From the Director
Happy March! It’s the month of the match! And basketball! And hopefully warmer days! And, of course, MiniCEX Madness! We ended February well with an extraordinarily great showing at the NC ACP meeting. Congratulations to all of our presenters, and especially to Jennifer Rymer who won BEST RESEARCH POSTER, BEST OVERALL POSTER and THIRD PLACE for CLINICAL VIGNETTE and to Mike Woodworth who won BEST CLINICAL VIGNETTE. As Vaishali said, we basically swept it. Great work!
Kudos this week also go to Noah Kalman from the 8100 nurses for great communication, to Alan Erdmann from Brice Lefler for great work on VA Gen Med, and to Jennifer Creed, Lindsay Anderson, Carter Davis, Jeremy Gillespie, Trevor Poseneau, Michael Shafique and Kaley Tash for being part of DRH’s Maestro roll out! Hany El Mariah and Laura Caputo had fantastic SAR talks this week as well. Also a huge thanks to our most recent ACRs Mandar Aras, Lindsay Boole and Carter Davis for your hard work these past two months.
Thanks to Bill Hargett for the first “preparing for fellowship” meeting. A second meeting to replace the snow day will be announced ASAP.
This week’s pubmed from the program goes to Hany Elmariah for his resident burnout study poster accepted to the Duke Patient Safety and Quality Conference!
Have a great week — ask your attendings to fill out MINI CEX’s. Jen will be checking the MiniCex count at the end of the week. Those with minicex’s completed will be eligible for prize drawings.
What Did I Read This Week?
Submitted by Murat Arcasoy, MD
What did the authors do?
The authors evaluated intern and patient outcomes associated with protected nocturnal nap periods of three hours that do not require an additional house officer to provide coverage. Two randomized controlled trials were conducted in parallel at an academic center university hospital and its affiliated VAMC. They examined the impact of the protected nap intervention on intern sleep, periods of prolonged wakefulness, sleep disturbances, an objective measure of behavioural alertness, and patient outcomes during extended duty hours (30-hours) in 2010-2011.
Why did the authors perform this study ?
As our SARs will recall, concerns about prolonged duty hours had led to the 2011 ACGME requirements mandating that duty hours for residents in PGY-1 not exceed 16 hours. For more senior residents who could still be scheduled to work 24 continuous hours + 4 hours for transfer of care, the ACGME strongly encouraged the use of alertness-management strategies such as “strategic napping” especially after 16 continuous hours of duty and especially between the hours of 10 pm and 8am. The authors asked if strategic napping during 30 hour duty could be an alternative to mandatory short shifts. Previous studies of protected sleep periods for interns resulted in increased amount slept and improved cognitive alertness but required supplemental personnel. The authors set out to determine whether a sequential protected sleep period of 3 hours (one intern sleeps from midnight to 3 am and the second sleeps from 3 am to 6 am) is feasible and effective in increasing the amount slept on extended duty overnight shift (30-hour) without extra personnel.
What was the methodology?
The authors assigned 94 interns at the VAMC and 61 interns at the university hospital to two randomized blocks during the study year, consisting of 12 four-week blocks. The standard schedule (control) months consisted of one resident and two interns on call on night float with both interns admitting patients throughout the night and responsible for cross-coverage until 7am, working a total of 30 hours (in 2010-2011). The intervention schedule incorporated the protected 3 hour nap periods as above and the interns were assigned to alternate between the early (12 midnight-3am) and the late (3am-6am) protected period. During the protected period they gave their cell phone/pagers to the night float resident. Each intern wore an Actiwatch a device that contains a sensitive accelerometer to measure physical motion, collecting data in 1-minute epochs. They completed a 3 minute Psychomotor Vigilance Test each morning and every night and filled out an electronic sleep log. Patient outcomes included length of stay, discharge to the MICU, death and 30-day readmission.
What did the authors find?
Interns with protected sleep periods were less likely to have on-call nights with no sleep (6% vs 21%), significantly longer sleep durations compared to controls and had fewer attention lapses on the psychomotor test. Proportion of interns reporting sleep disturbance was significantly lower in each of the protected sleep periods(57% vs 89% P<0.0001). There were no differences in any of the patient-level outcomes except VAMC patients cared for by the control group compared with the intervention group had shorter length of stay. Interns in both groups left the hospital at the regular time.
What are the conclusions of this interesting study?
This is the first examination of a personnel-neutral protected sleep period during extended work periods (30 hours). Strategic napping provides an alternative to mandatory short shifts, such as the 16 hour shifts, that create significant discontinuity in both care and education. Comparative effectiveness research of alternative forms of fatigue management would inform the optimum way of reducing house officer fatigue while preserving and enhancing the quality of education.
From the Chief Residents
March 4: Amanda Elliott / Jenn Rymer
|3/3||MKSAP Mondays – General Internal Medicine||Chiefs||12:00||Subway||Med Res Library|
|3/4||SAR TALKS||Amanda Elliott / Jenn Rymer||12:00||Bullock’s BBQ||2003|
|3/5||IM-ED Combined Conference||12:00||Cosmic Cantina||2002|
|3/6||Christina Sarubbi from ID–topic TBD||Christina Sarubbi||12:00||Saladelia||2001|
|3/7||Chair’s Conference||Chiefs||12:00||Rudino’s||Med Res Library|
From the Residency Office
Hoops Watch Invitation/Reminder ….
Join local DukeMed alumni from the classes of 2004-13, current and recent house staff to cheer the Blue Devils on to victory over our Tar Heel neighbors!
Duke Blue Devils vs. UNC Tar Heels
Saturday, March 8 | 8:30 pm Tyler’s Taproom 324 Blackwell St Durham, NC 27701 (919) 433-0345
Complimentary appetizers and one drink ticket per person provided.
Pain Narrative for Primary Care
Pfizer, Community Care of North Carolina and The Governor’s Institute invite you to attend an informational program on pain management: Tuesday, March 4th, 2014
“Pain Narrative for Primary Care”, featuring Ashwin Patkar M.D.
5:30 PM – Registration
6:00 PM – Dinner and Informational Program
(Please use the registration link for this program) https://prolazdurham.eventbrite.com
Immediately following the Pfizer presentation Community Care of North Carolina & The Governor’s Institute Presents: A Guide to Rational Opioid Prescribing, featuring Ashwin Patkar, M.D.
7:00 PM – Informational Program
3100 Tower Blvd. 17th Floor
Durham, NC 27707
Interested in Learning About GI Fellowship?
If you are thinking about completing a fellowship in GI, the following is an opportunity to add to your schedule.
- What: GI Interest Meeting
- Date: March 31, 2014
- Location: Tyor Conference Room
- Time: 4:00pm
F0r more information feel free to touch base with Jill Rimmer, GI Program Coordinator
Health Care Value For Physicians: Understanding Quality and Cost
With recent health care reforms and changes in reimbursement impacting how we practice, understanding quality and cost is an increasingly important part of medical training. The GME Incentive Plan Task Force is please to announce a 6-part lecture series: Health Care Value for Physicians: Understanding Quality and Cost led by representatives from the School of Medicine and health system administration. These lectures are geared towards house staff, but are open to anyone.
All lectures will be held in the Trent Semens Center: Time: 7:00 – 8:00pm in the Trent Semens Center
Light refreshments will be served – including cheese from around the world
The complete schedule can be found on the following attachment: Health Care Value Lecture Series
March 5: Pay for Performance under the Affordable Care Act
Jennifer Rose, Director, Performance Services, DUHS
March 19: Performance Measurement
Bill Burton, Vice President, Performance Services, DUHS
March 26: Quality in Healthcare
Bimal Shah, Director of Quality, Department of Medicine
Liability Insurance Information
For those who are finding themselves filling out the vast packets of information required for fellowship or credentialing packets, please note the following information regarding liability insurance:
- >> Name of insurance coverage provider: Durham Casualty Company, Ltd.
- >> Policy Number: 12PL1022-P
- >> Mailing Address: DUMC Box 3811, Durham, NC 27710
- >> Phone Number: 919-684-3277
- >> Fax Number: 919-684-6543
- >> Per claim amount: In excess of $3M
- >> Aggregate amount: In excess of $20M
Information/OpportunitiesCompHealth_Info res fellow CompHealth_Locum_Tenens Central Louisiana Internal Medicine Los Angeles RSA-105 Flyer South Texas Internal Medicine Outpatient
Upcoming Dates and Events
- March 8: Duke Blue Devils vs. UNC Tar Heels
- BLS Blitz 3-2014: March 17 – 20
- March 21: Match Day CELEBRATION !!
- March 22: Gastrointestinal Cancers Program 1st Annual 5K Run/Walk DukeCRC5K.org
- April 11: Final Faculty Resident Research Grant applications
- April 18: Charity Auction
- April 18: SAR Class Picture (rescheduled)
- May 3: the Stead Tread 5K
- June 3: Annual Resident Reseach Conference
- May 31: SAR Dinner, Hope Valley CC
- March 14 Resp Fit Testing-T-Dap-TB Skin Testing Flyer
- Main Internal Medicine Residency website
- Main Curriculum website
- Ambulatory curriculum wiki
- Department of Medicine
- Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response