Department of Internal Medicine

What WE have accomplishedWhere We are going

Department of Internal MedicineFull time Faculty 11Divisions 18Clinical Faculty 80Adjunct Faculty 5

Program Director Lisa Staton MDAssociate Program Director Cathy Payne MDProgram Coordinator Ms. Deborah FullerClerkship Director Gary Malakoff

MDResearch Director Victor Kolade MDUMA Director Lisa Staton MDAssociate Director Victor Kolade MDChief Residents D Meadows MD/A

BhushanMD M Tveite MD/N Gupta MDAdministrative Assistant Ms. Laura NihiserTransitional Year Program Ms. Joyce Poke Coordinator

Leadership

Department of Medicine

Dr. BW Ruffner

President-elect of the TMA for 2009-2010

Dr. Charles F. Longer

Chairman, Board of Trustees

New FacultyGeneral IMGIEndocrineCardiologyHospitalistsNeurohospitalistNeurology

Administrative Staff

New Administrative Assistant - Ms. Laura Nihiser

Electronic Completion of Evaluations via New Innovations by Faculty, Residents and Staff

Monthly Staff MeetingsFaculty Appointment System (Notification of Final Appointment

Completion)Monthly UTCOMC sponsored New

Innovation & Web Training Sessions

Residency and Fellowship Program

Dr Lisa Staton

Palliative Care FellowshipSuccessful accreditationSuccessful completion of first yearSuccessful recruiting

Medical Knowledge Noon Conference Block In-training Exam Board Passage Rate

Patient Care Home Visits ACLS one-on-one

Practice Based Learning Quality Data Dedicated Case manager and Clinical documentation

personnel

Interpersonal Skills and Communication Ethics Quarterly One on One mentoring

The Past Year

Professionalism Transition to Residency – Chief Residents Pharmaceutical Company Interactions- Bhushan and Grubb Ethics Conferences Esprit de Corp Activities RRRnR sessions 3 Alper Humanism inductees, IM resident received award DOM established the UT campus wide Gold Humanism

Society Chapter

Systems Based Practice Recruiting Inpatient Teams (core faculty and hospitalists) Rotation updates (Inpatient Medicine, Critical Care, Night

float, Private Office, Neurology) Competency committee enhanced Accountability committee

The Past Year

University Medical Associates

Dr Lisa StatonDr Victor KoladeMs M Calloway

OVERVIEWFirm AssignmentsChange in Continuity Clinic HoursChanges in Cardiology ClinicStaff Retreat

WHY FIRM ASSIGNMENTSTo structure resident clinic as a group

practiceTo allow for shared responsibility for

learning To provide continuity of patient careTo promote an interdisciplinary approach

to patient careTo encourage mutual support and

collegialityTo help ensure mentoring and supervision

during resident’s continuity experience

CHANGE IN CONTINUITY CLINIC HOURSAllow residents to be able to round on

inpatients without interruption for clinic

Provides adequate time for conferences

Allows time for clinic staff to prepare for clinic

Allows time for clinic staff to handle calls and additional paper work

CHANGES IN CARDIOLOGY CLINICCardiology Clinic changed from two clinic a

month to four clinics a month to allow for increase in patient volumes

Pacemaker Clinic implemented (1st Wednesday of each month)

Referral Form implemented to ensure that patient referred have specific test prior to appointment

New EKG machine purchasedDedicated Medical Assistant for Cardiology

ClinicProposal for onsite Chest X-Rays

STAFF RETREAT JUNE 12, 2009 Team building activities

To foster better communication between staff, residents and attending physicians

To improve staff moraleTo improve patient flow

Medical Students

M3 Clerkship AccomplishmentsRestructured orientation to include

How to write notesHow to present to an attendingProfessionalism

Instituted shelf reviews with faculty/chief residents

Moved several core lectures to beginning of the clerkship to avoid interruptions in clinical rotations

Physical diagnosis teleconference across all 3 campuses

First class of GHHS inducted

Medical Student AccomplishmentsPulmonary/critical care as separate entitiesInitiated student evaluation of

clerkship/rotationsSecured palliative care experience in the

ambulatory and specialty rotationsGME office organizing special interest groups

for medical students rotating hereTotal of 7 students completed their patient

safety QI clerkship through our department4 of our 10 new IM interns rotated in our

department1 of 6 new TY interns rotated in our

department

Youth Health Forum M3 and M4 students, IM and TY

residents and Dr Malakoff and Panda participated

Mentoring of 4 UTC premed students

Future of Medical Student RotationsPossible neuro/psych rotationsIncreased class size = more students

in Chattanooga in 2 yearsActively involved in selection process

for these students

Quality Improvement ProjectsInitiated chapter of IHI Open SchoolImproving inpatient glycemic ControlEvaluating the global trigger tool to

identify adverse events in the hospitalEvaluating and improving inpatient VTE

prophylaxis protocolEvaluating successful implementation of

the national patient safety goals in regards to anticoagulation medications

Review of internal medicine admissions daily to assure equitable distribution between hospitalists and teaching service

Quality Improvement Projects Ambulatory Geriatric Screen & chart

auditConsultation formCode committeeInpatient Medicine ScorecardTransfer of CarePneumonia Core MeasuresCHF core measuresAMI core measuresAntibiotic StewardshipHand Hygiene

Quality Improvement ProjectsVAP bundleSepsis protocolPatient flowMortality reduction

Publications, Lectures, Meetings, Research, QI,

UMA, Education, Scholarships

Department of MedicineScholarly Activity Update

Peer-Reviewed Publications

Patel V, Yalavarthy U, Desbiens NA. Does reporting estimated glomerular filtration rate affect ordering of timed urine collections? Am J Med Sci. Mar 2009;337(3):185-187

Li HY, Grubb M, Panda M, Jones R. A Sore Throat-Potentially Life-Threatening? J Gen Intern Med. May 10 2009

Gupta N, Patel C, Panda M. Hepatitis following famotidine: a case report. Cases J. Jan 27 2009;2(1):89

Rahman AA, Panda M. Locked lung by looped hernia: a case report. Cases J. Jan 8 2009;2(1):29

Pai S, Panda M. Limited Wegener's granulomatosis presenting as lung nodules in a patient with rheumatoid arthritis: a case report. Cases J. Dec 23 2008;1(1):417

Estrada C, Panda M, Landry M. Why Should I Write a Case Report or Clinical Vignette? SGIM Forum December 2008; 31(12):5, 9

Gray ER, DeVersa R. Hereditary Multiple Exostoses. Hospital Physician. November 2008;44(11):8

Navaid M. Perception of hospice/palliative medicine: a fellow's narrative. J Palliative Med. Apr 2009; 12(4):385-6

• Tumlin JA. Lupus nephritis: histology, diagnosis, and treatment. Bull NYU Hosp Jt Dis. 2008;66(3):188-194

• Desbiens NA. A departmental experience in promoting oral and poster presentations. Teach Learn Med Jul-Sep 2008;20(3):254-260

• Heath GW. Recommended Levels of physical activity and health-related quality of life among overweight and obese adults in the US. Journal of Physical Activity & Health 2008;JPAH-2008-0028.R1

• Tindni A, Gaurav K, Panda M. Non-healing painful ulcers in a patient with chronic kidney disease and role of sodium thiosulfate: a case report. Cases J. 2008;1(1):178

• Ross MA, Amsterdam E, Peacock WF, et al. Chest pain center accreditation is associated with better performance of centers for Medicare and Medicaid services core measures for acute myocardial infarction. Am J Cardiol. Jul 15 2008;102(2):120-124. (F Fesmire)

• Jones R, Panda M, Desbiens N. Internal medicine residents do not accurately assess their medical knowledge. Adv Health Sci Educ Theory Pract. Nov 2008;13(4):463-468

Roux L, Pratt M, Tengs TO, Yore MM, Yanagawa TL, Van Den Bos J, Rutt C, Brownson RC, Powell KE, Heath G, et al.  Cost effectiveness of community-based physical activity interventions.  Am J Prev Med. Dec 2008;35(6):578-588

Bhattarai N, Panda M. Uremic Frost. Mayo Clin Proc. December 1, 2008;83(12):1309

Dutta G, Panda M. An uncommon cause of lower gastrointestinal bleeding: a case report. Cases J. 2008;1(1):235

Conner C, Paydar A. Intradural Extramedullary Arachnoid Cyst Presenting as Arteriovenous Malformation in the Thoracic Spinal Cord. Radiology Case Reports 2009;4:263

Cecil WT, Kasteridis P, Barnes JW, Jr., Mathis RS, Patric K, Martin S. A meta-analysis update: percutaneous coronary interventions. Am J Manag Care. Aug 2008;14(8):521-528

Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW, (Fesmire FM, et al), American College of Emergency Poisoning.  Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache.  Ann Emerg Med.  Oct 2008;52(4):407-436

Cardiel MH, Tumlin JA, Furie RA, Wallace DJ, Joh T, Linnik MD. Abetimus sodium for renal flare in systemic lupus erythematosus: results of a randomized, controlled phase III trial. Arthritis Rheum. Aug 2008;58(8):2470-2480

Scherer K, Gupta N, Caine W, Panda M Differential Diagnosis and Management of a Recurrent Hepatic Cyst:  A Case Report and Review of Literature JGIM

Navaid M Power of presence and compassion J Palliative Med

Makdsi F, Brit M A Case of Sclerosing Mesenteritis With Rheumatoid Arthritis South Med J 

Makdsi M, Fall M Acute Renal Infarction J Hosp Med

Dutta G, Panda M Bands of cacophony Cases JScherer K, Panda M, Johnston J Dural Based

Mass Journal of RadiologyMakdsi F Acute Pancreatitis with Eruptive

Xanthomas J Hosp Med

Book ReviewMathis R. Cause And Coincidence In Autism. Health Aff. May 1, 2009;28(3):916-917

SubmissionsMakdsi F Transient Thyrotoxicosis as an Initial

Presentation of Rheumatoid Arthritis, accepted Cases J Makdsi F Inflammation of Actinic Keratosis with

Combination of Alkylating and Taxane Agents, Cases J Staton L, Rybolt A, Panda M, Jones R Achieving the

AAA's of Ambulatory Medicine - Aptitude, Appeal and Appreciation J GME, in review

Panda M, Desbiens N Life long learning after residency J GME, in review

Increased frequency and nocturia in a middle-aged male may not always be due to Benign Prostatic Hypertrophy (BPH): a case report Gaurav, Panda JCR in review

Submissions Pending DecisionsLeucocytoclastic vasculitis JGIMAVM Cases JDKA and Pneumomediastinum Cases JSubacute Combined Degeneration With

Normal Vitamin B12, submitted to Cases J   

Manuscripts in PreparationCatastrophic Antiphospholipid Antibody

Syndrome JacobsonScrofula KafleExtragonadal Germ Cell Tumor Hadgu, Tindni,

PandaHow much is too much Grubb, Gaurav, PandaClonidine overdose TveiteA Rare Cause of Acute Seizure in a Young Man 

Krummert, Scherer, Whitley, Dixon, Sirelkahtim, Panda

Diabetes Insipidus Chhakchhuak, TumlinPulmonary LCNEC Kaako

Local and Distant Conferences

Posters and Oral Presentations

Panel DiscussionsApproaches to Interactions with Industry:

A Multidisciplinary Panel Discussion to Educate Residents In TrainingDr MalakoffRobin Grant, R.Ph.Dr MathisDr ForeSylvia Friedl

Physician Stress & Burnout” at the Departmental Residency Retreat  Cohen, Barker, Panda

Research Week Research AbstractsRAPID RESPONSE TEAMS: Their Impact on the

Rate of Cardiac Arrests at the Baroness Erlanger Hospital (BEH) of the University of Tennessee at Chattanooga Jacobson, Tindni, Panda, Staton (2nd place poster)

The Frequency and Significance of Incidental Thyroid Nodules (ITNS) on Chest CT Scans,  a retrospective study:  Scherer, Means, Chijioke, Karmin, Panda (3rd place poster)  

Clinical Decision Making for Pulmonary Embolism: Are Physicians Using the Latest Evidence? Makdsi, Staton, Panda

Research Week Case Reports1. A Rare Cause of Acute Seizure in a Young

Man  Krummert, Scherer, Whitley, Dixon, Sirelkhatim, Panda (3rd place poster)

2. Painful Ophthalmoplegia as the first Manifestation of Lung Carcinoma Mocanu, Obaid, Kolade

3. Late-Onset Asthma and Stridor; Think about Adenoid Cystic Carcinoma! Kaako, Stansell, Kolade

4. The Persistent Parasite, Patient, and Physician Scherer, Gupta, Caine, Panda (also presented at Internal Medicine 2009)

3 workshops9 oral presentations13 posters

SSGIM, 2/09

Presented at National SGIM

1. Numbness in a 39 Year-old Man Makdsi F, Kadrie H2. Common shortness of breath for uncommon reason:

Rahman A, Kolade V3. When A Piece Of Heart Hurts The Brain. Kafle P,

Dutta G, Yium J4. Painful Ophthalmoplegia as the first Manifestation of

Lung Carcinoma Mocanu B, Obaid B, Kolade V5. Late-Onset Asthma and Stridor; Think about Adenoid

Cystic Carcinoma! Kaako A, Stansell K, Kolade V6. Oral: A Case of Leukocytoclastic Vasculitis with Rare

Complications Finch T, Brit M, Panda M7. Workshop: Getting your vignette published, a step

wise approach Panda et al

International Humanities in Medicine (Posters)Chijioke C, Scherer K, Panda M

Relaxing, rejuvenating and rejoicing in residency: RRR in Residency

Kaako A, Panda M Taking care of the Muslim patient: How culturally aware are our health care providers?

International Conference of the American Thoracic Society, May 15-20, 2009

Food and Particulate Aspiration Pneumonia Gupta N, Enjeti S

Abstracts Dr Yium Lead Toxicity: Lead and Moonshine

NephropathyNorth American Society for Dialysis and

Transplantation, July 12-16, 2009; Kapalua-Maui, Hawaii

Dr Tumlin 1.Bilateral Symmetry in Chronic Uremic Pruritus: The

Brain-Skin Connection2.A Phase III, Randomized, Double-Blind, Placebo-

Controlled Study of Tenecteplase for Improvement of Hemodialysis Catheter Function: TROPICS 3American Society of Nephrology MeetingOctober 27 - November 1, 2009; San Diego

Ongoing Research And QI

Current projectsKyle, Stansell, Rahman, Anower, Tumlin,

Boldt, Gunter, Shome: PRESSURE TrialGupta, Strelnikova, Boldt, Panda: VIPP

studyKaako, Panda: Care of Muslim PatientsTodd, Payne: Vaccine history and

pneumococcal sepsis in alcoholics Hawkins, Malakoff, Chhakchhauk: C.

difficile ColitisNavaid: Quality of life in hemodialysis patientsBhushan, Payne: Patient handoffs

Bringing Back the Black BagDrs Rybolt, Panda and C. Cunningham; begun

March 09 This 3-year project promotes improving humanism in

medicine through the use of House CallsInternal medicine residents do house calls in teams of

two residents, attending physician and nurse and/or home care agency/other community care provider

We expect residents will develop stronger physician-patient connections and have more interaction with the multidisciplinary team caring for their patients

Residents will be taught skills needed to make house calls

Surveys of physicians, patients and caregivers will explore attitudes toward and benefits of house calls

H.A.I.R Scherer, Chijioke, Waterhouse, Cunningham, Kramer-Mai; Fore, Panda,

ObjectivesExplore the influence of breast cancer treatment

associated side effects (including alopecia) in patients diagnosed with breast cancer, their spouses/significant others, and health-care providers

Provide a structured opportunity to teach and role model the concept of “taking ownership” and “getting to know” the patient as a complete human being

Study the influence of journaling in coping strategies of breast cancer patients undergoing treatment, spouses/significant others, and their health-care providers

Evaluate potential resident outcomes as they relate to fatigue and resource recovery

Provide financial and cosmetic support to patients as needed

RRR in RChijioke, Scherer, C Cunningham, Panda

Pilot study to address the following aims: To provide and promote an encouraging environment in

which information is shared among residents, faculty, and healthcare workers from different spiritual and cultural backgrounds

To facilitate discussion regarding issues about cultivating good human interactions, improving well-being of health care providers, achieving personal growth and becoming sensitive to the needs of fellow human beings

To evaluate the effectiveness of the RRR in R sessions as a mechanism for recovery and fatigue/burnout prevention for residents, as indicated by scores on the Need for Resource Recovery Scale, the Fatigue Assessment Scale and Burnout scale as well as more qualitative questions about RRR in R sessions

To assess and monitor stress/fatigue/burnout amongst resident over a three year period and evaluate the effectiveness of RRR intervention

To begin to develop a process for identifying residents at the highest risk of developing burnout and a connected process to train these individuals in the necessary techniques to prevent these negative outcomes from developing

 

Grant SubmissionsHi-TECH project: Technology Enhanced

Code team HelpDr Kolade, Panda, DartSubmitted to NIH

Controlling Diabetes Among Low-Income Patients:  Physical Activity, Dietary Assessment and Counseling Coupled with Community NavigationCollaboration with Family Medicine and

community physiciansStaton, Heath, Kolade, PandaSubmitted to CDC/CTSI

Grants ReceivedArnold P Gold Foundation BBBB project Gold Humanism Honor Society H.A.I.RHulbert FoundationBCBSTDCI

PRESSURE trial Kyle, Stansell, Rahman, Anower, Tumlin, Boldt, Gunter, Shome

Hypothesis: Primary ventilatory therapy using Airway Pressure Release Ventilation (APRV) will improve recovery from Acute Lung Injury (ALI) or Adult Respiratory Distress Syndrome (ARDS), and reduce all cause mortality at 28 days compared to conventional ventilation using low tidal volume-cycled ventilation

IHI

Lectures

Stop Stroke SaturdayDr. Malakoff

Grand RoundsDesignation as an ACP educational

event means attendance counts towards participation in College activities

Topics includedPsoriatic ArthritisCan One Patient Teach It All?Renin-Angiotensin-Aldosterone Axis in

Chronic Kidney DiseaseAcute Renal Failure: Pathogenesis, New

Definition and Role of Cytokines

Grand Rounds

Papadakis M, et al.Ann Intern Med. 2008;148:869-876.

J Cohen MD “Stress Management in Residency: First Line Medications with Psychiatric Disorders,” at the Family Medicine Update 

J Cohen MD “Psychological Aspects of Coping with Chronic Kidney Disease,” Chattanooga Renal Symposium

J Cohen MD “Treatment of the Agitated Dementia Patient” Geriatric Medicine-Phoenix, Arizona

J Cohen MD “Adapting to Change,” Jewish Community Federation of Greater Chattanooga

J Sizemore MD Antibiotic StewardshipJ Boldt MD Interpreting PFTs Tennessee ACP

BCBST/Lunch & LearnVitamin D deficiency - Harmful, but preventable and treatable: Kolade

ARDS: KyleBariatric Surgery – Criteria, Outcomes and Pitfalls : Payne

HHP 597: Introduction to Epi. MethodsKoladeCigarette Smoking and Lung Cancer

Clinical Applications: Vitamin D, the Sunshine Vitamin

Resident Education

ScholarshipsMohammed Anower, MD and Brett Krummert, MD

received scholarships from the Ochsner Clinic to attend a resident symposium titled ‘Clinical Updates in Cardiology,’ November 2008 in New Orleans

Molly Tveite, MD received a scholarship from Boston University to attend ‘Addiction Medicine: Improving Clinical and Teaching Skills for Generalists - A Chief Resident Immersion Training (CRIT) Program’ from May 6-9 in Cape Cod, Massachusetts; Faculty Mentor - Dr Kolade

Andrew Todd, MD received a scholarship from the American Pain Society to attend its 28th Annual Scientific Meeting and a pre-course entitled ‘Fundamentals of Pain Management: A Primer for Residents and Fellows’ May 5-9 in San Diego, California

Amanda Grubb, MD has been awarded a scholarship by the Mayo Clinic for its Internal Medicine Board Review scheduled for July 17-23 in Rochester, Minnesota

Scholarly Points PolicyExpected total - 21 or more points,

obtainable throughManuscriptsMedical Images publicationsResearch: Proposal approval, data collectionPosters/oral presentationsWorkshopsIHI modules

Points garnered over 3 years

Summary 2008-2009>20 peer-reviewed publications on file>11 oral and 32 poster presentations6 workshops Several intramural and extramural

lectures

Esprit de corps Activitiesand

Community Service

Department of Medicine

Esprit de corps Activities 2008-2009

Chambliss Shelter and Audobon Acres Service Project

Annual Canned Food Drive/Design Competition

Recruitment Dinner and Match Day Celebration

Ocoee River Rafting TripBoy Scout Medicine Merit BadgeRace for the CureHalloween/Fall Festival CelebrationTrunk or Treat/Chili PartyMulticultural Lunches

Thanksgiving Canned Food DriveHoliday Musical PerformanceUMA patient sponsorship for ChristmasTransitional Year and Internal Medicine

Holiday PartySporting Activities (Basketball and

Soccer)Chattanooga Girls Leadership Academy

Service ProjectEagle Scout Service Project Phase 1 and

2

Mutia Health Center Fundraiser/BowlingApril Day of Service Activity in

coordination with Weed and SeedTour de Cure in coordination with

Erlanger and American Diabetes Association

YMCA “BIG” Project“Press Out” Domestic Violence Bench

Press Competition RRR in R SessionsIM/TY Retreat Gold Humanism Honor Society

Minority Health FairWomen's Health FairUS Xpress Health Fair

Department of Internal Medicine

What WE have accomplishedWhere We are going

Medical KnowledgeNew MKSAP available in July John Hopkins Ambulatory Curriculum In Training Exam Dates

Patient Care Intern Clinic Orientation Additional Clinics Resident Chart Simulated Recall

Practice Based LearningScholarly Point AssignmentsRevise Evaluations

Interpersonal Skills and Communication Professionalism

Abstracts (professionalism and multicultural) Systems Based Practice

Site Visit 2010New Program Guidelines

The Upcoming Year

GoalsContinue to improve the education, patient

care, faculty structureJournal clubM & MRecruitment for Divisions of Endocrinology,

GI, Cardiology, Critical CareFaculty Practice Plan will improve primary

careStandardization based on new CMS

requirementsWW6 renovationDepartmental expansion

Department of Internal Medicine

TEAM = Together Everyone Achieves

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