The University of Tennessee Graduate School of Medicine 2012 Dean's Report

education

discovery

Learners at the UT Graduate School of Medicine are immersed in educational experiences, but they aren’t just learning how to provide excellent patient care.

Although our research programs differ greatly, one element is prominent in all: A vast sense of curiosity coupled with a drive to find answers for man’s maladies.

Physicians and dentists at the UT Graduate School of Medicine approach healing in innovative ways, bringing about healing of the mind and body.

Inside: • Continuing education offerings expanded in 2011-2012 to reach more physicians than ever.

• Simulation proves there’s more to educating medical professionals than lecture.

• An innovative series helps young physicians understand the business side of medicine.

• Never underestimate the power of listening.

Inside: • Using advanced technology of PET/CT, teams tackle heart disease, cancers, diabetes.

• Physician scientists collaborate with the University of Tennessee.

• A team of researchers is helping our smallest patients survive and thrive.

Inside: • The healing benefits of the human-animal bond are experienced in Preston Medical Library.

• Family Medicine employs a new modality of patient care in a new facility.

• Veterans and patients with special needs receive compassionate care from dentistry professionals.

Immersion and expression.

Curiosity and collaboration.

Healing Patriots and patients.

Also inside: Economic Impact and Alumni News http://gsm.utmck.edu

Serving Our Communities Educating: 2011-2012 • Residency and fellowship programs: 19

Caring: 2011-2012

• Total residents and fellows: 192

• Patient visits in Family Medicine, Genetics Center, Internal Medicine and Obstetrics/Gynecology: 36,137

• Residents who chose to continue their education in fellowship programs: 20

• States served: 24

• Residents and fellows who entered medical and dental practice: 30

• Tennessee counties served: 59%

Helping: 2011-2012

Alumni Impact: A History

More than 900 Graduate School of Medicine physician and dentist graduates have chosen to serve in Tennessee, 715 in East Tennessee, alone: Cumulative Impact on East Tennessee of Graduates of the UT Graduate School of Medicine

• Residents and fellows who stayed in Tennessee to practice: 43%

County

• M3 and M4 medical students: 128

Anderson ...................21 Blount ........................72 Campbell ...................4 Claiborne ..................5 Cocke .........................1 Cumberland ..............6 Fentress ......................4 Grainger ....................2 Hamblen ...................10 Hancock ....................1 Jefferson .....................14 Knox ..........................516 Loudon ......................13 McMinn ....................14 Monroe ......................1 Morgan ......................1 Roane ........................9 Scott ...........................2 Sevier .........................18 Union ........................1

• Physician-assistant students in interprofessional education: 35 • High school juniors and seniors and college freshmen in the Medical Explorations summer program: 38 • Visits to the UT Center for Advanced Medical Simulation in 2011: 2,018 • Faculty, resident and fellow presentations and publications: 255

Exploring: 2011-2012

• Clinical trials providing access to new medicines and devices: 296 • Residents and fellows who partici pated in supervised research: 52%

Assistant Professor Valerie Berthelier, Ph.D., [pictured] director, Conformational Diseases and Therapeutics Research, received a grant totaling $200,000 from the Alpha-1 Foundation to investigate treatments for alpha-1 antitrypsin deficiency. This research is conducted in collaboration with UT and the Spallation Neutron Source/Oak Ridge National Laboratory.

Physicians, residents, fellows, nurses and others gave generously of their time and expertise to fulfill needs for healthcare services locally and across the world. Trauma and Critical Care surgeons Blaine Enderson, M.D., [center] and Lou Smith, M.D., [left] visited Kurdistan in Iraq to assist in training physicians in blunt trauma and setting up trauma systems.

This institution’s legacy of support also includes helping those in our own region. Members of the Department of Family Medicine provided food and clothing and raised funds for local non-profits through its Community Outreach committee. Dentistry faculty and residents provided emergency dental care through Trinity Health Ministries throughout the world.

Facebook: UTGSM Twitter: utgsm

Number of Physicians/Dentists

The Point: Through innovative educational programs, the legacy of the UT Graduate School of Medicine means enhanced access to quality medical and dental care and health information as well as medical breakthroughs in all fronts of research for our community and world.

The Dean’s Report is published by the University of Tennessee Graduate School of Medicine to share news of education, discovery and healing with friends and alumni. The UT Graduate School of Medicine is a regional campus of the UT Health Science Center and with clinical partner, University of Tennessee Medical Center, forms the region’s only academic medical center. For comments, contact DeansReport@ utmck.edu or call 865-305-9290. Editorial Committee: James J. Neutens, Ph.D., FASHA, Dean; Eddie Moore, M.D., Associate Dean; Amanda F. Johnson, APR, Editor. PAN: R08-6350-001-003-13

Points of view

Dear Colleagues, Friends & Alumni, In this inaugural issue of the Dean’s Report, I hope to share with you the academic, clinical and research advancements of an institution that for some of you is an old friend and for others, a new acquaintance.

The Graduate School of Medicine has been in existence for more than 50 years, and in our history, we’ve educated more than 2,100 new doctors and dentists.

Many stay in the state of Tennessee to practice medicine—50%, in fact. Of those, 93% are in primary care—which is good news for our nearby neighbors, and 50% choose to practice medicine or dentistry across the country and world.

That’s good news for everyone.

We educate students, residents, fellows, as well as practicing physicians every day. We experienced a successful match in 2011-2012. A total of 52 resident positions were offered through the National Resident Matching program, reaching a total of 192 residents and fellows for the year. We welcome our new learners.

An informative series, Fellows Research “Bootcamp” teaches new fellows basic research design and statistics. In its

fourth year, the course takes fellows through the entire research process, from formulating ideas to presenting abstracts.

As a direct result of this course, our Office of Research, Education and Development created teaching modules that have been incorporated into the curricula of the residency training programs.

Educating practicing physicians is accomplished through an active continuing education program and at the new UT Center for Advanced Medical Simulation. This 6,500-squarefoot facility opened in February 2012 for the region’s medical professionals and provides high fidelity technology for advanced team training. Read more inside.

I was pleased to welcome three new chairs in 2011-2012: Rajiv Dhand, M.D., Medicine; Lisa Duncan, M.D., Pathology; and O. Lee Wilson, D.M.D., who was named chair of our new Department of Dentistry. Our chairs are leaders in ensuring the Graduate School of Medicine provides quality patient care and innovative research and education.

Their efforts do not go unnoticed by our Board of Visitors.

Three years ago, we created the Board of Visitors as a community advisory group. The primary purposes of the board are to assist in strategic planning and implementation of goals; conduct community outreach; and garner financial support for education, research and clinical care.

I am honored that Dr. Joe Johnson, University of Tennessee President Emeritus, agreed to chair this extraordinary board, who are all active in the community and their own businesses but volunteer their time and talent to support the Graduate School of Medicine.

I extend my thanks to current and former members of the Board of Visitors for their service: Dr. Joe Johnson Mr. Sam Anderson Mr. Bert Bertelkamp Mr. Patrick Birmingham Dr. Randal Dabbs Ms. Deborah Diddle Mr. Mike Edwards Dr. N. Lynn Ferguson Mr. Bruce Hartmann Dr. Mackenzie Hay

Dr. Leonard Hines Mr. Eddie Jessup Mr. Dale Keasling Mr. Doug Kennedy Ms. Anne McKinney Mr. David Moon Dr. Joe Rainey Mr. Frank Rothermel Mr. Dick Westerling

Our impact on the community also is deepened by our partnership with The University of Tennessee Medical Center, creating the region’s only academic medical center. In 20112012, the University of Tennessee Medical Center earned the American Nurses Credentialing Center Magnet Designation and was named in U.S. News and World Report as one of just two hospitals in Tennessee and the only one in Knoxville to be nationally ranked.

Based on patient-care performance, U.S. News and World Report ranked the medical center second in the state behind Vanderbilt Medical Center, and two of its specialties, gynecology and pulmonology, were ranked 31st and 34th, respectively, in the nation.

Of all of our accomplishments, perhaps the one I am most proud of is our perseverance, integrity and commitment to quality in a time of change.

Jim Neutens, Ph.D., Dean

alumni

Association Advances Institutional Goals The impact of the UT College of Medicine and its three campuses in Memphis, Chattanooga and the Graduate School of Medicine in Knoxville is evident through the College of Medicine alumni, who comprise more than 40% of Tennessee physicians. Many of these alumni are part of the College of Medicine Alumni Association, which supports and advances the goals of the college.

The governing body of the association, the Alumni Council, is comprised of 60 alumni representing all areas of Tennessee. Paul Huffstutter, M.D., [pictured] co-director of the Center for Advanced Medical Simulation at the Graduate School of Medicine, is president of the Alumni Council. “The Alumni Association supports and improves our educational institutions and locally raises awareness of the role of the Graduate School of Medicine and the Chattanooga campus in medical care and education in Tennessee,” said Huffstutter.

Other council members in the East Tennessee area include Leonard Hines, M.D., [pictured] co-director of the Center for Advanced Medical Simulation; Mark

Gaylord, M.D.; Molly Peeler, M.D.; John Little, M.D.; David Hill, M.D.; William Willford, M.D.; Joe Black, M.D.; James Morris, M.D.; Mary Hammock, M.D.; and Michael Greer, M.D. Membership in the College of Medicine Alumni Association is open to graduates of the UT College of Medicine; physicians who served for one year or more in a training program at any of the College of Medicine campuses; present and former faculty members of the College of Medicine; and others.

Learn: http://uthscalumni.com.

Alumni Influence In its 50-year history, the Graduate School of Medicine has graduated about 2,100 new physicians and dentists, and of those, more than 1,000 chose to practice medicine in close to 20 counties in Tennessee. Further, about 90% of all the graduates from the Graduate School of Medicine who chose to stay in Tennessee practice in primary care specialties of family medicine and internal medicine, filling dire shortages of these specialists.

Saving Catarina John Little, M.D., (UTHSC ’92) and Rick Glover, M.D., (UTHSC ’89) joined forces this year to save the life of 11-yearold Catarina, who was suffering from a large malignant facial tumor.

Little, a pediatric otolaryngologist at East Tennessee Children’s Hospital, led a remarkable collaboration of Children’s Hospital, University of Tennessee Medical Center and UT Graduate School of Medicine to assemble a team of a dozen specialists to try to save Catarina, a native of Belize, Central America.

In April 2012, Catarina [pictured before surgery and after with friend, Sarah] underwent more than 33 hours of surgery at UT Medical Center, and today, she lives with the Glovers while completing 22 rounds of chemotherapy.

“She’s a strong and resilient little girl,” Little said. To date, no recurrence of cancer has been found.

The Point Through its active Alumni Association and alumni who practice in Tennessee, the Graduate School of Medicine continues to positively influence healthcare across the state.

Education

Continuing Education Expands Through continuing education activities in academic year 2011-2012, the Graduate School of Medicine educated close to 3,400 physicians and other medical professionals from 39 states and three countries. Activities included continuing medical and dental education (CMDE) conferences, series activities and web-based training. During that time period, the institution offered a total of 28 CMDE activities, including four new tumor boards, an overall increase of 25% from 2010-2011. To further expand continuing education offerings, the Graduate School of Medicine is collaborating with nursing administration at the University of Tennessee Medical Center to earn accreditation from the American Nurses Credentialing Center.

Learn: www.tennessee.edu/cme

Simulation Center Opens to Educate the Region In February 2012, the Graduate School of Medicine opened its new UT Center for Advanced Medical Simulation, and the center is quickly becoming a regional asset for physicians, nurses, EMTs, dentists and other practicing professionals as well as residents, fellows and students.

Simulation immerses learners in clinical scenarios to improve patient care.

A 6,500-square-foot facility, the center offers a skills laboratory, mock operating and intensive care rooms, delivery room, dental area, endoscopy and endovascular suites and other specialty areas. Practicing professionals enhance skills they put into practice immediately for the benefit of patient care and safety, and educational programs reach residents, fellows and students.

Learn: http://gsm.utmck.edu/simulation/main.cfm

Residents Learn Business Residents and fellows learn more than compassionate medicine using today’s best technologies. At the Graduate School of Medicine, they also learn how to manage careers in private practice, hospital or academic settings. An innovative series of educational sessions offers topics including billing and collections; changes in healthcare management; credentialing; compensation models; debt management and more. Offered through Graduate Medical and Dental Education, the monthly series is in its fourth year.

“This course gives the participants the business savvy for private practice and a keen awareness of the constellation of investment resources they need as busy practitioners,” said William Metheny, Ph.D., Assistant Dean. Experts identified from the business community volunteer their time to lead the sessions.

Learn: http://gsm.utmck.edu/education/main.cfm

Converging Science and Expression East meets West in two new programs.

Ronald Lands, M.D., Associate Professor, employed a lifelong appreciation of writing and literature in a Narrative Medicine elective for medical students and residents. Narrative medicine is a philosophy that leads physicians to listen to their patients’ stories. “When you listen to a patient’s story, you hear clues about their disease,” Lands said.

“As physicians, we have an obligation to listen.” Another new educational offering is Literary Rounds. Led by Lands and Poet-in-Residence at Preston Medical Library, Donna Doyle, the rounds offer attendees a way to learn expression using medically-themed literature and poetry to support their ability to treat the whole person. The rounds also encourage improved communication skills.

Learn: http://gsm.utmck.edu/internalmed/ curriculum/areas/narrative.cfm

The Point: The Graduate School of Medicine is using innovation, technology and engagement to prepare today’s medical professionals to provide compassionate patient care.

discovery

Teams Tackle Heart Disease, Cancers

Collaborations Yield Innovative Discovery

Research Brings Safety to Small Patients

Researchers in the Molecular Imaging and Translational Research Program are studying similarities of human and animal health. One team, led by Amy LeBlanc, D.V.M., UT College of Veterinary Medicine, [pictured] is investigating a novel cardiac PET tracer, which will benefit future studies of cardiac metabolism in humans with congestive heart failure.

The team, working with Oral and Maxillofacial Surgery, also was granted an exploratory Investigational New Drug application to study preoperative imaging characteristics of head and neck cancer patients utilizing PET/CT. To target melanoma tumors, researchers identified new compounds that can image tumors and deliver drugs and radioactive molecules to fight the disease. Jonathan Wall, Ph.D., [pictured] and team founded a company, Solex LLC, that is seeking funding from the National Institutes of Health and industry partners. They hope to perform clinical trials for patients with melanoma or type 2 diabetes.

Progress in research is often a result of the confluence of heterogeneous ideas from diverse sources collaborating to solve a problem. Physician scientists at the Graduate School of Medicine and scientists at the University of Tennessee, Knoxville, share research efforts that lead to novel discovery. Together, we are

Research being conducted by Christopher P. Stephens, Ph.D., research assistant professor, Vichien Lorch, M.D., and Mark Gaylord, M.D., is aiding infants in neonatal intensive care. The work is in collaboration with the Department of Mechanical Engineering at the University of Houston and supported through funding from the University of Tennessee. The research includes development of a new soft hydrated coating that should improve the seal of the cannula in infants’ nostrils and decrease the potential for irritation and a new device that will interface with infants’ apnea monitors to gently stimulate premature infants with breathing difficulties. Also under investigation are a computer-diagnostic stethoscope and a breathing-assist chest plate.

Learn: http://gsm.utmck.edu/research

• Studying the effect of the supplement Zyflamend™ on prostate cancer • Monitoring the effects of exercise on pregnant women with gestational diabetes • Looking at the food cravings of obese patients undergoing interventions including bariatric surgery • Investigating communication of patient information in the critical care unit.

Other collaborative efforts among scientists at the two institutions are featured in this issue of the Dean’s Report. They have kept a robust flow of outstanding research enabling the Graduate School of Medicine to establish itself as a noteworthy research center.

Learn: http://gsm.utmck.edu/research

Learn: http://gsm.utmck.edu/research

The Point: Medical research leads to answers.

Researchers at the UT Graduate School of Medicine explore healthcare using regional, collaborative and technological resources—and a vast sense of curiosity—to derive answers for us all.

Healing

A Special Place for Special Patients Dental work sometimes can be frightening or confusing for those with mental disorders. A team in the Department of Dentistry understand this and offer a solution. Through a unique arrangement, team members care for patients with special needs in operating rooms at University of Tennessee Medical Center.

Anesthesiologists administer general anesthesia, so all dental work can be completed with no emotional trauma for the patient. For those needing oral surgery or other procedures, physicians from the departments of Oral and Maxillofacial Surgery and Family Medicine also are on hand. This compassionate approach to care has been offered for more than 25 years by the Department of Dentistry, and in 20112012, more than 150 patients were served.

Veterans also hold a special distinction with the dental professionals, who cared for more than 250 veterans last year.

Now in its tenth year, this program has accommodated veterans from World War II, Vietnam, Korea, Iraq and others. “Certainly we benefit by being able to gain experience with unique patient cases,” said O. Lee Wilson, D.M.D., Chair, [pictured with LTC (Ret.) Kenneth Allred and Karen Sowers, Ph.D.] “but we believe we also help people who would have difficulty finding care otherwise. Everyone here takes to heart providing this very special service.”

Learn: http://gsm.utmck.edu/dentistry/main.cfm

New Family Medicine Facility Puts Patients at the Center A new building is much more than bricks and mortar for the Department of Family Medicine. It encourages a patient-centered approach to teaching techniques and means improved patient care and better prepared physicians for the region. Family Medicine has provided care in East Tennessee for more than 40 years and had grown to manage a patient base of about 21,000 in its 20,000-square-foot facility.

The renovated and expanded facility is physically designed to employ the patient-centered medical home model of care, allowing for an additional 7,000 patient visits each year. “This model of care improves patient care by providing more consistency for patients, employing a team approach and enhancing educational offerings for our physicians,” said Gregory Blake, M.D, Chair. They also will have a full spectrum of support services available on site, making their visits more efficient. “This model is ideal for education,” said Amy BargerStevens, M.D., Family Medicine Residency Program Director. “The new facility offers technological and clinical enhancements that improve education, and this model of care teaches continuity of care and provides exposure to a breadth of ambulatory issues that was not possible before.”

Learn: http://gsm.utmck.edu/legacy/campaign.cfm

Wags Bring Healing Studies show that pet ownership can lower blood pressure and cholesterol and increase one-year survival rates after heart attack. Research shows that neurochemicals are released during interaction with companion animals, resulting in lower stress levels, and animals help people cope with chronic conditions and appear to strengthen human resilience. Whether the healing benefits of the human-animal bond are psychological or physiological, they are experienced weekly in Preston Medical Library. Through collaboration with the University of Tennessee College of Veterinary Medicine’s Human-Animal Bond in Tennessee (H.A.B.I.T.) program, a four-legged patron visits the library regularly, and the effects on human patrons is immediate. “The posture of the students relaxes immediately when Nash [pictured] visits,” said Donna Doyle, Poet-in-Residence Preston Medical Library. H.A.B.I.T. service dogs also regularly visit the Cancer Institute at the University of Tennessee Medical Center.

Learn: http//gsm.utmck.edu/med_library/main.cfm

The Point: Physicians and dentists at the UT Graduate School of Medicine provide care through more than 36,000 patient visits each year using the compassion, quality and knowledge associated with an academic medical center environment.

Economic Impact & Financial Report Institution Supports Economy of the Region

The Graduate School of Medicine has statewide and regional impact through direct expenditures, indirect spending, employment impact and tax revenue impact.

According to a recent study conducted for the Graduate School of Medicine, the institution makes a significant impact to the economy of Tennessee through attracting and retaining talent, jobs, investment and growth: • Residents and fellows who are educated at the Graduate School of Medicine and begin practicing medicine in the area represent an economic impact of $34-$45 million annually for the state.

• The economic impact of the institution’s research engine is estimated at $20 million and creates 189 jobs.

• Close to 1,400 full-time jobs in Tennessee are supported directly and indirectly by the institution.

• Total economic impact of the Graduate School of Medicine is more than $108 million for Tennessee and almost $44 million for East Tennessee alone.

By the Numbers

As with all medical schools and regional medical campuses, Graduate School of Medicine support comes from several sources.

•Principal funding comes from the Centers for Medicare and Medicaid Services (CMS), which help underwrite the cost of resident education, but the capping of CMS dollars with the Balanced Budget Act of 1997 is becoming problematic across the nation. Since 1997, medical schools have expanded and new medical schools have opened, resulting in more graduates seeking residencies. Because of the cap, however, the number of available residency positions has remained virtually stagnant.

•TennCare resident education dollars comprise 10% of sources of support for the Graduate School of Medicine, which helps meet the expenses of educating residents and fellows.

UT Graduate School of Medicine Sources of Support: 2011-2012

2% 11% 8% 13%

55%

10%

• Graduate School of Medicine patient care through Family Medicine, Internal Medicine and Obstetrics/Gynecology centers as well as the Genetics Center provides funding, allowing us to meet our mission of healing.

• State appropriations make up slightly more than 11% of total support particularly for medical student education and research efforts.

• Graduate School of Medicine researchers were successful in acquiring grants to support the discovery mission by bringing in 8% of total funding.

Overall, the Graduate School of Medicine is doing very well with successful programs and patient care; however, given the cap on residents and the impending shortage of physicians, philanthropic dollars are needed to increase the size of our programs, making more physicians and dentists available to the community.

Philanthropic Initiatives

The Graduate School of Medicine’s Board of Visitors are working on our behalf with the University of Tennessee Medical Center on five philanthropic initiatives: • Health Information Center • UT Center for Advanced Medical Simulation • Family Medicine Expansion • Neonatal Intensive Care Unit • Cancer Institute The Health Information Center will house Preston Medical Library in the new

Federal Resident Education

55%

TennCare Resident Education

10%

Patient Care

13%

Research Grants

8%

State Appropriations

11%

Other 2%

Heart Hospital making the center readily available to patients, families and the community in addition to our faculty, staff and residents.

The UT Center for Advanced Medical Simulation opened in its new space (6,500 square feet with 2,500 on the horizon) last spring making it available for training of all University of Tennessee Medical Center staff; Graduate School of Medicine faculty, residents and students; and of course healthcare professionals in the community.

Expanding our Family Medicine facility will allow us to use the most advanced teaching techniques and increase the number of patients we serve. This expansion of care is critical, given the shortage of primary care physicians in Tennessee and across the nation.

The Neonatal Intensive Care Unit is starting Phase II of renovation and expansion, so our smallest patients can continue to receive the best medical care.

The Cancer Institute opened in October 2012 and houses outpatient oncology services, education resources and cancer research.

For more information about the philanthropic initiatives, visit http:// gsm.utmck.edu/philanthropy. If you are interested in supporting our goals, please contact us or the Development Office at 865-305-6611, development@utmck.edu.

The Point: In a struggling economy, the UT Graduate School of Medicine continues to educate young doctors and dentists, conduct patient-centered research, provide compassionate patient care and give time and expertise to those in need.