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IM Residency Program News: November 11, 2013

From the Director

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

Some great Duke victories this past week! Will there be 2 pick 6’s in the Turkey Bowl?

Thank you for your great energy for recruiting. Couldn’t have asked for a better kickoff week- special thanks to our tour guides, to Nick rohrhoff and Bronwen Garner for presenting at report and chairs, and to Joanne Wyrembak, Jason Zhu, Hal Boutte, Carling Ursem and Chris Hostler for talking with applicants at the end of the days.

Other kudos to Nick Turner from the MICU nurses, Erin Boehm and Amy Jones from the VA teams for taking some extra admits, to Jason Zhu from Nick Rohrhoff for strong work at the VA, and to Myles Nickolich and Brittany Dixon for coming in after a CAD night to say hi to applicants from their med schools.  And, from Steve Bergin, a BIG thanks to Jessie Seidelman and Carling Ursem for being more than willing to help out in the very busy, short-staffed ACC last week.

If you haven’t read Chris Hostler’s email about Veterans Day, please do. If you are working at the VA tomorrow (or enjoying a free day on amb bc the clinics are closed), remember to thank a veteran for their service.

Big week this week – come out to watch the Duke-Kansas game, JARs are headed to Dr Klotmans for a networking event with the fellowship directors and division chiefs and we have a med student event on Thursday!

This weeks pubmed from the program goes to alum Steve SumnerAssociation Between Earthquake Events and Cholera Outbreaks: A Cross-country 15-year Longitudinal Analysis;  Authors Sumner SA, et al, Prehosp Disaster Med. 2013 Oct 29:1-6. [Epub ahead of print]

Have a great week



I reread this article this week after hearing about Jenn Rymer’s presentation at the AAMC conference about our housestaff incentive program.  The UCSF incentive program, which began in 2007, was the prototype for our program here at Duke, and this paper from BMJ Quality and Safety from earlier in 2013 shows one of the successes they have had engaging residents in program-wide quality initiatives.

Joel Boggan, MD, MPH

Joel Boggan, MD, MPH

Background:  Prior to the study, resident discharge summaries were completed at an average of 3.5 days after discharge.  The goal of the project, decided on by residents and program leadership, was to have 75% of discharge summaries completed within 24 hours of discharge at UCSF’s main hospital.  If this metric was achieved over a year-long period, each resident would receive an additional $300 of salary.Two residents commandeered the effort, leading other residents and faculty through brainstorming, analyzing the data, and performing PDSA cycles about what to include in a new discharge template.  These residents also took a lead updating their peers biweekly on the performance metric when they rotated at UCSFMC.

Methods:  To improve discharge summary timing, the group created an electronic discharge summary template, which included medication changes and full reconciliation, functional status at discharge, follow-up plans, pending tests and discharge instructions.  Any team member could edit the template at any point during the hospitalization, and the template served as the discharge day note if completed on the same date as discharge.

Measurements included the time from patient discharge to resident completion of the discharge summary in days, the proportion of discharge summaries completed on the day of discharge, as well as frequency of use of individual aspects of the template that were considered to be important for a ‘quality’ summary.  Assessment of these ‘quality’ measurements from the summaries was performed by chart review and compared results for 80 summaries in the pre-intervention period to 160 from the near intervention (first two months) and further intervention periods (more than six months, with 80 from each period).  Chi-square statistics were used to compare proportions completed on the day of discharge and for presence/absence of individual quality metrics.  Results were presented to rotating residents twice weekly for the year-long incentive period, although the measurements were continued for an additional six months after the cessation of resident feedback and incentive target date to assess longer-term influence.

Results:  2560 discharges occurred during the study period, and the template was used in more than 96% of the summaries.  Average time to completion of discharge summaries decreased from 3.5 days to 0.6 days (p<0.001) and the percentage completed on the day of discharge increased from 38% to 83% (p<0.001).  The residents earned their extra $300, and the increased frequency of completion on the day of discharge was sustained for six months after the incentive period finished (see run chart below).

The percentage of summaries that included all recommended quality criteria also increased significantly, from 5% to 88%, including a full medication reconciliation (from 10% to 88%) and pending tests and follow-up (from 34% to 98%, p<0.001 for all).

WIRTW graph

What does this all mean? 

Mostly, it means that engaged residents, like we have here at Duke, make a real difference in care.  The residents in this study not only performed the discharge work that determined the success of this project, they also helped choose the metrics and led the project.  Furthermore, the residents were motivated by the quality of the work itself:  A follow-up survey found that several factors about the project were more important to the residents than the money being offered, including improving workflow by having the summary replace the day of discharge note, sharing the summary as an editable ‘team’ document prior to finalizing it, and that the timeliness of the discharge summary could improve continuity of care.

And, the project did improve continuity of care.  Prior to this study, 38% of outpatient providers surveyed by this group saw a patient in the outpatient setting ‘often or always’ prior to receiving a discharge summary.  With this project, that number dropped to 4%, and the information provided in the summaries was much more uniform and complete.

Overall, much of what they included in their summary template is already captured in our EPIC and CPRS templates, but I think their discharge timing speed could serve as a potential goal for our program in the future.  In the meantime, let’s work on hand hygiene and flu vaccination . . .


From the Chief Residents

SAR Talks, Noon Conference, 11/14/13

12:00-12:30: Angiogenesis and VEGF – The history of Avastin – Ben Heyman, MD

Grand Rounds


11/15/2013 Dr. Andrew Wolf


Noon Conference


Date Topic Lecturer Time Vendor
11/13 Schwartz Rounds Lynn O’Neill, Lynn Bowlby 12:00 Jersey Mike’s
11/14 SAR   talks: Angiogenesis and VEGF – The history of Avastin Ben   Heyman 12:00 Domino’s


From the Residency Office

The Martin Society Invites You To Dinner with Senior Faculty

This is the first in a special series hosted by the Martin Society to provide an opportuity to meet with senior faculty and discuss key topics over a light dinner.

Watch for the “INVITE” in your email, and please respond no later than Friday, November 14th, so that we can plan accordingly

Choosing a Career as a Clinician Educator
Presented by Diana McNeill, MD

Monday, November 18th at 7:00 PM
Medical Residents Library
10 Searle Drive, DUMC 3702, Durham, NC


Geriatric Curriculum Needs Assessment Survey (submittted by Tom Dalton, MD)

“This is a request for you to participate in a multi-institutional research study.  The goal of the research is to understand the need for further development of educational initiatives aimed at caring for hospitalized older adults.  We would like to know how often internal medicine and family medicine residents are assessing common issues that arise in this patient population.

To this end, we are asking you to complete an anonymous survey.  This survey will take about 2 minutes.   Taking part in this study is voluntary.  If you would like to participate, please click on the link below and complete the anonymous survey.  Please do not record your name or other identifying information on the survey form.”

Please feel free to contact Thomas Dalton (  with questions


GME Research Training Series for Residents

Registration for the SATURDAY sessions (November 16th and 23rd) will close on Monday, November 11th.

Take note of the learning opportunties shown below, offered by Duke’s GME office.  These sessions focus on enhancing resident QI and research experiences, and help ensure residents follow sound research principles and practices now and upon graduation.

Registration Link:


1. Human Subjects Research &Research Data Collection and   Security


Tuesday October 22, 2013 7:00am – 9:00am
Saturday November  16, 2013 8:00am – 10:00am
Wednesday January 15, 2014 12:00pm – 2:00pm
Thursday March 6, 2014 4:00pm – 6:00pm
2. How to Ask and Answer Research   Questions Using Library Resources &Ethics of Conducting Research Tuesday October 29, 2013 7:00am – 9:00am
Saturday November  16, 2013 10:15am-12:15pm
Wednesday January 22, 2014 12:00pm – 2:00pm
Thursday March 13, 2014 4:00pm – 6:00pm
3. IRB Overview, Informed Consent   and Regulations  Tuesday November  5, 2013 7:00am – 9:00am
Saturday November  23, 2013 8:00am – 10:00am
Wednesday January 29, 2014 12:00pm – 2:00pm
Thursday March 20, 2014 4:00pm – 6:00pm
4. Presentation and Dissemination   of Data  Tuesday November  12, 2013 7:00am – 9:00am
Saturday November  23, 2013 10:15am – 12:15pm
Wednesday February 5, 2014 12:00pm – 2:00pm
Thursday March 27, 2014 4:00pm – 6:00pm


Training in Advanced Research   Principles and Practices Saturday February 8, 2014 8:00am – 12:30pm
Saturday April 26, 2014 8:00am – 12:30pm

If you have questions, please feel free to contact:

  • Alisa Nagler in the GME office
  • Holly Tiemann in the DOCR office


**REMINDER: The deadline to submit your abstract(s) is Saturday, December 14, 2013 at midnight.**

The North Carolina Chapter is excited to announce the Call for Abstracts for the 2014 Chapter Scientific Session, taking place February 28 – March 1 at the Grandover Resort in Greensboro, NC.

This competition is open only to Associate and Medical Student members of the ACP North Carolina Chapter. First authors must be Medical Students or Associate-level members of ACP or have made official application for membership in order to enter this competition. There will be no exceptions to this requirement. If you have not joined ACP (medical students join for free; associates should contact their residency program directors), please visit ACP Online to find out more and apply.

Each abstract will undergo careful review and will be ranked for scientific merit, originality, proper presentation, and clinical application.  To view ACP’s guidelines and tips on preparing an abstract, click here.

We will accept as many posters for display and judging as time and space permit.

The deadline for submitting entries is Saturday, December 14, 2013 at midnight.

Abstracts can be submitted electronically online only.  To electronically submit an abstract, visit the Online Abstract Submission Form.

Why Submit?

  • Educational opportunity to showcase your work.
  • Best Clinical Research, Basic Research, Clinical Vignette, QI, and Student Poster will each receive a cash award of $300 and reimbursement of travel  expenses to the 2014 ACP Internal Medicine Meeting to present their poster.
  • Best Overall Poster will receive an additional cash award and reimbursement of travel expenses to the 2014 ACP Internal Medicine Meeting to present the winning poster.
  • Free meeting registration for all Associates and Students who attend.

For questions concerning this abstract competition, please contact Nancy Lowe, CMP, Associate Director of the North Carolina Chapter, at

Thank you,

Byron J. Hoffman, Jr., MD, FACP
ACP Governor, North Carolina Chapter


General Medicine Grand Rounds on Tuesday, November 12, 2013

Clinical Psychology in treating Chronic Pain (and other diseases)

Presented by:  Katherine L. Applegate, Ph.D

  • 7:30am to 8:15am
  • 3024 Pickett road, 2nd floor
  •  Durham, NC 27705


AAIM Offers Free AJM Subscriptions to Residents in 2014! Sign Up by December 6

Details on the attached flyer

AAIM Offers Free AJM Subscriptions to Residents in 2014



Idaho Internal Medicine

Idaho Hospitalist

Louisiana Internal Medicine

CentralNorth Dakota Internal Medicine

FM flyer

Upcoming Dates and Events

  • November 13:  Networking Event at Dr. Klotman’s! (An opportunity for JAR’s, fellowship directors, and division chiefs to connect!)
  • November 28:  Annual “Turkey Bowl”
  • January 15th:  “Voices in Medicine”

Useful links

by · Posted on November 10, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Internal Medicine Residency News: November 4, 2013

From the Director


Doctoberfest/comes sadly to a close/hello, recruitment! ….or perhaps another haiku to get us started on the recruiting season  daylight savings time/longest call night of the year/turkey bowl is soon! 

We welcomed the preliminary intern applicants on Friday, with our first recruiting day, and Monday marks the first categorical recruiting day! We are looking forward to meeting our future Duke residents, and appreciate the efforts of everyone to make them feel welcome and to show off our fantastic residency program.  Coach K’s grand rounds certainly gave us some “street cred” to get the season started.  Please remember to sign up with Erin for the recruitment dinners, as well as take time to talk with the applicants at lunch and throughout the day.

Kudos this week to Jenn Rymer and Christine Bestvina – Jen presented the GME incentive program at the National AAMC meeting this weekend and Christine presented at the ASCO Quality Care Symposium.  Over the weekend, I received emails from our DIO Dr. Cathy Kuhn regarding Jenn’s superb presentation, and from Duke Med Res alum and current oncology fellow Tian Zhang about Christine’s outstanding talk as well.  Other kudos to Schell Bressler on her gold star for outstanding patient care,  Amera Rahmatullah for winning the final Doctoberfest question (what are ghost cells?), and to Noah Kalman and Landon Meekins for helping with prelim interview day.

To conclude our “Building Our Community” Doctoberfest, WE DID IT!!! We raised over $1200 to purchase the mobile wheelchair ramp for the North Street Community.  I am so proud of everyone for their efforts to help others and to make a difference in the lives of the residents of North Street.  Thank you so much for your thoughtfulness and generosity.  In addition, we took time to recognize the nurses who work with us everyday in the hospital and in the clinics.  And, as a result of all this, the chiefs and I have to sumo wrestle (honestly, it seemed like a good idea at the time).  Details to follow.

We are continuing to work to make our program even better.  Last week, we had our first Clinical Competency meeting.  This is an RRC requirement for all programs, and allows the advisors, chiefs and I to summarize each residents clinical performance, year to date.  Please take time to meet with your advisor and me to discuss the process and to set further learning goals for the year.  This week, we will be having our “Noon Conference” summit, where representatives of the residency council will work with the APDs, chiefs and I to analyze the information from the Noon Conference survey and plan how to improve noon conference. Thanks to Steve Bergin for organizing and leading this effort.

This weeks Pubmed from the Program goes to Josh Briscoe for his presentation at the Association for Medicine and Psychiatry national meeting in Chicago.  His presentation  “Bridge Over Troubled Water: Philosophy in Medicine and Psychiatry”  sparked great discussion among attendees.

Have a great week and HAPPY RECRUITING!


QI Corner

QI Noon Conference

Please join me in thanking Dr. Joanna Kipnes and her discussion of “Health Insurance” as part of our High Value Cost Conscious Care Lecture series.

Stay tuned for our next HVCC lecture, 11/20/2013 with Dr. Daniella Zipkin discussing “High Value Biostatistical Concepts”


Flu Vaccine & QI Champs

Congratulations to Susanna Naggie and Martin Society for being the first recipients of our Flu Vaccine Compliance Trophy by being the first Stead Society to reach 100%.  They were also award the honor of QI Champs for the month of September.

We also want to acknowledge Jennifer Averitt as a QI Champ for her efforts helping to coordinate the flu vaccine campaign.  Special thanks to all residents and Stead Leaders who once again helped us protect our patients by getting vaccinated – 100% 3 years running!

2013 stead flu trophy presentationstead flu trophy














Burnout and Resiliency Survey

Don’t forget to complete you burnout surveys as part of a resiliency study lead by Dr. Hany Elmariah. Our goal is >50% completion and we are currently around 30%.

 GME Incentive Program Update

Here is our current HH performance through Mid-October


Observations YTD Compliance YTD Non Compliance YTD Hand Hygiene Rate YTD
Unit 9300





Unit 9100





Unit 8300





Unit 8100





Unit 7800





Unit 7300





Unit 7100












What Did I Read This Week

Submitted by Lynn Bowlby, MD

What Would You do if it Were Your Kid?  NEJM October 3, 2013 369 (14) ;1291-1293, Author:  David N. Korones, M.D.

What would you do if it were your kid?

I hope that many of you have had an opportunity to attend the Schwartz Center Rounds, the monthly Rounds I lead with Lynn O’Neill where caregivers share their feelings and responses to a particular case, with the goal of improving our compassionate responses to patients and their families.

The next Rounds are in 2002 Noon Nov 13.

We can add you to the list serve to send you the monthly announcements, many are the 3rd Tues of the month during noon conference. Just email me to be added!

One of the many benefits to Rounds is the working across Departments and Divisions. The ED has presented several cases. David Gordon sent me the following article as a topic idea for the Rounds.

Have you ever been asked what you would do by a patient if they were your parent or spouse?

All of us know the very ill and complex patients we take care of and often the very difficult decisions that have to be made.

When we make medical decisions for our own family, we use our emotions just as much as our cognition. What we want for our family may be very different than what another family wants.

So how do we answer that question? Can we share with them what our instincts tell us? They ask for guidance, can we be a bit human with them and tell them?

Some families may be asking for our permission to do something different than what we might do..can we help give them permission to do what they feel is right?  Some words to use…explain how our decision is both emotional and rational, and we don’t know exactly what we would do…but here is what I think I would do…

Think about those time when it has been your family member with hard medical decisions….and you will feel some of what our patients and families feel in trying to make these tough decisions.










From the Chief Residents

SAR Talks, Noon Conference, 11/5/13

12:00-12:30: “Blood Transfusions – From Monsters and Murderers to Modern Day Marvel” – Dr. Carter Davis

12:30-1:00: “TAVR – Past, Present, Future” – Dr. Wassim Shatila

Grand Rounds

Lord Ajay Kakkar

Noon Conference

Date Topic Lecturer Time Vendor Room
11/5 SAR talks: Blood Transfusions – From Monsters and Murder to Modern Day Marvel / TAVR – Past, Present, Future Carter Davis, Wassim Shatila 12:00 Bullock’s BBQ 2002
11/6 Ambulatory Town Hall  Clinic Directors 12:00 Chick Fil-A 2002 (8262 Pickett, 2003 PRIME)
11/7 Speed Bumps in the Head and Neck Ray Esclamado 12:00 Sushi 2001


From the Residency Office

DOCTOBERFEST was a Huge Success!




Your contributions are SO appreciated and will more than pay for the new portable wheelchair ramp that is so needed! – We will be sharing information about a presentation of the donation soon!

In case you haven’t heard it recently, the Duke Internal Medicine Residency Program family ROCKS!!!


Opioid Safety
Have you been reading about opioid safety? Aware of the epidemic of accidental opioid overdose deaths? More people now die from accidental overdose then from motor vehicle accidents. We’ve seen a tripling in our state over the last 10 years or so. I currently serve as co-chair of the Opioid Safety Task Force and we are trying to take steps to protect our patients. Here something simple you can do- sign up for the North Carolina Controlled Substance Reporting System. This would allow you access via a website to all of the controlled substances prescriptions that your patients have filled. This allows us to identify drugs that might interact with an opioid such as benzodiazepines but also allows us to know who is prescribing to our patients and what prescriptions they are filling. Sign-up is easy though it does require renewal each year while you are in training. After your training is over, you don’t need to re-register.  Your application must be notarized and include a photocopy of your drivers license. At the medical residents’ office, find Lauren Dincher and at Duke Outpatient Clinic, look for Gloria Manley to notarize your application.   The website is reasonably easy to use and is quite current. Attached is a copy of the application form and a brief list of do’s and don’ts that you might review. Please take a minute and do this, you could save a life.

Do and Dont NCCSRS


Larry Greenblatt, MD

DOC Stead C Chief

Medical Director, NPCC, and affiliate of CCNC (Medicaid Care Management)


The time has come to plan the 14th Annual Duke Charity Auction!

For those new to the Duke family, the Charity Auction is one of the most fun events of the year –  with heavy hors d’oeuvres, drinks, and best of all – a silent and live auction, with all proceeds going to Senior PharmAssist, a program that helps low income seniors afford their medications, and the DOC patient fund. Last year, we raised over $16,000!

It’s a chance to bid on and win awesome auction prizes– such as Dr. Zaas-coverage on the rotation of your choice, Dr. Zipkin- coverage of your clinic at the DOC, Duke Basketball tickets, or gift certificates to your favorite restaurants and bars around Durham.  BUT we need your help in planning, and would LOVE to have you join us on Monday, Nov 4th at 5:45pm at the Med Res library. Interns are especially welcome! This is a great opportunity to get involved in something fun that is also for a great cause!

So, to recap:

WHAT: Charity Auction Planning Meeting

WHEN: Monday, Nov 4th at 5:45pm

WHERE: Med Res library


Thanks everyone!

Laura Caputo, Jen Chung, Meredith Clement, Marianna Papademetriou, Carling Ursem


NC ACP Meeting

The meeting this year is Friday and Saturday, February 28 – March 1, 2014, at the Grandover Resort in Greensboro, NC. They are accepting poster/abstracts until December 15th. There is an on line submission on the ACP web site

The prize is trip to the National ACP meeting to present the poster.  Flight, room board, and registration fees are included. The 2014 the meeting is in Orlando, Florida

Sharon Rubin, MD, FACP

Assistant Professor, Duke University Medical Center

Residency Director at Pickett Road

Internal Medicine

The annual enrollment period for medical, dental, vision and reimbursement account benefits for 2014 is now open. You have until 6 p.m. on Friday, Nov. 8 to review and make benefit selections to ensure appropriate coverage.

Please, remember that your participation in the Health Care and/or Dependent Care Reimbursement Accounts does not automatically continue from year to year. If you wish to use a reimbursement account in 2014, you must enroll to participate. However, your current selections for medical, dental and vision insurance will automatically continue for 2014 unless you make changes.

There are two ways to enroll or make changes to your benefits selections:

If you need assistance or have questions, contact the Duke Open Enrollment Service Center at 919-684-5600. Representatives are available weekdays from 8 a.m.- 6 p.m. from Oct. 28 – Nov. 8 and from 8 a.m.- 5 p.m. on Saturday, Nov. 2.


PIM 2013 pdf

Aspirus Internal Medicine-IM Residency Programs 10.22.13

Recruting Flyer Hospitalist


Upcoming Dates and Events

  • November 13:  Networking Event at Dr. Klotman’s! (An opportunity for JAR’s, fellowship directors, and division chiefs to connect!)
  • November 28:  Annual “Turkey Bowl”
  • December 4:  “Voices in Medicine”

Useful links

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

Internal Medicine Residency News: October 28, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi Everyone! We are entering the last week of Doctoberfest….this week starts with our RECRUITMENT KICKOFF PARTY! Erin and Lynsey found us a great location, and we are looking forward to seeing you all there.  Hard to believe, but prelim interviews are on Friday and the first applicants to the categorical program arrive on Sunday night!  Your participation is vital so that our new class can be as good as the current 3 classes – we will see applicants on rounds on Duke Gen Med, Oncology and in the MICU, and also at lunch on Mondays and Fridays (after chairs conference which moves to 11:30 am starting 11/8).  Med Peds also starts interviewing, so look for Med Peds applicants to be rounding with us and having lunch with us on Tuesdays.  A few more Doctoberfest questions will come this week, so be on the lookout for a final chance to answer.

Kudos this week go to Allyson Pishko from Jan Dillard at the DOC for outstanding patient care.  Additional kudos to our DOCTOBERFEST-recognized nurses (Valencia from Pickett Road, Anderson and Joey from 9100, the team at the VA CCU,  Brittany from 9300, Kim, Lashonda, Dee, Gina and Keisha from the DOC, PRM Ron Campos, Shannon Venditelli from 7800, Kara Richey, and Desta Abate from the VA.   Our nurses sent in recognition for the following residents: Myles Nickolich, Alan Erdmann, Hal Boutte, Matt Atkins, and  Marc Samsky.  A few more days left, so please send in comments about the nurses who help us do our jobs everyday.  Thank you also to our outgoing ACRSMatt Summers, Alex Fanaroff and Lauren Porras.  Turkey bowl is less than a month away, so trash talk should start heating up.

Thanks to all who have volunteered to work on our noon conference task force.  More information to come…if you are interested, please let Steve Bergin know!

This week’s Pubmed from the Program goes to APD Jon Bae and the QI team for our upcoming poster at the IHI National Forum…”Improving Quality Improvement Residency Education and Provider Performance Through a Shared Online Experience”

Have a great week!


QI Corner

Burn-out survey
is still collecting survey information for resident resilience/burnout after each rotation.  Interns, please fill them out for your most rotation and JARs/SARs look for the surveys this week!  Help us pump up the response numbers . . .

Burnout graphic

QI Noon Conference
Our next QI conference is this WEDNESDAY, 10/30, with Joanna Kipnes in 2002 talking about health insurance.  Come and get the latest Hand Hygiene updates, as well . . .

Flu congratulations
Also at the conference, we will watch the Martin Society and Susanna Naggie win the trophy for fastest Stead Society to reach 100% flu compliance!

Business Cards
Now that everyone has had their business cards for a while, remember to keep handing them out to patients in both the inpatient and outpatient settings.  Watch for some more follow-up about this over the next few weeks . . . Joel

What Did I Read This Week

Submitted by Suzanne Woods, MD

Universal Glove and Gown Use and Acquisition of Antibiotic-Resistant Bacteria in the ICU  JAMA 2013; 310 (15): 1571 – 1580 Authors:  Anthony D. Harris et al (Benefits of Universal Glove and Gown (BUGG) Investigators

Why did I read this article: I am currently rounding on gen med and the frequent donning and doffing of yellow gowns and gloves always leads me to question if this garb really does anything for patient safety….not to mention the cost of such equipment.  Is this really efficacious and safer for our patients?  Just last week JAMA had an article on this very topic!

Known:  Infections with antibiotic resistant bacteria are associated with higher patient morbidity and mortality.128708_suzanne_woods_prd

Unknown:  Do gowns and gloves for all patient contact in the ICU decrease the acquisition of antibiotic resistant bacteria?

Study:  20 medical and surgical ICU’s in 20 US hospitals.  In the intervention ICU’s:  all health care workers (HCW’s) wore gown and gloves for all pt. contact anytime entering a patient’s room.  Control group:  Gowns and gloves used based on CDC guidelines (only for pts. with clinically identifiable antibiotic resistant bacteria).  The investigators looked at acquisition of MRSA and VRE colonization.  9 month study with 26,180 patients enrolled.


  • Universal gown and glove use did not appear beneficial overall in preventing MRSA or VRE acquisition (primary outcome)
  • Rates of MRSA or VRE acquisition per 1000 patient days decreased from 21.3 at baseline to 16.9 during the study period in the intervention ICU’s;  in the control units a decrease of 19.0 to 16.3 was seen.  Not statistically significant.
  • Secondary outcomes:  individual VRE and/or MRSA acquisition, frequency of HCW visits to patients rooms, hand hygiene compliance, HCW associated infections, and adverse events.
    • Of these outcomes – there was a lower risk of individual MRSA acquisition in the intervention group but no difference with individual VRE acquisition.
    • Using universal gloves and gowns did decrease entry into the pts. room by HCW’s and did increase room-exit hand hygiene compliance when HCW’s did go into the rooms
    • There was no statistically significant effect on the rates of adverse events between the groups.

In the accompanying editorial “Preventing Infections in the ICU, One size does not fit all” by P Malani, several points for consideration were brought up:

  • ? if lack of benefit with universal gowns/gloves is due to the lack of reducing VRE acquisition. Could there be have been errors with assessment of baseline VRE colonization.  ? false negative screening tests to blame
  • Study did not look at other bugs, such as multidrug resistant gram neg pathogens so maybe universal gowns/gloves would make a difference for those bugs
  • Intervention units had higher baseline rates of MRSA acquisition than control units.  ? higher “colonization pressure” with increased risk of transmission, especially in an ICU setting
  • With no difference in adverse event reported….maybe harm was not measured in all categories.  Did the use of gloves and gowns make the patients feel more isolated?  Do HCW’s have a change in behavior with patients that they have to gown and glove universally for? With an overall increased awareness/culture of patient safety maybe this is not an issue?
  • Should patients be bathed daily with chlorhexidine gluconate?  Should all patients have intranasal mupirocin?

Take home points: 

  • Is there really potential value in universal gown and glove use to prevent infection?  The evidence to support this is lacking.
  • Don’t look for the yellow gowns to go away anytime soon!  And….I plan to see if I can obtain cost data for these supplies at Duke Hospital. 

From the Chief Residents

Grand Rounds

Dr. Gowtami   Arepally Apheresis

Noon Conference

Date Topic Lecturer Time Vendor Room
10/28 Noninvasive Ventilation Bill Hargett 12:00 Pita Pit 2002
10/29 Internist’s Guide to   Contraception Sharon Rubin 12:00 Rudino’s 2003
10/30 QI Patient Safety   Noon Conference 12:00 Cosmic Cantina: B 2002
10/31 Tobacco Dependence   Management Clint McSherry 12:00 Domino’s 2001
11/1 Chair’s Conference Chiefs 12:00 Chick-Fil-A MEDRES


From the Residency Office



“Building Our Community”  October 1-31, 2013

SummoThank you to everyone who has donated so far to our Doctoberfest Fundraiser for the Northstreet Community Project (info on page 2 of the attachment)!  We have raised $755 to date!  PLEASE help us our goal of $1240, the amount needed to purchase a new portable wheelchair ramp for the community.  Please donate using the link below and help us reach $1240 by October 31, 2013 – every penny counts!

You may donate online using the link below, or in person in the MedRes office or outside of Noon Conference each day:

As Doctoberfest 2013 draws to a close next week, we would like to thank everyone for their participation and leadership this year.  We have gathered some wonderful tributes to both our trainees and nursing staff and we are thrilled with the success of our fundraising efforts to date!

This week we will be unveiling the new trophy to be awarded to the winners of the flu shot campaign (Martin Society)

Trick or Treat will also not be forgotten, with plenty of extra candy to be shared at various locations.

Resident and Nurse “Wall of Fame”:  If you have not yet seen the “wall of fame” in the Med Res office, you have to stop by and see the awesome comments we have received regarding both nurses and residents.  If you have someone you want to recognize, here is the link  to do so.

We look forward to celebrating with and honoring our incredible Duke Medicine community all month

Fleece, MKSAP, Business Cards, Posters

We are clearing up the office this week in preparation for recruiting.  If you have not picked up items that belong to you (and you know who you are) this is the last chance.  At the end of the week any remaining items will either packed away of disposed of.

Lynsey Michnowicz is Official

If you wonder who that person is who is sitting at the main desk in the office, assisting at conference, or emailing reminders – here is the answer.  Lynsey, who started with us as a temp, is now officially a member of the team.  In addition to what you might all ready know, Lynsey has taken over a long list of responsibilities, including: organizing and supporting clinical epidemiology, supporting academic half day, conference attendance and uploading recorded sessions to MedHub, QI and Sharepoint assignments/reporting, and backing up Erin and event support.  This is just the short list.  So, if you have not already met her, make a point of saying HI tomorrow at noon conference – or at the KICKOFF event in the evening

Hiking Picture

Med Res Hiking (Activities) Club?

Great times were had by the Kempner Society on their hiking trip to Hanging Rock last weekend! Led by the fearless Matt Crowley and David Simel, even SAR Marcus Ruopp was able to keep up with littlest Crowley!Hanging Rock Photo Group 3

Thanks to Matt and Dr. Simel for organizing!



EBM Scholarship Opportunity

Interested in Evidence-Based Medicine?

Apply to attend Teaching and Leading EBM: A Workshop for Educators and Champions of Evidence-Based Medicine ( This renowned workshop delivers core EBM knowledge through interactive sessions and allows participants to practice teaching EBM in innovative ways in supportive small groups.

Three scholarships to attend the workshop are available to Duke trainees or faculty who want to further their knowledge and practice of EBM. Scholarships include:

  • full tuition ($1780)
  • a stipend (up to $500) to develop an EBM product or teaching session for the resident’s or faculty member’s home department after the workshop conclusion

Workshop dates are March 4 – 7, 2014. The workshop is held on Duke’s campus at the Fuqua School of Business. Participants will need to commit to attending all 4 days of the workshop.

To apply, complete the online form located here You will be asked to provide narrative responses (250 words or less) about 1: your prior experience with EBM, including any formal coursework or training, and 2: a brief description of an educational project (such as a teaching session) that you propose developing with the knowledge and skills gained in the workshop. You will also be asked to send an email or letter of support from your Program Director or Division Chief noting your availability to attend the entire workshop (March 4-7).

Deadline: November 1, 2013. Notification of acceptance will be given by November 15, 2013, to allow for planning.

Questions? Please contact Megan von Isenburg, Medical Center Library, or 919.660.1131.

EBM Scholarship Notice



PIM 2013 pdf

Aspirus Internal Medicine-IM Residency Programs 10.22.13

Recruting Flyer Hospitalist


Upcoming Dates and Events

  • October 28:  Annual Recruitment Kickoff
  • November 13:  Networking Event at Dr. Klotman’s! (An opportunity for JAR’s, fellowship directors, and division chiefs to connect!)
  • November 28:  Annual “Turkey Bowl”
  • December 4:  “Voices in Medicine”

Useful links

by · Posted on October 27, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Weekly Update · Read full story · Comments { 0 }

Internal Medicine Residency News: October 21, 2013

From the Director

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

Interns are now officially 1/3 done with intern year! The ITE went smoothly – thanks to everyone for helping out by covering their colleagues so we could get the test scheduled. Pretzels were a hit for Doctoberfest – as Ragnar Palsson pointed out in his answer to “what is the salted pretzel sign” – one possible answer is the bump in noon conference attendance when pretzels are served.

As you will see with WDIRTW, noon conference attendance is a big topic for our program to discuss. We started at our GME leadership meeting and Chris and Armando were able to attend. Lane PhotoLook for an email asking if you’d like to participate in our working group.

Other fun this week included western day on gen med 4. Nice boots team!

Also I spotted Carling Ursem, Meredith Clement,Brian Miller and Aaron Mitchell at the bull city race fest half marathon. Aaron won 2nd place for his age group! Way to go.Aaron

Kudos from Vaishali Patel to Bobby Aertker for  gracefully picking up a busy consult service at the last minute, to Hany Elmariah and Phil Lehman for excellent presentations at VA Med-Surg conference, and to Mandar Aras for leadership as
VA day float

Kudos and pubmed from the program goes This week to our presenters at Clinical Science Day - Lindsay Anderson, Noah Kalman, John Stanifer, Hany Elmariah, Carling Ursem, Aaron Mitchell and Meredith Clement,  Jen also was selected for an oral presentation.  Nice work!

We’ve made great progress on our community donations.  Check out the email for our paypal link if you’d still like to donate to help buy a wheelchair for the North Street Community. Also thanks for recognizing our nurses! Full list of those recognized to be announced at the end of Doctoberfest.

Have a great week



QI Corner

Flu Wrap-Up
Congrats again to all of us for achieving 100% vaccination in 24 days and the Martin society, in particular, for being the first ones to hit 100%.  Your trophy is coming . . .

QI Noon Conference
Our next QI conference will be on 10/30 in 2002, so plan on coming to hear the next in the High Value, Cost-Conscious Care series.

Hand Hygiene Update
Our current numbers through the end of September. . . be on the lookout for another update at the QI noon conference.

Actual Hand Washing Rate for September = 84.0%

Actual Hand Washing Rate Overall = 85.4%
Goal = 91%

What Did I Read This Week

Submitted by Aimee Zaas, MD

What did I read : three articles about conference attendance:

Why did I read them: as a program, our attendance at conference is struggling. This is a nationwide issue per my conversations with other program directors, with “work compression” and duty hours cited as major reasons. Steve has taken the lead on analysis of this for our program and thank you to the 60 (!) residents that filled out the survey. We talked about this at our GME meeting on Friday as well.

What did the authors do? Two of the studies looked at single programs. The authors tried to correlate conference attendance and content (as well as lunch provided or not) and the other looked at conference attendance and ITE scores over a four year period.

What did they find – the weaker study (the one year study) found :  Residents’ attendance at conferences was 34% overall or 54% excluding excused absences. Adjusting for the conferences’ and residents’ characteristics, attendance declined by one third as the year progressedProviding lunch at noon conferences enhanced residents’ attendance (odds ratio [OR] 1.26 overall and OR 1.64 for residents on inpatient rotations). Higher attendance was not associated with improvement in standardized medical knowledge test scores.

The stronger study did find a correlation between core conference attendance and ITE scores.

Specifically, total conference attendance was significantly associated with increased IM-ITE scores, with cohort mean increase of 2.30% (95% confidence interval [CI], 1.24% to 3.36%; P<.001). Core curriculum conferences accounted for much more of this association than either medical grand rounds or morbidity and mortality, with cohort mean increases of 2.05% (95% CI, 0.13% to 3.90%; P=.04), 0.24% (95% CI, -0.56% to 1.03%; P=.61), and 0.03% (95% CI, -1.69% to 1.69%; P=.97), respectively.

The third was more of an opinion – read for yourself.

What is the take away ? Conference attendance is waning nationally (personal communication).  In fact, likely because of the 16 hour rule, The ACGME no longer has a minimum requirement for attendance. We know that there are many rotations where it is not possible to attend (nights and ICU).

But, as a group, the residents and faculty value conference, especially our core lecture series.  Lunch at conference is a way to recognize the busy-ness of the day and is the #1 line item in our budget. Most importantly, lifelong learning is an important part of our professionalism. So….please join our working group to enhance conference and to set reasonable expectations for content and attendance.

And thank you Randy for doing my pub med search! Above and beyond!!!

From the Chief Residents

Grand Rounds

Oct. 25:  Dr. Arati Rao AML in the Elderly

Noon Conference

Date Topic Lecturer Time Vendor Room
10/21 The CDC’s   Antibiotic Resistance Threats and Antimicrobial Stewardship Richard Drew 12:00 Saladelia   Sandwichs 2002
10/22 Common   HIV Mgmt Issues Chuck   Hicks 12:00 Bullock’s   BBQ 2002
10/23 Stead Society Conference Stead Leaders 12:00 Jersey   Mike’s 2002,   8262, 4275, 1120, 208
10/24 Chronic Opiod Management Lynn Bowlby 12:00 Cosmic   Cantina: Q 2001
10/25 Research   Conference 12:00 Panera 2002


From the Residency Office

November 13th- Networking Event at Dr. Klotman’s!

Reminder to our current JAR’s – Upcoming opportunity for junior residents to enjoy some time to connect with Duke’s Division Chiefs and Fellowship Program Directors! This is a great way to have some face time with your future mentors!

Don’t forget to sign up so that we know who is coming.



“Building Our Community”  October 1-31, 2013

SummoThank you to everyone who has donated so far to our Doctoberfest Fundraiser for the North Street Community project.  With the addition of the opportunity to contribute via PayPal, donations jumped over 400%!!!  Clearly technology has a lot to do with success!!! Keep in coming, and the Sumo suits you see in this picture will soon be filled by Dr Zaas and Chief Residents.  Our goal?  $1,240, the amount needed to purchase a new portable wheelchair ramp for the community.  Please donate using the link below – every penny counts!

Resident and Nurse “Wall of Fame”:

If you have not yet seen the “wall of fame” in the Med Res office, you have to stop by and see the awesome comments we have received regarging both nurses and residents.  If you have someone you want to recognize, here is the link  to do so.

Still remaining – more trivia, recognition of the flu shot campaign success, haloween party, trick or treat, and of course – the Sumo wrestling contest (we hope).

We look forward to celebrating with and honoring our incredible Duke Medicine community all month


Research Support – New Opportunities

The Office of Clinical Research has partnered with GME and the Internal Medicine Residency Program to offer a broad list of resources supporting resident research projects.  A number of our residents have already taken advantage of the free consultation regarding their work, some leading to dedicated statistical analysis and support using the funds they received in their Resident Research Awards.

We are attaching two documents for reference:  a power point slide set outlining the project, and a 2nd document that summarizes how this works/points of access.

A special thanks to Dr. Arcasoy for helping to coordinate this effort to expand access to research design support and statistical analysis for our residents.

DOCR GME Resident Orientation

DOCR and DTMI support for Internal Medicine resident research projects


Resident’s Thoughts Regarding Code Status

(Tufts Medical Center)

“How do residents ask patients about code status? Do they think this discussion is the responsibility of a resident or an attending? We ask these and other questions in a nation-wide survey of Internal Medicine residents on how they approach discussions of code status with patients with advanced cancer.  This project has been reviewed by the Tufts Medical Center IRB. There is a lottery for prizes for participants, including $10 and $25 Amazon and iTunes gift certificates.”


David Einstein, MD (PGY-3, Internal Medicine, Tufts Medical Center) with Paul Mathew, MD



Upcoming Dates and Events

  • October 28:  Annual Recruitment Kickoff
  • November 13:  Networking Event at Dr. Klotman’s! (An opportunity for JAR’s, fellowship directors, and division chiefs to connect!)
  • November 28:  Annual “Turkey Bowl”
  • December 4:  “Voices in Medicine”

Useful links

by · Posted on October 20, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

The Robert J. Lefkowitz Society provides unique opportunity for physician-investigator trainees

At Medicine Grand Rounds this morning, Mary Klotman, MD, chair of the Department of Medicine, announced the formation of The Robert J. Lefkowitz Society, which provides a home for MD and MD/PhD post-graduate trainees who are in the Duke University Department of Medicine Internal Medicine Residency and Fellowship programs and are pursuing careers with a primary focus on basic and translational research as physician-investigators.

Through formal and informal mentoring relationships, the Lefkowitz Society provides promising post-graduate trainees with a greater understanding of how to develop successful academic careers. The Society provides members with opportunities to develop successful research projects and helps them find appropriate research mentors and investigative teams as early as possible in order to enhance their future research success and productivity. Members will benefit from direct interactions with senior physician-investigators at Duke through a series of dinner programs and other activities.

The Lefkowitz Society is named for Robert J. Lefkowitz, MD, professor of medicine in the Division of Cardiology and recipient of the Nobel Prize for Chemistry 2012. In his 40 years as a Duke researcher, Dr. Lefkowitz has mentored more than 200 trainees who have come through his lab. He has embraced the opportunity to serve as a role model and informal mentor for members of the eponymous Lefkowitz Society.

Learn more about The Robert J. Lefkowitz Society at For more information, please contact Gerard Blobe, MD, PhD, professor of medicine and Lefkowitz Society program director.

by · Posted on October 18, 2013 in Fellowship programs, Internal Medicine Residency, Medical Education, Research · Read full story · Comments { 0 }

Internal Medicine Residency News: October 14, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Doctoberfest continues! We are so excited to report that we reached 100% flu vaccination for the program on Oct 10th!!!! Tremendous job,and thanks to our Stead leaders for encouraging everyone in this important patient safety effort.

Congrats to our residents with best noon conference attendanceBrittany Dixon, Christine Bestvina and Jim Gentry  as well as best Grand Rounds attendanceDeanna baker, Marc Samsky and Tyler Black! We have (root) beer and pretzels this week so be sure to be there!

Other kudos go to Stephanie Giattino and Ashley Bock for excellent work from their VA gen Med JARs Michael Woodworth and Kedar Kirtane, to Mike Shafique from Matt Sparks for his leadership as VA day float, to Howard Lee for his appearance on Animal Planet (the liver fluke!) and to Amanda Verma from Neil Friedman for her work on cards consults! Our nurses have recognized great patient care and teamwork from Myles Nickolich, Matt Atkins and Alan Erdmann! Please remember to send in the names of nurses who are doing a great job helping you care for patients.

We will have the opportunity to use Paypal for our community service project – raising money to buy a portable wheelchair ramp for the North Street Community. You can find the link below next to the picture of sumo wrestlers (which I hear is what you might get to see).  If we all donate $10, we can meet our goal.

Our “safe discharge” milestones study has begun on gen med. we are part of a 14 center study looking at milestones needed to allow residents to do all the steps of a patient discharge independently. Unlike other milestone studies, we involved nurses and patients in choosing the milestones. Our site PIs are David Ming and Mitch Black. Please remember to fill out the pre study survey, and, interns on gen med should have attendings observe them doing the components of patient discharge.

This weeks pubmed from the program goes to Tyler Black for his article with Dr Rebecca Burbridge.  Black TP, Guy CD, Burbridge RA, “Retroperitoneal Cystic Lymphangioma Diagnosed by Endoscopic Ultrasound Guided Fine Needle Aspiration,” Clinical Endoscopy 2013; 46 (5): 595-597.Isa - black and white

Also congratulations to duke residency alum and renal fellow Blake Cameron on the birth of Elizabeth Ann, to Tim and Sarah Mercer on the birth of Isaaya (“Isa”) Jilani Mercer ( Isa – born October 11. – wearing the cap) and to the Trulock family Turlockon the birth of Eliza Renee Trulock, pictured here with her big sis Hattie!

Have a great week!   Aimee



What Did I Read This Week

Submitted by  Saumil Chudgar, MD

Strausburg MB, Djuricich AL, Carlos WG, Bosslet GT.  “The Influence of the Residency Application Process on the Online Social Networking Behavior of Medical Students: A Single Institution Study.”  Acad Med.  Epub ahead of Print, 25 Sep 2013

Why did I read this?

It is that time of year again – recruitment season!  Drs. Zaas, Butterly, and Hargett are reviewing thousands of residency applications, Erin Payne is scheduling hundreds of interviews, and Dr. Hargett and I recently finished advising the ~60 Duke med students applying for Categorical or Prelim Residencies.  A couple students had sought my advice regarding social media during the application process. This article piqued my interest as I was skimming the email from Academic Medicine with recent articles.133410_saumil_chudgar_prd

What I learned from reading this?

A survey study from Indiana University showed that of the 3rd and 4th year medical students who answered their survey, 99% used an online social networking site. Over half (60%) either changed/plan to change the profile somehow in preparation for applying to residency.  Of the people who changed their profiles, 50% deleted pictures/posts, 13% deleted their profile completely, 28% changed privacy settings, and 10% changed their names.  Reasons for change include inappropriate for PD to view their site (30%) and not believing they should be judged professionally by their personal site (60%).

Of those who did not change their profiles, the primary reasons were that they felt the content of their site was appropriate (42%) and due to privacy settings they had in place (36%).

70% of students believed program directors would use social media accounts to screen applicants, and most about half felt it was ethically acceptable to do so.

Thoughts about the article

I found the social media article very interesting in that medical students recognize that their online profiles may be accessible to program directors, and 70% of them believe PDs screen their social networking sites.  Admittedly this article is from a single institution and has a modest response rate for a survey study (30%).  It would be interesting to see if this behavior holds across other institutions.

A similar survey of program directors looking to see if they actually do so would be interesting—my guess is most of them don’t have time for that!  The implication for our own residents as they apply for fellowships should also be considered.  Finally, in the context of the new Duke social media policy, are our patients and colleagues also looking at our social media profiles, and how should that change our behavior?

From the Chief Residents

Grand Rounds

Alumni/Stead Dr. Lefkowitz


Noon Conference

Date Topic Lecturer Time Vendor Room
10/14 Acute Leukemias   Overview Louis Diehl 12:00 Picnic Basket 2002
10/15 MED   PEDS SAR TALK (Awerbach/Tolan) OR Difficult Death Debrief SARS/Galanos 12:00 Saladelia   Salads 2002   OR DN9242
10/16 Inpatient   Pain and Opiate Management Chris   Jones 12:00 Pita   Pit 2002
10/17 Intraosseous   Line Lab Chiefs/EZ-IO   Group 12:00 Domino’s 2001
10/18 Chair’s   Conference Chiefs 12:00 Chick-Fil-A MEDRES

From the Residency Office


“Building Our Community”  October 1-31, 2013

Thank you to everyone who has donated so far to our Doctoberfest Fundraiser for the Northstreet Community project.  We have raised $135 to date!  The option to have our Chief Residents and Dr. Zaas sumo wrestle is by far the most popular option.  If you would like to see Summothat happen, (and really, who wouldn’t?) we must reach at least 50% of our goal of $1240, the amount needed to purchase a new portable wheelchair ramp for the community.  Please donate using the link below and help us reach $620 by October 31, 2013 – every penny counts!

Also, don’t forget to acknowledge a nurse for their outstanding work:

October 16 Join us at noon conference for a traditional “beer” garden treat!

October 31 Halloween Tricks and Treats! Join us at Noon Conference for some Halloween goodies and for the announcement of our fundraiser’s “winning” Chief!

We look forward to celebrating with and honoring our incredible Duke Medicine community all month


Evaluations – How do They Get Assigned?

Some of the evaluations that residents are assigned happen automatically – like rotation evaluations, which are generated directly from MedHub at the end of each rotation.  However, the vast majority of evaluation assignments start with you – the resident – beginning with the Resident Identify Supervisor (RIS) request.  You are asked to select the faculty you worked with on the rotation, and on some rotations you are asked to assign no less than an minimum number of faculty.  Please do not wait to make the assignments – complete the RIS selections when you receive the request – hopefully on the same day.  Why?  Faculty want to give you accurate feedback, and the only way to do that is if you give them the chance to do so BEFORE they move on to work with other residents.  Waiting weeks to make RIS selections does not help you – or the faculty you work with.  Delays generate the largest # of complaints that we receive from faculty when it comes to completing evaluations of trainees.


“Help me, I’m burned out…..”

Judy Milne, RN MSN CPHQ CPPS  

Patient Safety Officer, Duke University Hospital

You may be looking for resources for your team related to resilience.  The following information is offered by Bryan Sexton, PhD, Director of the Duke Patient Safety Center:

1) Consider the 3 day Resilience Retreat (every May and November) coming up November 4-6 2013, at the University Tower, 17th Floor.  Click the link to register.
- Registration Information; November 4 – 6, 2013
- Course Description

2) A shorter alternative, newly created is the 1 day Resilience Essentials Course (January 28 2014 will be awesome)
- Registration Information; January 28, 2014
- Registration Information; April 22, 2014
- Registration Information; September 30, 2014
- Course Description

3) And something you can do individually or with your group is to sign up for “Three Good Things”:

November/December 2013

For other course options, please check out the website:

There is much more to come from the Patient Safety Center, as it is expanding the line of tools for patient safety and resilience significantly in 2014.  In terms of numbers, the center has trained over 2,600 in our Resilience and Patient Safety Officer Certification courses!  Wow.  Keep them coming, the center can handle the numbers. In fact, the favorite evaluation item is “I would recommend this course to a friend,”  which has had nothing but “agree” for 2 years now, and 95% of that is “agree strongly”!  You will certainly enjoy any of these options you select!


GME Research Training Series

This is a reminder of the GME Research Training Series for residents beginning this month. Registration for the October sessions will close this week.

Please note two updates in this announcement:

  • Learning Objectives for the Sessions are attached
  • Given program feedback, we have added a new day/time option of two Saturdays (and deleted the April/May session times)

Additional Information on the Blitz sessions will be shared shortly.

These sessions will help meet ACGME requirements, enhance resident QI and research experiences, and help ensure residents follow sound research principles and practices now and upon graduation.

GME Research Training Series Announcement

GME Research Training Series Learning Objectives

Registration Link:



CareerMD Career Fair

“I am writing to let you know that the physicians in your program are invited to attend the CareerMD Career Fair for residents and fellows in Winston-Salem on the evening of Monday, December 02, 2013. Could you please advise the residents or fellows in your program of the upcoming event, at which they will be able to learn about postgraduate career opportunities and network with prospective employers?

Representatives from leading hospitals, practices, and healthcare organizations from around the country will be at the Winston-Salem CareerMD Career Fair to meet residents and fellows in all specialties and in all years of training.

Residents and fellows who would like to attend are asked to RSVP online at or by emailing me directly at The event is free of charge to residents, fellows and their guests.

Location: The   Hawthorne Inn & Conference Center, 420 High Street, Winston-Salem, NC
Date   & Time: Monday,   December 02, 2013; arrive any time between 5:00 PM and 8:00 PM
Details: Casual   attire, complimentary light refreshments, spouses and significant others   welcome

Please feel free to contact me with questions about this event. Additional information is available at

Charles Howell
41 East 11th Street
New York, NY 10003
(800) 355-2626


Upcoming Dates and Events

  • October 18:  SoM Clinical Science Day
  • October 28:  Annual Recruitment Kickoff
  • November 13:  Networking Event at Dr. Klotman’s! (An opportunity for JAR’s, fellowship directors, and division chiefs to connect!)
  • November 28:  Annual “Turkey Bowl”
  • December 4:  “Voices in Medicine”

Useful links

by · Posted on October 13, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Internal Medicine Residency News: October 7, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Doctoberfest continues! Remember, our theme is “Building Our Community and we are working to recognize the fantastic nursing staff that partner with us to take care of patients in the hospital and in the clinics.  Donuts and cider were delivered to the nursing stations on Monday, as well as the clinics.  Send us a note about a nurse (or nurses) who have been particularly outstanding, and we will recognize them on our Wall of Fame in the Med Res office.  Look for more Doctoberfest trivia, as well as the opportunity to see the chiefs and I do something ridiculous (sumo wrestling?!?!)   You can make that happen by donating to our community cause…we are trying to raise money to buy a portable wheelchair ramp for the North Street Community.  Collection buckets are in the med res office, and will also show up at noon conference.

We are FLU SHOT SUPERSTARS! When I left town on Wednesday night, we were at 96% overall for the house staff, with Martin Society edging out the win (Warren had 100% “in country” members get a flu shot first) and Orgain coming in 3rd.  It’s possible we are at 100% by now! Either way — what a tremendous effort and thanks to our Stead Leaders, to Jen Averitt for tracking and reporting (and reminding!) and to all of you for keeping our patients safe.  If we are not at 100%, and you are part of the few holdouts, GO GET YOUR SHOT!

Kudos this week go to SAR Lindsay Boole for helping out a colleague, to Jessie Seidelman for a great intern report (strong participation by the entire audience!), and to Fola Babatunde (from Murat Arcasoy) for presenting an amazing diagnosis that she made at the DOC during DRH morning report! More kudos to APD Bill Hargett for the milestones video! Bill, Murat and I presented a seminar on faculty development at the program directors meeting in New Orleans this weekend, and one of our participants said that watching the video was “worth the price of admission to the whole meeting!”.  It’s on medhub, so watch it if you haven’t seen it yet! Also at the meeting were Jane Gagliardi, Saumil Chudgar, Diana McNeill and Mary Klotman!  

Turkey Bowl preparation continues, and we are very excited that the recruitment season is about to begin. Look for recruitment dinner sign ups, and also for Erin to be asking you to help out with tours, talking to the applicants and for any other ideas you have to make our recruitment season successful!

This week’s Pubmed from the Program goes to Marc Samsky! Note the Duke Med Res alums Jake Jentzer and Ashleigh Owen as co-authors!  Ten Year Experience with Extended Criteria Cardiac Transplantation, Marc Samsky, Chetan B. Patel, Ashleigh Owen, Phillip J. Schulte, Jacob Jentzer,  Paul B. Rosenberg, G. Michael Felker, Carmelo A. Milano, Adrian F. Hernandez, and Joseph G. Rogers,  Circ Heart Fail.  Originally published October 2, 2013. doi: 10.1161/CIRCHEARTFAILURE.113.000296

Have a great week!  Aimee

QI Corner

Patient Safety and Quality Council
Our next meeting will be this Wednesday at 5:30 pm in the Med Res Library – come and bring some nifty recipes for quality . . .

Flu Vaccination Campaign

Thanks to everyone who has been vaccinated – Martin Society was the first to hit 100% and that we’re only THREE residents short of 100% compliance!  Strong work everyone!

Our Thanks
If the Baldrige site visitors came and spoke to you this week, many thanks for your participation – we’ll let you know when we hear more.
We will be sending you the September handwashing information in the next week or two – keep foaming!

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  David Butterly, MD

Efficacy of Remission-Induction Regimens for ANCA-Associated Vasculitis


I read this article after seeing a patient this past month in clinic with John Roberts.

The patient is a 63 yo woman referred for a second opinion on treatment for ANCA associated vasculitis.  She reports a 2-3 year history of microscopic hematuria noted on routine yearly physicals.  Urology evaluation including CT and cysto were normal.  This spring she developed constitutional symptoms with weight loss, low grade fever and polyarthralgias.  Lab exam showed continued microscopic hematuria along with low grade proteinuria and creatinine now elevated at 1.8.  Serologies done were notable for P-ANCA positive at 1:640 and kidney biopsy revealed a pauci immune necrtotizing GN consistent with GPA vs MPA.  She was started on 60 mg of Prednisone and referred in for a second opinion regarding further therapy.

This study appeared in the NEJM  8/1/2013 and details longer term follow up from the RAVE trial evaluating the efficacy of Rituximab in patients with ANCA-associated128907_butterly005 vasculitis.  Earlier results from this trial were published in the NEJM in 2010.  Of note, Bill St. Clair and Nancy Allen of our Rheumatology Division at Duke are co-authors in this study.

Granulomatosis with polyangitits (formerly termed Wegener’s Granulomatosis) along with Micrscopic polyangitis are both ANCA-accociated vasculitidies because they are frequently associated with antibodies against PR3 or MPO.  For nearly 40 years now standard therapy for induction has been corticosteroids and Cytoxan.  In the early results of the RAVE trial published in 2010, a 4 week course of Rituximab was shown to be equally efficacious to Cytoxan followed by Azathioprine.  The current study reports on longer term results in this same patient group.

This study is a multicenter, randomized, double blind, placebo controlled study comparing 4 weeks of Rituximab (375 mg per square meter) with Cytoxan/Azathioprine given for 12-15 months.  Patients enrolled had severe ANCA associated vasculitis (AAV) with antibodies positive for PR3 or MPO along with Birmingham Vasculitis Activity scores for Wegener’s (BVAS/WG) of 3 or more.  Patients were randomized 1:1.  Prednisone was tapered in both groups over 5.5 months.  Ritux was given weekly for 4 weeks.  Patients in the Cytoxan group received CTX at 2 mg/kg for 3-6 months followed by Azathiopine (2mg/kg) for remaining 18 months.

A total of 197 patients were randomized.  99 received Rituximab and 98 were treated with CTX/AZA.    Figure 1 gives details on randomization and follow-up.  Complete remission was defined as a BVAS/WG score of 0.  64 % of patients in the Rituxan group had complete remission at 6 months with 48% and 39% retaining the remission at 12 and 18 months.  This compared to 53% , 39%, and 33% in the CTX-AZA group.  Rituximab thus met criteria for non-inferiorority, but not criterion for superiority.

As shown in Figure 2, relapse was common in both groups (2A).  As has been demonstrated previously, PR3 ANCA along with history of relapsing disease were strong predictors of relapse.  However increases in ANCA titer did not predict relapse in either treatment group.  There was no difference demonstrated between treatment groups in PR3 vs MPO ANCA patients (2C).  There was also no difference in adverse events between the groups with the exception of increased risk of leukopenia and pneumonia in the group receiving CTX-AZA.

So in conclusion, Riuximab given weekly for 4 weeks was found to be equally efficacious to 18 months of continued immune suppression with CTX-AZA.  Relapses were not uncommon in both groups, particularly in the group with PR3 antibodies.

Based on these results we elected to treat our patient with Rituximab.  She is now 3 weeks into her treatment course.  She has tolerated it well thus far with no problems with the infusions and a creatinine which has improved form 1.8 to 1.4.

Thanks for reading.

From the Chief Residents

Grand Rounds

Each year, as part of Duke Medical Alumni Weekend, the Department of Medicine hosts the Eugene A. Stead Jr., MD Lecture at Medicine Grand Rounds.

Please plan to join us at 8 a.m. on Fri., Oct. 18 in the Great Hall of the Trent Semans Center.

This year, the Stead Lecture will be presented by Ralph Snyderman, MD, James B. Duke Professor of Medicine and Chancellor Emeritus, to honor Robert Lefkowitz, MD, professor of medicine (Cardiology), and Nobel Laureate.

Dr. Snyderman’s talk, “From the Bronx to Stockholm via Duke: Bob Lefkowitz’s Journey,” will honor his friend and colleague.

Please save the date and note the special location. A continental breakfast will be served beginning at 7:30 a.m.

Noon Conference

Date Topic Lecturer Time Vendor Room
10/7 Resident’s Townhall –   “Coffee Talk with Armando and Chris” Residency Council 12:00 Saladelia   Sandwiches 2002
10/8 Adrenal   Insufficiency Lillian Lien 12:00 Bullock’s   BBQ 2002
10/9 COPD Peter Kussin 12:00 Moe’s   Burritos 2002
10/10 Global   Health Gallops Global Health   Residents 12:00 Sushi 2001
10/11 Chair’s   Conference Chiefs 12:00 Rudino’s MEDRES

From the Residency Office


“Building Our Community”  October 1-31, 2013

We hope everyone enjoyed the cider and donuts that were delivered to the clinics, gen med services, and program office to kick off the month.  Hats off to Jen and Lauren who trucked in 18 dozen donuts and gallons of cider.Before Renovation

So, what’s next?

The fund raiser is up and going – and on behalf of Renovated HousesErin and the Friendship House and Jubilee House here in Durham, thanks for the support.  A lot has all ready been done – here are just two pictures of the before renovation and after renovation to show what can ba accomplished.

Thus far we have raised $126 towards our goal of $1,200 – with Summo Wrestling by the Chiefs and Dr Zaas leading the way. 

Recognition of our nurses are coming in and posted to the wall of fame in the program office.  Keep them coming – using the following link:

October 15 Join us at noon conference for a traditional “beer” garden treat!

October 31 Halloween Tricks and Treats! Join us at Noon Conference for some Halloween goodies and for the announcement of our fundraiser’s “winning” Chief!

We look forward to celebrating with and honoring our incredible Duke Medicine community all month long!

Fit Testing – T-Dap- TB – Flu Shots

Take note of the schedule posted below for easy access to these services in Duke N, or check out where to find them elsewhere using the following link:

October 2013 Resp Fit Testing-T-Dap-TB Skin Testing Flyer


New BLS Challenge Class Available

New BLS Challenge class has been added on a trial basis. Class will be on Nov. 5th. This course will offer the Healthcare provider the opportunity to renew their BLS (CPR) skills according to American Heart Association Standards and receive the AHA card valid for 2 years. Pre-Work/skills necessary for participation See attached flyer for more information. Questions, contact 919-684-4293.

BLS Blitz Schedule

BLS Blitz is scheduled for November 18-21, 2013. See instructions in flyer to register for classes. Remember absolutely no participant will be allowed in class after the session begins or if the participant does not have their manual with them.

BLS Blitz flyer 11-2013        BLS Challengeflyer


How do You Ask Patients About Their Code Status

(Tufts Medical Center)

“How do residents ask patients about code status? Do they think this discussion is the responsibility of a resident or an attending? We ask these and other questions in a nation-wide survey of Internal Medicine residents on how they approach discussions of code status with patients with advanced cancer. I am writing to ask your permission to distribute a brief online survey to your residents. This project has been reviewed by the Tufts Medical Center IRB. There is a lottery for prizes for participants, including $10 and $25 Amazon and iTunes gift certificates.”

Sincerely, David Einstein, MD (PGY-3, Internal Medicine, Tufts Medical Center)


Kraft Fellowship in Community Health

The Kraft Fellowship is a two-year, multidisciplinary program providing formal academic training in Community Health leadership while immersing fellows in community health center practice.   It is open to graduates of residency training in primary care/internal medicine, pediatrics, family medicine, obstetrics/gynecology and psychiatry.  More details are available below and at:


Raleigh Medical Group, PA part-time MD letter 2014

Raleigh Medical Group, PA part-time MD position 2014

Hospitalist – Georgia


Upcoming Dates and Events

  • October 18:  SoM Clinical Science Day
  • October 28:  Annual Recruitment Kickoff
  • November 13:  Networking Event at Dr. Klotman’s! (An opportunity for JAR’s, fellowship directors, and division chiefs to connect!)
  • November 28:  Annual “Turkey Bowl”
  • December 4:  “Voices in Medicine”

Useful links

by · Posted on October 6, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Internal Medicine Residency News: September 30, 2013

From the Director

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

Looking forward to DoctoberfestSaumil started us off with Pumpkin Spice M and M’s –  curiously good! On Saturday, We had a pre-Doctoberfest kickoff with housestaff vs faculty paintball! Fun had by all (including those of us who were here rounding instead – we were thinking of you!). Pretty certain a rematch will be called by disgruntled faculty. Thanks again to Chris Hostler for working so hard to plan this event! Turkey bowl trash talk has begun. Who knew DRH had cheerleaders??? Hope you all an make it to practice on Sundays!

Kudos to everyone for our amazing flu shot compliance rate. Details below, but the interns are about to hit 100% as is the Warren and Martin societies. Our goal is Oct 1 so if the remaining 11% of residents could find their way to ANYWHERE in Duke, DRH or the DVAMC or the clinics by Tuesday, we will accomplish this. It’s easy, and it protects our patients!

Block change tomorrow for the SARs – strong work by all this month. Being on gen med, it’s been great to see all the teaching by Bobby Aertker, Wendy Chan, Jeremy Gillespie, Ben Heyman and Mandar Aras. Plus, we have opened up the 4300 floor and workroom – come visit gen med 4 in our new home!

Be on the lookout for the residency values google DOC from the chiefs. We are very committed to putting the vision for the program into words and YOUR input is critical! Look for more updates on this exciting project soon.

Pubmed from the program this week goes to VA Chief Vaishali Patel for her upcoming poster presentation at ACG:  De Novo Tuberculosis Infection presenting with Ocular Granuloma in a Patient on Infliximab for Crohn’s Disease;  Vaishali Patel, Dr Roger Liddle

Have a great week! Happy Doctoberfest !!!


QI Corner

Flu Shots – the Home Stretch

The number of residents who have not received their vaccinations is dropping by the hour – and the race is on for the 1st Stead Group to hit 100%.  October 1 is next Tuesday – let’s see who rings the bell first!

flu data_9 27 13

flu data_9 27 13











QI Conference

Thanks to Dan Kaplan for leading us through a discussion of appropriate test ordering using syncope as an example.  Thanks also to our residents for learning and participating – these are not easy topics and there are no easy answers!

QI Champion

Congrats to Aparna Swaminathan, our Champ of the month, for her role in designing our We Follow-Up campaign and taking on a leading role at PRIME.

QI Craigslist

Join Aparna and help us improve our appropriate lab follow-up rate at the DOC and Pickett Road – contact Jon or Joel if interested!

Baldrige Site Visit

As you well know, next week we will receive a site visit by a team of Malcolm Baldrige National Quality Award examiners. This year, only 10 U.S. sites were chosen across all industries to receive site visits; eight of those sites are from the health care industry.

From Monday, Sept. 30 through Wednesday, Oct. 2, eight examiners will be onsite to talk to you and find out more about how our team delivers the Duke Experience to our patients, their loved ones and each other.

We want you to keep doing the excellent work you do every day, and we want your responses to be guided by your passion for patient care.

To learn more about our Journey to Excellence, and to review site visit prep materials including videos and potential site visit questions, visit the Journey to Excellence website from any Duke Hospital-based computer.

We’re proud of the work our team does every day, and we’re pleased that others outside the organization are also recognizing you for all you do.

Thank you for being an important part of the Duke Experience.

Visit the Journey to Excellence Website:

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 Sharon Rubin, MD

Screening for Lung cancer with low dose Computed Tomography: a  systematic review to Update the US preventative Services task Force recommendation

Humphre LL, Deffebach M. Pappas M, Baumann C, Artis K, Mitchell JP, Zahker B, Fu R, Slatore CG. Annals of Internal medicine September 17, 2013

Why did I read this? I first heard about this in the news in August and looked on the USPSTF home page210_RubinSharon and finally the article has been in print. Lung cancer is the 3rd most common cancer and the leading cause of cancer related death in the US . If there is any way primary care doctors can prevent this, we should try. The debate has raged on to screen with chest xray/Ct scan or not to screen.  The pendulum from the article supports screening.

What did the authors do? Review of 4 major trials: 1 US (majority of patients) and 3 European trials, looked at mortality reduction with LCDT screening.  The conclusions were mainly driven by the US study National Lung Screening Trial. Conclusions that LCDR screening decreased mortality in 20% smokers/former smokers age 55-75.

Why is this study important? This has up dated the USPSTF 2004 recommendation that low dose computed tomography (LDCT) from insufficient to strong evidence to screen. This review has been more comprehensive in terms of patients and studies.  Overall the reductions in lung cancer and all cause mortality suggest benefit of screening out weigh harm of over diagnosis.

Intervention Outcome NNT
Breast cancer screen MMG Prevent one breast cancer death women 50-59 after   11-20 years follow up 1339
Cervical cancer screening Prevent one death over ten years 11402
Flex Sig Prevent one colon cancer death 8176
Antihypertensive therapy Prevent one stroke, MI, death over one year 7001
LCDT screen lung cancer Prevent 1   lung cancer death NNS 3207
LCDT screen lung cancer Prevent 1   death over all (6.5 years) NNS 2197
Statins Prevent one death over five years 1071
GP brief advice to stop smoking (3  – 5 minutes) Prevent one premature death* 803
Add pharmacological support Prevent one premature death* 38-564
Add behavioural support Prevent one premature death * 16-405,6
In all smoking cessation Smoking related disease 10

*Over half of all continuing smokers will die prematurely from a smoking-related disease.  For every two long term quitters, one premature death is avoided (Doll and Peto).  1 Bandolier. 2 Gates, Amer Fam Phys 2001. 3 West 2006. 4 Bandolier 2006. 5 Cochrane 2007.  6 Anthonisen, Ann Inter Med 2005. 7 Schoen NEJM 2012. 7. Church NLST N Eng J Med 2013

Who to screen and other lingering questions? Still awaiting the final recommendation from USPSTF: high risk patients ages 55 to 74 screen with LDCT yearly ? Radiation exposure for LCDT 0.61-1.50 mSv  = similar to mammography mSv but for 10-20 years? Subsequent procedures from screening, false positive, concern for over diagnosis and overtreatment? Consider the psychological consequences of screening. Is this generalizable to women and other racial groups?

Bottom line: Smoking cessation and discuss with your patient risks and benefits of radiation with LDCT to screen smokers/former smoker for lung cancer. I am still waiting for the official recommendations and I still wary of CT scan for all smokers even at low dose for 20 years to screen for cancer.

From the Chief Residents

Grand Rounds

Date:  October 5, 2013

Presenter:  Gowthami Arepally, MD;  Apheresis

Noon Conference

Date Topic Lecturer Time Vendor Room
9/30 Staph Aureus   Bacteremia – Essentials of Management Vance Fowler 12:00 Picnic Basket 2002
10/1 Peripheral   Blood Films Murat Arcasoy 12:00 Saladelia Salad 2002
10/2 PFT   Interpretation Talan Dahhan 12:00 Moes Quesadillas 2002
10/3 DNR   Discussions: Fun Role Play with Dr G. Tony Galanos 12:00 Dominos 2001
10/4 Chair’s   Conference Chiefs 12:00 Chic-fil-a MEDRES

Note from the Chiefs:

Thank you to everyone who was able to attend the Town Hall noon conference where we presented what goes on behind the scenes in the program with regards to duty hours, scheduling, and some of the improvements we are working on this year!  Was the presentation helpful?  Were there topics that we did not cover about which you want more information?   Please feel free to reach either the Chiefs or ACRs directly, or contact your Residency Council representatives with your questions!   They can find out the answers to your questions from us on your behalf and get back to you.  Alternatively, you can use the confidential comment line!  Whatever you choose, we would love to hear any feedback or questions that you have about the content we presented!

From the Residency Office

Lunch – Things we Learned at Conference on Wednesday

Thank you all for persevering through our first attempt offering Chinese food at noon conference.  Comments that we heard included:  “amazing”, “let’s try Thai food next”, and “let’s have a repeat performance”.  We also learned that the best plans do not always work out, and Panda Express is sincerely apologetic for NOT delivering at the appointed time.  So, a few take aways to consider, and yes – we will do this again.

  • Timing is crucial, and we will continue to make every to have our vendors to be on time
  • Be considerate of your fellow residents – some of the folks who actually attended noon conference Wednesday didn’t get any food because other people left with a heaping plate of food (as in over flowing) without attending conference.  Please be mindful of the fact that when you do this, someone else does not get to eat.
  • Our office staff are not there to pick up or mop the floors.  If you drop something or accidents happen, you need to help take care of the problem – not just walk away

Lauren and Lynsey are working on plans for October.  With your help we will give it another try.



“Building Our Community”  October 1-31, 2013

Join the Internal Medicine Residency Program in our annual celebration as we recognize members of our Duke Medicine community and give back to our neighbors in the Durham community!

October 1, 2013 will mark the start of our 2nd Annual “Doctoberfest” celebration!

Fundraiser As part of our effort to give back to our friends and neighbors in our local community, we will be having a fundraiser to benefit a local charity in Durham (below)

October 15 Join us at noon conference for a traditional “beer” garden treat!

October 31 Halloween Tricks and Treats! Join us at Noon Conference for some Halloween goodies and for the announcement of our fundraiser’s “winning” Chief!

We look forward to celebrating with and honoring our incredible Duke Medicine community all month long!

Open the following PDF for more details, click on the pumpkin tab at the bottom- and see which Chief Resident you think belongs to which pumpkin!!


Building our Community – Doctoberfest Fun(d)

Submitted by Erin Payne

Alex WelcomeThe Northstreet community started with a few families gathering together to dream about what it could look like for their children with intellectual and developmental disabilities to live in community. To be in a place where they could have greater independence, be deeply valued, and truly thrive. Just a few years later, we are being given the incredible gift of seeing this dream become a reality and I have the honor of being a part of it!

This community is rare; in fact, it’s the first in North Carolina! 18 houses in downtown Durham that were abandoned and drug infested are being renovated and have already brought such new life to the area. Each person and home is unique- adding such beauty in diversity. Not all of the houses have been completed yet but it’s a combination of two Friendship Houses (Duke students doing life with and building close friendships with adults with special needs), a community house (an open space to build community not just within the neighborhood but more so with Durham as a whole), a Jubilee House (a home where young men who have been incarcerated can transition and be built up/taught independence), families, care givers, and a large amount of adults with and without developmental disabilities. All of us have very different stories of why we are here but come together with the common realization that each person is a gift in which we have a lot to learn from! That we flourish that much more when the people around us are flourishing as well!

AMAZING things are happening and it’s still just the beginning! There is a lot of joy even in the small things; such as Sloan and Wendyblock parties, street soccer, magnet making, karaoke nights, tutoring, meals together, etc.

As mentioned above, a huge part of our community is having a place where many who are often overlooked and pushed aside can belong! Currently my friend Sloan who lives in my house and many of our friends who are in wheelchairs are held back from fully engaging because only 2 of the 18 houses currently have handicap ramps. We need your help!!

Our hope is to raise money to buy a portable ramp ($1,239.99) so that all of our friends ALWAYS have the option of joining in on the fun that’s going on!


Residents! Recruiting Ideas! (submitted by Erin Payne)

We are looking for volunteers to help with the recruitment of applicants who are especially interested in Duke and would greatly appreciate your participation! The goal is to pair each applicant with a resident that has similar interests. The idea is that the resident could then provide more information about how they were able to explore those interests at Duke. We hope that by adding this personal touch, applicants can get a clearer sense of what they can accomplish here!

If you are willing to help us recruit, please fill out a few basic questions about yourself through the following link:


Harvard Biomedical Informatics Research Training Program

Infomatics is a major theme and methodology for biomedical science as well as for health care delivery, public health, and health care education. Biomedical Informatics is the convergence of biomedicine, at every level of biological scale, with a variety of technological and quantitative disciplines, including computer and information sciences, biostatistics, and cognitive science.

Applications for the 2014-2015 academic year, with a start date of July 2014, are now being accepted. The deadline for applications is October 28, 2013. The fellowship program is funded by a grant from the NIH’s National Library of Medicine and is, therefore, open only to US citizens and permanent residents.

Please see the attached document for additional information.


  • Alexa T. McCray, PhD
  • Associate Professor of Medicine
  • Harvard Medical School
  • Director, BIRT program
  • Co-Director, CBMI

1st Annual Advanced Heart Failure Symposium


October 5, 2013

Details / registration link on the attached flyer

Heart Failure Sumposium – REGISTER NOW


Duke Cardiovascular Research Center Seminar Series

October 2, 2013 – 4:00pm; 143 Jones

Sudha Shenoy, PhD, Associate Professor in Medicine, Assistant Professor in Cell Biology, Department of Medicine, Duke University

“Ubiquitination of Seven-Transmembrane  Receptors and Beta-Arrestin : Impact on Signaling and Physiology”

October 9, 2013 – 4:00pm; 143 Jones

David Pollock, PhD, Regents Professor, Section of Experimental Medicine, Department of Medicine, Georgia Regents University

Endothelin and sodium regulation: Implications for salt-dependent hypertension”

October 16, 2013 – 12:00pm; 143 Jones

Howard Jacob, PhD, Director, Human and Molecular Genetics Center, Warren P. Knowles Chair of Genetics, Professor, Department of Physiology & Pediatrics, Medical College of Wisconsin, Vice Chair of Research, Department of Pediatrics, Children’s Hospital of Wisconsin

“Use of Whole Genome Sequencing in Clinical Medicine”



Sourtheast Opportunities

Upcoming Dates and Events

  • October 1:  Duke’s Global Health-Internal Medicine Residency  deadline to submitt applications
  • October 18:  SoM Clinical Science Day
  • October 28:  Annual Recruitment Kickoff
  • November 13:  Networking Event at Dr. Klotman’s! (An opportunity for JAR’s, fellowship directors, and division chiefs to connect!)
  • November 28:  Annual “Turkey Bowl”
  • December 4:  “Voices in Medicine”

Useful links

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