Department of Internal Medicine
What WE have accomplished
Where We are going
Department of Internal Medicine
Full time Faculty
Divisions
Clinical Faculty
Adjunct Faculty
11
18
80
5
 Program Director
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Lisa Staton MD
Associate Program Director Cathy Payne MD
Program Coordinator
Ms. Deborah Fuller
Clerkship Director
Gary Malakoff MD
Research Director
Victor Kolade MD
UMA Director
Lisa Staton MD
Associate Director
Victor Kolade MD
Chief Residents
D Meadows MD/A BhushanMD
M Tveite MD/N Gupta MD
Administrative Assistant
Ms. Laura Nihiser
Transitional Year Program
Ms. Joyce Poke
Coordinator
Department of Medicine
Leadership
Dr. BW Ruffner
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President-elect of the TMA for 2009-2010
Dr. Charles F. Longer
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Chairman, Board of Trustees
New Faculty
 General IM
 GI
 Endocrine
 Cardiology
 Hospitalists
 Neurohospitalist
 Neurology
Administrative Staff
 New Administrative Assistant - Ms. Laura Nihiser
 Electronic Completion of Evaluations via New
Innovations by Faculty, Residents and Staff
 Monthly Staff Meetings
 Faculty Appointment System
(Notification of Final Appointment Completion)
 Monthly UTCOMC sponsored New Innovation &
Web Training Sessions
Residency and Fellowship Program
Dr Lisa Staton
Palliative Care Fellowship
 Successful accreditation
 Successful completion of first year
 Successful recruiting
The Past Year
 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
University Medical Associates
Dr Lisa Staton
Dr Victor Kolade
Ms M Calloway
OVERVIEW
 Firm Assignments
 Change in Continuity Clinic Hours
 Changes in Cardiology Clinic
 Staff Retreat
WHY FIRM ASSIGNMENTS
 To structure resident clinic as a group practice
 To allow for shared responsibility for learning
 To provide continuity of patient care
 To promote an interdisciplinary approach to
patient care
 To encourage mutual support and collegiality
 To help ensure mentoring and supervision during
resident’s continuity experience
CHANGE IN CONTINUITY CLINIC HOURS
 Allow 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 CLINIC
 Cardiology Clinic changed from two clinic a month
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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 purchased
Dedicated Medical Assistant for Cardiology Clinic
Proposal 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 morale
 To improve patient flow
Medical Students
M3 Clerkship Accomplishments
 Restructured orientation to include
 How to write notes
 How to present to an attending
 Professionalism
 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 Accomplishments
 Pulmonary/critical care as separate entities
 Initiated student evaluation of clerkship/rotations
 Secured palliative care experience in the
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ambulatory and specialty rotations
GME office organizing special interest groups for
medical students rotating here
Total of 7 students completed their patient safety QI
clerkship through our department
4 of our 10 new IM interns rotated in our
department
1 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 Rotations
 Possible neuro/psych rotations
 Increased class size = more students in Chattanooga
in 2 years
 Actively involved in selection process for these
students
Quality Improvement Projects
 Initiated chapter of IHI Open School
 Improving inpatient glycemic Control
 Evaluating the global trigger tool to identify
adverse events in the hospital
 Evaluating and improving inpatient VTE
prophylaxis protocol
 Evaluating 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 audit
 Consultation form
 Code committee
 Inpatient Medicine Scorecard
 Transfer of Care
 Pneumonia Core Measures
 CHF core measures
 AMI core measures
 Antibiotic Stewardship
 Hand Hygiene
Quality Improvement Projects
 VAP bundle
 Sepsis protocol
 Patient flow
 Mortality reduction
Department of Medicine
Scholarly Activity Update
Publications, Lectures, Meetings,
Research, QI,
UMA, Education, Scholarships
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 ThroatPotentially 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
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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 J
Scherer K, Panda M, Johnston J Dural Based Mass
Journal of Radiology
Makdsi F Acute Pancreatitis with Eruptive Xanthomas J
Hosp Med
Book Review
 Mathis R. Cause And Coincidence In
Autism. Health Aff. May 1, 2009;28(3):916917
Submissions
 Makdsi F Transient Thyrotoxicosis as an Initial Presentation
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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 Decisions
 Leucocytoclastic vasculitis JGIM
 AVM Cases J
 DKA and Pneumomediastinum Cases J
 Subacute Combined Degeneration With Normal Vitamin
B12, submitted to Cases J
Manuscripts in Preparation
 Catastrophic Antiphospholipid Antibody Syndrome Jacobson
 Scrofula Kafle
 Extragonadal Germ Cell Tumor Hadgu, Tindni, Panda
 How much is too much Grubb, Gaurav, Panda
 Clonidine overdose Tveite
 A Rare Cause of Acute Seizure in a Young Man Krummert,
Scherer, Whitley, Dixon, Sirelkahtim, Panda
 Diabetes Insipidus Chhakchhuak, Tumlin
 Pulmonary LCNEC Kaako
Local and Distant Conferences
Posters and Oral Presentations
Panel Discussions
 Approaches to Interactions with Industry: A
Multidisciplinary Panel Discussion to Educate
Residents In Training
 Dr Malakoff
 Robin Grant, R.Ph.
 Dr Mathis
 Dr Fore
 Sylvia Friedl
 Physician Stress & Burnout” at the Departmental
Residency Retreat Cohen, Barker, Panda
Research Week Research Abstracts
 RAPID 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 Reports
1. 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)
SSGIM, 2/09
 3 workshops
 9 oral presentations
 13 posters
Presented at National SGIM
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Numbness in a 39 Year-old Man Makdsi F, Kadrie H
Common shortness of breath for uncommon reason: Rahman A,
Kolade V
When A Piece Of Heart Hurts The Brain. Kafle P, Dutta G, Yium J
Painful Ophthalmoplegia as the first Manifestation of Lung Carcinoma
Mocanu B, Obaid B, Kolade V
Late-Onset Asthma and Stridor; Think about Adenoid Cystic
Carcinoma! Kaako A, Stansell K, Kolade V
Oral: A Case of Leukocytoclastic Vasculitis with Rare Complications
Finch T, Brit M, Panda M
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 Nephropathy
 North American Society for Dialysis and Transplantation,
 July 12-16, 2009; Kapalua-Maui, Hawaii
 Dr Tumlin
Bilateral Symmetry in Chronic Uremic Pruritus: The
Brain-Skin Connection
2. A Phase III, Randomized, Double-Blind, PlaceboControlled Study of Tenecteplase for Improvement of
Hemodialysis Catheter Function: TROPICS 3
1.
 American Society of Nephrology Meeting
 October 27 - November 1, 2009; San Diego
Ongoing Research And QI
Current projects
 Kyle, Stansell, Rahman, Anower, Tumlin, Boldt,
Gunter, Shome: PRESSURE Trial
 Gupta, Strelnikova, Boldt, Panda: VIPP study
 Kaako, Panda: Care of Muslim Patients
 Todd, Payne: Vaccine history and pneumococcal sepsis
in alcoholics
 Hawkins, Malakoff, Chhakchhauk: C. difficile Colitis
 Navaid: Quality of life in hemodialysis patients
 Bhushan, Payne: Patient handoffs
Bringing Back the Black Bag
 Drs Rybolt, Panda and C. Cunningham; begun March 09
 This 3-year project promotes improving humanism in medicine
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through the use of House Calls
Internal 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,
Objectives
 Explore the influence of breast cancer treatment associated
side effects (including alopecia) in patients diagnosed with
breast cancer, their spouses/significant others, and healthcare 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 R
Chijioke, Scherer, C Cunningham, Panda
 Pilot study to address the following aims:
 To provide and promote an encouraging environment in which
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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 Submissions
 Hi-TECH project: Technology Enhanced Code team
Help
 Dr Kolade, Panda, Dart
 Submitted to NIH
 Controlling Diabetes Among Low-Income
Patients: Physical Activity, Dietary Assessment and
Counseling Coupled with Community Navigation
 Collaboration with Family Medicine and community physicians
 Staton, Heath, Kolade, Panda
 Submitted to CDC/CTSI
Grants Received
 Arnold P Gold Foundation
BBBB project
Gold Humanism Honor Society
H.A.I.R
 Hulbert Foundation
 BCBST
 DCI
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 volumecycled ventilation
IHI
Lectures
Stop Stroke Saturday
Dr. Malakoff
Grand Rounds
 Designation as an ACP educational event means
attendance counts towards participation in College
activities
 Topics included
 Psoriatic Arthritis
 Can One Patient Teach It All?
 Renin-Angiotensin-Aldosterone Axis in Chronic
Kidney Disease
 Acute 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
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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 Stewardship
J Boldt MD Interpreting PFTs Tennessee ACP
BCBST/Lunch & Learn
 Vitamin D deficiency - Harmful, but
preventable and treatable: Kolade
 ARDS: Kyle
 Bariatric Surgery – Criteria, Outcomes and
Pitfalls : Payne
HHP 597: Introduction to Epi. Methods
Kolade
 Cigarette Smoking and Lung Cancer
 Clinical Applications: Vitamin D, the
Sunshine Vitamin
Resident Education
Scholarships
 Mohammed 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 Policy
 Expected total - 21 or more points, obtainable through
 Manuscripts
 Medical Images publications
 Research: Proposal approval, data collection
 Posters/oral presentations
 Workshops
 IHI modules
Points garnered over 3 years
POINTS
120
100
80
#60
40
20
0
1
2
3
4
5
6
Resident
7
8
9
10
Summary 2008-2009
 >20 peer-reviewed publications on file
 >11 oral and 32 poster presentations
 6 workshops
 Several intramural and extramural lectures
Department of Medicine
Esprit de corps Activities
and
Community Service
Esprit de corps Activities 2008-2009
 Chambliss Shelter and Audobon Acres Service
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Project
Annual Canned Food Drive/Design Competition
Recruitment Dinner and Match Day Celebration
Ocoee River Rafting Trip
Boy Scout Medicine Merit Badge
Race for the Cure
Halloween/Fall Festival Celebration
Trunk or Treat/Chili Party
Multicultural Lunches
 Thanksgiving Canned Food Drive
 Holiday Musical Performance
 UMA patient sponsorship for Christmas
 Transitional Year and Internal Medicine Holiday
Party
 Sporting Activities (Basketball and Soccer)
 Chattanooga Girls Leadership Academy Service
Project
 Eagle Scout Service Project Phase 1 and 2
 Mutia Health Center Fundraiser/Bowling
 April Day of Service Activity in coordination with
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Weed and Seed
Tour de Cure in coordination with Erlanger and
American Diabetes Association
YMCA “BIG” Project
“Press Out” Domestic Violence Bench Press
Competition
RRR in R Sessions
IM/TY Retreat
Gold Humanism Honor Society
 Minority Health Fair
 Women's Health Fair
 US Xpress Health Fair
Department of Internal Medicine
What WE have accomplished
Where We are going
The Upcoming Year
 Medical Knowledge
 New 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 Learning
 Scholarly Point Assignments
 Revise Evaluations
 Interpersonal Skills and Communication
 Professionalism
 Abstracts (professionalism and multicultural)
 Systems Based Practice
 Site Visit 2010
 New Program Guidelines
Goals
 Continue to improve the education, patient care,
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faculty structure
Journal club
M&M
Recruitment for Divisions of Endocrinology, GI,
Cardiology, Critical Care
Faculty Practice Plan will improve primary care
Standardization based on new CMS requirements
WW6 renovation
Departmental expansion
Department of Internal Medicine
TEAM = Together
Everyone Achieves More