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Meet your chief resident: Krish Patel, MD

Krish Patel, MD

Krish Patel, MD

Since he became the chief resident of Internal Medicine for Duke University Hospital, Krish Patel, MD, has learned first-hand the many logistical details in the Internal Medicine Residency Program.

“There’s a part of my role that ends up being scheduling and maintenance of schedules for the various services in the hospital,” Dr. Patel said. “Much of that is troubleshooting the small things that could make the educational experience on those services better.”

While Patel and his team keep all the different parts of the program at Duke University Hospital moving, he also is responsible for weekly Chair’s conferences, Resident Report sessions that residents on the General Medicine service attend four days a week, and a similar didactic small group session for interns that meets once a week. These sessions are teaching opportunities and chances for Patel to see what parts of the program need improvement.

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by · Posted on August 28, 2013 in Chief Residents, Internal Medicine Residency, Medical Oncology · Read full story · Comments { 0 }

Weekly Updates: August 26, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Happy end of block 2, interns! Hard to believe how fast time goes. We’ve had a great week in the program, with Jon Bae and the Quality Team receiving an NC ACP grant to support Share point and also a similar grant went to Tim Mercer and Jane Trinh! We have 8 posters accepted at Clinical Science Day as well. Exceptional!

Kudos to Marc Samsky from the endocrine team for outstanding work. It has been fun watching the interns and residents teaching our new MSIIs – spotted has been ED intern Andrew Iannuzi, night resident Ben Lloyd, and also Myles Nickolich. I know the rest of you are teaching as well!

This week we have our second JAR dinner – looking forward to seeing 5 of you at Mateo. Dr Klotman starts her SAR mentoring lunches as well. While I shamelessly stole the JAR dinner idea from my good friend Harry Hollander at UCSF, I’m not aware if any other chairs who do lunch with small groups of residents – please sign up if you haven’t yet!

This week’s pubmed from the program goes to Jenn Rymer who will be presenting the GME incentive program at the national AAMC meeting! Congrats to Jenn and coauthors George Cheely and Jon Bae.

Have a great week!


QI Corner (submitted by Joel Boggan, MD)

New Patient-Centered Business Cards

The new patient-centered business cards have arrived!  Please pick them up in the Med Res office this week.  Your business cards are primarily geared towards inpatient care, but your clinics will have stickers to place on the back for outpatient use.  We encourage you to use your cards on both inpatient wards and outpatient clinics.  On the examples, please note there are places where you can help fill out information to tell patients who you are, what your role is, and who else might be taking care of them in the hospital . . .

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Patient Safety Noon Conference

A big thank you to Luke Chen who presented on Infection Control procedures at Duke on Wednesday.  Hopefully, you’re inspired to wash hands, use (and ask for) the contact stethoscopes, and wash your white coats!

August QI Champs
A special congratulations to our first QI champs of this academic year:  Jonathan Hansen, Stephanie Giattino, and Jessica Seidelman, who were our first people to sign up to be Hand Hygiene Ward Champions.  You’ll be hearing updates from all of us through the year as we work toward our 91% hand hygiene goal on the 7th, 8th, and 9th floors.
Follow Us on Twitter

- @DukeMarines – Duke Chief Resident Updates
- @JonBae01 – QI and Patient Safety (general news and program updates)
- @DukeDOMQuality – Duke DOM Quality Updates
- @bcg4duke – Maestrocare and health informatics

What Did I Read This Week

 Submitted by Krish Patel, MD

Long-Term Survival of Participants in the Prostate Cancer Prevention Trial. N Engl J Med 2013; 369:603-610

Why I read this:  I recently learned that the Surviving Sepsis Guidelines had been updated in Feb 2013 and having not been the primary doctor in the MICU for at least 1 year, I wanted to know what was good and new.  Well after reading the 56 page manifesto and realizing that the levels of evidence for many of the new guidelines left a lot to be desired (and that I’d never WIRTW it as well as Bill Hargett!) I quickly retreated back to my oncology roots… No but really, I came across this article in this week’s NEJM and was intrigued. All in all, it was a pretty interesting read as it tries to answer some important questions left open by an almost 20 year old study that investigated the use of finasteride to prevent prostate cancer back in the 1990s.

Background:  In 2003, a large RCT (n=18,882) published in NEJM looked at whether finasteride 5mg daily (vs. placebo) could reduce the prevalence of prostate cancer in healthy men (median age 63.2 yrs) over a 7 year treatment period.  The take home from that study was that finasteride did indeed reduce the prevalence of prostate cancer (18.4% vs 24.4%, a relative risk reduction of 24.8%; p<0.001) but it resulted in an increase in the prevalence of high-grade prostate cancer (6.4% vs 5.1%, a relative risk increase of 25%;  p<0.001).  There was no mortality analysis reported in that study (fair I guess since mortality from prostate cancer typically occurs over 10+ years), so it was unknown what the possible benefit of reducing the overall rate of prostate cancer was versus what the harm may have been from the absolute increase in prevalence of high-grade cancers.  This study actually lead to the FDA requiring finasteride to be labelled as increasing the risk of developing high grade prostate cancer and finasteride never received approval for use in prostate cancer prevention.

Results: Now, almost 10 years later, three of the authors from the original paper have published a mortality analysis from the long term (15+ years) follow of the 2003 study to try answer the question of what the ultimate harm/benefit of finasteride chemoprevention is.  A picture is worth a thousand words                       Copy of Snapshot of Med Onc Data (2)

Yep, that line is as purple as Nick Rohroff’s pants…Ok, they found no difference in overall survival in the study population…  So, perhaps the concerns from the original study that development of more high grade cancers would lead to harm were unfounded. Or perhaps there were increased harms but they were offset by the benefits of preventing more low grade cancers (and those people died of something else).  Unfortuntately we just don’t know. The majority of the mortality data used in this follow up was largely obtained through the Social Security Death Index so there was no way to know who died of what or calculate prostate-specific mortality.  The follow up did show a lower prevalence of high grade prostate cancer than the 2003 study (3.5% vs 3.0%; p=0.05 compared to 6.4% vs 5.1%; p<0.001) and continued to show a lower overall rate of prostate cancer (10.5% vs 14.9%; p<0.001) in the finasteride group.  The authors also looked at survival by cancer grade and again found no significant difference between finasteride and placebo despite stratification by grade.

What does this mean: Preventing prostate cancers with finasteride doesn’t appear to affect mortality, so why even bother thinking about it? Well, I’ll make a controversial suggestion: perhaps finasteride can be used to prevent certain patients from the morbidity of diagnosis and treatment of low grade prostate cancers detected by PSA/DRE screening.  It’s certainly not clear that universal prostate cancer screening substantially reduces mortality (hence the USPTF recommendation against it).   Yet, it still widely occurs and results in the over diagnosis of low grade prostate cancers that are then managed/treated aggressively with potential harms and few benefits.  Could we offer finasteride prophylaxis instead of (or along with) prostate cancer screening to low risk men who still elect for screening with the goal of reducing the likelihood (and cost) of potentially unnecessary surgery and/or radiation therapy for low grade prostate cancers?  Hmm…or perhaps we should just stop screening low risk patients…

Krish Patel, MD

SOM Clinical Science Day

Congratulations to the following residents who have been selected to present their work at the School of Medicine Clinical Science Day, to be held on October 18, 2013.

  • Dr Hany Elmariah
  • Dr Lindsay Anderson
  • Dr Jennifer Rymer
  • Dr Carling Ursem
  • Dr Aaron Mitchell
  • Dr Wassim Shatila
  • Dr John Stanifer
  • Dr Noah S Kalman

From the Chief Residents

Grand Rounds

Date:  August 30, 2013

Topic:  M&M

Presenters:  Dr. Kussin and Dr. Stout

Noon Conference

Date Topic Lecturer Vendor
8/26 Diagnostic   Radiology Essentials Lexie Riofrio The Picnic Basket
8/27 Approach   to the Anemic patient Murat Arcasoy Jersey Mike’s
8/28 IM-ED   Combined Conference: Evidence Based Emergency Medicine David Newman The Pita Pit
8/29 Liver   Transplantation Alastair Smith Moe’s
8/30 Chair’s   Conference Chiefs Rudinos


Thanks For Helping Out (from Yevgeniya Foster)

My wonderful friend and colleague Andrea Sitlinger is doing me a huge favor this weekend. She’s covering my pull list while I go on the vacation I planned without adequately ensuring I had no other obligations. She offered to do it when no one else would, and even though she has no other weekend to switch with me.  I’d love for everyone to know how amazingly gracious she is…

Thank you! Have a great day!”    

From the Residency Office

Med Res Comment Line

The link to the comment line, which is just one of the many ways residents can share their recommendations or concerns, can always be found in the “Useful Links” section of Weekly Updates.  One of the recent submissions was a request to offer Indian or Tai food  for lunch at noon conference.  This can be a little tricky, but we are working on the idea, and expect to try it out this fall to see how it might work.

Keep watching the noon conference schedule to see when, and thanks for the recommendation.



Developing the next generation of globally educated, socially responsible healthcare professionals dedicated to improving the health of disadvantaged populations.

Accepting Applications for Global Health Elective Rotations

The Hubert-Yeargan Center for Global Health (HYC) is accepting applications for Global Health Elective Rotations for July 2014 and March 2015. Application is open to residents from Departments of Medicine: Internal Medicine (PGY 2); Med-Peds (PGY 3) and Med-Psych (PGY 4).  Access the application form and FAQ at   (Application addendum is available by request –

Application deadline is September 17, 2013. Interviews will be held in late September/early October. We encourage you to speak with past participants to get a better idea of what daily life is like on the wards of your top sites. For more information, contact Tara Pemble, Program Coordinator at or 668-8352.


Annual Flu Vaccination – Condition of Employment at Duke University Health System

Last week we started to announce the annual flu shot campaign.  We will keep the link to the intranet site posted in Updates and the dates for the Blitz and other information as it becomes available.

Exemptions:  If you are planning to submit a request for an exemption, please note that you only have 3 weeks left to do so.

You can download the following:

Medical Exemption Application, Religious Exemption Application, Outside Vaccination Reporting.

Trivia Night / Stead Society Overview

Results are in – and once again, Kempner Society (lead by Matt Crowley) came out on top.  Congratulations, and the word we heard is that everyone enjoyed the competition.

Just in case there is still confusion as to the titles of each Stead Society (which used to be labeled A through E), we are attaching the Stead Society Overview for reference.  Each society is named after a distinguished Duke faculty member, led by a prior chief resident, and supported by a team of attendings.

Stead Society overview_2013


Supported in part by the Chancellor’s GME Innovation Fund

Thre Fuqua School of Business and the Duke University Hospital Office of Graduate Medical education have joined together for the 5th year to offer a Health Policy lecture series for Duke GME programs. Program Directors, residents and fellows are invited to participate. Physicians will benefit from an understanding of health care delivery systems, payment structures, incentives, and policy.  Increasingly, the role of the physician will be less of a clinical technician and more of a team-leader as our health care system evolves, using a more multidisciplinary & team-based model.  To this end, we are offering a program which covers topics that will allow residents and fellows to acquire a baseline understanding of our health care system. Participation addresses the ACGME competency of Systems Based Practice and provides critical knowledge to graduate physician leaders.


  • Health Care Policy (September 19th, 2013)
  • Comparative Health Systems (October 10th, 2013)
  • MedPac Annual Report Overview: Medicare/Medicaid (November 14th, 2013)
  • Health Informatics (December 12th, 2013)
  • Quality & Pay for Performance (January 9th, 2014)
  • Healthcare Reform (February 13th, 2014)
  • Health Care Disparities (March 13th, 2014)
  • Accountable Care Organizations  (April 10th, 2014)
  • Conflicts of Interest (May 8th, 2014)

The series will kick-off with the “Health Care Reform Panel: Obama-care versus Canada Single-Payer Care”

Thursday, September 12th 

5pm – 7pm, Duke South Ampitheatre

Light refreshments will be served

For more information and to register for the panel please use the following link -

Contact Information/Opportunities

Upcoming Dates and Events

  • September 17:  Application deadline for Global Health Electives
  • September 18/19:  Flu Shot Blitz
  •  October 1:  Duke’s Global Health-Internal Medicine Residency  deadline to submitt applications
  • October 18:  SoM Clinical Science Day

Useful links

by · Posted on August 25, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Meet your chief resident: Vaishali Patel, MD

Vaishali Patel, MD

Vaishali Patel, MD

Vaishali Patel, MD, has a lot of ideas for her year as chief resident of the Durham VA Medical Center, a role she began earlier this summer.

Dr. Patel says it has already been an exciting summer for her as she has watched the interns join the program and the junior assistant residents take on new leadership roles. She hopes that the Durham VA will be a robust and gratifying learning environment where the residents can take an active role in the program.

“I think it’s important for the residents to remember that thinking about your patients is fun – this is why we chose this profession,” Patel said. “I want to create a lively environment because the more the residents are enjoying themselves at work, the more they will learn.”

Patel said she is collecting data about areas in which the residents would like to improve as well as changes that they would like to see at the VA that will help them take better care of their patients. She is looking for opportunities to help the residents grow and also to impact process improvement at the VA.

“I would like to promote a culture that allows the residents to feel empowered to get involved and shape their training. This is their program,” Patel said.

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by · Posted on August 21, 2013 in Chief Residents, Internal Medicine Residency · Read full story · Comments { 0 }

Meet your chief resident: Joel Boggan, MD, MPH

Joel Boggan, MD, MPH

Joel Boggan, MD, MPH

This summer Joel Boggan, MD, MPH, became the Durham VA Medical Center’s second chief resident of quality improvement and patient safety.

Dr. Boggan is one of 32 such chief residents across the country who will be leading QI projects, receiving expert training from mentors and participating in a national curriculum meant to help usher in a new generation of QI leaders who will help residents implement QI initiatives.

For Boggan, chief resident training began last January with a series of seminars on quality improvement theory led by Dave Simel, MD, vice chair for Veterans Affairs in the Department of Medicine. Boggan will continue the work of Ryan Schulteis, MD, who served in the chief resident role last year.

“The projects I’m beginning are focusing on decision support around the ordering of diagnostic imaging, hand hygiene monitoring and infection control on the wards, hand-off standardization between emergency room providers and the inpatient team, and generating feedback for individual residents on the care they provide,” Boggan said.

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by · Posted on August 19, 2013 in Chief Residents, Internal Medicine Residency, Quality Initiatives · Read full story · Comments { 0 }

Weekly Updates: August 19, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi Everyone! We are really happy that the weather held out and that so many of you could join us for the back porch Summerfest at our home! Special thanks to Erin Payne and Randy Hefflefinger for their help in making the party such a success, and very glad so many of our Stead Society faculty and APDs could join us.

Kudos this week go to Joe Brogan, who I hear from many people did an amazing VA morning report, from Blake Cameron to Ashley Bock for her stellar work on renal consults, to Chris Hostler for planning the upcoming “Battle of the White Coat Paintball Extravaganza”, and to Jim Lefler for what I hear was a fantastic chairs conference – sorry to have to miss it (especially w a diagnosis of cryptococcal disease!) Saumil sends his kudos and thanks to the chiefs and to the following residents who helped with the med student CSI course:

Procedures: Lindsay Anderson‎; Brian Miller‎; Kevin Shah‎; Aaron Mitchell‎; Ryan Huey‎; Kathleen Broderick-Forsgren‎; Erin Boehm

Handoffs: Adam Banks; Jenn Rymer.

Congratulations to Ben Heyman and Anastasie Dunn Pirio on their wedding. A great showing by med and neuro. Also congrats to Armando and Jen Bedoya on their wedding in Nicaragua!

We have some upcoming events to be aware of, including the 2nd annual Stead Society Trivia Night this week (Wednesday, August 21st). Check your emails from Murat for additional opportunities for research training as well.

This week’s pubmed from the program goes to Christine Bestvina for her abstract with Yousef Zafar, that she will present as an oral presentation  at the upcoming ASCO Quality Conference! The abstract is titled”  “Patient-oncologist cost communication, financial distress, and medication adherence.” 

Have a great week!


Snapshots from the “Summer Celebration”

Friday night turned out to be an absolutely perfect evening to be outside.  Can you believe it was even comfortable huddling about the fire pit making smores?  Here are few snapshots from the evening.

Bae+at PartyFood Truck - 2




SmooresResident Summer Celebration








What Did I Read This Week

Laura W. Musselwhite MD,MPH

PGY-2, IM Global Health Residency Program

Protection Against Malaria by Intravenous Immunization with a Nonreplicating Sporozoite Vaccine

Why is this discovery one of the most exciting in public health this year?

A quarter of a billion people get malaria every year and half a million die from it. This massive burden of disease results in millions of disability-adjusted life-years (DALYs), contributing to multigenerational cycles of poverty abroad, and some argue resultant political instability. Musslewhite

From a drug development standpoint, a malaria vaccine is one of the few drugs for neglected tropical diseases for which there is a commercial market in the developed and developing world. In the developed world, the market lies in global tourism (108 malaria-endemic countries exist and travelers are susceptible) as well as global warming concerns (mosquito vectors are coming!).

The following paper’s results show encouraging data in malaria vaccine development, albeit at an early phase. In this study, investigators report a highly efficacious, dose-dependent vaccine that targets the parasite at a particularly susceptible stage in its life cycle. Moreover, this research provides an ideal model of industry (Sanaria Inc.) and academia (the NIH) working together to create a marketable product for the public’s good.


Consistent high-level, vaccine-induced protection against human malaria has only been achieved by inoculation of Plasmodium falciparum (Pf) sporozoites (SPZ) by mosquito bites. We report that the PfSPZ Vaccine, composed of attenuated, aseptic, purified, cryopreserved PfSPZ, was safe and well-tolerated when administered 4-6 times intravenously (IV) to 40 adults. 0/6 subjects receiving 5 doses, 3/9 subjects receiving 4 doses of 1.35×105 PfSPZ Vaccine, and 5/6 non-vaccinated controls developed malaria following controlled human malaria infection (P = 0.015 in the 5-dose group and P = 0.028 for overall, both versus controls). PfSPZ-specific antibody and T cell responses were dose-dependent. These data indicate there is a dose-dependent immunological threshold for establishing high-level protection

Future directions

We need bigger, prospective PfSPZ vaccine trials with fewer doses needed, in a non-IV formulation that is efficacious for a prolonged period of time. The future is bright.

From the Chief Residents

Grand Rounds

Date:  August 23, 2013

Presenter:  Dr. Olveen Carrasquillo

Noon Conference

Date Topic Lecturer Vendor Room
8/19 Edema, Renal   Syndromes and Clinical use of Diuretics John Roberts Saladelia 2002
8/20 Delirium   OR Difficult Death Debriefing Sarah   Rivelli OR Galanos Bullock’s BBQ 2002   OR DN9242
8/21 QI   & Patient Safety Noon Conference Moe’s 2002
8/22 Inpatient   management of CHF Joe   Rogers Dominos 2002
8/23 Chair’s   Conference Chiefs Chick-fil-A MEDRES

From the Residency Office

Annual Flu Vaccination – Condition of Employment at Duke University Health System

Annual vaccination against the flu is now a condition of employment at Duke University Health System.  This policy applies to all people who provide care, treatment or services in the organization, including those receiving pay (for example, permanent, temporary, part-time personnel), as well as members of the medical staff, contract employees, volunteers, vendors and health profession students.

Below are a few FAQ’s to take note of and link to the website:

Q: Exemptions:  When will the exemption/vaccination forms be available to download, and where will we be able to find the forms?

A: The forms are currently available online now.  You can download the following: Medical Exemption Application, Religious Exemption Application, Outside Vaccination Reporting.
If you are requesting an exemption, your request MUST be submitted no later than September 13, 2013
Q: Can I self-declare a medical exemption to the influenza vaccine?
A: No, medical exemptions must be documented by your healthcare provider on the application form for a medical exemption. This is the same process that was used last year.
Q: Who should I contact if I have additional questions about the policy?
A: First, ask your manager. If you have additional questions, submit them to The Universal Flu Vaccination Work Group will respond within 72 hours. Questions will be used to continue to build on the FAQs, as we intend for this to be a dynamic document.
Q: Will we have a BLITZ again this year?
A: Yes – the blitz is scheduled for September 18/19.  Watch for more information in the coming weeks.


Orders for MKSAP are now closed.  We will contact you when we have comfirmation as to a release date.

Trivia Night – Carolina Ale House

The Warren Stead Society would like to invite the residents from ALL the Stead societies (i.e. all the residents) to a special Trivia Night to be held on Wed, Aug 21, at the Carolina Ale House at 7PM.  Leaders from each Stead Society will be present at 7pm to claim a table, and the Societies will cover all your food and drink for the evening.  Please feel free to bring your families.  Trivia starts at 8pm.  Each Stead group will form a table, and to the highest scoring Stead team, we will provide $100 to donate to their local charity of choice.  Last spring the Stead societies took over the main room of the Ale House with this venture, and we’re hoping to have strong turnout again.  This event should present another terrific opportunity to welcome our new interns.  We hope to see all the housestaff there!

The address of the Carolina Ale House is:

3911 Durham Chapel Hill Boulevard

Durham, NC 27707

Abstract Submission for NIH Resident Research Career Day- September 1st Deadline

Please see the announcement of an wonderful opportunity below to submit an abstract for presentation of your research at the NIH on October 7, 2013.

This is an excellent academic opportunity and outstanding experience. Furthermore, it would support fellowship applications for those of you applying this year.  The deadline for submission is September 1, 2013 by email (see below)

You will need:

  • A brief letter of support from the training program director (Aimee and I are happy to provide this if you please let us know asap)
  • The resident’s statement of career interest including intended clinical subspecialty field
  • Curriculum vitae

The resident’s abstract of the research work or scholarly activity to be presented should be sent to:

  •    Robert M. Lembo, MD
  •    Chair, Resident Research Career Day Organizing Committee
  •    NIH Clinical Center, National Institutes of Health
  •    10 Center Drive, MSC 1158, Bethesda, MD 20892
  •    or e-mailed to:

Please let us know if you have any questions or if we can help in any way !

Murat and Aimee

2014 – 2016 Kraft Fellowship in Community Health 

Funded by a generous gift from the Kraft family, the Fellowship is a two-year, multidisciplinary program that provides formal academic training in Community Health leadership while also immersing fellows in community health center practice. Fellows will be prepared to tackle complex public health problems and evolve to be leaders in community health centers or public health departments, faculty at academic medical centers, and charismatic role models for the next generation of medical students and residents.

Open to graduates of residency training in primary care/internal medicine, pediatrics, family medicine, obstetrics/gynecology and psychiatry, the core Fellowship components include the following:

  • Full tuition support for a Masters of Public Health degree at the Harvard School of Public Health
  • Community health practice 3 sessions/week
  • Mentorship from academic and community leaders
  • Salary with benefits at the PGY4 and PGY5 levels
  • Student loan repayment (up to $50,000)

Fellows will be expected to remain in Community Health for three years post-fellowship training.

The deadline for the application is October 15, 2013.  We would appreciate your sharing this information with your residents, and directing them to our website at for detailed information.

Derri Shtasel, MD, MPH, Executive Director

  • Kraft Family National Center
  • for Leadership and Training in Community Health
  • 25 New Chardon Street, 3rd Floor
  • Boston, MA 02114
  • Phone: 617-726-6072
  • Email:

VA Perceptions Survey (LPS)

This particular survey is being offered by the Office of Academic Affiliations (OAA). Because the VA oversees the largest health professions training program in the nation, the survey asks trainees to rate various aspects of their clinical training experiences. The (LPS) has proven to be very beneficial in collecting direct trainee information on a nation-wide level, this is our Return on Investment (ROI) by ultimately improving care to our Veterans.

Listed below are just some of the improvements made here at the Durham VA Medical Center. These noteworthy improvements/changes are a direct result of working in  conjunction with the ACOS/Education, OAA Liaison and the former trainees who completed the (LPS).

  • Meal Cards- Physician Residents
  • Physician Residents Sleep Rooms – updated – computers added
  • Training areas/work rooms – updated
  • Lactation Room added
  • Laboratory hours extended
  • Pharmacy hours extended
  • Quality Management
  • Tests completed in a timely manner
  • Ancillary Support

Please note a trainee may complete the (LPS) for various rotations that begins our AY – 1 July 2013 and ends on the 30th of June 2014.

LPS Flyer AY 2013-2014

Now recruiting eligible candidates for Duke’s Global Health-Internal Medicine Residency Program

Duke Global Health Residents from the Department of Medicine extend the duration of their residency training by 12 months to gain specific global health core competencies. This extended residency includes nine months of course work which will lead to a Master of Science in Global Health and a total of nine months providing clinical care and conducting mentored research at a Duke University international partner site.

Please visit our website for an in-depth description of the core curriculum including rotations, global health competencies, and program requirements as well as application instructions:

Watch:  Current Global Health Resident, John Stanifer, discusses his decision to pursue global health training at Duke.

Internal Medicine Residents who have successfully completed PGY1 are eligible to apply.  Send all application materials electronically to

Applications accepted on a rolling basis until October 1, 2013.  Offers will be made November 1, 2013.

Contact Information/Opportunities

Hospitalists Residency Flyer 8.12.13

Upcoming Dates and Events

  • August 21st  Trivia Night, Carolina Ale House, 16th  7 PM 
  • September 18/19  Flu Shot Blitz

Useful links

by · Posted on August 18, 2013 in Chief Residents, Fellowship programs, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Weekly Updates: August 12, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi everyone!

Hope you are staying cool in the first real week of an NC summer. Hopefully you took advantage the chance to sign up for up to date on your phone. Also please remember to log in and sign up for MKSAP if you are placing an order this year – see the details below.

Kudos this week go to Amy Little and Adva Eisenberg from Carter Davis for outstanding 9300 handoffs, to Jessica Morris for a great diagnosis at the DOC, to Carli Lehr for being selected for the Cleveland Clinic Lung Summit, and to Bobby Aertker for helping a colleague. Also to the MSIVs for fantastic work that we were able to see at AOA day on Friday. Spectacular work!

Final kudos to Carling Ursem and Steve Bergin for getting coffee at DRH report! Look at the lengths we will try to get you there!!!!  Bring your mug and enjoy!

If you haven’t had a chance to watch our first QI conference on “healthcare stewardship” then please watch it on Medhub.

Looking forward to seeing you all at the Summerfest this Friday! Keep Stead trivia on your calendars for next week.

This weeks pubmed from the program goes to Aaron Mitchell:  Mencarelli CMitchell ALeoncini RRosenbaum JLupetti P., Isolation of IFT trains. Cytoskeleton. 2013 Jun 27. doi: 10.1002/cm.21121. [Epub ahead of print], PMID: 23804580

Have a great week!


Why did I read these?  Well, first, my husband sent them to me since the work-related conversation at our house has centered around health care stewardship.   Don’t worry, we can talk about normal stuff too.  Also, I am always looking for ways to make the topic relevant to the program and also to myself, as I can tend to glaze over at the MBA/policy wonk-style conversations.

What are the articles about? The first focuses on healthcare cost and how it affects patients (do a search on Yousef Zafar and his “financial toxicity” of cancer care work…very interesting). Basically, they calculate that the average family of four will spend more on healthcare than on food…$9,144/year in payroll deductions and out of picket costs, as part of the 22k total for the family (employer costs).

The remainder of the article looks at the components of these costs and how they might be affected by the ACA.

The second article relates how much more money Gen Y will spend on health care than the baby boomers. Being neither a boomer or a gen Y, I suppose I will spend somewhere in the middle.  They calculate that Gen Y will spend twice as much as a boomer, but that they will use 3x as much as they paid for, in contrast to the boomers who will spend 2x as much as they paid into the system.

One can only wonder how any of this is sustainable and what increasing proportion of our costs will be passed on to patients and families (which includes us). So, my take home message from these two articles is that we have to keep trying to control health care costs because it really will affect our patients livelihoods.

From the Chief Residents

Grand Rounds

Date:  August 16, 2013

Presenter:  Dr. Sway Desai

Noon Conference

Date Topic Lecturer Vendor Room
8/12 Hem-Onc Emergencies Rich Reidel Saladelia 2002
8/13 Withdrawal Sarah Rivelli The Pita Pit 2002
8/14 Schwartz Rounds Lynn Bowlby, Lynn   O’Neill Jersey Mike’s 2002
8/15 Insulin/DMS Overview Lillian Lien Sushi 2002
8/16 Chair’s Conference Chiefs Rudinos 2002

Interns Selected to Residency Council:

Congratulations to the following interns who were recently selected to represent the intern class:

  • Jessie Seidelman
  • Matt Atkins
  • Jess Tucker
  • Andrea Sitlnger

Coffee at the DOC

We realize your expert diagnostician brain may not be fully engaged at 7:15, so we’re providing coffee to help!placebo

Comments overheard this week:

“We should have done this a long time ago!”

Dr. Greenblatt: “Coffee, where did that come from?”

Brice Lefler: “Heaven”

interventionTo quantify the importance of this addition, some residents were randomized (after IRB approval of course):


From the Residency Office

QI Corner

Medicine Residency Patient Safety and Quality Council

Our next meeting is THIS WEEK! It will be Wed., 8/14, at 5:30 PM in the Med Res Library.  We’ll discuss each of our potential project topics for this year, including recruiting Hand Hygiene Champions for each of our wards, and try and shake Jon Bae out of his #dufnering.  If you can’t make it, email me at

Patient Provider Awareness Study & Patient Centered Business Cards (submitted by Kathleen Broderick-Forsgren)

As some of you may know, we are in the process of doing a quality improvement project to examine patient awareness of their physicians, their role, and how to contact them.   The recent advent of resident duty hour restrictions has fragmented care between more health care providers.  There is increasing use of a night float system to provide patient coverage overnight which increases hand-offs between physicians and likely decreasing time spent with patients.  Patients are also frequently introduced to inpatient consultation teams.  According to one study, 75% patients could not identify one provider on their medical team.

One of the focuses of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is improving healthcare communication between caregivers and patients.  As part of this project (and to hopefully improve patient care), we are trying out different interventions including the use of patient-centered business cards.  The program has designed new patient-centered business cards which will be available for you to pick up in the next week (watch for an email from the office).  The business cards are designed to help improve communication with your patients (both inpatient and outpatient) to alert them to who you are, your role, and how best to contact you.  We encourage you to use your cards on both the inpatient wards and your outpatient clinics.  Thanks in advance for your participation and please contact Katie Broderick at for any questions, comments, or feedback.

QI Craigslist

We will lay out some of the Craigslist options at the meeting (see above)!  Look for another email later in the week . . .

Follow Us on Twitter
- @DukeMarines – Duke Chief Resident Updates
- @JonBae01 – QI and Patient Safety (general news and program updates)
- @DukeDOMQuality – Duke DOM Quality Updates
- @bcg4duke – Maestrocare and health informatics

Joel C. Boggan, MD, MPH
Chief Resident in Quality and Safety

New Phone # for Lauren Dincher

Following up on last week’s announcement, please note that Lauren also has a new phone number:  681-4090.


Last week to submit requests for MKSAP.


  • Confirm that you are a member of the ACP  (annual fee for residents $109)
  • Have your membership number when you are ready to submit your request
  • Decide which level of MKSAP is right for you.
  • Complete the online request form

How much does it cost?

  • MKSAP 16 Digital – $389 for members (paid for by the program)
  • MKSAP 16 Print – $389 for members  (paid for by the program)

Note – ACP has made either option the same price

  • MKSAP 16 Complete Set – $629 for members (your cost $240 - includes Digital and Print copies)


  • This offer is open to all Categorical, Med Peds, and Med Psych trainees who have NOT previously received a copy of MKSAP
  • We cover the cost of the MKSAP16 Digital or print copies this year
  • You are required to be a current ACP member to participate
  • We do not place orders randomly at different times in the year.  This offer is for a limited time only – ending on August 18, 2013.

Now recruiting eligible candidates for Duke’s Global Health-Internal Medicine Residency Program

Duke Global Health Residents from the Department of Medicine extend the duration of their residency training by 12 months to gain specific global health core competencies. This extended residency includes nine months of course work which will lead to a Master of Science in Global Health and a total of nine months providing clinical care and conducting mentored research at a Duke University international partner site.

Please visit our website for an in-depth description of the core curriculum including rotations, global health competencies, and program requirements as well as application instructions:

Watch:  Current Global Health Resident, John Stanifer, discusses his decision to pursue global health training at Duke.

Internal Medicine Residents who have successfully completed PGY1 are eligible to apply.  Send all application materials electronically to

Applications accepted on a rolling basis until October 1, 2013.  Offers will be made November 1, 2013.

Contact Information/Opportunities

IM or FP needed in RI      Cardiologist Opportunuity Texas

Idaho Hospitalist        North Dakota Internal Medicine

Idaho Internal Medicine     July 2013 – Hosp Opp Flyer

Upcoming Dates and Events

  • August 16th  Program Wide “Summerfest Party” at the Zaas’s

Useful links

by · Posted on August 11, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Weekly Updates: August 5, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Happy August! And the end of a long “Block 1″ for our JARs and SARs.  I hope we say it enough, but thanks to you all for an incredibly fantastic start to the year.  The SARs, Krish and I enjoyed a celebratory lunch at Nosh and the JARs celebrated at the VA as well. We had our first JAR dinner, so thanks to Joe Brogan, Carli Lehr, Amera Rahmatullah, Sneha Vakamudi and Allyson Pishko for joining me at Pizzeria Toro. JARs, we’ll be sending out the August date this week, so keep an eye out.

This week we have kudos to Nina Beri for her grand rounds intro, to Howard Lee for great work on the hepatology consult service, to Liz Campbell for being extremely helpful to a colleague at the DOC, to Kevin Shah for filling in a coverage gap in the CCU, Hal Boutte for a great chair’s conference, everyone for awesome chair’s conference participation, and to Chris Hostler for organizing the First Annual White Coat Housestaff vs Faculty PAINTBALL extravaganza! Date is still in the planning stages, but check your emails and sign up!

Please check your BLOCK FOUR schedule for your IN TRAINING EXAM DATE (categorical interns, JARs, SARs, Med Peds and Med Psych).  We have a limited window of time that we are allowed to offer the In Training Exam, so Lauren and the chiefs have worked hard to balance the coverage of teams and the ITE dates.

Also, we had a great noon conference with the SARs regarding fellowship application interviews.  For more information, check Medhub –> resource documents –> fellowship.

Its time to order your MKSAP 16 — instructions below.  Remember, we get you a MKSAP one time in your training (digital version), so please take advantage of this offer!  VA Gen Med

THANKS to our JARs for a rockin 5 weeks at “Club VA Gen Med”.  And also to our SARS for the 5 weeks of maestro filled greatness at Duke Gen Med.

Also kudos to Sajal Tanna for winning the noon conference attendance prize (2 Durham bulls tix) for July! 19 conferences!!!

This week’s PUBMED FROM THE PROGRAM goes to Nina Beri for her upcoming oral presentation at the International CLL meeting in Germany! “Molecular and clinical associations between Vitamin D and Chronic Lymphocytic Leukemia”.  This work was done under the mentorship of Mark Lanasa.

Have a great week!


There was not specific clinical question or motivation for reading this article beyond general intellectual curiosity… I just recently ran into it while perusing the literature to stay up to date.


The Lung Transplant Program Duke is one of the largest and most successful in the world.  Despite working with the most challenging cases (e.g. complex patients turned down by other centers, multi-organ candidates), our post-transplant outcomes such as survival are significantly greater than national averages.  Our research efforts work in concert with our clinical care and we’re particularly adept at rapidly incorporating new findings directly into improved patient care.


•              Design – cohort (prospective database)

•              Patient Population – approximately 7000 adult first time lung transplant recipients in the UNOS registry between May 2005 and April 2010 (post-LAS era)

•              Prognostic factors – pTLC-ratio (the ratio of donor:recipient lung size calculated from gender and height)

•              Analysis – Kaplan-Meier survival and Cox proportional hazards models; cohorts were stratified (bilateral vs. unilateral) and subsequently grouped by pTLC-ratio quartiles

•              Outcome – Risk of death at 1 year after transplantation

•              Follow-up – Patients with missing information or aberrant values (suspected data entry error) were excluded


•              In bilateral lung transplants patients, each 0.1 increase in pTLC-ratio was associated with a 7% reduction in the risk of death at 1 year (HR 0.93, 95% CI 0.88 to 0.98, p = 0.01); multivariate model included diagnosis, comorbidities, acuity, donor, and transplant factors

•              Stratification on propensity scoring (ordinal quintiles) supported the treatment effect

•              The pTLC-ratio was not associated with 1-year survival in unilateral lung transplant patients


This is one of those fun articles that produces a stampede of thoughts, ranging from the most basic (estimating validity) to much broader and more complex considerations (e.g. organ utilization, outcomes pathophysiology), so I’ll keep things brief and highlight a few things I found interesting.

Face validity is pretty reasonable, though some of the details regarding patient accounting are not provided and both the heterogeneity of transplant protocols and changes in practice and experience over the study interval are important unmeasured variables.

That a higher pTLC-ratio (suggesting an oversized allograft) may be associated with improved survival after bilateral lung transplant is a pretty cool thing to think about.  A good first question is whether the measurement of the treatment, in this case is the pTLC-ratio, is meaningful and appropriate?  As you may recall, prediction equations for PFTs consider age, gender, and height and were derived predominantly from nonsmoking Caucasians of northern European ancestry.  There are multiple equations and correction factors available but, in short, the methodology for determining pTLC is not standardized and the pTLC-ratio is not necessarily a reliable marker of size matching.  This is only further confounded in the context of changes in thoracic size in patients with end-stage lung disease.  In this study, it’s completely unsurprising to find a relative surgical (and survival) advantage in patients who were “very oversized” (and in whom there was a disproportionate percentage diagnosed with COPD).

Among the amazing and complex care we provide for our pre- and post-transplant patients, how much does donor-recipient lung size discrepancy impact clinically important outcomes?  Smaller studies have produced more variable results and there is also some support for size-reduced allografts.  Oversized allografts implanted into a smaller thoracic cavity may physiologically contribute to post-operative complications due to atelectasis, bronchial anatomy distortion, and impaired airway clearance (variable data on the effect on pulmonary vascular resistance).  Presupposing that oversized allografts do indeed confer a survival advantage, what might be the mechanism?  This also remains uncertain but my favorite hypothesis would be the relative reduction of ventilator associated lung injury in allografts receiving relatively lower tidal volumes (i.e. less “hyperinflation” leads to improved allograft function and survival) though I’m sure some surgeons and pulmonologists might disagree.

In the big picture, how the size of the donor lungs relative to the recipient impacts outcome remains uncertain but any area that might improve organ utilization and survival is an exciting opportunity for further research.

From the Chief Residents

Grand Rounds

Date:  August 9, 2013

Presenter:  Dr. Jennifer Green

Noon Conference

Date Topic Lecturer Vendor Room
8/5 Lung Transplants Laurie Snyder The Picnic Basket 2002
8/6 Hazards of   Hospitalizations Tony Galanos Jersey Mike’s 2002
8/7 IM-ED Combined   Conference Tiffany Christensen Moe’s 2002
8/8 EKG Interpretation Al Sun Dominos MEDRES
8/9 Chair’s Conference Chiefs Chic-fil-A 2002

Chief Residents – Get to Know us Better!

It is a real challenge to find the opportunity to work with everyone in our program as closely as we would like.  Unfortunately this means we do not have the chance to get to know everyone well as we start off in the new year.  With this in mind, wboggan_1e thought it would be helpful if we shared a little more about ourselves, including our training background, interests, and our goals for this year as chief residents.

First up – Joel Boggan, who is our Chief Resident for Quality and Patient Safety a the VA Medical Center.

“Throughout residency, I became interested in projects related to quality improvement, even though I wasn’t aware that’s what they were at the time.  First, I worked on antibiotic resistance and how we report it in antibiograms, and then I helped out on a hypertension control audit and feedback project.  Around the time that second project was kicking off is when I realized these really were QI-related and I really enjoyed this type of work.  Second, I got involved with the GME Patient Safety and Quality Council, mainly by chance rather than purpose, but I developed a strong interest in handoffs and was able to continue some very important work that originated with a group of SARs within our program and has now become a set of precepts we shared with many other departments.  If you’ve had your handoffs assessment already this year, know that those evaluations came directly from your preceding peers! 

Overall, I think our program offers lots of resources and experts to speak with you if you have a specific interest, or, if like me early on, friendly perspectives if you don’t know exactly what you want to do.  And, you’ll definitely get great clinical training to go with it!  Other things I love talking about are food and where to get it in Durham, backpacking, travel, and Duke basketball, when it’s time . . .”


VA Prime Policy Updates (submitted by Sonal Patel, MD)

“I wanted to spend a minute and review the late policy that we are going to start implementing in PRIME clinic.  Remember however that you should always use your discretion and there are always extenuating circumstances where it would be helpful to bend rather than have everything in black and white.

Be mindful and understanding of patients that are elderly, ill, inclement weather, have traveled a great distance for the first time to PRIME clinic  and underestimated the time it took to get to the VA.  Please use your judgment and see how busy you are at that time and if other patients have checked in.  It is OK to see patients for abbreviated visits or reschedule if you are busy, use your judgment.

  1. “Late” is defined as checking in for an appointment 15  minutes after the scheduled appointment time.  Any patient who      arrives before this time will be considered “on time” and will be seen by the provider for which his appointment is scheduled.
  2. If a patient is over 15 minutes late, the Clerical Support Staff will alert the Resident Provider and ask if there is a possibility that the patient can be worked in or seen at the end of clinic
  • If the resident provider agrees, Clerical Support  Staff will let patient know that the visit will be abbreviated and patient might have to wait until a no show to be fit into clinic or wait until end of clinic
  • If the Resident Provider cannot see the patient in his/her own clinic that day, the RN will be notified to assess the patient’s needs-  if needed if there are any open time slots that day or in the next couple of days the patient will be rescheduled with another provider or the patient’s own provider depending on patient preference and provider availability
  • If there is no urgency and patient is rescheduled, RN will let resident provider know if any medications or orders need to be placed for patient before his rescheduled appointment

Also PRIME staff was requesting to please be aware of the time for patients that are seen later in the afternoon. For example for your 3:30 patient, if you do not finish seeing your patient and send him/her for checkout at 4:30 or later, the patient still needs to be seen by the nurse, seen by the clerk and often times then to EKG or Lab or Radiology or other clinics that might be closed.

Please try to have patients out of your clinic room by 4:15p if possible so the nurse and clerk can finish up with the patient in a timely manner.  Of course the staff realizes that this might not always happen if a patient shows up late or if a patient is complicated but the staff politely requested that you try and have the patients out of the clinic room and to check out by 4:15 if possible.’

From the Residency Office

QI Corner

‘High-Value, Cost-Conscious’ Care QI Lecture Numero Uno

Thank you to all who made it to our first Quality and Safety Noon Conference this week for an “Introduction to High-Value Cost Conscious Care”.  We hope we highlighted some of the nuances within Cost-Conscious Care, how we might think about costs and benefits of specific tests, and illustrated how different strategies for diagnosis can lead to vastly different billing charges.  This is the first of a several-part lecture series we’ll be doing throughout the year, complete with QI updates (as shown below)!

If you missed it and would like to watch online, the link is below.

The two articles (attached) complement the lecture.  The first provides a framework for how to think about the levels of benefit vs. cost for studies we order, while the second estimates the amount of waste within healthcare.

Clinical Guidelines, ACP, HVCC     Eliminating Waste in US Healthcare Berwick

Stay tuned for our next Quality and Safety Conferences:

8/21/2013: Dr. Luke Chen presents Hospital Infection Control/Hand Hygiene

9/25/2013: High Value Cost Conscious Care Series, Lecture 2: “Healthcare Waste, Costs, and Over-ordering of Tests” by Dr. Dan Kaplan

Rotation Burnout Assessment

The first batch of rotation burnout surveys have been distributed via email.  Please look for these in your inbox and fill them out promptly.  You will be receiving these are every rotation this year, and we plan to use these data to determine which rotations/schedule types are most prone to burnout.   For any questions, please contact Hany Elmariah <>.

GME Incentive Program/Hand Hygiene

Beginning Thursday, our hand hygiene compliance went online for the Incentive Program.  This is our program-specific metric (along with the other three mentioned before Jon’s lecture), and housestaff can earn a total of $600 EACH by the end of the year if we reach the goals. Data - HH

Our target for hand hygiene will be >90% compliance (overall) for 8 of 10 months between August and May, meaning we’re already being watched.  Here’s the July run-in data, just to show where we stand.  As you can see, we have some work to do. . .
If you are interested in learning more about the Incentives, please contact Joel Boggan <> or Jennifer Rymer <>

QI Craigslist Update


Patient Safety Case Reviews:

Need 1-2 resident to help review approximately 25 cases for categorization of root causes

Possible academic output = poster +/- publication

Estimated 3-4 hours/work/month

Contact Jon Bae <> if interested.

Bears Pulling Trash Cans

If you know any amazing YouTube videos or funny links that need to be viewed, send them to Joel & Jon.  We may share them, but mostly we just like to laugh . . .

Follow Us on Twitter
- @DukeMarines – Duke Chief Resident Updates
- @JonBae01 – QI and Patient Safety (general news and program updates)
- @DukeDOMQuality – Duke DOM Quality Updates
- @bcg4duke – Maestrocare and health informatics

Where Can I Find Lauren Dincher?

As you may have noticed, Lauren has a new “home”, and has moved to the office that is right across from her old desk.  This move is not without a lot of planning, and also is in recognition of Lauren’s growth in level of responsibilities.  Lauren is taking over ALL of the scheduling duties for the program, and in doing so has been recommended for promotion to Staff Specialist.  Yes, she still serves as our notary, but many of her other duties have been reassigned.   Lauren’s goal in moving to the new office is to ensure an added level of privacy when needed and to find some “quite space” to allow her to focus on the complex tasks of managing the schedules for over 150 residents.

So, if you come by the office – it’s OK to stop by and congratulate her, and when it comes to scheduling questions – Lauren is your “go to” person.

You will also see that Lauren’s old desk is now occupied by Toni Nicholson. Toni has joined us from Duke Temps as we work though realignment of duties and work to fill the position that was vacated by Shawna Alkon.

LaurenCONGRATULATIONS, and thanks for all that you do!!


The program encourages residents to take advantage of the opportunity to obtain Medical Knowledge Self-Assessment (MKSAP) at a significantly discounted rate.

How?  First, you need to become a member of the ACP.

Associate membership costs $109/yr . Please make note to record your ACP # – you will need it to complete our online request form

  • Which MKSAP format do you want?

The cost for Digital MKSAP 16 is covered by the program – simply complete the order blank using the following link.

If however you request MKSAP 16 Print (hard copy), or the complete set, you will need to cover the additional cost.

MKSAP 16 Digital – $389 for members (paid for by the program)

MKSAP 16 Print – $389 for members (your cost $50)

MKSAP 16 Complete – $629 for members (your cost $290) includes Digital and Print copies


  • This offer is open to all      Categorical, Med Peds, and Med Psych trainees who have NOT previously      received a copy of MKSAP
  • We cover the cost of the MKSAP16 Digital release
  • You are required to be a current ACP member to participate
  • You have the option to request the printed version or complete set – but you will need to cover the      additional cost
  • We do not place orders randomly at different times in the year.  This offer is for a limited time only – ending on August 18, 2013.

Inservice Training Exams (ITE’s)

Weeks of work to map out a schedule to ensure that everyone is slotted in to take the ITE’s has come to a close.

The schedule is now loaded in MedHub, and the complete schedule is also posted in MedHub as a resource document.  Our office will send out reminders, but please take special note of your assignment.

Just in case you wonder why we put so much effort into ITE’s, its not just that they are required.   As examples of how they are used, the reports (individual) may offer you insights as to what areas to focus on in preparation for the boards, are a tool referred to by your advisor,  and in the aggregate help us determine what changes and should be incorporated into the training program.

Learning Portfolio – Residents AND Core Faculty

In accordance with the ACGME’s Next Accreditation System(NAS), we are required to report on the scholarly activity for our residents and core faculty on an annual basis.  To assist us in the process, we are asking all Internal Medicine residents and core  faculty members to maintain a current list of their publications, presentations, awards, etc., in the Learning Portfolio area of MedHub.   You can find the tab to access this section on the header of our MedHub home page.   If you have any questions, please feel free to contact Jen Averitt in the MedRes  office (

As a reminder to all residents and core faculty, PLEASE complete and return the scholarly activity worksheet that you were sent via email no later than 8/15/13!

Now Accepting Applications for Global Health Elective Rotations


Now Accepting Applications for Global Health Elective Rotations

The Hubert-Yeargan Center for Global Health (HYC) is now accepting applications for Global Health Elective Rotations for July 2014 and March 2015. Application is open to residents from Departments of Medicine: Internal Medicine (PGY 2); Med-Peds (PGY 3) and Med-Psych (PGY 4).  Access the application form and FAQ at

Global Health 8-5(Application addendum is available by request –


Application deadline is September 17, 2013. Interviews will be held in late September/early October. We encourage you to speak with past participants to get a better idea of what daily life is like on the wards of your top sites. For more information, contact Tara Pemble, Program Coordinator at or 668-8352.



Contact Information/Opportunities



Upcoming Dates and Events

  • August 16th  Program Wide “Summerfest Party” at the Zaas’s

Useful links

by · Posted on August 4, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Weekly Updates: July 29, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Interns are starting block 2 this week! Once again, congrats on an outstanding start to the new year. This weekend, a big thanks to our MICU team, including Allyson Pishko, Mike Woodworth, Nick Rohrhoff, Veronica Jarido, and  Talal Dahhan, as well as Drs Govert and Hollingsworth and the entire MICU staff for a smooth transition to the new (amazing) MICU.  It was nice to see them settling in to the new place!

Kudos this week also to Kristen Glisinski from the ICU team for her work on 9300, and to Scott Tolan, Chris Hostler and Adrienne Belasco for helping us out during Physical Exam Week.  A big thanks to Dr. Arcasoy for planning a fantastic week of noon conferences!

Please fill out your website information for Erin if you haven’t already done so…it is the most important part of our website…prospective Duke residents want to know you!

Coming up this week is the fellowship interview discussion with Bill Hargett and me at noon on Tuesday in the med res library. Regular noon conference will take place in 2002 for interns, JARs and those not applying to fellowship this year. For those looking at attending jobs next year, please try to attend the job interview panel hosted by Sharon Rubin and the NC ACP (details below!)

This weeks pubmed from the program goes to Chris Hostler! We found his article while doing a lit search in afternoon report:  Hostler CW and Chen L., Fidaxomicin for treatment of clostridium difficile-associated diarrhea and its potential role for prophylaxis, Expert Opin Pharmacother. 2013 Aug;14(11):1529-36. doi: 10.1517/14656566.2013.802307. Epub 2013 May 17.

Have a great week!


BowlbyThis has been an exciting time at the Duke Outpateint Clinic with the roll out of the year long DOC Redesign work.  Among many new initiatives, we now are organzied into 3 large Stead Groups, with a Lead Stead Attending, and are hiring a second care manager and an advanced practice provider.  In the analysis of our data over the past year during this redesign work, we saw the high number of patients with a mental health diagnosis, and the high utilization of expensive venues such as the ED.  One of the most important metrics we will be following over the next year is the rate of ED utlization. Not only is the ED an expensive location of care, but due to the social and psychiatric complexitiy many of our patients are admitted from the ED.  Handling the need for those acute unscheduled visits is a complex matter.  This recent article in the Annals of Internal Medicine showed that we are not the only ones with this challenge.

In the US there are 2 general locations for these acute unscheduled visits, the ED and primary care. Acute unscheduled care is about 30% of the outpatient visits in the US. There is not a system in place to help patients determine where to go and when, they can be caught in the middle with financial and emotional punishment for the wrong choice.

Continuity of care plays into the mix as well, with low acuity acute needs not impacted by the lack of continuity, but acute exacerbations of chronic disease benefiting from continuity of care with the PCP. One popular solution is expanding the primary care workforce. Now only 42% of acute visits are with the PCP.

Much of health care reform is focused on reducing ED visits due to cost issues. The fixed costs of the ED are high, so the marginal cost of one extra patient may not be that much more than going to the PCP. The ED facility charges are the driver for the high cost.

Innovative solutions? a new business model for the ED with a different service line, similar to urgent care is one.  The barriers for this is the profit from these visits is high, especially with commercial insurance.

Can the delivery model be changed in primary care? incentivize the primary care work force, after hours care, virtual care, alternative care prividers, health coaches are all ideas that are begin explored.

As we all plan ideas and solutions for our local challenges, good to know the national perspecitve as well.

From the Chief Residents

Grand Rounds

Date:  August 8, 2013

Presenter:  Dr. Mark Lanasa

Topic:  CLL

Noon Conference

Date Topic Lecturer Time Vendor Room
7/29 Pneumonia Zaas 12:00 Saladelia salad 2002
7/30 JAR/SAR   Fellowship Prep AND Shock (Interns in MedRes) Zaas/Hargett  and Bergin 12:00 Bullock’s 2002   AND MEDRES
7/31 DVT/PE Vic   Tapson 12:00 Saladelia sandwich 2002
8/1 QI   & Patient Safety Noon Conference: High Value Cost Conscious Care Bae/Boggan 12:00 Sushi 2002
8/2 Chair’s   Conference Chiefs 12:00 Rudinos 2002


On Tuesday, 7/30 Dr. Zaas, Hargett and chiefs will lead noon conference in the Med Res Library which will cover interview scheduling and advice for securing a great match.  SARS currently applying for fellowship are strongly encouraged to attend.  JARS planning to apply for fellowship are also welcome to attend.

The interns and medical students should report to the DN 2002 conference room.  We’ll continue the emergency lecture series with “Shock”.  Though not required, those attending the shock lecture should bring smartphones, tablets or any device with a web browser, as the session will be interactive.

Ambulatory Updates

Traditionally, Preclinic conference (PCC) has been held at each clinic site once the Intern Emergency Lecture series concludes. PCC was designed to deliver a core ambulatory curriculum but has been complicated by a number of logistical issues over the years.  As we work to prioritize Academic Half Day and revitalize our core conferences, this important curriculum will be delivered in a different venue.  As a result, we will no longer have a mandatory PCC.  Each clinic site may still host events occasionally during what would have been PCC time as an additional opportunity to be involved in clinic improvements or other educational opportunities.  More details to come soon!

From the Residency Office

QI Corner

Quality Improvement & Patient Safety Noon Conference

Join us for the first QI and Patient Safety noon conference of the year this Thursday, August 1. We will be kicking off our series of QI lectures on High Value Cost Conscious Care (one per month).

When: Thursday, August 1, 2013; Noon Conference

Who: Jonathan Bae - Introduction to High Value Cost Conscious Care.

Special Guest: Joel Boggan with QI Updates and the key to capturing bearded individuals and Hany Elmariah discussing his rotation burnout assessment study.

Come for the QI, stay for the AUDIENCE RESPONSE SYSTEM

Rotation Burnout Assessment (submitted by Hany Elmariah

  • New 1-2  minute optional burnout survey Q2 weeks
  • Fill it out to Stomp Out Burnout
  • For more details, email Hany or see below

HannyI wanted to let you all know about a new QI project we are starting that will make our residency program even better!  Basically, we are trying to stomp out burnout among the residents in our program…essentially turning our residency program into a year-round vacation. But, we need your help!

The goal of the project is to identify factors in our program, like especially taxing rotations or the newish shift-work system, that seem to cause more burnout among the residents…a first step in eliminating or improving these factors.

So, what can you do to help, you ask? Basically, you just have to respond to our email survey to evaluate your level of burnout throughout the year. I know, I know, no one wants to do more surveys. The good news is, this survey takes LITERALLY 1-2 minutes, even if you read on a fourth grade level like all of the VA ACRs.

The surveys will go out every 2 weeks. We will follow your responses over time to see how each resident’s level of burnout changes over the course of the year. We won’t know what your responses are, but we will be able to follow your responses anonymously using a unique identifier (mother’s maiden name and birthday). Because the survey is intended to identify your level of burnout on the day it is sent to you, we ask that you please fill out the surveys within a few days of receiving it. If you forget to respond to one of the surveys, that’s okay…you can just start back up with the next one.

We will also be tracking survey completion rates by class year as well and hope to be able to reward the class with the highest return rate.

Of course, you don’t HAVE to participate in this survey, but we are really excited about this opportunity to make our program better, and hopefully you will be as well. The first cycle goes out to interns this Friday (tomorrow) for the end of block 1.

If you have any questions, please contact Hany Elmariah ( you all very much for participating!

QI Craigslist – HELP WANTED

Patient Safety Small Group Debrief - Help teach and debrief patient safety topics with rising MS2′s from 10:30-12:00 on Wednesday 7/31!  You will be paired with a faculty member to lead 10 students in a discussion of PS topics, and to reflect upon the video, panelist testimonial, and lecture they receive that morning.  Discussion questions and materials will be provided for your review beforehand.  It should be a fun and engaging session!  Sessions will be held in the new medical school building.

Handoffs Workshop - On Wednesday, 8/7, from 1-4PM, Rising MS2′s will receive a 1 hour introductory lecture on inpatient handoffs and then be broken up into small groups for hands-on case-based practice.  Please join our faculty members in teaching and supervising these students as they take on handoffs, likely a brand new concept to them!  Resident input and anecdotes will be invaluable to this session!  You would be needed from 2-4 to help facilitate the small groups, and would be sent the materials and overview beforehand.  Sessions will be held in the new medical school building.

If interested, please contact Aubrey Jolly Graham ( ASAP!  We are excited to get the students exposure to a variety of clinicians and residents during these sessions, and to give residents invaluable teaching experience!

Follow Us on Twitter
- @DukeMarines – Duke Chief Resident Updates
- @JonBae01 – QI and Patient Safety (general news and program updates)
- @DukeDOMQuality – Duke DOM Quality Updates
- @bcg4duke – Maestrocare and health informatics


Now Accepting Applications for Global Health Elective Rotations


Boggan Global HealthThe Hubert-Yeargan Center for Global Health (HYC) is now accepting applications for Global Health Elective Rotations for July 2014 and March 2015. Application is open to residents from Departments of Medicine: Internal Medicine (PGY 2); Med-Peds (PGY 3) and Med-Psych (PGY 4).  Access the application form and FAQ at  (Application addendum is available by request –

Application deadline is September 17, 2013. Interviews will be held in late September/early October. We encourage you to speak with past participants to get a better idea of what daily life is like on the wards of your top sites. For more information, contact Tara Pemble, Program Coordinator at or 668-8352.

Picture from Kenya

Lindsay Boole share the following picture of from her experiences in Kenya with Anne and Dr. Kussin

Kenya Picture - 7-2013


TSMA (work done inside Duke for extra compensation)

The following policies apply to the moonlighting opportunities that are available to trainees:

At no time may the hours allocated for TSMA activities negatively impact training or violate duty hour policies. Residents who would like to be considered for Temporary Special Medical Activity (TSMA) in Oncology, Emergency Medicine, Cardiology, or Student Health must meet the following:

  1. Program level – either JAR or SAR
  2. Successful completion of rotations on MICU and Gen Med
  3. Be in good standing and without any active corrective action
  4. Provide written support from their advisor supporting the trainee’s request. The advisor may send an email to the attention of the Program Director, copy to the Program Coordinator, confirming their approval (to be completed prior to initiating the online TSMA form).
  5. Initiate the online TSMA form found on MedHub.
  6. Meet any additional training requirements as specified by the sponsoring department.

On notification of approval by GME, the trainee may contact the service Director and request approval to participate in the TSMA service.

Please Note: TSMA is approved only for each academic year. If you are currently participating in TSMA and plan to continue after July 1, you will need to resubmit the required forms for approval.

TSMA Updates:

Cardiology  (submitted by Dr. Matt Sherwood/contact for additional information)

“Our chief of service (and other attendings) have asked me to encourage the medicine residents to sign up for the weekend morning PAC and HFS rounding positions.  They run from 7AM to ~12-1PM and pay $420.  Light work, rounding on several patients and possibly discharging 1-2 of them”

Student Health (submitted by Dr. David Mellinger / contact for additional information)

“I am in the process of recruiting residents/fellows who are interested in working at Duke Student Health in a moonlighting capacity this academic year.  We will be open only on Saturdays this year from 9am-1 pm, not on Sundays as we have done in the past.  You can also let fellows know that with approval of their division they can participate as well.  The residents/fellows will be staffed by an on-site attending and will be compensated at $75 an hour.  Please announce this and pass on the information and have residents email me directly ASAP with questions and to express their interest.”


Contact Information/Opportunities

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Upcoming Dates and Events

  • August 16th  Program Wide “Summerfest Party” at the Zaas’s

Useful links

by · Posted on July 28, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Weekly Update · Read full story · Comments { 0 }