finished a lecture       on collagen injections in the practice of urogynecology. Richard Scottie,       who's Associate Professor at Albert Einstein Medical Center and at       Montefiore Hospital in the Bronx, gave the lecture and wants to give us a       few tips on how to use collagen and what it can do for our patients."
       
       

       "Thank you, Jeff. As you know, collagen came on the scene about five       years ago, and it really filled the gap that needed to be filled. There       are a number of people who develop urinary incontinence who have a       well-supported bladder neck so surgical approaches will not work for them.       In fact, their problem is primary urethral dysfunction. It used to be       called "urethral insufficiency," now we call it "intrinsic       sphincteric deficiency." Something's wrong with the sphincteric       mechanism, and the way we diagnose these people is to measure urethral       pressure or leak point pressure - two urodynamic tests to determine       whether or not they have this problem. If they have that combined with no       real anatomic descent of the bladder neck, they're candidates for       collagen."
       
       

 "In       your lecture, you also talked about some of the issues with slings. What       are appropriate patients for sling procedures?"
       
       

       "A sling operation works best on a person who has intrinsic sphincter       deficiency but a lot of hypermobility because the sling combines       increasing urethral outflow resistance with elevating the bladder neck,       where as collagen just helps to increase the outflow resistance by       injection under the mucosa of the urethra at about the level of the       bladder neck or even further down."
       
       

 "One       of the things that we try to do at IMET is to run some very high level       educational courses with a lot of hands on experience for our physicians.       I know you're running a course in a couple of weeks in June, in New York.       Why don't you tell the audience a little bit about that course."
       
       

       "We've tried to get some of the leading experts in urogynecology, so       there'll be Alfred Bent, who's at the Greater Baltimore Medical Center -       he's written a couple of textbooks actually, and Dr. David Staskin, a       urologist. So we have a blend of gynecologists - Dr. Bent and myself, and       urologists - Dr. Staskin and Dr. Whitmore. What we hope to do is give a       real good scientific basis for incontinence and pelvic floor prolapse with       a lot of practical hands on experience. That will include a number of       laboratories rotating through different stations, urodynamics, some of the       newer technologies, surgical technologies, and it's potentially going to       be a great program. I'm very enthusiastic about it as you know, and I       think that we'll have a very successful program, and hopefully, the       participants will take away something they can use in their       practices."
       
       

 "One       last thing, you're including some musical expertise in this conference       too. Why don't you just tell us a little about that."
       
       

       "Of course, any conference needs some entertainment, and I have been       a professional jazz musician for most of my life, longer than I've been a       physician - so we put the program together called, "Jazz Greats of       New York." I have Ray Gomez on the base - who has played with Benny       Goodman, Jerry Mulligan, Miles Davis - he's one of the real "working-est"       base players in New York. I have Elliott Zigman on the drums - who's also       played with Bill Evans who did some amazing work after he left Miles, and       I have an excellent piano player. And there are two physicians up front       playing the horns, and I just don't play with doctors because they're       doctors - they've got to be good, and Dr. Morantz is a fantastic alto sax       player. We're going to do tunes that represent New York as the jazz       capital of the world."
       
       

       "That's great - we're looking forward to it, and thank you very much       for participating in our educational program here at IMET."
       
       

From ACOG - Philadelphia, Pennsylvania - May, 1999

Collagen injection for urinary incontinence

 "I'm       Jeff Levy, and I'm the Director of Medical Education for IMET which is       Innovations in Medical Education and Training. We run several conferences       and educational programs. Tim McKinny, who is sitting on my right, has       been involved in many of those programs and is at the University of       Medicine and Dentistry in New Jersey, and he has an expertise in       urogynecology. He's had tremendous experience with multiple types of       procedures in one of the world's largest experiences in laparoscopic Burch       procedures - and especially using mesh, but is now started working with a       new procedure called the "TVT." I'd like Tim to talk about that       procedure a little bit, and tell us why he uses it."
       
       

"Thanks       a lot, Jeff. It's kind of an exciting, innovative procedure that has not       been new to the world but it's new to this country. It's been used since       about 1984 in Europe, and particularly over the last three to four years       heavily. There's been over 14,000 of these procedures done over in Europe,       which has been followed very carefully and studied very carefully by Dr.       Ulmstun. The results is three-year data which has been very scrutinized as       86% total cure, with another 11% tremendously improved - for about a 97%       success rate which rivals most procedures. The beauty of this is that it       is a procedure that can be done under a local anesthesia in a rather rapid       sequence with these kind of results. It is done so that the patients       themselves can participate in the surgery and actually give us the input       for when we have completed the procedure and gotten them dry. So during       the procedure, once we get the tape in the right position, we're able to       have the patient cough, sneeze, and do their normal provocative maneuvers.       When they end up losing the urine, we tighten up the tape until we stop       seeing them leak from the urine - at that point, we end the procedure. In       that way we can actually customize the procedure to the patient, not       customize the patient to what we're doing, which is a tremendous       improvement. The other design difference is most of the procedures for       incontinence have all been designed around supportive measures with the       urethra-vesico junction. This is a supportive procedure for the       mid-urethra, which physiologically is where most of the urethral closure       pressure occurs in a normal patient. In fact, post-operatively, if we look       at this, we're not changing the physiology at all of the urethra at rest,       we actually augment the urethra and the maximal urethral closure pressure       during stress situations, so pressure transmission tests will show a       tremendous uplifting of the pressure, and therefore, causes us to have the       incontinence procedure done."
       
       

       "Tim, you have the device here. Can you explain to us what it is and       how you use it?"
       
       

"The       device involves a disposable portion which involves two trocars that are       connected by way of the actual tension free tape, which consists of       Prolene mesh, as well as a covering over it of a plastic sheathing that is       perforated or separated in the middle, and it kind of overlies itself. The       reason why you need to have this plastic sheathing is so that it can slide       through the tissue easily. Once you've exposed the mesh, it's almost like       Velcro, it sticks to everything. That's why when you end up finishing the       procedure - after you get the sling in the right place and the right       tension - you release the cellophane off the outside of it. Now you've got       the sling underneath it, and you don't have to sew it in place because it       sticks that well. The other device to introduce it - attaches onto the       tail end and gives you a handle to be able to give you some fulcrum and       elevation ability, and allows you some distance away from your trocars to       slide it right underneath the pubic bone and out."
       
       

 "The       sling procedures are generally done by urogynecologists, do you feel that       general gynecologists can do this procedure?"
       
       

"I       think that people with proper training and proper abilities to understand       the complexities of incontinence, and who have an interest in incontinent       patients and not just trying to do the procedure, can absolutely do this.       It doesn't take a tremendous training aspect to be able to do this. You       need to be able to assure that you don't do any harm to the patient so you       have to have cystoscopy privileges to be able to make sure that this has       not done any harm. You also need to do appropriate work-ups for the       patient so you don't miss any underlying disease states because       incontinence is a symptom for underlying reasons that include things such       as cancer, neurological reasons - multiple sclerosis, so we don't want to       miss those little early key off to other diseases. As long as we don't       miss those, I think anybody can take care of this."
       
       

 "Now       do you have any pearls or suggestions of how you would select patients for       this procedure?"
       
       

"Originally,       I started off with utilizing this procedure on the worst of my worst       population, by that I mean the worst candidates for surgery. I had a       350-pound lady with a two pack per day smoke history, couldn't even lay       flat, that I ended up doing a procedure on times eight, eight other       surgical procedures ! She had been wet since 1985, and I performed this       procedure on her. My selection process at first was intrinsic sphincter       deficiency, the classic sling usage. Over in Europe, they use this as a       primary procedure for incontinence. Indeed, it's probably because of the       low mobility to it; it is probably a good choice for a primary procedure       especially with the data that's coming in. Although not long, long term       data, it's getting to be rather compulsive as far as the actual findings       and with the minimum invasion to it, with the shortness of time involved       in the O.R. which everybody is concerned over - cost containment and O.R.       time equals money. The average time for our study in the United States,       which is a virgin study over the last six months, we looked into the first       ninety-five patients, and we found that even our time in the initial       findings were less than thirty minutes - anything from sixteen to about       forty some odd minutes for the procedure. So it's very exciting, and I       wish I'd have come up with the design."
       
       

       "We're going to have several courses at IMET that are going to be       featuring some of the issues around TVT. Tim will be involved in those       courses so we look forward to some of the developments, and we look       forward to some of the long term data in the United States."
       
       

Jeff Levy, MD

Articles

MedCases

Incontinence: What You Should Look For In Finding A Doctor For Treatment

Osteoporosis Screening Center

Collagen injection for urinary incontinence

TVT Procedure for Stress Incontinence