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 Di s c ove ry w ith H um anis m in Me dicine
Vol. 8 Issue 3 July 2019
MisStep, or Step in the Right Direction?
The impact that one’s Step 1 score has on one’s future causes enormous anxiety in medical students. Scores below a particular threshold effectively rule out consideration by certain schools and specialties, and (with some exceptions) students cannot retake a Step exam that they have previously passed. With stakes that high, the time and effort students devote to doing well on the Step 1 exam can be at the expense of participation in classes, as well as their health and relationships. Additionally, the current system appears to result in unintended discrimination against financially less well-off students due to the high cost of additional study prep materials. Dr. Mark Rasnake, Program Director for the Internal Medicine residency, describes himself as ambivalent about the proposal. “On the one hand, standardized tests don’t predict who will be a good resident, or a good doctor,” he notes. However, the Step 1 exam does predict the likelihood that a student will pass the American Board of Internal Medicine (ABIM) exam. The fact that it is objective and nationally-recognized can help some students. “Performing well on Step 1 is a way for students from less well-known schools and international schools to distinguish themselves,” observes Transitional Year Program, Director Dr. Daphne Norwood. With the high volume of applications to residency programs, stellar Step 1 scores allow students from these schools to capture the attention of residency program directors. Changing to a pass/fail reporting system could backfire and result in less diversity, more stress, and more applications to residency programs, which would then have fewer criteria to sort them out. If Step 1 scores are reported as pass/fail, what other criteria could be used to evaluate candidates for residency programs? “In many ways,
The first of the three United States Medical Licensing Examinations (USMLE), known as the Step 1 exam, is taken after the second year of medical school. It was designed as a pass/fail test to ensure that students have adequate knowledge of basic science for the purpose of licensure. However, numeric scores have come to be widely used to screen and rank applicants to residency programs. In March of this year, key stakeholders met to discuss whether to report Step 1 results simply as pass/fail, without disclosing scores. The change is being considered due to concerns that a “Step 1 climate” -- that is, a disproportionate emphasis on the exam -- is interfering with the preclinical learning environment and student well-being.
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Points of View
numbers could be a matter for debate, it is clear that the death rates due to medical errors are unacceptably high. While errors occur in all industries, health care has a much higher error rate compared to other complex enterprises, such as airlines, banking, or courier delivery. In fact, I was shocked to learn that medical errors are now ranked as the third leading cause of death just behind cardiovascular diseases and cancer being the first and second leading causes respectively in the United States! Medical errors may arise from a variety of sources including: failure to diagnose, wrong diagnoses, errors in treatment, failure to provide preventative care, inadequate monitoring, poor follow up treatment, as well as laboratory errors, or equipment failure. However, in my opinion, the most common underlying problem that results in serious medical errors leading to a fatal outcome is a breakdown in communication at multiple levels. Most hospitals, including ours, are making strong efforts to reduce all potential sources of medical errors with a strong emphasis on patient
Physicians strive to do the best for their patients by constantly giving their best to provide high quality, timely, and patient-centered medical care. On most occasions, we are successful in this mission so patients and their families are very grateful for the care they receive. However, in some instances the health care system falls short of providing optimal care for our patients. We in Rajiv Dhand, MD, Chair the medical profession need to be very concerned about the significant error rate in the care we provide. In a widely quoted study, experts at Johns Hopkins analyzed medical death rates in U.S. hospitals over eight years and concluded that medical errors account for more than 250,000 deaths each year. Other studies have also reached similar conclusions. While the exact
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Hematology/Oncology Welcomes New Division Chief The University of Tennessee Medical Center is proud to announce Dr. Radhakrishnan Ramchandren as the new Division Chief of the Hematology and Oncology Division within the Department of Medicine. Dr. Ramchandren comes to UTMC from the Karmanos Cancer Institute in Detroit, Michigan where he helped lead the clinical and research lymphoma program. His primary objective at UTMC is to “bring clinical interest in lymphoma and interest in research to the Medical Center, to engage in clinical trials, and to build the division of hematology and oncology within the Department of Medicine.” Currently, he is active in developing a curriculum and recruiting faculty for the initiation of a hematology/oncology fellowship. He hopes to one day establish a bone marrow transplant service here at UTMC, citing the great need for this in our area. His family will be joining him from Michigan this summer after his children complete their school year. He is eager to show them all the great things Knoxville has to offer!
Internal Medicine Graduates
Transitional Year Graduates
Matthew Allison, MD: Hospitalist for Team Health, Morristown Hamblen Health System, Morristown, TN Leigh Ball, MD: Sleep Medicine Fellowship, Washington University, St. Louis, MO Christopher Hill, MD: Hospitalist at UTMC Clayton Humphrey, DO: Hospitalist at UTMC Christina Kitsos, MD: Hospitalist with United Health Center, Bridgeport, WV Bill Lorson, DO: Cardiovascular Disease Fellowship, University of South Carolina, Columbia, SC Joseph Pendley, DO: Cardiovascular Disease Fellowship, University of Tennessee, Chattanooga, TN Blair Reynolds, MD: Hospitalist for StatCare, Knoxville, TN Henry Shiflett, DO: Infectious Disease Fellowship, Medical University of South Carolina, Charleston, SC Sister Teresa Mary Kozlovski, RSM, MD: Primary Care Physician, Sacred Heart Mercy Health Care Center, Alma, MI Benjamin Verzi, MD: Hospitalist at UTMC Chris Waggoner, DO: Hospitalist at UTMC
Kerry Hennessy, MD: Dermatology research fellowship, University of South Florida, Tampa, FL Andrew Johnston, MD: Ophthalmology residency at UT Memphis Matthew Curry, MD: Radiology residency here at UT Jacob DePolo, MD: Radiology residency here at UT Nicholas Link, MD: Radiology residency here at UT Kenan Wilhoit, MD: Radiology residency here at UT
New Transitional Year Residents
Lorin Bibb, MD: East Tennessee State University Quillen College of Medicine, Johnson City, TN Dennis Martin, MD: Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA David Norton, MD: Mercer University School of Medicine, Macon, GA Taylor Oakley, MD: Augusta University Medical College of Georgia, Augusta, GA Jared Peacock, MD: Eastern Virginia Medical School, Norfolk, VA Katherine Sumarriva, MD: Vanderbilt University School of Medicine, Nashville, TN
New Internal Medicine Residents
Cardiovascular Disease Fellowship Graduates
Nick Cline, MD: Mercer University School of Medicine, Macon, Georgia Tyler Coombes, MD: American University of the Caribbean School of Medicine, St. Marten Emily Daniels, DO: Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, TN Chad Hughett, DO: Edward Via College of Osteopathic Medicine Carolinas, Spartanburg, SC Samuel Mowery, DO: Lake Erie College of Osteopathic Medicine, Erie, PA Sam Purkey, DO: Edward Via College of Osteopathic Medicine Auburn, Auburn, AL Megan Sears, DO: Edward Via College of Osteopathic Medicine Carolinas, Spartanburg, SC Laylan Shali, MD: American University of the Caribbean School of Medicine, St. Marten Jared Spoons, DO: Philadelphia College of Osteopathic Medicine, Philadelphia, PA Samuel Treat, MD: St. George’s University School of Medicine, Grenada, West Indies Bethany Wright, MD: St. George’s University School of Medicine, Grenada, West Indies Meagan Young, MD: St. George’s University School of Medicine, Grenada, West Indies
Rajiv Sharma, MD: Invasive non-interventional cardiologist, Hospitals of Providence East Campus, El Paso, TX Robert Tonks, MD: Interventional Cardiology fellowship here at UT
New Cardiovascular Disease Fellows
Eddie Abney, MD: University of Texas at Austin Dell Medical School, Austin, TX Emmanuel Isang, MD: Jersey Shore University Medical Center, Neptune, NJ
Interventional Cardiology Fellowship Graduate Kayleigh Litton, MD: Returning as UTMC faculty
New Interventional Cardiology Fellow
Robert Tonks, MD: University of Tennessee Graduate School of Medicine, Knoxville, TN
Pulmonary/Critical Care Fellowship Graduates Bimaje Akpa, MD: Sleep Medicine fellowship, University of Chicago, Chicago, IL Sameh Attia, MBBS: Returning as UTMC faculty Ashish Thakkar, MD: Faculty, Jacobi Medical Center, Albert Einstein College of Medicine, New York City, NY
New Pulmonary/Critical Care Fellows
Megan Doyle-McClam, MD: University of Tennessee, Chattanooga, TN Ralph Maroun, MD: Saint Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA 2
Resident Spotlight - Meet Drs. James Livesay, Zachary Marlette, and David Wilson As we embark upon a new residency year, our internal medicine program would like to introduce the new medicine chiefs! Dr. James Livesay is serving as the intensive care unit chief. His responsibilities include assigning resident ICU teams and establishing an ICU lecture series that will be incorporated into the noon conference schedule. His goals for the year include facilitating more Sim Center opportunities as well as starting a multidisciplinary committee to optimize patient placement and streamline throughput within the ICU to improve patient experience and length of stay. Dr. Livesay is pursuing a fellowship in cardiology. Outside of the hospital, he and his wife enjoy hiking, camping, fishing, and cheering for the Vols. Dr. Zachary Marlette is serving as chief of the Resident Clinic. His goals for the year include additional resident education on primary care topics and improvement of the efficiency and reimbursement of the clinic. After residency, Dr. Marlette is planning to stay in Knoxville and join a local primary care practice. Outside of residency, he is busy planning his upcoming wedding, taking care of his new golden retriever, and enjoys reading about physician finance. Dr. David Wilson is serving as the inpatient medicine chief. He plans to continue to improve the house staff medicine rotations by increasing inpatient volume and thereby increasing exposure to a variety of illnesses. He looks forward to continuing the inpatient relationship with UTH, which has flourished over the past year. In the future, he hopes to work as a Hospitalist. Outside of residency, he enjoys spending time with his wife and 16-month-old daughter.
MisStep, or Step in the Right Direction?
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the Shelf exams tell you more about what you want to know about a medical student, and the material is more apropos of residency.” said Dr. Kim Morris, Division Chief of General Internal Medicine. The AAMC’s Holistic Review Project for screening applicants to medical school, which contextualizes metrics such as GPA and MCAT scores with experiences (e.g. with healthcare, with community service) and attributes (e.g. gender identity, age, ethnicity), has been mentioned as a possible model for screening applicants to residency programs as well. It is certainly a complex problem that will require an integrated solution. Final recommendations are expected this fall.
Points of View
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safety. Ongoing efforts are geared towards providing standardized care at UTMC in an effort to streamline processes and help prevent communication errors from all employees involved with patient care. We have come a long way but more needs to be done. As responsible physicians we have an obligation to be champions in efforts to reduce medical errors and ensure the best quality of care to each patient.
Faculty & Resident Awards and Honors Rawson Recipients
The Rawson Award for excellent teaching and clinical skills was given to Sister Teresa Mary Kozlovski, PGY-3, at the 2019 Department of Medicine Residents’ and Fellows’ Awards Dinner. This award is given in memory for Freeman Rawson, MD, who joined the Department of Medicine in 1956 as one of our first teaching faculty and was known for his compassion and expertise. Dr. Rawson passed away in 2003.
Clinic Star of the Year
The UT Internal Medicine Center presented the Clinic Star of the Year Award to Sister Teresa Mary Kozlovski at the 2019 Department of Medicine Residents’ and Fellows’ Awards Dinner. Congratulations to Sister Teresa Mary on her well-deserved award!
Medical Student Teaching Awards
The medical students who rotated through the Internal Medicine department voted to select the residents with the best teaching abilities: Drs. Joseph Pendley, Blair Reynolds, Henry Shiflett, and Chris Waggoner. Sister Teresa Mary Kozlovski was named the best teacher among the residents and awarded a $100 cash prize. These residents were acknowledged at the 2019 Department of Medicine Residents’ and Fellows’ Awards Dinner. 3
Faculty & Resident Awards and Honors (continued) 5th Annual Department of Medicine Research Awards
On June 11, 2019, the Department of Medicine held the 5th Annual Residents’ and Fellows’ Research Contest. A faculty committee reviewed the research papers submitted by Department of Medicine residents and fellows and selected the top three to present at the Research Awards. The audience voted to select the placement of the winners. Dr. Jason Frisbee won first place with “Hydrocortisone and Fludrocortisone vs. Hydrocortisone Alone in Critically Ill Medical Patients with Septic Shock,” Dr. Bimaje Akpa won second place with “Relation of Subjective Assessment of Perceived Activity and Weakness Score (PAWS) to Health Outcomes up to 90 Days after Hospital Admission for Medical Weakness,” and Dr. Tyler McLaurine won third place with “Characterization of the Microbiome on Various Nebulizer Parts after Short-term Use by Hospitalized Patients.”
Jim Neutens Award for Best Teaching Division of the Year
Last year, the Department of Medicine created the Jim Neutens Award for Best Teaching Division of the Year in honor of Dr. Jim Neutens, who retired in 2018 after years of service as the Dean of the Graduate School of Medicine. Graduating internal medicine residents select the department that made the most impact upon them after three years of residency training. For the second year in a row, this honor went to the Division of Pulmonary and Critical Care Medicine.
New Faculty
We are delighted to welcome Dr. Dennis Lester as an Assistant Professor in the Division of Internal Medicine. Dr. Lester graduated cum laude with his Bachelor of Science degree in biology from Concord University in Athens, West Virginia. He received his Doctor of Medicine from Marshall University in Huntington, West Virginia. He completed an internal medicine residency at University of Tennessee Graduate School of Medicine in Knoxville, Tennessee. Dr. Lester joined UT Hospitalists in July 2018.
New Staff
Jenny Roark recently joined the department as an administrative support assistant III. She has her Bachelor’s degree in Psychology from Maryville College and has been working as a medical scribe. Among other things, Jenny will serve on the department’s In Touch newsletter committee, will oversee the department’s CME conferences, and will assist the vice chair with credentialing. We are thrilled to have her as a part of our department and look forward to working with her.
The Department of Medicine wishes to congratulate Susan Burchfield on her retirement. Susan provided over 20 years of exceptional service to the Department of Medicine. Susan plans to spend time with family, travel and devote more time to paddleboarding. She will be greatly missed by her coworkers, faculty, and residents.
Guest Speaker
Congratulations Dr. Rod Ramchandren, Professor of Medicine and the Division Chief of Hematology Oncology, recently published an article entitled, “Nivolumab for newly diagnosed advanced-stage classic Hodgkin lymphoma: Safety and efficacy in the phase II CheckMate 205 study” in the Journal of Clinical Oncology. This article is the first ever evaluation of immuno chemotherapy for newly diagnosed Hodgkin lymphoma
Retirement
to be presented worldwide. We are honored to have a progressive researcher and practitioner, such as Dr. Ramchandren, on our faculty. The National Board of Echocardiography administered the first exam for certification in advanced critical care echocardiography (ACCE) on January 15, 2019. Congratulations to Dr. Francisco Soto on persevering through this challenging process and obtaining this special competence.
We were honored to have Stephen M. Davis, LTC (P), MD, FACS, present the Department of Medicine Grand Rounds, “Military War Surgery: How Do You Prepare?,” on Tuesday, March 26, 2019. Dr. Davis is an adjunct clinical professor practicing at Green Hills Plastic Surgery in Nashville, Tennessee. Dr. Davis has more than 25 years of experience, is board certified with the American Board of Plastic Surgery, Principle of General Surgery and American Board of Medical Examiners.
CME Opportunities—Mark Your Calendars! • Cardiology Conferences, held weekly on Wednesdays for .75 hour CME credit. • Medicine Grand Rounds, held on the 2nd and 4th Tuesdays of each month for 1.00 hour CME credit. • Ethics Case Rounds, held on the 4th Thursday of the month at noon in Wood Auditorium, are available for 1.00 hour CME credit. 3
In Touch
Ethics Case Rounds – A Cry For Help Ethics Case Rounds are monthly, hospital-wide discussions of morally distressing cases. Cases are deidentified to protect patient confidentiality. “George” is a 65-year-old gentleman who was admitted via EMS after a suicide attempt. As he was unable to communicate and was facing a life-threatening emergency, he was treated with presumed consent. His daughter, “Jenny”, said she had become concerned about the way he was talking during a phone call that evening. She went over to his apartment to check on him, and arrived in time to call 911. Jenny states that her father has a history of alcoholism and untreated depression. He is in the middle of his second divorce. He felt his soon-to-be ex was “after his money” and was fighting to keep the couple’s home, which George had spent considerable effort and money renovating. He is presently living in an apartment, which he does not like. He worked for UPS for many years, but suffered a back injury last year and has been working part-time at temporary jobs. Jenny says this has been hard on his self-esteem, and that he misses his old work routine and friends. When George awoke from anesthesia, he was groggy and agitated. While he was unable to talk, he could communicate by writing. He indicated that he did not want any more treatment, writing “Just leave me alone and let me die.” He has no Health Care Agent, but Jenny appears to be an appropriate surrogate decision maker for him. She says she wants him to get better, but is worried about making treatment decisions that he will “hate me for.” Suicide: Facts & Figures • An average of 3 people die by suicide each day in Tennessee. • In 2017, there were 1,163 recorded suicide deaths in Tennessee, at a rate of 17.3 per 100,000; the highest number and rate recorded in the last 35 years. • As of 2017, suicide is the second-leading cause of death for young people (ages 10-19) in Tennessee, though Tennesseans aged 45-64 are more than three times more likely to die by suicide than those aged 10-19. • Firearms remain the most common means of suicide death and attempts in Tennessee, accounting for roughly two-thirds of the suicides in our state in any given year. According to Brown, et al (2013), care planning for patients following a suicide attempt should generally include life-sustaining treatment for several days to establish a likely medical and psychological prognosis. The team should consider what care plan(s) would be reasonable if the condition was not due to a suicide attempt. They should also assess the decision making capacity of the patient and the adequacy of the surrogate. Psychiatry was consulted to work with George. He was initially reluctant to discuss his situation but did engage after he received medication for pain. He continued to report suicidal ideation, but agreed to try medications for depression. He became agreeable to treatment, and over time expressed readiness to pursue outpatient therapy to address his depression and alcoholism “and get on with my life.” He was discharged into Jenny’s care. Comments on this case may be sent to amendola@utmck.edu References • Brown, SM; Elliott, CG; and Paine, R. “Withdrawal of Nonfutile Life Support After Attempted Suicide” The American Journal of Bioethics 13(3): 3-12, 2013 • http://tspn.org/wp-content/uploads/2019/01/TSPN-Status-of-Suicide-2019.pdf WHERE TO GET HELP The National Suicide Prevention Lifeline is a free, 24-hour hotline available to anyone in suicidal crisis or emotional distress. Call them at 1-800-273-8255, or text TN to 741741 to connect to the Crisis Text Line and a trained counselor.
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! 4
Vol. 8, Issue 3: July 2019
Publisher 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 Kimberly Givens David Wilson, DO Elana Smith Sister Teresa Mary Kozlovski, MD 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.