D epartment
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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. 9 Issue 3 Jul. 2020
Online Education
The recent events with COVID-19 and social distancing had our Internal Medicine department seeking creative online solutions to continue didactics and education for residents. Beginning in midMarch, Tennessee’s governor issued a “Safer At Home” order with advisories to avoid gatherings of more than 10 people. In accordance with this order, all in-person resident didactics were cancelled. Creativity and resourcefulness at the hands of a team of residents, faculty, and staff ensured that residents continued their education despite these changes. Many faculty members have given their specialty-specific lectures over Zoom. Resident presentations, such as clinic conference, clinical pathology conference, and morning report, have also been utilizing Zoom. The normally interactive sessions now include questions asked both verbally and via a chat box, with efforts made to communicate that questions and concerns are still welcome and thoroughly answered. “I think the primary benefit of online content is that it gives people the chance to access our material from remote sites,” states Dr.
Mark Rasnake. “It also provides a means to archive content so that residents can access materials they would have otherwise missed due to occasional conflicting responsibilities during conference times.” Quiz Bowl, a beloved resident activity modelled on Jeopardy, was also moved online to include Zoom and the phone application Kahoot, an online group gaming platform. In contrast to the in-person, teambased game, residents answered 40 questions individually on their mobile phones and scores were automatically tallied by the Kahoot system. The top 4 winners were awarded Amazon gift cards via their resident mailboxes to comply with social-distancing guidelines. In cases where real-time, interactive platforms cannot be used or lecturers are unavailable, online resources are used to supplement resident learning. Faculty created PowerPoints, peer-reviewed journal articles, and lectures from the University of Louisville School of Medicine are posted on MedHub to allow residents the opportunity to continue their learning on their own time. continued on page 2
Points of View
Rajiv Dhand, MD, Chair
to the start of a new academic year with a great deal of enthusiasm and renewed energy. Several new opportunities will be available for our residents and fellows through the active collaboration of many services in the hospital and the Graduate School of Medicine. Plans are underway for a multidisciplinary ECMO program and a cellular therapy program that will provide advanced level of services, including bone marrow transplantation and CAR-T cell therapy, to our patients. A new program that I am particularly excited about in the next academic year is the Point of Care Ultrasound (POCUS) program for IM residents and pulmonary/critical care medicine fellows. This multi-phase training program will teach our trainees to acquire ultrasound images, interpret them accurately, and integrate their findings with the rest of the patient’s continued on page 2
The 2019-2020 academic year, especially the last couple of months, has been eventful due to the COVID-19 pandemic. I am so grateful that everyone took this unprecedented challenge in stride. We were able to negotiate our way out of this crisis thanks to the adaptability of all the members of the department under these stressful circumstances. However, as a wise woman said, “Don’t look back ─ you’re not going that way.” Indeed, we are now looking forward 1
Telemedicine In response to the need to provide health care while maintaining physical distance during the COVD-19 pandemic, many providers are developing the skills and infrastructure to provide telemedicine. Telemedicine is the practice of using electronic information and telecommunications technologies to support long-distance patient care. While not new, the use of telemedicine has “gone viral” since March. Telemedicine has the potential to expand access, reduce costs, and improve health outcomes. Dr. Spencer Leong, PGY-3, felt there may be a lower rate of no-shows to clinic appointments with telemedicine since patients don’t have to deal with transportation and parking. As with any innovation, though, there are drawbacks. Some patients don’t have internet access or a reliable device to access telehealth services, and some have difficulty navigating the steps to connect to a telehealth visit. Additionally, gaps remain in regulations regarding information security, licensing, insurance reimbursement, and liability. Dr. Austin Nunemaker, PGY-2, reflected that telehealth seems to be most helpful for routine visits when patients are doing well. Other situations present a kind of Catch-22; the patients who especially need to be seen in person are often the same ones who need to be particularly careful to limit their exposure to the virus. Dr. Megan Sears-Smith, PGY-1, notes that the use of telehealth requires acquisition of a new skill set in order know when and how to use it to benefit patients. While nothing can replace a hands-on physical exam of a patient, as Dr. Sears-Smith notes, “adding telehealth as a skill in addition to another tool in the ‘toolbox’ of healthcare will be an overall benefit if utilized correctly.” For additional information about telehealth at UT Medical Center, visit https://www.utmedicalcenter.org/physician-telehealth/
Online Education
continued from page 1
Residents are able to earn credit for their participation and continued learning in the era of COVID-19 by applying for asynchronous credit via MedHub. This allows their participation to be documented for ACGME requirements and also enables faculty and staff to track resident participation online. But, as can be expected, not everything has gone to plan. Among the top complaints are presentation times have started early or run long which has caused some issues with the recordings. Some staff have had difficulty navigating Zoom and therefore have not felt comfortable giving their presentations virtually. Additionally, some lecturers have trouble gauging audience interest due to barriers to participation. “I find I miss seeing everyone and all the nonverbal parts of a conversation,” states Dr. Annette Mendola. “It’s hard to know what people find interesting, boring, or confusing; and it seems like people might be more reluctant to talk because it’s such a decision to talk – you have to unmute yourself and say your piece, then mute again – it’s less organic.” Most of all, residents and staff alike have found the inundation of emails for Zoom invites, coordinating start times, and discussing issues to be a distraction to their work day. While residents, faculty, and staff have learned to get past these issues and continue education and social interaction; many of us hope to begin in-person meetings soon and to meet safely with colleagues and friends in the near future. Lessons learned during our time of social distancing have given the department new virtual tools and experiences to continue to improve learning opportunities in the future for residents and staff.
Points of View
continued from page 1
history, physical examination, and laboratory findings. The directors for this program, Drs. Soto and Pierce ably supported by Drs. Lamsen and Kravitz, have been busy working and planning behind the scenes to develop a curriculum and training schedule to facilitate implementation of this training. The curriculum includes didactic lectures, supervised bedside use of POCUS, and hands-on sessions in the Sim Center that should provide a comprehensive, longitudinal experience to the residents and fellows during the three years of their training. We have acquired additional equipment to help in this endeavor and look forward to providing these state-of-the-art resources for educating and training internists and specialists in our department. 2
Comings and Goings
Incoming NEW INTERNAL MEDICINE RESIDENTS
Taylor Chaney, DO: Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, TN James Drew, MD: University of Tennessee Health Science Center College of Medicine, Memphis, TN Benjamin Fogelson, DO: Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, TN Gregory Desrosiers, MD: University of Queensland, Brisbane, Australia Saffet Guleryuz, MD: St. George’s University School of Medicine, Grenada, West Indies Andrew Nolin, DO: Edward Via College of Osteopathic Medicine Auburn, Auburn, AL Mark Oropilla, DO: Edward Via College of Osteopathic Medicine Auburn, Auburn, AL Charles Morris, MD: Medical Universities of the Americas, Caribbean (Charlestown, Nevis, or West Indies) Chirag Patel, DO: Edward Via College of Osteopathic Medicine Auburn, Auburn, AL Krupaben Patel, DO: Edward Via College of Osteopathic Medicine Auburn, Auburn, AL Joshua Pickett, DO: Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, TN Michael Rohrer, DO: Marian University College of Osteopathic Medicine, Indianapolis, IN Ghassan Wadi, MBBS: University of Jordan School of Medicine, Amman, Jordan NEW TRANSITIONAL YEAR RESIDENTS
Carol Elsakr, MD: George Washington University School of Medicine, Washington D.C. Kaleb Darrow, MD: University of Tennessee Health Science Center College of Medicine, Memphis, TN Obaid Anwar, MD: University of Tennessee Health Science Center College of Medicine, Memphis, TN Jack Barrow, MD: Mercer University School of Medicine, Macon, GA Paul Miller, MD: Loma Linda University School of Medicine, Loma Linda, CA Casey Shumberger, MD: University of South Carolina School of Medicine, Columbia SC
NEW CARDIOVASCULAR DISEASE FELLOWS
James Livesay, DO: UTMCK Internal Medicine. Elliott Goodwin, DO: Internal Medicine Residency at University of Kentucky, Lincoln, KY Rachel Goodwin, DO: Internal Medicine Residency at University of Kentucky, Lincoln, KY NEW INTERVENTIONAL CARDIOLOGY FELLOW
Hassan Tahir, MBBS: Cardiovascular Disease Fellowship at the University of South Alabama, Mobile, AL NEW PULMONARY/CRITICAL CARE FELLOWS
Milind Bhagat, MBBS: Internal Medicine Residency at St. Vincent Hospital, Worcester, MA Nick Fuerst, MD: Internal Medicine Residency at Eastern Virginia Medical School, Norfolk, VA
Graduating INTERNAL MEDICINE GRADUATES
Ryan Dorman, DO: Hospitalist for Methodist Medical Center, Oak Ridge, TN Karim Sleiman, MD: Ophthalmology Resident for Lebanese American University Medical Center in Beirut, Lebanon & Part-time Primary Care Physician in Beirut, Lebanon Marie Fouad, MD: Hospitalist TBD Jason Frisbee, DO: Pulmonary/Critical Care Fellowship at Virginia Commonwealth University in Richmond, VA Spencer Leong, MD: Hospitalist for Spartanburg Regional Healthcare System in Spartanburg, SC James Livesay, DO: Cardiovascular Disease Fellowship at UTMC, Knoxville, TN Zach Marlette, MD: Primary Care Physician for Faculty Internal Medicine, Knoxville, TN Tyler McLaurine, MD: Hospitalist for American Physician Partners at Mercy Lourdes Hospital, Paducah, KY Alexander Nourse, DO: Hospitalist for Vanderbilt Univ. Medical Center in Nashville, TN & Assistant Professor of Clinical Medicine with Vanderbilt Univ. School of Medicine 3
Alina Novoa, DO: Hospitalist for Cumberland Medical Center, Crossville, TN David Robinson, DO: Hospitalist for UTH at UTMC, Knoxville, TN David Wilson, DO: Hospitalist for UTH at UTMC, Knoxville, TN TRANSITIONAL YEAR GRADUATES
Lorin Bibb, MD: Dermatology Residency at the University of CT Health Center in Farmington, CT Katherine Sumarriva Peters, MD: Ophthalmology Residency at Duke University in Durham, NC Dennis Martin, MD: Radiology Residency here at UT David Norton, MD: Radiology Residency here at UT Taylor Oakley, MD: Radiology Residency here at UT Jared Peacock, MD: Radiology Residency here at UT CARDIOVASCULAR DISEASE FELLOWSHIP GRADUATES
Jaime Holbert, DO: Private practice at Cardiology Associates of East Tennessee, Knoxville, TN, followed by Interventional Cardiology fellowship at UTHSC in Memphis. Aimee Wehber, MD: Returning as an attending physician at University Cardiology’s Lenoir City location. INTERVENTIONAL CARDIOLOGY FELLOWSHIP GRADUATE
Robert Tonks, MD: Private practice at St. Luke’s Magic Valley Medical Center, Twin Falls, ID PULMONARY/CRITICAL CARE FELLOWSHIP GRADUATES
Swati Baveja, MBBS: Attending Physician at Desert Valley Hospital in Victorville, CA Isaac Biney, MBChB: Completing the program on November 30th, 2020.
Resident Spotlight – Meet Drs. Kat Coombes, Morgan Morelli, and Nikhil Jain As we embark upon a new residency year, our internal medicine program would like to introduce the new medicine chiefs! Dr. Coombes is serving as our resident clinic chief. Her goals for the year include improving the clinic by focusing on resident education, hands on teaching, and simulation lab emphasis. Dr. Coombes hopes to incorporate more Point of Care Ultrasound (POCUS) training in the clinic and dedicate time to develop resident led quality improvement projects. Dr. Coombes states, “Now that we will have PowerChart in the clinic, we will be able to streamline flow and improve continuity for our patients.” She plans to pursue a career in outpatient medicine while her husband, a second-year resident in our program, finishes his residency. Outside of the hospital, Dr. Coombes enjoys hiking and spending time with her husband and their dog, Ranger. Dr. Morelli is serving our inpatient medicine chief, in charge of resident house staff and inpatient rotations outside of the ICU. Her goals for this year include continuing to recruit a diverse group of residents for our program and building more opportunities for advancement and growth of resident research at UT Medical Center. Dr. Morelli is applying for a fellowship in infectious disease. Outside of healthcare she enjoys making homemade Italian food. She is also a member of a Knoxville bocce league who practices at Hops & Hollers. Her team, Sedice Palle, are 2 times defending champions! Dr. Jain is serving as our ICU chief. His duties include working closely with our ICU team to schedule successful resident rotations in the intensive care unit. His goals for the year include recruiting more diverse residents, improving the efficiency and quality of patient care, and cultivating an inclusive and collaborative environment. Dr. Jain is interested in pursuing a career in cardiology. Outside of the hospital, he enjoys traveling, reading, and spending time with his wife Sneha, a radiology resident at UT, and their dog, Yuki.
Faculty & Resident Awards and Honors Rawson Recipients
The Rawson Award for excellent teaching and clinical skills was given to Dr. Jason Frisbee, DO, and Dr. Kat Coombes, MD, at the 2020 Department of Medicine Residents’ 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 Zach Marlette, MD at the 2020 Department of Medicine Residents’ Awards Dinner. Congratulations to Dr. Marlette on his 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. David Wilson, James Livesay, Tyler McLaurine, and Ryan Dorman. However, Dr. Zach Marlette was named the best teacher among the residents and awarded a $100 cash prize. These residents were acknowledged at the 2020 Department of Medicine Residents’ Awards Dinner.
6th Annual Department of Medicine Research Awards On June 9th, 2020, the Department of Medicine held the 6th 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. James Livesay won first place with “Infective Endocarditis (IE) due to Methicillin-resistant Staphylococcus aureus (MRSA), Transesophageal Echo (TEE) or No TEE? That is the Question,” Dr. Kristin O’Connor & Dr. Sam Purkey won second place with “Diagnostic Utility of Technetium-Labeled Red Cell Scans in the Diagnosis and Treatment of Acute Lower GI Bleeds at a Tertiary Academic Center,” and Dr. David Norton won third place with “Code stroke in the stroke belt; a cross-sectional analysis.”
Jim Neutens Award for Best Teaching Division of the Year
In 2018, 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 third year in a row, this honor went to the Division of Pulmonary and Critical Care Medicine. 4
Faculty Announcements New Faculty
We are delighted to welcome Dr. Esha I. Cannon as a Clinical Assistant Professor in the Division of Oncology. Dr. Cannon received her Doctor of Osteopathic Medicine from the Philadelphia College of Osteopathic Medicine in Suwanee, GA. She completed a residency in internal medicine and oncology fellowship at East Tennessee State University Quillen College of Medicine in Johnson City, TN. Dr. Cannon was honored twice as “Resident of the Year” during her training. She served as chief resident and chief fellow during clinical education. She has co-authored publications in high impact journals and has made several presentations at regional and national meetings. Since August 2018, she has been with the University Cancer Specialists at the University of Tennessee Medical Center.
We are pleased to welcome Dr. Anthony R. Villarosa as a Clinical Assistant Professor in the Division of Cardiology. Dr. Villarosa received his Doctor of Medicine from The University of Santo Tomas in Manila, Philippines. He completed an internal medicine residency and cardiovascular medicine fellowship at Seton Hall University School of Graduate Medical Education, in South Orange, New Jersey. In 2017, Dr. Villarosa was the recipient of Geisinger’s Top Patient Experience Clinicians, a recognition as a 90th percentile winner for patient satisfaction and being in the top ten percent in the country for improvement in patients’ experience. Since October 2019, he has been with University Cardiology at University of Tennessee Medical Center.
We are delighted to welcome Dr. Diana R. Quintero as Clinical Assistant Professor in the Division of Pulmonary/Critical Care. Dr. Quintero earned her Doctor of Medicine from the Universidad del Valle School of Medicine in Cali, Columbia. She completed a residency in pediatrics at University of Illinois at Chicago in Chicago, Illinois. She completed a fellowship in pediatric pulmonology at Baylor College of Medicine in Houston, Texas. Dr. Quintero is an accomplished pediatric pulmonologist with a broad knowledge base. She has experience teaching medical students and residents and has been recognized numerous times for her outstanding teaching abilities. Since September 2017, she has been with East Tennessee Children’s Hospital specializing in pediatric pulmonology.
Praise for Dr. J. F. Turner The Department of Medicine wishes to thank Dr. J. F. Turner for his five years of service at the Graduate School of Medicine as the Vice Chairman of Medicine and the University of Tennessee Medical Center as Co-Director of the Thoracic Oncology Clinic. Dr. Turner has a heart to help people, has over 30 years of experience in the medical field, and is a world-renowned expert in interventional pulmonology. During his tenure at UTMC, Dr. Turner was instrumental in the addition of critical care medicine to the pulmonary fellowship program. He also served as a mentor and teacher to many fellows and introduced an advanced bronchoscopy boot camp. His contributions to the school have been invaluable and his involvement in the educational and clinical arenas will be sorely missed. We wish him all the best in his future endeavors.
Guest Speaker We were honored to have Carol Iddins, MD present “Ionizing Radiation Injuries and Illnesses” at the virtual Medicine Grand Rounds Conference on April 14th, 2020. She was gracious enough to present via Zoom and there was a lot of participation from the audience. Dr. Iddins is the Director of the Radiation Emergency Assistance Center / Training Site (REAC/TS) which is located in Oak Ridge, TN and managed by ORAU for the U.S. Department of Energy. They provide 24/7 medical support and help with deployment of emergency medical consultation for incidents involving radioactive materials and ionizing radiation worldwide. REAC/TS also conducts ongoing research into the biological effects of radiation and provides continuing medical education for healthcare providers, other professionals and students.
CME OPPORTUNITIES — currently done virtually (via Zoom or Microsoft Teams) • Cardiology Conferences, held weekly on Wednesdays in the Medicine Conference Room for .75 hour CME credit. • Medicine Grand Rounds, held on the 2nd and 4th Tuesdays of each month in the Medicine Conference Room for 1.00 hour CME credit. • Ethics Case Rounds, held on the 4th Thursday of the month at noon in Wood Auditorium and are available for 1.00 hour CME credit . • Pulm/HTN Conferences, held on the 2nd Monday of the month at noon in different locations and are available for 1.00 hour CME credit.
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Ethics Case Rounds – A Doctor in the House: When a Patient’s Loved One is a Physician
In Touch
Ethics Case Rounds are monthly, hospital-wide discussions of morally distressing cases. Cases are de-identified to protect patient confidentiality.
Publisher Rajiv Dhand, MD, Chair, Department of Medicine and Associate Dean of Clinical Affairs
“Alice” is a 74-year-old woman who was admitted for a UTI and pneumonia. She and her husband, “Ken,” a retired physician, have been married for 40+ years. They retired to East Tennessee five years ago. Ken has taken care of Alice since her stroke three years ago, which seriously inhibited her mobility, cognition, and speech. Her wishes for healthcare are unclear as her verbal communication is minimal, but she seems to have adjusted to her new baseline. She generally seems to want to have Ken nearby, but sometimes his presence seems to make her anxious, especially if he is upset. She seems distressed whenever there is conflict. Ken is intense and can be intimidating. He has very specific, exacting ways he wants her care provided. He is hypervigilant and hypercritical, questioning everything and wanting to discuss alternatives and recent trends in the literature. Some of his ideas are helpful, but many are not. Risks associated with medical family members’ involvement with their loved one’s care include loss of objectivity, inappropriate deviations in care (including over-testing and under-testing), threats to fair use of professionals’ time, and threats to intra-familial relationships. Additionally, staff may feel intimidated or defensive around the medical family member. Staff may make the mistake of assuming the family member knows more than they do, or that their understanding of a situation results in the emotional capability to cope with it. Strategies to help medically-trained family members observe good boundaries include clarifying the provider-patient relationship early, discussing plan of care with patient alone if possible, discussing plan of care in detail with the medically-trained family member if the patient wishes, and avoiding over-identification with patient and family. A meeting was held with Ken and the team so that he could express his ideas and concerns and so staff could clarify the plan of care. After a lengthy admission, Alice was discharged to a skilled facility, but was readmitted several times. A pattern ensued: Ken was an over-zealous advocate for Alice, demanding (and getting) extra and nonstandard tests, interventions, and equipment for her. He compiled a rigorous schedule, diet, and list of do’s and don’ts. He also created a list of providers he did not want involved in “our care” anymore. Alice became difficult to place, as facilities where they had been would not take them back. His behavior seemed partly due to extreme fatigue; he had been unwilling to leave her bedside for more than short intervals when she was hospitalized. Another meeting was held, and boundaries were re-established – including that Ken must leave the floor overnight to rest and allow Alice to rest. Ken was initially upset with these limits but complied. With Ken away, Alice slept better and was more communicative with staff. When asked about her wishes, she stated repeatedly that she wanted to go home. She recovered enough to go home, where she remained on hospice for several months. After she died, Ken called to thank the staff who took care of Alice, and of him. Comments on this case may be sent to amendola@utmck.edu References • Alfandre, D. et al. “Caring for ‘Very Important Patients’: Ethical dilemmas and suggestions for practical management” The American Journal of Medicine (2016) 29: 143-147. • Schneck, SA. “’Doctoring’ doctors and their families.” JAMA (1998) vol. 280 no. 23 pp 2039-2042.
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! 6
Vol. 9, Issue 3: July 2020
Editor Annette Mendola, PhD Administrative Director Jenny Roark Contributors Jenny Roark Robin Underwood Kristin O'Connor, MD Rajiv Dhand, MD Kandi Hodges Annette Mendola, PhD Cassandra Mosley Megan Sears-Smith, DO Elana Smith 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. Disclaimer: quotes/ interviews are edited for length and clarity