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. 11 Issue 1 Jan. 2022
Research Productivity During Residency & Fellowship:
American College of Cardiology in Atlanta in May 2021. Our third-year internal medicine residents have also remained quite busy. Dr. Samuel Purkey presented “A rare diagnosis of cryptogenic multifocal ulcerous stenosing enteritis following partial small bowel resection for retained capsule endoscope” at the Society of American Gastrointestinal and Endoscopic Surgeons in Las Vegas in September 2021; “Histoplasmosis, the great imitator of COVID-19 pneumonia?” at the Society of Hospital Medicine Conference in Atlanta in October 2021; and “A rare case of Amyand’s hernia presenting as acute uncomplicated appendicitis” at the American College of Gastroenterology Scientific Meeting in Las Vegas in October 2021 (photo). Dr. Samuel Treat presented “When to pull the trigger – Persistent upper gastrointestinal bleeding in the setting of splenic artery pseudoaneurysm and cystogastrostomy stent ultimately requiring coil embolization” at CHEST in September 2021 in Orlando. He also presented “Comparing discharge and readmission medication regimen for AECOPD” at the American Thoracic Society International Conference in San Diego in May 2021; continued on page 2
Despite the changes in conference format over the past 2 years, our department residents and fellows have remained active with research and presentations. From nearby to across the country, residents have presented at numerous conferences over the past year. Our pulmonary critical care fellows have been hard at work, with Dr. Ralph Maroun presenting “Managing a rare case of congenital atresia of the left superior pulmonary vein with associated atypical coronary anatomy in an adult patient with new onset self-limited chest pain”; and Dr. Milind Bhagat presenting “Cavitation due to Covid-19: A case of secondary atypical mycobacterial infection post-Covid-19” and “Highflow nasal cannula requirements in hypoxemic respiratory failure secondary to COVID-19: Identifying FIO2 cutoffs that predict a higher risk for ICU admission, mechanical ventilation, and death” at CHEST in Orlando, FL in October 2021. Dr. Bhagat also tied for first place for the Alfred Soffer Research Award that is given for the best original research presentation at the CHEST conference. Dr. James Livesay from our cardiology fellowship also presented “Heme effects in lowering patient discomfort in radial artery verapamil injection (HELP-RA)” at the
Points of View
Antonio as an active-duty officer with the US Air Force. During this time, while completing his IM residency and ID fellowship he met and later married Niki. He returned to his East Tennessee roots and joined the ID division, and later when he assumed the role of IM Program Director, he took on the challenge of running a program that had received several citations from the ACGME. For the past 13 years, Mark has successfully managed the program to become one of the premier training programs in the region. The highlights of his tenure as PD include: an increase in categorical IM residents from 27 to 36 residents, initiating a 3rd hospitalist team, successful match for several years, consistent improvement on in-training examination scores, no citations from ACGME for continued on page 2
Farewell to Power Couple in Medicine The dawn of the New Year brings with it some mixed blessings as we bid farewell to a very talented couple: Dr. Mark Rasnake, and his wife Niki. Mark who is an Associate Professor and Internal Medicine Program Director (PD), will be leaving to join a similar position with the Mayo Clinic affiliated program at Naples, Rajiv Dhand, MD, Chair FL. Niki has been an admirable resource as the Program Manager for the Level I Trauma Center at UTMC. Mark and Niki’s expertise and dedication to medical education will be sorely missed. After medical school at the University of Tennessee Health Science Center in Memphis, TN, Mark spent the next 9 years in San 1
Resident & Fellow Research Awards Conference: Come one, come all. It is time for the 8th Annual Department of Medicine Research Awards. This is a great opportunity open to transitional years, internal medicine residents, and fellows to highlight original research or a unique case presentation. The process is quite simple, and it is important to think ahead before the official email is sent out in April. Qualifications for a good submission can be an interesting case study; however, original research projects retrospective or prospective are preferred. The abstract may contain a maximum of 250 words and must be submitted to Jenny Roark by May 24th, 2022. Only one submission per individual is allowed. The submissions will then be reviewed by the committee, and the top three will be invited to present at the Medicine Grand Rounds Conference on June 14th, 2022. Greg Desrosiers, one of the current PGY-2 residents, was thankful he reached out to Justin Wolfe because in doing so, Mr. Wolfe was able to gather data and aid in Dr. Desrosiers project, which won 2nd place and prize money last year! That is right folks, the winners get prizes. This year’s top three winners will receive $300, $200, and $100 respectively. Martin Valdes, one of our outstanding interns, is working on a project to assess the correlation between a patient’s maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and peak inspiratory flow rate (PIFR) to their subjective perceived activity and weakness score (PAWS). He was proactive and contacted Dr. Dhand during his first month into residency. Martin is interested in pulmonary critical care and encourages others to get involved with research projects early on by reaching out to co-residents, fellows, and attending physicians for guidance. He hopes to be one of the winners selected and share the results of his project with everyone at the Medicine Grand Rounds Conference.
Research Productivity During Residency & Fellowship: continued from page 1 “Evaluation of prophylactic antibiotic administration in patients with spontaneous bacterial peritonitis” virtually at the Society of General Internal Medicine in April 2021; and “A twisted case of lower gastrointestinal bleeding caused by midgut volvulus” virtually at the Society of Critical Care Medicine Annual Conference in February 2021. Dr. Megan Sears-Smith presented her project “utilization of stem cell transplantation in newly diagnosed multiple myeloma patients lacking geographic proximity to a transplant center” at the American Society of Hematology Annual Conference in Atlanta in December 2021 and Dr. Jared Spoons presented “EVALI masquerading as cannabinoid hyperemesis syndrome” at the American Thoracic Society International Conference in San Diego, CA in May 2021. Our second-year internal medicine residents have also been busy. Dr. Chirag Patel presented “Acute appendicitis: A rare side effect of nivolumab” at the American College of Gastroenterology Annual Scientific Meeting in Las Vegas in October 2021 and Dr. Taylor Chaney presented “When anticoagulation is not enough - COVID-19” virtually for the Society of Hospital Medicine Converge in May 2021. We are incredibly proud of our trainees and their research mentors for such a successful research year and representing the department on both the regional and national level. We are wishing everyone another successful year in 2022!
Points of View
continued from page 1
several years now, expansion of fellowship programs, and the crowning achievement of a 100 % pass rate on the IM Boards for each of the past 3 years! He has done all this while nurturing residents to be excellent physicians and they, as well as the department staff, deeply love him for it. In recognition of his talents, Mark received several teaching awards, including the departmental London teaching award in 2008 and 2019 and the Dean’s “Spirit of the Graduate School Award” in 2012. Niki has not only played a supporting role in facilitating Mark’s activities, but she is herself a force in promoting education in the Trauma Center and uses her expertise and skills to train doctors and nurses locally as well as in Zimbabwe, Africa. Mark and Niki’s departure will be felt by many trainees at UTMC. Mark is an exceptional ID physician and as the hospital epidemiologist he played a vital role in directing the response to the COVID-19 pandemic. He was an excellent resource for the Medical Center and the community on all matters “COVID” for the past almost 2 years. For his expertise, guidance, and leadership during the pandemic he received a special recognition award from the institution in 2020. The love of fishing and life closer to the beach have lured Mark and Niki to what they believe will be their permanent home in Naples. While we are sad to see the departure of such talented and valued colleagues, we offer our very best wishes to them in their future lives. 2
Amyloidosis Research: 1st Human Trial of Peptide Imaging Completed:
Amyloidosis represents a somewhat rare and challenging collection of diseases where complex protein aggregates deposit within a number of internal organs often leading to poor outcomes. Although the disease state is somewhat well understood from a tissue and cellular standpoint; reliably identifying and locating early amyloid deposition remains a challenge. If amyloid deposits could be detected more reliably and earlier on in the progression of the disease then patients may begin to achieve better outcomes. Currently, the disease is often not identified until later stages which may be harder to treat. The Amyloidosis and Cancer Theranostics Program (ACTP) here at the University of Tennessee Graduate School of Medicine, led by Jonathan Wall, PhD, Director and Professor of Medicine, has identified a synthetic peptide designated “p5+14” which can be labeled with iodine-124 and used to detect amyloid through positron emission tomographic (PET) imaging. With such a groundbreaking discovery, the multidisciplinary ACTP team set out to seek approval for human trials to evaluate the new imaging modality on all the major systemic forms of amyloidosis. Since approval by the FDA in 2018, Dr. Wall and his team have imaged a number of patients from all across the United States. In parallel to these human trials, treatment strategies for how to eliminate the protein aggregates from the body itself are being developed. Hopefully, our work here at UT can be implemented across the globe to make it a future mainstay in the treatment of amyloidosis. The University of Tennessee Graduate School of Medicine would like to congratulate Dr. Wall and his team on their remarkable accomplishments and contributions to the lives of patients and medical literature on this topic.
Resident Spotlight: Drs. Chirag & Krupa Patel Chirag and Krupa Patel are husband and wife currently in their PGY-2 year as a part of the Internal Medicine Residency Program here at UTMCK. They both grew up in the same city in India however, never crossed paths in their younger years. Krupa later moved to the USA and it was not until a few years later she would meet Chirag after returning to India to visit family. Originally meeting through mutual friends, they established a unique connection that would withstand the challenges of such a long-distance relationship. Chirag made plans to attend college in the USA with Krupa who would soon become his fiancée. They attended UT Chattanooga for college and after graduation returned to India briefly to be married. As newlyweds, they completed medical school together and made plans to attend residency together as well. Krupa states, “Being in residency together is great! We are able to relate to each other in most aspects of life, which is so comforting knowing that he already understands what I am going through. He is always there to motivate and encourage me on the days I need it most.”
CME OPPORTUNITIES
Currently hybrid attendance: half joining 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. 3
Special Announcements: Dr. I. Reid Collmann Scholarship Winners – Summer 2021 This past summer, two medical students participated in a focused research experience at the University of Tennessee Graduate School of Medicine through the I. Reid Collmann, M.D. Medical Student Education Fund. Daniel Faradji and Christopher Forsythe both worked with Dr. Rajiv Dhand on pulmonary research topics. Daniel Faradji participated in a study entitled, “Perceived Activity and Weakness Score (PAWS): Correlation of Subjective Assessment with Measures of Respiratory Muscle Strength in Adult Patients.” The PAWS scale was developed by Dr. Dhand as a 5-item Likert scale-based questionnaire to assess muscle strength and endurance. The research team found that patients’ perceived weakness, assessed with PAWS, had a strong correlation with their inhalation strength and peak inspiratory flow rate and no correlation with their exhalation strength. Christopher Forsythe participated in a study entitled, “Corticosteroid Dosing in Acute Exacerbations of COPD (AECOPD): A Retrospective Cohort Analysis.” Optimal dosing strategies for corticosteroids in patients with AECOPD in terms of outcomes, such as hospital readmissions for AECOPD, are not known. Christopher found no significant differences in outcomes between the cohorts on high versus low doses of corticosteroids. At the time of this observational study, dosing practices for corticosteroids were highly variable (the median dose was 100 milligrams of prednisone equivalents per day ranging from 0 to 360 milligrams per day). The team plans to conduct further investigations to determine optimal corticosteroid dosing practices in patients with AECOPD. The work of Daniel and Christopher formed the basis of 3 abstracts submitted for the American Thoracic Society Annual Conference in May 2022.
New Year Brings New Changes to the Internal Medicine Residency Program and Transitional Year Program Dr. Daphne Norwood begins the role of interim program director January 1, 2022. She has been with the Department of Medicine since 1996 and has been the internal medicine associate program director since 2004. In 2007, she also became program director of the transitional year residency, which has been continually accredited and received several commendations from Accreditation Council for Graduate Medical Education (ACGME) during her tenure. She worked closely with Dr. Rasnake in all aspects of the residency program and her extensive knowledge of the ACGME and the department will guide the department and residency to grow on the foundation that Dr. Rasnake has built.
Faculty Announcements
Dr. Elizabeth Ergen, Assistant Professor in the Division of Dermatology, begins the role of interim program director for the transitional year program January 1, 2022. She is a practitioner with Dermatology Associates of Knoxville and works in the IM dermatology clinic teaching and supervising residents. Currently she is a member of the research committee for the department and interviews TY applicants. She will organize the transitional year program in accordance with the current requirements of the ACGME.
• Dr. Mark Peirce (2020) and Dr. Janet Purkey (2021) received the London Award, which is presented to a teacher who exhibits a dedication to excellence. The recipients of this award are chosen by our residents. • Drs. William Law, Jr. and Jon Wall (2020) as well as Dr. Daphne Norwood (2021) received their 25-year service awards. • Dr. Mark Rasnake (2021) received the Chariman’s Outstanding Service Award for his extraordinary dedication and service to the Department of Medicine. All of these award recipients have provided superb service to the Department of Medicine. We are delighted to recognize them for their many contributions.
Several faculty and staff awards were presented at this year’s Annual Faculty Recognition Dinner held on Wednesday, December 2nd, 2021 at the Gettysvue Country Club. This encompasses awards from 2020-2021! • The Beasley Pylon Award for extraordinary leadership and service to the Department of Medicine was presented to Dr. John Stancher (2020) and Dr. Daniel Ely (2021). • The R.A. Obenour, MD, Distinguished Alumnus Award in Recognition of Outstanding Career Achievement in the Field of Medicine was presented to Dr. Spencer Gregg (2020) and Dr. James Cox (2021). • Dr. Annette Mendola (2020) and Dr. Mahmoud Shorman (2021) received the R.A. Obenour, Jr., Excellence in Teaching Award for steadfast dedication and excellence in teaching.
New Faculty
We are excited to welcome Dr. Zachary Marlette for the appointment to the rank of Clinical Assistant Professor. Dr. Marlette completed medical school at the University of Tennessee Health Science Center College of Medicine in Memphis. He completed residency in internal medicine at the University of Tennessee Graduate School of Medicine. Dr. Marlette has several accolades for his level of service, including Clinic Star of the Year in 2020. Dr. Marlette is a primary care physician with Faculty Internal Medicine.
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We are delighted to welcome Dr. Anne Kassira for the appointment to the rank of Clinical Assistant Professor in the department of cardiology. Dr. Kassira completed medical school at Penn State College of Medicine in Hershey, PA. She completed residency in internal medicine at Cleveland Clinic Foundation in Cleveland Ohio, followed by a fellowship in cardiovascular medicine and cardiovascular imaging. Dr. Kassira has many publications and received several accolades for her research.
Suicide Among Medical Professionals & Prevention Methods Early in the COVID-19 pandemic, images of stressed, grieving health care providers emerged alongside the images of patients on ventilators. Providers everywhere have been exhausted and overwhelmed as the waves of COVID have continued to wreak havoc on our communities Physician burnout was a well-recognized problem even before COVID-19. According to a recent Medscape survey, 79% of respondents experiencing burnout indicated that their stress began prior to the onset of the pandemic. Top contributors to burnout before COVID-19 included frustration over excessive bureaucratic tasks, lack of autonomy in practice, and long hours at work. The pandemic has exacerbated these longstanding stressors and added new ones. In particular, the increased lack of trust that patients and families have for health care providers has made patient care more challenging and less rewarding. Coupled with extremely long hours, high patient loads, and unrealistic expectations; patient and family distrust has pushed rates of burnout to a critical level. Some speculate that distress may worsen as the pandemic wanes and acute stress gives way to clear-eyed recognition of the extent of loss it has wrought. Additionally, providers’ own lives have been disrupted by COVID-19. More than 70% of respondents said burnout has affected their personal relationships. This is concerning because of the role relationships play in protecting mental health. Even more troubling, the risk of suicide among physicians may be increasing. 13% of respondents said they considered suicide since the pandemic began; an additional 1% had made a suicide attempt. Since suicide affects physicians at disproportionately higher rates than the general population, this is a truly alarming development. Fortunately, the crisis is provoking conversation. There is growing recognition of the need to support healthcare providers and address the toll the pandemic has taken on their well-being. While individual resilience is important, it is essential to approach physician wellness comprehensively rather than placing responsibility on individuals alone. Increased awareness of the factors that interfere with physician well-being must be followed by responsiveness to the problems they deal with. Steps must be taken to increase transparency and reduce stigma surrounding physician depression, anxiety, and suicide. Historically, many physicians have resisted seeking help due to fear that patients and colleagues would lose esteem for them. Identifying individuals at risk, responding with respect and compassion, and encouraging physicians to access mental and other health care are essential. Finally, a strong sense of community in the workplace helps protect mental health. There is no substitute for the feeling of belonging and the shared sense of purpose that a solid community provides. We need colleagues with whom we can commiserate, problem-solve, and socialize. As members of a moral community, physicians have commitments to themselves and one another as well as to patients and families. Attention to the well-being of physicians in the forms of physician self-care, support for one another, and support for physicians by the larger medical community ultimately leads to better patient care. Comments may be sent to amendola@utmck.edu
References • DeCamp, M., & Levine, M. for the ACP Ethics, Professionalism and Human Rights Committee. Physician Suicide Prevention and the Ethics and Role of a Healing Community: an American College of Physicians Policy Paper. J GEN INTERN MED 36, 2829–2835 (2021). https://doi.org/10.1007/s11606-021-06852-z • https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456#5
In Touch Vol. 11, Issue 1: January 2022
Publisher Rajiv Dhand, MD, Chair, Department of Medicine and Associate Dean of Clinical Affairs Editor Annette Mendola, PhD Administrative Director Jenny Roark Contributors Jenny Roark Robin Underwood Rajiv Dhand, MD Kandi Hodges Annette Mendola, PhD Cassandra Mosley James Drew, MD Marc Oropilla, DO Megan Sears-Smith, DO 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
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
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