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Title: Department%20of%20Internal%20Medicine

Department of Internal Medicine
  • What WE have accomplished
  • Where We are going

Department of Internal Medicine
  • Full time Faculty 11
  • Divisions 18
  • Clinical Faculty 80
  • Adjunct Faculty 5

  • Program Director Lisa
    Staton MD
  • Associate Program Director Cathy Payne MD
  • Program Coordinator Ms. Deborah
  • 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
  • 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
  • President-elect of the TMA for 2009-2010

  • Dr. Charles F. Longer
  • 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
  • Interpersonal Skills and Communication
  • Ethics Quarterly
  • One on One mentoring

The Past Year
  • Professionalism
  • Transition to Residency Chief Residents
  • Pharmaceutical Company Interactions- Bhushan and
  • Ethics Conferences
  • Esprit de Corp Activities
  • RRRnR sessions
  • 3 Alper Humanism inductees, IM resident received
  • 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

  • Firm Assignments
  • Change in Continuity Clinic Hours
  • Changes in Cardiology Clinic
  • Staff Retreat

  • 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
    residents continuity experience

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

  • Cardiology 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 purchased
  • Dedicated Medical Assistant for Cardiology Clinic
  • Proposal for onsite Chest X-Rays

  • 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
  • Moved several core lectures to beginning of the
    clerkship to avoid interruptions in clinical
  • Physical diagnosis teleconference across all 3
  • First class of GHHS inducted

Medical Student Accomplishments
  • Pulmonary/critical care as separate entities
  • Initiated student evaluation of
  • Secured palliative care experience in the
    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
  • 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

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 2009337(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
  • Rahman AA, Panda M. Locked lung by looped hernia
    a case report. Cases J. Jan 8 20092(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 20081(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
  • 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.
  • Desbiens NA. A departmental experience in
    promoting oral and poster presentations. Teach
    Learn Med Jul-Sep 200820(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 2008JPAH-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. 20081(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
    2008102(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

  • 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 200835(6)578-588
  • Bhattarai N, Panda M. Uremic Frost. Mayo Clin
    Proc. December 1, 200883(12)1309
  • Dutta G, Panda M. An uncommon cause of lower
    gastrointestinal bleeding a case report. Cases
    J. 20081(1)235
  • Conner C, Paydar A. Intradural Extramedullary
    Arachnoid Cyst Presenting as Arteriovenous
    Malformation in the Thoracic Spinal Cord.
    Radiology Case Reports 20094263

  • 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 200814(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 200852(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 200858(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
  • Navaid M Power of presence and compassion J
    Palliative Med
  • Makdsi F, Brit M A Case of Sclerosing
    Mesenteritis With Rheumatoid Arthritis South Med
  • Makdsi M, Fall M Acute Renal Infarction J Hosp
  • 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, 200928(3)916-917

  • Makdsi 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 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
  • 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,
  • 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
  • A Rare Cause of Acute Seizure in a Young Man 
    Krummert, Scherer, Whitley, Dixon,
    Sirelkhatim, Panda (3rd place poster)
  • Painful Ophthalmoplegia as the first
    Manifestation of Lung Carcinoma Mocanu, Obaid,
  • Late-Onset Asthma and Stridor Think about
    Adenoid Cystic Carcinoma! Kaako, Stansell, Kolade
  • 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
  • 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

International Conference of the American Thoracic
Society, May 15-20, 2009
  • Food and Particulate Aspiration Pneumonia Gupta
    N, Enjeti S

  • Dr Yium Lead Toxicity Lead and Moonshine
  • North American Society for Dialysis and
  • July 12-16, 2009 Kapalua-Maui, Hawaii
  • Dr Tumlin
  • Bilateral Symmetry in Chronic Uremic Pruritus
    The Brain-Skin Connection
  • A Phase III, Randomized, Double-Blind,
    Placebo-Controlled Study of Tenecteplase for
    Improvement of Hemodialysis Catheter Function
  • 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
  • Navaid Quality of life in hemodialysis patients
  • Bhushan, Payne Patient handoffs

Bringing Back the Black Bag
  • Drs Rybolt, Panda and C. Cunningham begun March
  • This 3-year project promotes improving humanism
    in medicine 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 health-care
  • Provide a structured opportunity to teach and
    role model the concept of taking ownership and
    getting to know the patient as a complete human
  • 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 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
  • 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
  • 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
  • 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
    volume-cycled ventilation

(No Transcript)
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.
  • 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
  • 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

Resident Education
  • 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
  • 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,
  • 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
  • Manuscripts
  • Medical Images publications
  • Research Proposal approval, data collection
  • Posters/oral presentations
  • Workshops
  • IHI modules

Points garnered over 3 years
(No Transcript)
Summary 2008-2009
  • gt20 peer-reviewed publications on file
  • gt11 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
  • 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
  • Sporting Activities (Basketball and Soccer)
  • Chattanooga Girls Leadership Academy Service
  • Eagle Scout Service Project Phase 1 and 2

  • Mutia Health Center Fundraiser/Bowling
  • April Day of Service Activity in coordination
    with Weed and Seed
  • Tour de Cure in coordination with Erlanger and
    American Diabetes Association
  • YMCA BIG Project
  • Press Out Domestic Violence Bench Press
  • 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

  • Continue to improve the education, patient care,
    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