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5/15/13: Humanities in Medicine/Voices of Medicine show

The annual Humanities in Medicine event is coming up this Wed., May 15 at 7 p.m. at Casbah. Get ready to gather with internal medicine residents and members of the faculty for a night of music, poetry and storytelling. This event will be combined with Voices of Medicine, the Talk Story narrative variety show that features stories from Duke physicians, fellows and medical students.

This year’s event will showcase the talents of a number of Duke performers including  a story by medicine-pediatrics resident Scott Tolan; poetry by senior assistant resident Leah Rosenberg; piano by fellow Juliessa Pavon; flute by assistant professor Marisa D’Silva; photos and stories by Mary Driebeek; a capella music by Major Groove and much, much more.

Doors open at 7 p.m. and the show will start at 7:30 p.m. Casbah is located at 1007 W. Main St. in Durham.

 

by · Posted on May 13, 2013 in Events, Internal Medicine Residency · Read full story · Comments { 0 }

Weekly Updates: May 13, 2013

From the Director

Hi everyone,  it’s been a busy week with Maestro training gearing up – thanks to everyone for working thru the classes added to your schedules.  I was excited to hear from Murat Arcasoy about the 17 abstracts submitted for the Califf Award competition! Looking forward to resiient research night on June 4.  This week, don’t forget the Humanities/Voices of Medicine event!  This is the first year we are combining the program’s event with Anton Zuiker’s Voices of Medicine – please come out and show support for your very talented colleagues.

I heard compliments this week for John Yeatts, Erin Boehm and Aparna Swaminathan from the cardiology service.  Also congratulations to Matt Summers on his gold star. And a special thanks to Laura Kujawski who nominated the chiefs for gold stars! Their work on the 2012-13 schedule allowed Laura and Lauren to get the clinic schedules out in record time, making it easier for patients to get an appointment. And also thanks to David Ming for working with us on a project to improve timeliness of discharge summaries – Gen Med 3, under the leadership of Zach Healy and Aimee Chung, had 100% of the DC summaries dictated and singed within 48 hours.

Manesh Patel and Schuyler Jones want to meet up with all residents interested in cardiology! Join them May 16 at 6 pm at Alivia’s.

Please don’t forget to contact Ryan Schulties, David Simel or me regarding the applications for the VA CRQS position! All current JARs (or med peds JAR-2 or med psych SAR-1s) are eligible to apply.

Pubmed for this week goes to Jenn Rymer!  High Economic Burden of Caring for Patients With Suspected Extraesophageal Reflux.  Francis DORymer JASlaughter JCChoksi YJiramongkolchai POgbeide ETran CGoutte MGarrett CGHagaman DVaezi MF.   Source: Am J  Gastroenterol. 2013 Apr 2. doi: 10.1038/ajg.2013.69

Have a great week!

Aimee

QI Corner (submitted by Jon Bae, MD)

Medicine Residency Balanced Scorecard

Our medicine residency program balanced scorecard has been posted in sharepoint reflecting performance in FP9 (i.e. March).  Check it out now and if interested in learning more, contact your Quality Chiefs or Jon Bae.

Resiliency Alert!

Bryan Sexton from the Duke Patient Safety Center will be at noon conference 5/14 to discuss the results of our Three Good Things exercise from the fall.  There will also be an opportunity to do Three Good Things again!  Be sure to attend!​

What Did I Read This Week

(submitted by Jon Bae, MD)

Feldman, L., et al. “Impact of Providing Fee Data on Laboratory Test Ordering.  A Controlled Clinical Trial.” JAMA Int Med, 2013, online: E1-E6

For this edition of WIRTW, I thought I would take a break from my usual fare of care transitions and readmissions to read an article related to the most recent Quality Improvement catchphrase.  Of course, I am referring to “High Value, Cost Conscious Care”.  As health care expenditures continue to grow, it seems the whole world is racing to find ways to reduce waste.  For the sake of this article, the waste in question is that of unnecessary 072709_jonathan_bae_prdlaboratory evaluations.   Now without showing my hand too much, the most interesting part of this article for me was the Introduction as it detailed some factoids (clearly much better then full-on facts) about health care expenditures and waste that heretofore were unknown to yours truly.  For example, over the last 10 years, the use of imaging and diagnostic tests has increased by 85%.  This has contributed to an estimated $1.2 trillion(!) in health care spending waste.  Some studies have suggested that 67.9% of inpatient laboratory tests did not contribute to patient care.  Ergo, the need for an inspection of how and what we are ordering and more importantly, why we are ordering it.  All of these scary stats (or factoids, if you will) has led to an increased push for “high value cost conscious care” including the “Choosing Wisely” campaign (I’m sure you remember my excellent WIRTW on this last year), the new ACP curriculum for Cost Conscious Care (coming soon to a noon conference lecture series near you) as well as what is likely to be an increasing number of publications in the ensuing months similar to this one.

So, that brings me to this piece by Feldman, et al.  Herein, the authors describe a simple experiment to consciously, or perhaps subconsciously, influence provider order practices by showing them the “cost” of tests1.  In this case, the cost is the Medicare allowable charge, which is much as it sounds: the maximum dollar amount which Medicare will reimburse a hospital for a particular procedure or test.  The investigators first collected a 6-month baseline period of test ordering practices.  After this, 60 tests were randomized to an active arm (fee shown) or a control arm (fee not shown).  Providers were not educated in any way about the purpose of seeing test fees.  And lo and behold, after 6 months, the tests randomized to the active fee arm showed a decrease in ordering of 9% (compared with a 5% increase in the control arm).

Many people have suggested this same type of intervention here at Duke.  But before we start dialing up Epic (or MaestroCare if you please) to integrate cost into our test ordering, I think we need to pump the breaks a little first.  While I do find it fascinating that behavior changed with such a simple intervention, I still think the verdict on this type of “nudge” is out.  First of all, the absolute difference in test ordering was not huge (3.72 tests per patient per day to 3.40).  Granted, given the sheer volume of tests ordered, this resulted in decreased charges of around ~$450K in 6 months.  Certainly, a decrease in charges of close to a million dollars per year is nothing to sneeze at.  However, as I mention in my footnote, the true cost savings of this is harder to figure.  I also wonder about the sustainability of the affect on order practices.  How long does it take before the information provided becomes nothing more then background noise?  For example, can anyone tell me what information is provided on the insulin advisor other then boxes to put in insulin units?  Passive reminders such as these quickly become victims to alert fatigue and their effectiveness is limited in the long run.  Lastly, and probably more concerning, is that this type of intervention aims to decrease the number of tests ordered across the board rather than decreasing the number of unnecessary tests only.  In the spirit of high value cost conscious care, value is the key word.  It is not how much you spend, rather the quality of the information received relative to how much it costs.  A blunt instrument to reduce all tests may skim some of the waste off the top, but may also subconsciously nudge providers to order less when more is needed.  While I agree that we certainly order more than is needed, it is hard to know where the floor is on how much we can decrease lab utilization without affecting patient outcomes.  Such is life; the answer to these questions will not be as simple as providing information about cost when ordering labs.  It will require a multi-pronged strategy encompassing education, empowerment, and intelligent system design.  But at what cost?

I put “cost” in quotations because this grossly oversimplifies the true cost of a test.  In this case, the authors are referring to the Medicare allowable charge for an ordered item.  This is not to be confused with how much a health care system spends to run a specific test (which takes into account expenses for phlebotomy, materials, equipment) and is influenced by factors like batching, turn-around time, and offset by re-imbursement.  We often try to think in simplified terms such as “how much is this test I’m ordering costing this patient” but in truth, this becomes a very tricky question to answer.

From the Chief Residents

Grand Rounds

Date              Speaker                        Topic

May 17        Aimee Zaas, MD       State of IM Residency

Noon Conference

Date Topic Lecturer Vendor
5/13 How Doctors   cope with death & dying Dr. Galanos The Pita Pit
5/14 Board   Review (45 min), 3 Good Things f/u (15 min) ACRs/Brian Sexton The Picnic Basket
5/15 Prostate   Cancer Andrew Armstrong Saladelia
5/16 Oral   anticoagulation for atrial fibrillation Dr. Granger Domino’s
5/17 Chair’s   Conference Chiefs Chick-fil-A

 

Free Engraving by Duke Police (submitted by Jason Howard)

In light of the recent thefts (turns out one of our Grad Students had a computer stolen last Friday) I wanted to share the attached flyer from the Duke Police that was posted in the Jones Building. If you are interested make sure you bring your Duke ID or Driver’s License as it mentions on the flyer. If you have questions you can contact the Duke Police at 684-2444.

Duke Police Engraving Service

From the Residency Office

2013 Learners’ Perceptions Survey: Continuity Clinics

Yes, you will see one more email coming your way asking you to take another survey this week.

Why take this survey?  First, we value and need your input!

This survey in particular, which focuses on the continuity clinic experience, is particularly important. The information you provide will help to improve the educational experience for you and your fellow trainees in your residency program. Please take the time to complete this survey.

This is a confidential survey and focuses exclusively on your CONTINUITY CLINIC EXPERIENCE.  Because of the importance of this activity in internal medicine training, we would like you to provide input and feedback regarding this experience.

Thank you for your time!

OPPORTUNITY TO TEACH RESIDENTS FELLOWS PATIENT SAFETY AND QUALITY  

Duke University Health System is hosting a special edition of the Physician Leadership Course in Patient Safety and Quality on June 14th.  The first 50 residents are FREE!  ($50 for DUHS physicians, $75 for Affiliates, and $100 for docs external to our health system.)

Course details and registration are available at http://www.dukepatientsafetycenter.com

- Physician & Affiliate Registration Information; June 14, 2013

- Residents Only Registration Information; June 14, 2013

Quick description:

Our physician leadership course on patient safety and quality is led by internationally recognized leaders in the field.  This course is held at the Washington Duke Inn & Golf Club (June 14th), and receives outstanding evaluations for applicability, feasibility, use of evidence, pace and quality of discussions.  We cover leading through change, communication and dealing with difficult colleagues, and the science of resilience.

Key Faculty:

Michael Leonard, MD,  Co-Chief Medical Officer, Pascal Metrics http://www.pascalmetrics.com/about/michael-leonard.php

Dr. Bryan Sexton, Ph.D., Director, Duke University Health System Patient Safety Center,  View one of Bryan’s recent videos at http://dukepatientsafetycenter.com/video.asp

Dr. Karen Frush, MD, Chief Patient Safety Officer, Duke University Health System

SAR Board Review Schedule

Board Review Sessions will be held in the MedRes Library, Duke North, 8th Floor. Please contact Megan Diehl or Jeff Clarke if you would like to attend.  The schedule is as follows:

Date Topic Faculty
14-May Endocrine Dr.   Matt Crowley
22-May Renal Dr.   Butterly
28-May Neurology Dr.   Skeen
5-Jun Dermatology/Rheumatology Dr.   Criscione
11-Jun Mixed   Bag (Medical ethics, Palliative Medicine, Psych) Dr.   Zaas, Chiefs

Employee Health – TB Skin Test

If you are due for a TB Skin test in the next 30 days, you will have a 30 day grace period to complete the test due to a national shortage of the testing supplies.  This grace period will end when you receive an official email from either EHOW, OESO or Duke Hospital alerting you that supplies have been received and you should proceed with scheduling your test.

If you have any questions, please contact EOHW (919) 684-3136

Essentials Disability Income Insurance

As a trainee at Duke, you are eligible for concessions on disability insurance that won’t be available once you leave the training program.

The Benefit Planning Group is authorized by AMA Insurance to offer Essentials Disability Income Insurance to eligible finishing residents and fellows.  This program offers a simplified application process with no medical exams.  Other options exist for trainees not finishing this year.  However, you must enroll by 6/30/13 to take advantage of this offer.

This is a once-in-a-career offer; if someone doesn’t sign up this year they won’t be eligible again (for example a finishing resident can’t use this offer when they finish fellowship).

Attached are two fliers that explain some of the benefits and features of the program.  If you want to sign up directly and have a PIN please go to http://mybpginc.com/mflur.  If anyone needs information, including a PIN to login, please contact Marc Flur at 919-489-1720 or mflur@mybpginc.com.

Enrollment Process       Resident and Fellow Flyer

Contact Information/Opportunities

 

Upcoming Dates and Events

  • May 14/15:  Conflict Management Workshop     Register for the morning session, 7-9 am     Register for the afternoon session, 4-6 pm
  • May 15:  Voices of Medicine /  Humanities in Medicine
  • May 24:  Chief Grand Rounds – Jason Webb, MD
  • May 31:  Chief Grand Rounds – George Cheely, MD
  • June 4:  Resident Research Conference, Searle Center
  • June 7:  Chief Grand Rounds – Nicole Greyshock, MD
  • June 8:  SAR Dinner, Hope Valley Country Club
  • June 14:  Chief Grand Rounds – Ryan Schulteis, MD
  • June 21:  Chief Grand Rounds – Jeffrey Clarke, MD

Useful links

 

by · Posted on May 12, 2013 in Chief Residents, Events, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

6/14/13: Physician leadership course in patient safety and quality

Duke University Health System is hosting a special edition of the Physician Leadership Course in Patient Safety and Quality on June 14 at the Washington Duke Inn & Golf Club. The registration fee for this course is $50 for DUHS physicians, $75 for affiliates, and $100 for physicians external to DUHS. Registration for the first 50 residents is free. Physicians who attend can earn CME credits.

The physician leadership course on patient safety and quality is led by internationally recognized leaders in the field. This course receives outstanding evaluations for applicability, feasibility, use of evidence, pace and quality of discussions. The course covers leading through change, communication and dealing with difficult colleagues, and the science of resilience.

Click here for course details and registration.

Continue Reading →

by · Posted on May 10, 2013 in Events, Fellowship programs, Internal Medicine Residency · Read full story · Comments { 0 }

Weekly Updates: May 6, 2013

From the Director

It’s been a busy week to start Block 11. First, thanks to our ACRs Megan Diehl, Bonike Olorontoba and Carrie Horney! And welcome to Nilesh Patel, Ryan Nipp and Scott Westphal.

Notable this week include a report of the $6000+ earned for the Lincoln Clinic at the 2nd Annual Stead Tread last Sunday, a big win by the residents over the faculty at Cameron Indoor (apparently interns and oncology faculty can jump!), and also some wonderful discussions on end of life care by our visiting Greenfield Professor, Dr. Susan Block. Thank you to Dr. Greenfield for sponsoring, to Jason Webb for hosting and to Dr. Block for sharing your wisdom.

Congrats to Matt Summers for your gold star, and also a big thanks to Hal Boutte for helping out a colleague.  I also heard compliments from Peter Kussin regarding Mike Woodworth’s discussion with a family and from Lynn Bowlby  regarding Adam Garber and Blake Cameron’s work at the DOC.

Spring is also a time of weddings….congrats to Shannon Klebe; to Coral Day; and to Sam Horr and Tara Weiselberg. Pictures will be posted soon!

This past week was the program directors meeting in Orlando.  Major topics included milestones and also work compression. Thanks to all who have done their self=assessment – if you haven’t, please log into Medhub and complete this exercise. We will be using the same form for semi- annual evaluations and it’s a good way to see where you think you are doing well and where you want to improve.  We will be talking more about work compression and ways to improve our days, balance patient care w some conference attendance and also team leadership.

This week’s pubmed from the program goes to Alex Fanaroff for his JCI blog…http://blog.jci.org/2012/677/choices

Have a great week!

Aimee

QI Corner (submitted by Jon Bae, MD)

GME Trainee Performance Incentive Program Update:

We have just posted the most up to date results from the GME Incentive Program to Sharepoint.  We are still meeting 2 of 4 measures with one more period to go.  As it stands, all trainees are eligible for $400 in June if this trend holds!

What Did I Read This Week

(submitted by Lynn Bowlby , MD)

NEJM   May 1, 2013   Be prepared: The Boston Marathon and mass causualty events PD Biddinger and others

As an undergraduate (BU) and med student (Tufts) in Boston, I grew to know and love the city. Like others, I was shocked and horrified at the events at the Marathon on April 15. Looking at this tragic event thru the lens of a physician, how were so many lives saved, and what lessons can we all learn?

Planning, practicing and learning from other cities experiences all contributed to the successful medical intervention. Early tourniquet use for blast injuries in Iraq and Afghanistan saved lives.

How many of us have ever used a torniquet?

Hospital staff that heard of the event thru TV, their phones etc. began preparation before they were directed to by their leadership. The blasts occurred at 2:50 PM, and many nurse managers directed their day staff to stay on duty, ensuring 2 shifts of workers were present. Victims were able to get into the OR within minutes, some were in by 35 min from the time of the blast.  No patient that was transported to an ED died.  Excellent communication allowed almost even distribution of the victims to the 6 trauma centers in Boston. MGH managed the arrival of 31 victims within one hour, and 5 were in the OR within 8 minutes of each other. Simple, previously practiced strategies like a colored numbered wrist band to identify patients were used rather than computer generated labels.

There are many lessons for us.

At the DOC this week we had 2 patients that became unresponsive. One briefly lost a pulse. Drs. Garber and Cameron provided excellent quick responses. We did a post event huddle to examine what we did well as a clinic and what we can improve.  I now more fully appreciate the value of those drills and practices for unexpected events.

We never know if or when we will be needed the way the health professionals were in Boston that day. I know when I go to Boston next month and stand at the blast site on Boylston Street, I will wonder if I could  have thought so quickly to help save lives that day.

From the Chief Residents

Grand Rounds

Date              Speaker                        Topic

May 10         Dr. Rahul Shimpi        Esophageal Disease

Noon Conference

Date Topic Lecturer Vendor Room
5/6 Pulmonary Hypertension Dr. Terry Fortin Dominos 2002
5/7 Acid-Base Physiology Dr. Steve Crowley Moe’s 2002
5/8 Schwartz Rounds Lynn O’Neill, Lynn   Bowlby Jersey Mike’s 2002
5/9 ID for the Traveler Dr. Ralph Corey Bullock’s BBQ LIBRARY
5/10 Chair’s Conference Chiefs Saladelia 2002

From the Residency Office

Water – Water Everywhere – and Plenty for Everyone Drink!

OK, not quite so dramatic, but we DO want to clue the housestaff into a new effort started this week to stop our use of water bottles.  For those who might be wondering why, it’s all found in the numbers.Water Cooler  We go though approximately 18,000 bottles each year, most still finding their way into the land fill.   So, Mr. H G’Nome (yes, he has come back to life) has taken this project on as a special mission.  First up – the new water dispensers.  Where?  Med Res Office and in the ACR’s office.  He also has a few more tricks up his sleeves, so watch for more news in the coming weeks.

Try out the dispensers, and please, think twice before just grabbing a bottle.

Maestro Training and Retirement of E-Bowser Scheduled

Wave 4 – Maestro Training has begun!

Reminder – PLEASE ALSO USE THE LINK BELOW (YOU SIGN IN USING YOUR DUKE NET ID AND NET ID PASSWORD) TO DOUBLE-CHECK YOUR TRAINING DATE, START TIME AND LOCATION!

https://vmwlmsweb.duhs.duke.edu/SabaLogin

If you have any questions or concerns, please feel free to contact Jen Averitt in the MedRes office 919-681-4510

SAR Board Review Schedule

Board Review Sessions will be held in the MedRes Library, Duke North, 8th Floor. Please contact Megan Diehl or Jeff Clarke if you would like to attend.  The schedule is as follows:

Date Topic Faculty
May 8 Gastroenterology Drs. Choi and Desai
May 14 Endocrine Dr. Matt Crowley
May 22 Renal Dr. Butterly
May 28 Neurology Dr. Skeen
June 5 Dermatology/Rheumatology Dr. Criscione
June 11 Mixed Bag (Medical ethics, Palliative Medicine, Psych) Dr. Zaas, Chiefs

Annual Awards

Residents will receive a separate email on Monday, May 6th, including a link to vote for the annual program awards.  The initial slate of candidates has been selected by the residency council, and as in prior years, write-in candidates are welcome.

The awards, which will be announced during grand rounds in the coming weeks, recognize  the outstanding accomplishments and commitments to medical education throughout our program.

Award categories include the following: 

  1. The Eugene A. Stead, Jr. M. D. Award:  Given by the Internal Medicine House Staff for Excellence in Teaching (recipient – faculty)
  2. Durham Regional Teaching Award:  Presented by House Staff to the Faculty Attending at Durham Regional Hospital Exemplifying Excellence in Teaching (recipient – faculty)
  3. Ambulatory Medicine Teaching Award:   Presented by the House Staff to the Faculty Member Who Best Exemplifies  Commitment and Excellence to Teaching  in Ambulatory Medicine (recipient – faculty)
  4. Joseph C. Greenfield, Jr.  Research Mentorship Award:  To recognize and honor internal medicine faculty who have used their time and talents to mentor house staff in the fundamentals of research  (recipient – faculty)
  5. VA Faculty Teaching Award:  Presented by House Staff to the Faculty Attending at the VA Medical Center Who Exemplifies Excellence in Teaching (recipient – faculty)
  6. Fellow Teaching Award:  Presented by the House Staff to the Fellow who Exemplifies Excellence in House Staff Teaching (recipient – fellow)
  7. The House Staff Community Service Award:  To recognize and honor Physicians who exemplify in their lives the fundamental precept of medicine: TO SERVE (recipient – resident)
  8. Haskel Schiff Award:   Presented to members of the Duke Medical House Staff by their colleagues for excellence in the Practice of Clinical Medicine” (recipient – resident)
  9. NEW AWARD – Bruce Dixon Award:  Presented to the ”best clinician” as voted upon  by the interns and residents(recipient – resident)

Research awards will be presented at our annual research conference, which will be held on June 4th in the Searle Center.

Effective Time Management With Professional Organizer Lori Bruhns

Date:  May 9 from 2:00-3:00 p.m. in 2003 Duke Hospital Lecture Hall
Registration is not required, but seating is on a first-come, first-served basis. Seating fills up fast, so
get there early to ensure you get a seat!

Professional Organizer Lori Bruhns will share tips about how to better manage your office and personal time. If you have specific challenges you would like Lori to highlight fixes for, please e-mail your questions to: antoinette.parker@duke.edu

Contact Information/Opportunities

 

Upcoming Dates and Events

  • May 14/15:  Conflict Management Workshop     Register for the morning session, 7-9 am     Register for the afternoon session, 4-6 pm
  • May 15:  Voices of Medicine /  Humanities in Medicine
  • May 24:  Chief Grand Rounds – Jason Webb, MD
  • May 31:  Chief Grand Rounds – George Cheely, MD
  • June 4:  Resident Research Conference, Searle Center
  • June 7:  Chief Grand Rounds – Nicole Greyshock, MD
  • June 8:  SAR Dinner, Hope Valley Country Club
  • June 14:  Chief Grand Rounds – Ryan Schulteis, MD
  • June 21:  Chief Grand Rounds – Jeffrey Clarke, MD

Useful links

 

by · Posted on May 5, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Faculty-Housestaff basketball results

The housestaff team was victorious in the annual faculty-housestaff baskeball game on Wed., May 1.

In this photo, the two teams, the refs and families gather at half court in Cameron Indoor Stadium, site of the game.

2013 Basketball Group Picture

by · Posted on May 2, 2013 in Internal Medicine Residency, Medical Education · Read full story · Comments { 0 }

2nd annual Stead Tread raises more than $6,000 for Lincoln Community Health Center

SteadTreadMatt Crowley, MD, assistant professor of medicine (Endocrinology, Metabolism and Nutrition), sent the following note to the runners, walkers, cheerleaders, sponsors and friends who supported the 2nd annual Stead Tread 5K run.

On behalf of the group of medical residents that organized the race, I’d like to thank you for your participation in and/or support of Stead Tread 2013. It was a great race day. We had nearly 170 racers register, and despite the rainy weather, a strong turnout. While we are still tallying our final fundraising amount, we earned well over $6,000 for Lincoln Community Health Center, which will go a long way toward supporting Lincoln’s indispensible efforts on behalf of the Durham community.

We also would like to recognize Dr. Eisenson and all the other Lincoln staff who attended the event, along with the 20 Lincoln patients who registered. We look forward to continuing to grow the Stead Tread as a collaborative effort between the Duke Internal Medicine Residency and Lincoln.

Congratulations to our prize winners:

Top male/overall finisher: Ethan Ready – 18:23

Top female finisher: Meredith Clement – 22:48

Top resident finisher: Adam Banks – 19:08

Top Lincoln finisher: Holly Biola – 26:07

Again, thanks so much for your participation and support. We look forward to seeing you all at Stead Tread 2014!

by · Posted on April 30, 2013 in Internal Medicine Residency · Read full story · Comments { 0 }

Weekly Updates – April 29, 2013

From the Director

Hi everyone!  Believe it or not, only two months left of this year.  We’ve got a lot of exciting things happening between now and June 29th when the new interns officially hit the wards….first of all, thanks to everyone who completed the ACGME survey. We well-exceeded the required 70% and I appreciate you taking time to fill it out. Compliments this week also go to Kevin Trulock and Deng Madut for teamwork at the VA, to Lindsay Boole and Nancy Lentz  for helping out with some challenging situations at the DOC and to Carling Ursem for running the DM education group’s 20 patient full house. Shortly thereafter, Carling set out on vacation, only to assist a passenger in distress. All in a days work, I guess.  Plus, the DOC and Pickett teams were very happy with the block 1 clinic schedule – thanks chiefs and Laura and Lauren!

Thank you to Steve Crowley and the Warren Society for hosting a night at the Ronald McDonald house (taco night!) and also to Matt Crowley, Marianna Papademitriou, Meredith Edwards Clement and the Kempner Society for an amazing 2nd annual Stead Tread. While I was doing my other job as a soccer mom on the fields of SC, over 100 people were out supporting the Lincoln Clinic at the Stead Tread. Final tallies are pending, but word is that the lightning fast Ethan Bowlby (son of DOC fearless leader Lynn) won it all, with Meredith Clement winning for housestaff female and Adam Banks winning for housestaff male.  Very proud of this new tradition.

stead tread picture

 

 

 

 

 

 

 

 

Congrats to John Yeatts and family on the birth of Walter Ferrell Yeatts!

Walter Farrell Yeatts

 

 

 

 

 

 

 

Randy, Dr. Woods and I are going to be learning more about more about milestones and the next Accreditation System this week at the Program Directors meeting in Orlando.  Looking forward to sharing what we learn when we are back on Thursday.  Please take a few minutes to do your “self reflection” evaluation using the new ACGME reporting milestones…it’s in medhub waiting for you.

Have a great week and see you at the HS-faculty basketball game on Wednesday night.  Thanks to Chris Hostler and Tony G for organizing!

Aimee

Pubmed for this week goes to Lindsay Anderson!

Anderson, L., D. Dai, A. Miller, M. Roe, J. Messenger, T. Wang. Percutaneous Coronary intervention in older patients with syncope and coronary artery disease: A report from the NCDR. American College of Cardiology Conference, San Francisco, California. Marcy 9 – 11, 2013.

Have a great week

Aimee

QI Corner (submitted by Jon Bae, MD)

Quality Improvement and Patient Safety Noon Conference

Thank you to Melissa King from Dept of Pharmacy for her informative presentation on SRS reporting.

Clearly there are opportunities for physicians to report more and get more involved.  If interested, please let one of your quality chiefs know!

Also, save the date for our next Quality and Safety conference 6/10 when Zuben Eapen will be discussing opportunities to improve care transitions for our CHF patients

April Quality Champion:

This month we would like to acknowledge Jason Rose as our April Quality Champion.  Jason was an advocate for patient safety by identifying an unsafe condition and intervening quickly to ensure the patient received the needed care.

If there is anyone you would like to nominate as a quality champion, please tell your Quality Chiefs!

GME Quality and Safety Concentration:

Please see the attached flyer for details about you can apply for a GME Concentration in Patient Safety and Quality!

Its a great opportunity for anyone interesting in getting more training and experience

Concentrations Brochure July 2013

What Did I Read This Week

(submitted by Suzanne Woods, MD)

Operationalizing the Internal Medicine Milestones – An Early Status Report

Journal of Graduate Medical Education, March 2013:  130-137

Why did I read this article: Given the upcoming ACGME new requirements starting July 2013, it is prudent that program directors keep up with literature related to the Next Accreditation System.  One new requirement is the reporting of milestones data directly to the ACGME on each trainee semiannually. Milestones describe levels of clinical competence along a developmental trajectory during training.

Summary:   The internal medicine (IM) milestones were created to “advance outcomes based residency training” and was a mandate by the ACGME.  The IM residency program of New York Medical College at Winchester Medical Center implemented a milestones based evaluation process in 2010.  They included 26 residents in the study and concluded that both educators and trainees found that milestones “promoted a common understanding of what knowledge, skills and attitudes should be displayed at particular stages of training; permitted greater specificity in performance feedback; and enhanced uniformity and fairness in promotion decisions.”

Of note, initially the medicine milestones working group created 141 milestones which was impossible for any program director to conceive how we could collect data on that number of areas.  Fortunately they have since limited the reporting to 22 milestones.

My initial response to this article…oh bother!!!  Dr. Jane Trinh (Med-Peds Assoc PD) and I had just submitted a manuscript to JGME with our Duke experience and hoped we had not been scooped.  But…we have not yet had our manuscript rejected so will keep our fingers crossed.

The Duke experience…yes we have experience so far!

We created milestones-based evaluations for our Medicine-Pediatrics residency continuity clinic, the Pediatric Emergency Department (ED) rotation, and a resident self-assessment using milestones from the ABP/ACGME Pediatrics Milestone Working Group last Fall.  The medicine milestones had not yet been released.

Our experience during this pilot project implementing milestones-based evaluations demonstrates that evaluations based on new milestone terminology can be developed and implemented successfully.   Feedback by our residents and faculty was very positive.  Early implementation of new evaluations is important to be able to review and assess processes to identify areas of improvement.  Continued work is needed to develop accurate evaluations based on milestones, and to educate faculty and residents on milestones and the evaluation and reporting process to the ACGME.  Advancements in MedHub will improve the process for aggregate data reporting to the ACGME.

 

Take home points:

  • Faculty and resident education must occur for successful implementation of milestones evaluations.
  • In person feedback is critical to pair with the MedHub evaluation.
  • Increased direct observation will help collect information to inform milestones reporting.
  • I am looking forward to milestones based evaluations for more accurate evaluation of our trainees!

 

From the Chief Residents

Grand Rounds

Date                     Speaker                        Topic

May 3, 2013    Dr. Susan D. Block      VA Chief Speaker

Noon Conference

Day Date Topic Lecturer Vendor
Monday 4/29 PCOS Dr. Ann Brown The Pita Pit
Tuesday 4/30 “Prostate and Me” Dr. Galanos Sushi
Wednesday 5/1 IM-ED Combined Conference: Pleural effusions/chest tubes Momen Wahidi Rudinos
Thursday 5/2 EKG Conference Dr. Greenfield Dominos
Friday 5/3 Visiting Professor Dr. Susan Block Chik-Fil-A

 

From the Residency Office

Maestro Training and Retirement of E-Bowser Scheduled

Wave 4 – Maestro Training has begun!

All Internal Medicine Residents who need Maestro Inpatient Training have been scheduled for it in  Wave 4 – For most, this will mean two 4-hour sessions (IP MC 400 & 500).  Your schedule in Amion has been updated to show when your training will be.  PLEASE ALSO USE THE LINK BELOW (YOU SIGN IN USING YOUR DUKE NET ID AND NET ID PASSWORD) TO DOUBLE-CHECK YOUR TRAINING DATE, START TIME AND LOCATION!

https://vmwlmsweb.duhs.duke.edu/SabaLogin

If you have any questions or concerns, please feel free to contact Jen Averitt in the MedRes office 919-681-4510

The plans for retiring legacy systems, including E-Browser, have also been announced.  Please refer to the following attachment for the details:   Retirement of Ebrowser Begins

 

We are excited to accept applications from residents and fellows for the 2013 cohort of Duke GME Concentration participants. 

GME Concentrations were developed, with support from the GME Innovation Fund, in response to resident/fellow and program feedback to provide critical content to better prepare physicians for practice in the current & future health care system. Four Concentrations are being offered as an optional  “minor” for residents and fellows (PGY level 2 and above) across specialties at Duke.

Residents/fellows will participate in development of their individualized education plan by choosing from a list of educational opportunities related to their concentration. Participation will span over the course of their training and last a minimum of one year (some exceptions may apply) resulting in the awarding of a Certificate of Completion.

GME Program Directors must approve resident/fellow participation in order to ensure this commitment will supplement training and benefit the program overall.

Expert champions have been identified to serve as part of an Advisory Committee for each concentration identifying and developing educational objectives, opportunities/assignments, and assessment strategies. Committees will guide and assess the work of residents/fellows participating in each concentration and determine individuals’ successful completion.

Concentrations include:

  • Resident as Teacher
  • Patient Safety & Quality Improvement
  • Law, Ethics & Health Policy
  • Leaders in Medicine

Additional information can be found on the GME Concentrations website at:

http://sites.duke.edu/gmeconcentrations/

Applications can be found under the “How to Apply & Timeline” tab. The first round of applications are due by Friday May 17th.

We look forward to working with your residents/fellows to enhance their Duke GME experience. 

If you have questions, please contact:

Alisa Nagler

Mariah Rudd

Saumil Chudgar

Kathryn Andolsek

Survey

Please complete a 3-minute survey evaluating technology use among physicians.  This is the continuation of an on-going study that has been previously published.  The survey can be completed HERE.  All information is anonymous and results will be publicly available.

Thank you for your help,
Orrin Franko, MD
Resident Physician, Post-Graduate Year 4
University of California, San Diego

Once again:  SURVEY LINK HERE

 

violin

VOICES IN MEDICINE!! Our program’s annual Humanities in Medicine event for the year

We invite you to participate in a Voices of Medicine program for the Talk Story narrative variety show, featuring the stories, poetry, music and other artistic outlets of physicians and housestaff in the images piano

Department of Medicine. Come join in a unique and fun opportunity to share your outlets of creativity and see who each other are outside of medicine!

  •  Date: Wednesday, May 15th, 2013
  • Time: Doors open at 7:00pm, Event Starts at 7:30pm
  • Location: Casbah, 1007 West Main Street, Durham, NC 27701

If you are interested in participating please contact Erin Payne <erin.payne@dm.duke.edu> For questions, feel free to contact Jason Webb, Juliessa Pavon, Anton Zuiker, or Erin Payne.

Please note: Jeff Polish from the Monti organization will be providing professional storytelling coaching for those who are interested in sharing a story. Jeff has a PhD in genetics from Washington University in St. Louis. This is a great opportunity to help bring your story to life!

SAR Board Review Schedule

Board Review Sessions will be held in the MedRes Library, Duke North, 8th Floor. Please contact Megan Diehl or Jeff Clarke if you would like to attend.  The schedule is as follows:

Date Topic Faculty  
Tuesday April 30 Pulmonary Dr.   Govert
Wednesday May 8 Gastroenterology Drs.   Choi and Desai
Tuesday May 14 Endocrine Dr.   Matt Crowley
Wednesday May 22 Renal Dr.   Butterly
Tuesday May 28 Neurology Dr.   Skeen
Wednesday June 5 Dermatology/Rheumatology Dr.   Criscione
Tuesday June 11 Mixed Bag (Medical ethics, Palliative Medicine, Psych) Dr.   Zaas, Chiefs

Contact Information/Opportunities

STL_HospitalistAndNocturnistFlyer

STL_InternalMedicineFlyer2

Upcoming Dates and Events

  • May 1:  Annual Resident/Faculty BB Game
  • May 14/15:  Conflict Management Workshop     Register for the morning session, 7-9 am     Register for the afternoon session, 4-6 pm
  • May 15:  Voices of Medicine /  Humanities in Medicine
  • May 24:  Chief Grand Rounds – Jason Webb, MD
  • May 31:  Chief Grand Rounds – George Cheely, MD
  • June 4:  Resident Research Conference, Searle Center
  • June 7:  Chief Grand Rounds – Nicole Greyshock, MD
  • June 8:  SAR Dinner, Hope Valley Country Club
  • June 14:  Chief Grand Rounds – Ryan Schulteis, MD
  • June 21:  Chief Grand Rounds – Jeffrey Clarke, MD

Useful links

by · Posted on April 29, 2013 in Internal Medicine Residency, Medical Education, Weekly Update · Read full story · Comments { 0 }

Annual Humanities in Medicine event is 5/15/2013

Each year, the internal medicine residents and members of the faculty gather for a night of music, poetry and storytelling to reflect on their lives in medicine and show how medicine inspires the arts and humanities.

This year, we’re combining the event with the Voices of Medicine show we announced earlier – join us Wed., May 15, 2013 at 7 p.m. at Casbah, (1007 West Main Street, Durham) for the Voices of Medicine/Humanities in Medicine show.

Residents, fellows and faculty are invited to both participate and attend this. Volunteer to share a poem, tell a true story, sing a song or play an instrument, dance or explain the significance of a favorite photograph. Contact Erin Payne (erin.payne@duke.edu) by April 28 if you are interested in stepping on stage.

Not sure what we’re talking about? Have a listen:

Jeff Polish, executive director of The Monti, a Chapel Hill-based storytelling organization, will be providing professional storytelling coaching for those who are interested in sharing a story. (Polish has a PhD in genetics from Washington University in St. Louis.) This is a great opportunity to help bring your story to life.

For questions, feel free to contact Jason Webb, Juliessa Pavon, Anton Zuiker, or Erin Payne.

by · Posted on April 24, 2013 in Events, Internal Medicine Residency, Medical Education, Voices of Medicine · Read full story · Comments { 0 }