In Touch Newsletter - April 2016

D epartment

of

M edicine

Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d D i s cove ry w ith H um anis m in Me dicine

Vol. 5, Issue 2: Apr. 2016

Quality Measures I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.

– The Hippocratic Oath Analysis of quality measures is a contemporary innovation that helps physicians fulfill the ancient covenant they have with their patients: to follow the regimen that will benefit them. Given the blizzard of information available today, knowing which regimen will

patient, our focus should be on how well we achieve that goal, and our

best benefit the patient can be challenging. Quality as measured

data and compensation should reflect that. Of course, we will need to

through process and outcome measures is the foundation for best

be vigilant for the inevitable unintended consequences of change and

practice recommendations. They are also the criteria used for health

be prepared to modify practices and how we measure quality as new

care compensation, as we transition from keeping track of processes

knowledge becomes available. We will also need to find ways to link

to monitoring outcomes. While hospitals have been operating in a

quality and process measures to other contributors to health, such

“pay for performance” model for several years, physicians will soon

as personal motivation, treatment compliance, resources, and social

be under the same model. According to Dr. Inga Himelright, Chief

determinants of health.

Quality Officer for UHS, this transition will ultimately foster alignment

Dr. Juli Williams, Medical Director of the UT Internal Medicine

between physicians and other providers to ensure the best possible

Center, says that Graduate School of Medicine personnel pull up

quality health care for patients.

data on tests like mammograms, colonoscopies, and hemoglobin A1C

Dr. Himelright explained that the focus on quality measures is the

levels for diabetics, to analyze how often these are checked, as well

right step on the journey to an optimal health care system. Since the

as what the results were. “We are also tracking smoking cessation

ultimate goal of every health care encounter is enhanced health for the

continued on page 2

Points of View

get an additional fellow for a total of seven fellows in cardiology.

This fellowship provides an additional year of cardiology training

On behalf of all the members of the

in interventional procedures, such as balloon angioplasty and

Department of Medicine, I would like to

placement of stents in patients with coronary artery disease.

share our excitement about starting two

Fellows are trainees who have completed specialty training (e.g.

new fellowships, namely pulmonary and

in medicine) or super-specialty training (e.g. in cardiology). Thus,

critical care and interventional cardiology,

fellows are already fully licensed physicians and function at a junior

in the department beginning in July

consultant level. They acquire in-depth knowledge of their discipline

2016. The Department of Medicine has

during their training so that they are able to serve as independent

been striving to offer more fellowships.

Rajiv Dhand, MD, Chair

consultants at the conclusion of their training. Fellows are an

In particular, we have actively pursued a

excellent resource for training residents and medical students and

critical care medicine fellowship for the

for promoting effective patient care. As part of their training, they

past several years. With the addition of critical care medicine to our

are also expected to participate in research and other scholarly

current pulmonary fellowship, we will provide an additional year of

activities that bring recognition and acclaim to the department. The

training and recruit two additional fellows for a total of six fellows.

addition of fellows also helps us to expand the pool of applicants who

We will also be starting an interventional cardiology fellowship and 1

continued on page 2

Advance Care Planning Documenting our wishes for health care is challenging for all of us but even more difficult for people who lack a stable place to call home. Since 2012, the University of Tennessee Medical Center’s Ethics Service, University of Tennessee’s College of Nursing, and Knoxville’s Volunteer Ministry Center (VMC) have collaborated to offer twice-yearly events that assist neighbors at the VMC who want to express their medical preferences. “Research suggests that people who are homeless welcome the opportunity to create advance directives,” notes Dr. Annette Mendola, Director of Clinical Ethics at UT Medical Center, Knoxville. Trained nursing students assist those who want help writing an advance directive and send copies to be put on file at area hospitals, if requested. Nursing professors Dr. Polly McArthur and Dr. Sandy Mixer say the project prepares future nurses to understand life from the perspective of homeless persons, as well as learning how to facilitate advance care plans.

“The combination of educational resources and support has contributed to the sustainability of the project,” says Dr. McArthur.

The project was the subject of a recent paper in Nursing Ethics.

Free Medical Clinic Monday afternoon from noon to 6 PM is a busy time at the Magnolia Avenue Methodist church. Since 2013, an all-volunteer staff has operated the East Knox Free Medical Clinic there, providing free health care and services to area residents.

Volunteer physician Dr. Janet Purkey notes that hidden costs in obtaining health care can add up quickly, creating barriers even for those who have health insurance. The clinic fills a need in the community, and there are plans to add evening and weekend hours in the future. “We are always looking for volunteers,” said Dr. Purkey. “Whether you want to come regularly or just once, help of all kinds is always appreciated.”

Quality Measures

continued from page 1

counseling in our clinic and streamlining how we manage anticoagulation,” she said.

“When we started tracking how often diabetic patients received the recommended foot and eye exams, we found they were not getting screened for diabetic retinopathy as often as they should,” said Dr. Brock Mitchell, chief resident for ambulatory medicine. “Once we found this, we renewed efforts to get these screenings done, which resulted in cases of diabetic retinopathy being caught and treated.” Each year, residents in the clinic select a new quality improvement project on which to focus. This year, the focus was on how effectively the electronic medical record (EMR) is used. Dr. Mitchell believes the EMR is not yet being used to its full potential but that it is the single best tool for improving

Congratulations on the great match this year!

We wish to thank everyone who worked so hard on this very successful effort.

quality care in the clinic. “We have work to do to fully utilize the EMR,” he said. But with the resources available today, “it’s never been easier to practice good medicine.”

Points of View continued from page 1 are interested in residency training in our department so that they can pursue further specialty training of their choice without having to move to another institution. Because many fellows continue to practice in the area after graduation, we will also help to meet critical needs for specialty trained physicians in and around Knoxville.

Starting new fellowships helps to grow and strengthen the training programs in the department and further enhances our reputation as a regional academic medical center. Please join me in felicitating our colleagues in pulmonary and critical care medicine and cardiology for bringing these new opportunities to our department.

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Resident Highlight: Nathan Smith, MD, PGY-3

By Niva Misra-Sammons, MD As a medical student rotation from UT, Memphis, Nathan Smith recognized many of the great features of the Department of Medicine. He picked UT, Knoxville, for residency for several reasons, including the opportunity to be involved in committees and activities that would make a difference in the lives of residents and faculty.

Nathan stated that his interest in service came from the way he was raised. His father has always said that “if something needs to be changed, you should take the initiative and do it.”

Some of his first interests in service stemmed from the time between college and medical school during which he taught Spanish to 7th and 8th graders and also served as a football coach to middle and high schoolers. He said these experiences taught him about working hard to accomplish goals. His involvement in the residents’ continuity clinic led him to take an interest in the LEAN event at the hospital. There he learned how to model the flow of patients to go more smoothly. Nathan also worked with the marketing committee in clinic to create a new clinic brochure. In addition to his roles in the clinic, he serves as the graduate school resident representative to the UT Board of Visitors, a position which enables him to assist in making decisions to better the graduate school.

His biggest role during his third year has been to serve as chief resident of the ICU. He has worked with the hospital to improve the ICU schedule by changing it to 12-hour shifts. He said that his goals prior to graduation include helping the new chiefs continue to work on and solidify the ICU schedule. Nathan will be taking a position with UT Hospitalists in the fall and has already begun working on their Operations Committee to assist with workflow for patient admissions.

Nathan feels that coming to UT, Knoxville, for residency has been rewarding because he felt “welcomed to take part in committees and activities and was actually a voice that was listened to.” He stated when he started residency it was his “personal goal to make the residency better for everyone,” and he has continued to strive to do this.

How Philanthropy Plays a Role in Advancing the Graduate School’s Mission By: Michelle Geller The University of Tennessee Graduate School of Medicine prides itself on providing “comprehensive and state-of-the-art education for our students, the region’s health care professionals, and the health science professionals who educate them at The University of Tennessee Medical Center and its affiliated sites.” The graduate school does this by offering ample opportunities for residents, fellows, and students to learn exemplary patient care from physician scholars who are deeply committed to educating the next generation of health care providers.

Keenly aware of the organization’s mission and core responsibilities, the Development Office at the University of Tennessee Medical Center and Graduate School of Medicine builds and maintains relationships with internal and external stakeholders who are passionate about the organization. These stakeholders understand the important role the medical center and graduate school play in the community and, often times, make philanthropic investments that align directly with not only the Graduate School’s mission but also with its vision for the future.

One such example of this is the graduate school’s emphasis on establishing an endowed chair in the Department of Medicine. Once fully funded, the endowed chair will be used to: • Attract new faculty members who are interested in engaging in cutting edge research that will not only attract grant funding but also lead to medical discoveries that can save lives and improve health outcomes; • Recruit the best and brightest residents and medical students by creating new fellowship and training programs; and, • Enhance the reputation of the Department of Medicine and the UT Graduate School of Medicine as a leader in medical education and research.

In recognition of Dr. Wahid T. Hanna’s exemplary service to The University of Tennessee Medical Center and Graduate School of Medicine, the endowed chair of medicine will be named in Dr. Hanna’s honor. The Hanna Chair will serve as the first-ever endowed chair in the Department of Medicine, will exist in perpetuity and will, undoubtedly, advance the graduate school’s mission of education, discovery, and research.

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CME Opportunities—Mark Your Calendars!

• The 4th Annual Medicine CME Conference, Practice Updates for the Primary Care Physician, offering 11 hours of CME credit, will be held April 29-30, 2016, at the Holiday Inn World’s Fair Site. We hope you can join us for this informative event.

• Weekly Cardiology Conferences, which are now available for .75 hour CME credit.

• Medicine Grand Rounds, which are generally held on the 2nd and 4th Tuesdays of each month for 1.00 hour CME credit.

Awards And Honors We are pleased to announce that the Grand Rounds presentation on Tuesday, June 14, 2016 will be the Second Annual Department of Medicine Research Awards for Residents and Fellows.

We hope you will join us for this fun and informative event. The Audience will vote and prizes will be given at the event.

New Faculty

The Department of Medicine wishes to welcome three new additions to our faculty. Dr. Antony Charles practices with University Cancer Specialists. He completed his hematology/oncology fellowship at the Mayo Clinic in Jacksonville, FL, where he distinguished himself for his medical knowledge and compassion. Dr. George Torres practices with University Pulmonary and Critical Care. He attended his pulmonary Antony Charles, MD George Torres MD Megumi Vogt MD diseases fellowship at Damas Hospital, Ponce Puerto Rico. He received several military honors in the US Air Force and is a skilled and compassionate physician.

Dr. Megumi Vogt practices with the Knoxville Neurology Clinic. She completed her neurology residency at Wilford Hall Medical Center, San Antonio, TX. Dr. Vogt brings clinical acumen and talent as an educator and administrator.

We are very lucky to add these talented faculty members to our teaching staff.

Guest Speakers, Department of Medicine Grand Rounds

February 23, 2016 Douglas Jacoby, MD, FACC, FNLA, MD, Associate Professor of Clinical Medicine, Perelman School of Medicine at the University of Pennsylvania and Director of Penn Cardiology Preventive Care, Philadelphia Heart Institute “PCSK9 Inhibitors: Where do they fit in the treatment of dyslipidemia?”

Presentations, Publications, Awards Department of Medicine faculty, residents, and fellows share their knowledge and experience by publishing and presenting across the world. For a list of our most recent accomplishments, visit http://gsm.utmck.edu/internalmed/scholars.cfm.

Thank You For Your Support For information about philanthropic giving to the UT Graduate School of Medicine, Department of Medicine, please contact the Development Office at 865-305-6611 or development@utmck.edu.

If you would like more information about any of the topics in this issue of In Touch, please contact the Department of Medicine at 865-305-9340 or visit http://gsm.utmck.edu/internalmed/main.cfm.

We look forward to your input. Thank you.

Stay In Touch!

Alumni, please update your contact information by completing the simple form at http://gsm.utmck.edu/internalmed/alumni.cfm or by calling the Department of Medicine at 865-305-9340. Thank you!

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In Touch Vol. 5, Issue 2: April 2016

Publishers James Neutens, PhD, Dean Rajiv Dhand, MD, Chair, Department of Medicine and Associate Dean of Clinical Affairs Editor Annette Mendola, PhD Administrative Director Susan Burchfield, CAP-OM Contributors Susan Burchfield Rajiv Dhand, MD Kandi Hodges Annette Mendola, PhD Niva Misra, MD Jane Obenour Design J Squared Graphics In Touch is produced by the University of Tennessee Graduate School of Medicine, Department of Medicine.

The mission of the newsletter is to build pride in the Department of Medicine by communicating the accessible, collaborative and human aspects of the department while highlighting pertinent achievements and activities.

Contact Us In Touch University of Tennessee Graduate School of Medicine Department of Medicine 1924 Alcoa Highway, U-114 Knoxville, TN 37920 Telephone: 865-305-9340 E-mail: InTouchNewsletter@utmck.edu Web: http://gsm.utmck. edu/internalmed/main.cfm The University of Tennessee is an EEO/AA/Title VI/ Title IX/Section 504/ADA/ ADEA institution in the provision of its education and employment programs and services.