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Over the past quarter century, the management of even the most complex diseases has migrated toward the outpatient setting, yet internal medicine residencies continue to build training programs around a foundation of hospital-based practice. In a survey of internal medicine program directors and internal medicine residents published in the Journal of General Internal Medicine in 2009, more than half of the medical residents wanted more of their training in the hospital. Slightly less than half of the program directors agreed with them. The house staff medicine (HSM) teaching framework traces its genealogy back to Sir William Osler’s organization of the medical service at Johns Hopkins in the 1890s. He established a full-time residency, in which physicians lived a monk-like existence and trained sometimes for seven or eight years. He introduced the core clerkship for medical students, exposing them to intense and real responsibilities of patient care at a time when physicians often left medical school and started practice having never touched a sick person. Osler developed the idea of bedside teaching rounds, where learners of all levels could observe an experienced physician take a

history, perform a detailed physical examination, and then synthesize these observations into a differential diagnosis. He required trainees at all levels to teach one another at the bedside, too. After more than a century, many physician educators still believe that learning to confidently manage the seriously ill inpatient is the foundation for providing comprehensive outpatient care. Others note that the opportunity to convert medical knowledge into clinical reasoning is more efficient. Inpatients are sicker. Their needs are more immediate. Students can connect complex disease concepts because outcomes of treatment decisions are answered in real time. Learners may return immediately to the patient to validate their

physical findings or review aspects of the history, rather than wait for a follow-up clinic visit. The benefits of inpatient learning do not just apply to medical trainees. Attending physicians often view their rotations with the house staff team as an opportunity to read and review areas of medicine they do not see in their outpatient clinics. Others enjoy the challenge of demonstrating and teaching the critical thinking necessary to unravel complicated clinical problems. “Becoming a physician is like becoming a parent,” says one experienced UTMCK attending. “You can read all the books in the world, even memorize them, but you don’t learn and understand how to do it until you are doing it in all its amazing variety.” In an era where patient scenarios can be simulated in the lab, where the history has become a template of drop-down computer choices and the physical exam is in danger of being replaced by redundant and overlapping imaging procedures, HSM is an anchor to the past, an echo from a simpler time when the patient was the primary text, and some memorable attending taught us how to read.

In the not so distant past, but certainly until the end of the last century, the “triple threat”--the academic physician who excelled as a clinician, teacher, and researcher--was the envy of physicians all over the world. Young physicians in training aspired to become such individuals, who disproportionately represented the “stars” of academia. Their leadership resonated with physicians and trainees because they represented the best-of-the-best that medicine had to offer.

Surveying the landscape today reveals a shrinking number of physicians

who can rightfully claim to be “triple threats.” Medical research, which transformed modern medicine within the past fifty years, is increasingly becoming the prerogative of large academic health centers and other established research institutions. Financial and sociological factors, among others, contribute to a declining interest in research among trainees in many academic departments. Most medical students have a substantial amount of accumulated debt that can be a significant encumbrance for young physicians. Moreover, clinical, educational, and family demands preclude residents from spending long hours needed for research work. While medical students understandably receive intensive training in clinical medicine, only a few are exposed to the rigors of research. Clinical work comes naturally to physicians, is a priority area, and has a more linear relationship between effort and reward. Research, on the other hand, requires additional training, is cumbersome, tightly regulated,

The Patient is the Textbook

Points of View

Rajiv Dhand, M.D., Chaircontinued on page 3

Department of Medicine

Connect ing Technolog y, Educat ion and Discover y with Humanism in Medicine Vol. 3 Issue 3 July 2014

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The Kind of Physician I Hope to Be by Christen Fleming, MD

The Beat Goes On: The Making of a Physician

Mentorship of residents and students is very crucial to their development as physicians. We have many excellent mentors here at the Department of Medicine who invest a portion of each busy day in the development of young physicians. During my training here, Dr. Janet Purkey has emerged as a truly exemplary influence. At the beginning of their third year clerkships, many students’ first encounter Dr. Purkey and are immediately calmed by her easygoing personality. Shadowing her in

the clinic was a great learning experience, and when I later reflected on Dr. Purkey’s love of her profession and her passion for her patients, this had a strong impact on my decision to become an internist.

Besides myself, many students would call Dr. Purkey a mentor. Functioning as the UT Internal Medicine Medical Student Clerkship Director and also as an attending on housestaff, Dr. Purkey influences young medical minds each year. She does not limit her mentorship to physicians, however. She has also forgone private practice to help establish The Free Clinic of East Knoxville with several other “faithful volunteers.” Undoubtedly these patients, to whom she provides free medical care, learn medicine from her daily. She has many passions outside of medicine, each with a common theme: helping and teaching others. She is on the board for A Hand Up for Women, the Knox County site of a national ministry called Christian Women’s Job Corps. A pivotal experience for me was visiting a patient with Dr. Purkey at the patient’s home. The patient, whom Dr. Purkey has seen since intern year in the residents’ clinic, was celebrating her 93rd birthday. In her feeble state, without vision and with minimal hearing, this patient beamed with joy at the sound of Dr. Purkey coming with goodies in hand. I hope to have this impact on a single patient in my lifetime. Dr. Purkey has had a great influence on the career direction of the medical students and residents here. Her dedication to the community, her patients, and her residents and students is exemplary. Excellent mentorship has a great influence on residents, both as physicians and as individuals, and is essential in developing strong future physicians.

Many physicians know from a young age that they want to become a doctor. Not upcoming third year resident Dr. Kayleigh Litton. She initially attended Maryville College as a business major. One day, after a “particularly long accounting lecture about credits and debits,” she had a biology lab that she said “literally changed the direction of my life.” The class took live turtles “bound for turtle gumbo,” anesthetized them, and drilled a hole in the belly plate, revealing a beating heart. “We put different chemicals on the heart to make the rate faster or slower, and then took the heart out of the turtle and put it in a glass. Did you know that a heart can beat outside a body? I didn’t.” It was the most fascinating thing Dr. Litton “had ever seen, and on that day, I knew I wanted to be a Cardiologist.” Dr. Litton will begin application to cardiology programs this summer while also beginning her new endeavor as a joint third year chief. Congratulations, Dr. Litton!

The Department of Medicine wishes to congratulate Dr. Dan Kestler on his retirement on June 30th after over 20 years with the Department of Medicine. Dr. Kestler performed novel research with odontogenic ameloblast-associated protein (ODAM) and its relation to certain cancers, which was supported by a grant from the Komen Foundation. He was an important part of our research team and will be greatly missed.

The Department of Medicine wishes to congratulate Mike Patterson on his retirement from the Department of Medicine on June 27th. Mike began working in the Department of Medicine in 2003. In addition to his accounting responsibilities, Mike has organized the Medicine Grand Rounds, Quiz Bowl, Cardiology Noon Conferences, and the annual Medicine CME Conference, and has taken our department photos. We wish Mike the very best in his future endeavors.

Faculty It is with great pleasure that we welcome two new faculty members to the Department of

Medicine. Julia van Zyl, MD, and Jano Janoyan, DO, have both been appointed at the rank of Clinical Assistant Professor. Dr. Van Zyl and Dr. Janoyan practice with UT Hospitalists. Both bring experience and enthusiasm to their roles as department faculty.

Retirement Announcements

The author, Dr. Christen Fleming (L) pictured with her mentor, Dr. Janet Purkey

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Comings and Goings

and holds no assurance of success. In fact, in the current environment there is a greater likelihood of failure than success in a research career. In addition, increasing clinical and administrative demands on clinicians’ time make research pursuits especially daunting. The dwindling research infrastructure and decline in research activity among physicians will have consequences down the road. If this affliction persists, it will gradually erode the prestige of the United States as a world leader in medical research. I strongly believe that this spiral of waning interest in pursuing medical research should be a matter of serious concern for all physicians working in academic health centers.

Points of View continued from page 1

New Internal Medicine Residents 2014-2015• Marcum W. Collins, MD, Ross University School of Medicine, Dominica• Reem A. Hussein, MD, East Tennessee State University, James H. Quillen

College of Medicine, Johnson City, TN• Emmanuel Isang, MD, Ross University School of Medicine, Dominica• Kristen A. McFarland, MD, University of Tennessee Health Science Center,

College of Medicine, Memphis, TN• Jaime C. Morris, DO, Lincoln Memorial University, DeBusk College of

Osteopathic Medicine, Harrogate, TN• Amar Parikh, MD, Medical College of Georgia at Georgia Regents University,

Augusta, GA• Brandon Sammons, DO, Lincoln Memorial University, DeBusk College of

Osteopathic Medicine, Harrogate, TN• Tara R. Shields, MD, East Tennessee State University, James H. Quillen

College of Medicine, Johnson City, TN• Cody G. Stroupe, MD, University of Mississippi School of Medicine, Jackson, MS• Aimee A. Wehber, MD, Creighton University School of Medicine, Omaha, NE• Katoura Williams, DO, Edward Via College of Osteopathic Medicine,

Blacksburg, VA

New Transitional Year Residents 2014-2015• Barrett C. Thomas, DO, Lincoln Memorial University, DeBusk College of

Osteopathic Medicine, Harrogate, TN• B. Cole Seaton, MD, East Tennessee State University, James H. Quillen

College of Medicine, Johnson City, TN• Peter Coulson, MD, University of Tennessee Health Science Center, College

of Medicine, Memphis, TN• Tamer M. Hadi, MD, PhD, Virginia Commonwealth University School of

Medicine, Richmond, VA• Jeffrey N. Mahony, MD, University of Mississippi School of Medicine,

Jackson, MS• Katoura R. Williams, DO, Edward Via Virginia College of Osteopathic

Medicine, Blacksburg, VA• Xi Zhang, Medical College of Georgia at Georgia Regents University,

Augusta, GA

Internal Medicine Graduates• Swara Afiniwala, MD, is going home to be a hospitalist in New Jersey.• Dhanu Bhat, MD, will join an outpatient practice with OhioHealth in

Mansfield, Ohio.• Andy Dake, MD, starts an endocrinology fellowship at the Medical University

of South Carolina.• Ryan Kerr, MD, will stay here in Knoxville with the UT Hospitalists group.• Moses Osoro, MD, will stay locally as a fellow in the UT Cardiovascular

Diseases Fellowship Program.• Brian Reed, MD, graduates six months later, but for now plans to become a

hospitalist.• Sister Mary Gretchen will be working with her Sisters at the Sacred Heart

Clinic in Alma, Michigan. She will be practicing primary care outpatient, as well as inpatient, internal medicine.

• Matt Stone, MD, will stay close to home, working as a hospitalist at Methodist Hospital in Oak Ridge.

Transitional Year Graduates• Scott T. McElroy, MD, Hunter Pearson, MD, Luke Rawson, MD, and

Rupert O. Stansborough, MD, will stay here at the University of Tennessee Graduate School of Medicine for their radiology residencies

• John Prenshaw, MD, will start his ophthalmology fellowship at the University of Virginia.

• James Tidwell, MD, will move to the University of Louisville for dermatology.

New Cardiology Fellows 2014-2015• David Perkel, MD, did his internal medicine residency at Cedars-Sinai

Medical Center, Los Angeles, CA. He has been a hospitalist at Inpatient Specialty Program, Los Angeles, CA, since July 2012.

• Moses Osoro, MD, completed his internal medicine residency at the University of Tennessee Graduate School of Medicine, Knoxville, Tennessee.

Cardiovascular Fellowship Graduates• Janet Eichholz, MD, is going to do a 1-year interventional cardiology fellowship

at the University of Massachusetts Memorial Center, Worcester, MA.• Mitul Afiniwala, MD’s plans are still pending.

New Pulmonary Fellows 2014-2015• Victor Gordon, MD, did his internal medicine residency at St. John Hospital

in Detroit, MI, and a sleep fellowship at Henry Ford Hospital, Detroit, MI.• Rafael Alba Yunen, MD, completed his internal medicine residency at Lincoln

Medical Center, Bronx, NY, and a critical care fellowship at Mount Sinai Hospital, New York, NY.

Pulmonary Fellowship Graduates• Kashif Aslam, MD, is going to the University of New Mexico for a critical

care fellowship.• Syed Naqshbandi, MD, will be a critical care fellow at Montefiore Medical

Center, University Hospital for Albert Einstein College of Medicine, Bronx, NY.• Naveed Sheikh, MD, is starting private practice with East Tennessee

pulmonary group at Methodist Medical Center in Oak Ridge, Tennessee.

Pictured from left, Doctors Dhanu Bhat, Swara Afiniwala, Daphne Norwood, Rajiv Dhand, Moses Osoro, Sister Mary Gretchen, Matt Stone, Andy Dake, Brian Reed,

Ryan Kerr, and Mark Rasnake

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In Touch Volume 3, Issue 3: July 2014

Publishers James Neutens, PhD, DeanRajiv Dhand, MD, Chair

Editor Ronald Lands, MD

Administrative Director Susan Burchfield, CAP-OM

Contributors Susan Burchfield Rajiv Dhand, MD Christen Fleming, MD Kandi Hodges Ronald Lands, MD Jane Obenour

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 UT Graduate School of Medicine

Department of Medicine1924 Alcoa Highway, U-114Knoxville, 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.

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.

Presentations, Publications, Awards

Thank You For Your SupportFor 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 information 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!

The Heart, Lung, Vascular Update for the Primary Care Provider will be held on September 5-6, 2014, at the UT Conference Center, Knoxville, TN. This conference is provided jointly by the UT Graduate School of Medicine and the UT Medical Center Heart, Lung, Vascular Institute.

The 3rd Annual Medicine CME Conference, offering 11 hours of CME credit, will be held April 17-18 at the Holiday Inn World’s Fair Site. We hope you can join us for these informative events. Please join us, as well, for our weekly Cardiology Conferences, which are now available for .75 hour CME credit, and our Medicine Grand Rounds, which are generally held the on the 2nd and 4th Tuesdays of each month for 1.00 hour CME credit.

Sister Mary Gretchen, MD, pictured with Clinic Director Juli Williams, MD

CME Opportunities

The UT Internal Medicine Center was delighted to present Clinic Star Awards for March through May. The recipients are:

March 2014: Dr. Max RajanApril 2014: Dr. Rafaela TonioloMay 2014: Dr. Asha Pathak

The Clinic Star of the Year Award was presented to Sister Mary Gretchen, MD, at the Department of Medicine’s Residents’ and Fellows’ Graduation Dinner on June 14th. We wish to congratulate Sister Mary Gretchen on receiving this well-deserved award for her hard work and excellent clinical and interpersonal skills.

Clinic Star Award

Sister Mary Gretchen and Ryan Kerr, MD, PGY-3s, and Christen Fleming, MD, PGY-2, won the Rawson Award presented at the 2014 Department of Medicine Residents’ and Fellows’ Awards Dinner, which was held on Saturday, June 14, at the Ft. Loudon Yacht Club (venue provided courtesy of Dr. Rick Gibson and Dr. Bill Smith). This award

is presented annually to 2nd and 3rd year residents who embody the spirit of teaching and possess excellent clinical skills. This award is given in fond memory of Freeman Rawson, MD, who was a Clinical Professor Emeritus and founding member of the Knoxville Cardiovascular Group. Dr. Rawson was a physician known for his compassion and clinical expertise. He joined the Department of Medicine in 1956 as one of our first teaching faculty and practiced medicine in Knoxville for 47 years. Dr. Rawson passed away in 2003.

Rawson Award