InTouch Newsletter - July 2021

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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 D i s cove ry w ith H um anis m in Me dicine

Vol. 10 Issue 3 Jul. 2021

Virtual Recruitment: Pros & Cons Throughout history, one could make the argument that some of the greatest advancements in civilization have come from dedicated communities navigating the challenges placed before them. In modern times, COVID-19 has brought about unique obstacles that healthcare providers from all over the globe have worked tirelessly to overcome. As health systems continue to adapt in response to these new demands, practices in medical education itself have undergone change to preserve quality while complying with community safety guidelines. In particular, the resident recruitment and interview process saw significant change from years past. As our department begins to plan ahead, it is apparent some of these changes may have had unforeseen advantages. To begin, interviews were held virtually over Zoom representing a change that is likely here to stay at least in some capacity according to Dr. Mark Rasnake. Traditional interviews have created challenges for recruiting given that applicants will often seek interviews within their geographical area as they must schedule and finance their own travel expenses. With virtual interviews, applicants who may have not otherwise interviewed with our institution now have the option to do so virtually. Also, according to our residency coordinators, the number of interviews that were cancelled or rescheduled by applicants this last year was greatly reduced helping to stabilize the scheduling process. This may serve to improve our residency and fellowship programs through the matching of stronger applicants from more diverse places and backgrounds. Virtual interviews also benefit applicants themselves as the financial burden and scheduling conflicts brought about by the traditional interview season are largely circumvented. Medical students often rely heavily on student

loans for general living expenses and many current residents report taking out personal loans in the past to have funded their interview season travels. Lastly, virtual interviews also proved beneficial for faculty interviewers themselves as their flexibility was both convenient and less obstructive to other patient care activities. Another change that will likely persist is the applicant pre-interview meet and greet sessions. This was a scheduled Zoom meeting the night before an applicant’s interview where current residents volunteered to attend and share their perspective on what they enjoy about our residency program and the city of Knoxville as a whole. Applicant feedback on these sessions was overwhelmingly positive serving to give applicants a sense of the positive social atmosphere established at the University of Tennessee Medical Center. When paired with a virtual interview, this also provided an opportunity for applicants to address continued on page 2 any technological difficulties in a more

Points of View

by our residents and overcomes one of the key shortcomings of the ambulatory clinic experience for them. I am extremely grateful to Dr. Clay Callison and Mr. Michael Saad for prioritizing this project and dedicating funds and personnel to make this possible. To our clinic directors, Dr. Juli Williams and Kay Rangnekar, in addition to the staff in the IM/Ob/Gyn clinic; my profound thanks for their perseverance and patience through this difficult transition. The residents and attendings are also going through a period of adapting to a new system and I appreciate their understanding and receptiveness to these changes. The importance of having an integrated EMR can’t be overemphasized. An integrated EMR can readily provide information that is key to resolving complex clinical problems. Clinicians often feel continued on page 2 hampered by the lack of information from a

The desire to have an integrated Electronic Medical Record (EMR) in the Internal Medicine (IM) clinic and the hospital has been ongoing for several years. For me personally, completion of this project has been a mission. Through the extraordinary generosity of our CEO, Mr. Joe Landsman, and the exceptional efforts of a whole team of individuals our efforts were finally successful in Rajiv Dhand, MD, Chair May of 2021. The integration of the EMR addresses an important issue that has been repeatedly raised 1


Joint CPC Conference One of the newest additions to the UT Graduate School of Medicine didactic curriculum is the Multidisciplinary Clinical Pathology Conference. Initiated in February 2020, this conference involves a joint effort by residents and attendings from Internal Medicine, Radiology, and Pathology, as well as occasional subspecialty services, such as Cardiology or Hematology/Oncology. Most cases that are selected for presentation are chosen due to their unique characteristics, such as a rare diagnosis or an unusual clinical presentation. Presentations generally begin with a patient case presented by a senior IM resident, outlining the history of present illness, patient history, and brief workup. After this, a differential diagnosis is formulated and elaborated on by a faculty discussant. Audience participation discussing the likelihood of etiologies based on this information provides attendees with valuable clinical knowledge and great discussion. Imaging findings are presented by Radiology residents that participated in the patient’s care, offering valuable expertise beyond the individual patient’s scenario and exposure to imaging not regularly available to IM residents during other conferences. Discussions and education regarding appropriate imaging tests and evaluation techniques for the best-suspected diagnosis are invaluable to continuing to improve patient care. Each conference also requires a pathology component, with findings and photomicrographs presented and expanded on by pathology residents or attendings. This offers a definitive diagnosis for the patient’s case and information related to the pathogenesis of the disease. Treatment options and follow-up then conclude the presentation with ample opportunity for questions. These conferences are generally held once each quarter and are brilliant additions to the current didactic schedule. The best part: they are interactive and participation with questions or comments from attendees is encouraged!

Virtual Recruitment: Pros & Cons

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casual setting before their formal interview. Additionally, this event took the place of a traditional pre-interview dinner which may provide cost savings that could be distributed elsewhere in recruiting efforts. Despite our best efforts to connect effectively with applicants through a virtual format, it is the impression of many current residents and faculty that the incoming class may have more than average concern about what to expect in their first days as a new resident. Simply put, many of them have never visited Knoxville and even fewer have had the opportunity to experience our hospital setting. Although the most recent interview season was far from normal, it may have illuminated advantages and disadvantages to virtual recruiting that may have never been uncovered under normal circumstances.

Points of View

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previous hospital admission or clinic visit and finding this information could entail a great deal of effort -- an enormous waste of precious time. Having this information readily available will lead to faster acquisition of information and leverage clinician’s ability to provide a higher level of patient care. It will certainly lead to greater efficiency and improved satisfaction among other clinicians and staff because the records from the IM clinic will be available to users of Power Chart throughout the institution. The addition of the East Tennessee Health Information Network (ETHIN) to the Power Chart menu has been another welcome addition to the ability to search for patient records from within and outside our hospital. In my opinion, these are very significant advances as we move forward on our journey to achieve greater excellence as an academic medical center. We anticipate some issues during this transition period but once users become accustomed to the new system, the benefits will exponentially outweigh the downsides. I feel a sense of accomplishment with the integration of our EMR and look forward to implementation of other improvements in our residents’ clinic.

CME OPPORTUNITIES

currently done hybrid with a limited live audience and others joining 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. 2


Comings and Goings Incoming NEW INTERNAL MEDICINE RESIDENTS

NEW CARDIOVASCULAR DISEASE FELLOWS

Mary Alexander, DO: Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, TN

Justin Harrell, DO: Medical School at Lincoln Memorial University & Internal Medicine Residency at University of Kentucky, Lexington, KY

Abdallah Assaf, MD: Ross University School of Medicine, Miramar, FL

John Taylor, DO: Medical School at Lake Erie College of Osteopathic Medicine & Internal Medicine Residency at AdventHealth Orlando, FL

Muaz Assaf, MD: Ross University School of Medicine, Miramar, FL Sohiub Assaf, MD: Ross University School of Medicine, Miramar, FL Phillip Dougherty, DO: Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, TN Ashley Gutierrez-Santana, MD: San Juan Bautista School of Medicine, Caguas, Puerto Rico.

Michael Kopstein, DO: Medical School at Lincoln Memorial University & Internal Medicine Residency at HCA HealthONE Program, Lone Tree, CO NEW INTERVENTIONAL CARDIOLOGY FELLOW

William Black: Cardiovascular Disease Fellowship at the University of Tennessee Graduate School of Medicine; Knoxville, TN

Salem Karadsheh, MBBS: University of Jordan Medical School, Amman, Jordan

NEW PULMONARY/CRITICAL CARE FELLOWS

Sonya Khimani, MD: Ross University School of Medicine, Miramar, FL

Sharma Nishant, MBBS: Medical School at Kakatiya Medical College in India & Internal Medicine Residency at The Wright Center for Graduate Medical Education in Scranton, PA

Shawna Simpson, DO: Liberty University College of Osteopathic Medicine, Lynchburg, VA Natalie Street, MD: East Tennessee State University – Quillen College of Medicine, Mountain Home, TN Warner Thomas, MD: University of Tennessee Memphis - College of Medicine, Memphis TN Martin Valdes, MD: Ross University School of Medicine, Miramar, FL NEW TRANSITIONAL YEAR RESIDENTS

Hayden F Byrd, MD: McGovern Medical School at the University of Texas Health Science Center. Houston, TX. Matched at Vanderbilt Univ for Rad/Onc beginning 07/2022. Rachel Dykes, DO: Edward Via College of Osteopathic Medicine – Auburn Campus, AL Matched at Orange Park Med Ctr-FL for Dermatology beginning 07/ 2022. Alexandria Atkins, MD: University of Tennessee Memphis - College of Medicine, Memphis TN Matched w/Radiology here beginning 07/2022. M. Christian Gash, MD: East Tennessee State University – Quillen College of Medicine, Mountain Home, TN. Matched with Radiology here beginning 07/2022. Michael Gerbo, MD: West Virginia University School of Medicine. Morgantown, WV Matched with Radiology here beginning 07/2022. Jacob (Jake) Saxon, MD: Emory University School of Medicine, Atlanta, GA Matched with Radiology here beginning 07/2022.

Shawnt Tosonian, MD: Medical School at St. George’s University School of Medicine in Grenada & Internal Medicine Residency at Eisenhower Medical Center, Rancho Mirage, CA Elman Urbina Meneses, MD: Medical School at the Universidad Americana (UAM) Facultad de Medicina, Nicaragua & Internal Medicine Residency at MetroWest Medical Center/Tufts School of Medicine, Framingham, MA.

Graduating INTERNAL MEDICINE GRADUATES

Omar Alsharif, MD: Hospitalist for Tennova

North, Knoxville, TN & PRN Hospitalist for UTH at UTMC, Knoxville, TN Kathryn Coombes, MD: Primary Care Physician for Internal Medicine Associates at Summit Medical Group, Powell, TN Nikhil Jain, MD: Hospitalist for UTH at UTMC, Knoxville, TN Morgan Morelli, MD: Infectious Diseases Fellowship at Case Western University Hospital, Cleveland, OH Austin Nunemaker, DO: Hospitalist for UTH at UTMC, Knoxville, TN Kristin O’Connor, MD: Primary Care Physician for University Internal Medicine at UTMC, Knoxville, TN Clinton Phillips, MD: Hospitalist for UTH at UTMC, Knoxville, TN Scott Shubeck, DO: Hospitalist for Statcare Medicine, Knoxville, TN

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Bryan Walker, MD: Infectious Diseases Fellowship at University of Nebraska Medical Center in Omaha, NE Sam Walker, DO: Hospitalist for UTH at UTMC, Knoxville, TN Jimmy Wang, MD: Infectious Disease Fellowship at University of Miami/Jackson Health System in Miami, FL Heidi Worth, MD: Hematology and Oncology Hospitalist and Assistant Professor at the Medical College of Wisconsin, Milwaukee, WI TRANSITIONAL YEAR GRADUATES

Kaleb Darrow, MD: Radiology Oncology Residency at Vanderbilt University Medical Center Carol Elsakr, MD: Physical Medicine and Rehab Residency at Sunrise Health GME/Mountain View Hospital in Las Vegas, Nevada Obaid Anwar, MD: Radiology Residency here at UTMC, Knoxville, TN Jack Barrow, MD: Radiology Residency here at UTMC, Knoxville, TN Paul Miller, MD: Radiology Residency here at UTMC, Knoxville, TN Casey Shumberger, MD: Radiology Residency here at UTMC, Knoxville, TN CARDIOVASCULAR DISEASE FELLOWSHIP GRADUATES

Jenna-Lyn Johnson, MD: Cardiovascular Disease Specialist at Lexington Medical Heart and Vascular Center, Columbia, SC INTERVENTIONAL CARDIOLOGY FELLOWSHIP GRADUATE

Hassan Tahir, MBBS: Interventional Cardiology Specialist at Lake Cumberland Regional Hospital, Somerset, KY PULMONARY/CRITICAL CARE FELLOWSHIP GRADUATES

Fatima Wong, DO: Interventional Pulmonology Fellowship at Cooper University Hospital, Camden, NJ Spencer Pugh, MD: Pulmonology / Critical Care Specialist for Statcare Medicine, Knoxville, TN


Resident Spotlight: Meet Drs. Sam Purkey, Laylan Shali, and Emily Daniels As we look forward to the new residency year, the Internal Medicine program would like to introduce the new chief residents: Dr. Shali is serving as the inpatient medicine chief. This year she hopes to cultivate strong and successful internists, while also focusing on resident wellness. She is excited to continue to train and recruit high quality physicians at UT. Dr. Shali plans to pursue a career in cardiology after serving as chief. She is known for her amazing Kurdish cuisine, nurturing incoming residents, and recruiting friends to participate in Turbo Spin classes with her. Dr. Purkey is serving as the ICU chief. His goals are to foster resident learning and growth through didactics and interprofessional rounding. He hopes to promote resident knowledge as we transition to a time where COVID-19 patients are no longer the norm. Dr. Purkey has a special interest in gastroenterology. When he is not attending to patients, he can be found paddle boarding on the Tennessee River with his dog Bentley or eating at Sticky Rice Café with his co-residents. Dr. Daniels is serving as the clinic chief. She is embracing the challenge of optimizing the new PowerChart EMR for clinic. Additionally, she is implementing a plan to improve efficiency on REACT appointments. Dr. Daniels is passionate about outpatient medicine and has been nominated clinic star on multiple occasions. In her spare time, she enjoys exploring new restaurants with her husband Colby, having a girls night at the movie theatre, and being the “crazy plant lady.”

Faculty & Resident Awards and Honors Rawson Recipients

Clinic Star of the Year

The Rawson Award for excellent teaching and clinical skills was given to Dr. Nikhil Jain, MD, and Dr. Megan SearsSmith, DO, at the 2021 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.

The UT Internal Medicine Center presented the Clinic Star of the Year Award to Bryan Walker, MD at the 2021 Department of Medicine Residents’ Awards Dinner. Congratulations to Dr. Walker 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. Jimmy Wang, Sam Walker, Nikhil Jain, Kristin O’Connor, and Austin Nunemaker. These residents were acknowledged at the 2021 Department of Medicine Residents’ Awards Dinner. 4


7th Annual Department of Medicine Research Awards On June 8th, 2021, the Department of Medicine held the 7th 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 “Effect of Elevated Left Ventricular End Diastolic Pressure on Instantaneous Wave-Free Ratio and Fractional Flow Reserve Discordance.” Dr. Greg Desrosiers won second place with “Cardiologist Underutilization of New Antihyperglycemic Medications in Diabetic Patients with Cardiovascular Disease.” Dr. James Drew won third place with “A Retrospective Analysis Investigating Risk Factors for Rheumatologic Complications with the Use of Immune Checkpoint Inhibitors.

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 13 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 during three years of residency training. For the fourth year in a row, this honor went to the Division of Pulmonary and Critical Care Medicine.

Faculty Announcements: New Faculty We are elated to welcome Dr. Christina Han for appointment to the rank of Clinical Assistant Professor. Dr. Han completed medical school at the Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, FL. She completed a residency in pediatrics at the Penn State Milton S. Hershey Children’s Hospital in Hershey, PA. She is currently a Hospitalist at East Tennessee Children’s Hospital in Knoxville. Dr. Han is also the rotation director for the UT Family Medicine residents and Inpatient Pediatrics Clerkship Coordinator for UTHSC College of Medicine students. We are pleased to welcome Dr. Sai Sudha Mannemuddhu as Clinical Assistant Professor. Dr. Mannemuddhu completed medical school at the Osmania Medical College in Telangana, India. She completed a residency in pediatrics at Miami Children’s Hospital in Miami, FL, followed by a fellowship in nephrology at the University of Florida in Gainsville, FL. Dr. Mannemuddhu is currently a pediatric nephrologist at East Tennessee Children’s Hospital in Knoxville.

Faculty Awards Jonathan Wall, PhD, a Professor and Director of Research at the University of Tennessee Health Science Center’s Graduate School of Medicine, has been appointed as a University Distinguished Professor. The title is reserved for those who have contributed in a superlative way to UTHSC and brought distinction and respect to the university. Dr. Wall’s appointment comes from UTHSC Graduate School of Medicine Dean Paul J. Hauptman, MD, and UTHSC Chancellor Steve Schwab, MD. “It would be an understatement to refer to Dr. Wall’s research as impactful,” Dean Hauptman said. “When few investigators were focused on systemic amyloidosis, Dr. Wall was forging ahead with new, innovative, research ideas that are now bearing fruit. Most importantly, beyond his international stature among researchers, Dr. Wall continues to contribute to the Graduate School of Medicine and the wider UTHSC community through mentorship and service.”

UTMCK – Recent Publications http://gsm.utmck.edu/research/scholarlyactivity.cfm

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Ethics Case Rounds – Can we let him go? A homeless, COVID-positive patient wishes to leave AMA

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

Edward is a 40 y/o gentleman with a history of tobacco use, alcohol abuse, schizophrenia, and homelessness who presented with auditory hallucinations and thoughts of wanting to kill himself and his mother. He was involuntarily committed by the ED physician and underwent pre-admission COVID-19 testing with plans for transfer to a psych facility. Though he was asymptomatic, his COVID test was positive. Since he could not go to a facility or a shelter until 10 days after his first positive test, he was admitted here. Over the next several days, he endorsed auditory hallucinations but denied suicidal and homicidal ideation. He had a second positive COVID test but remained asymptomatic. On the fourth day after admission, he said he was doing well except for craving cigarettes, and asked to leave. He was medically and psychiatrically stable. He did not believe the staff when told that he could not go to a shelter while COVID positive. Infectious disease epidemics and pandemics disproportionately harm people living with poverty and marginalization. Indeed, homelessness increased during the COVID-19 pandemic, and homeless shelters are conducive to the spread of airborne disease due to crowding and high turnover. Limited access to health and social services and personal protective equipment (PPE), as well as factors that make it difficult for some individuals to adhere to pandemic-specific protocols such as mental illness and history of trauma, can compound the problem. Staff had concerns about Edward leaving, as he would not have a place to stay out of the elements. They were also concerned about his ability and willingness to keep from exposing others to COVID. Edward, however, was unconcerned. He said he felt sure he could go to a shelter, and that if he got sicker, he would come back to the hospital. While he agreed to stay masked and keep socially distant from others, he’d had difficulty complying with these measures while here. A caseworker who knew Edward from the community also believed he would not remember to stay masked or socially distanced. Providers’ primary duty is to individual patients, but we also have duties to the public health. The Health Department must be notified if an infectious patient leaves AMA, but hospitals do not have authority to quarantine COVID-positive patients without their consent, despite the risk they may pose to public health. Health care providers can encourage people to follow protocols one day at a time, take steps to build trust and rapport, and take a traumainformed approach to care. Basic principles of Trauma-Informed Care include recognizing the prevalence and signs of past trauma, ensuring people feel safe, fostering collaboration and mutual respect, and generating meaningful choices to empower action. Through the efforts of Volunteer Ministry Center and Knox County Health Department, Knoxville had a COVID-19 isolation facility for those in need of housing, called Guest House III. Patients had their own rooms and meals were provided. Individuals were required to be medically stable, able to complete their own ADLs, and willing and able to follow infection prevention protocols. Fortunately, Edward was pleased to learn of the option to go to Guest House III, especially because he could smoke there. He was discharged there in a psychiatrically stable condition and without symptoms for COVID-19. ***Due to declining numbers of COVID patients, Guest House III closed on June 30, 2021. Comments may be sent to amendola@utmck.edu

References • Ginsberg J, Shields S, Andrelchik A, Lesandrini J. When a Coronavirus Patient Requests to Leave AMA. J Radiol Nurs. 2020;39(3):179-180. doi:10.1016/j.jradnu.2020.05.004 • MacKenzie, OW; Trimbur, MC; & Vanjani, R. “An Isolation Hotel for People Experiencing Homelessness” N Engl J Med 2020; 383:e41

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! 5

Vol. 10, Issue 3: July 2021

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 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