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Internal Medicine Residency News: April 21, 2014


From the Director

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

A big thanks to all for your fantastic work during a VERY busy week at all 3 hospitals! The highlight of this week was certainly our FANTASTIC Charity Auction, held on Friday night at the Full Frame Studio at the American Tobacco Campus (Durham… it’s awesome!).  Carling Ursem, Christine Bestvina, Jen Chung, Allyson Pishko, Jessie Seidelman, Adrienne Belasco and Andrea Sitlinger worked incredibly hard over the past few months to put together an absolutely fantastic evening, with great silent and live auction prizes.  We couldn’t have done it without the support and commitment of Lynsey Michnowicz, Erin Payne, Lauren Dincher, Jen Averitt and Randy Heffelfinger before, during and after the evening.  Our fearless emcee Tony G was hilarious as always, and the chiefs were remarkably good sports about getting pies in the face (I’m sorry Joel, but Ann Marie made me do it!).  Hats off to Scott Evans who allowed Rob Harrison to pie him (with a “used” pie) as a symbolic representation of 1010 vs. the ED.  All in good fun, we promise.  Word has it that Scott was incredibly helpful in the planning of the auction as well. Overall, this auction had the BEST faculty attendance of any auction in history, as well as fantastic resident participation…thank you to everyone who donated, attended, bought, and supported our causes…SeniorPharmAssist and the DOC Patient Fund.

Other kudos this week go to Kevin Trulock from the venerable PSK for outstanding family communication in the MICU, to Claire Kappa for unsolicited coverage of a friend on night JAR, and to Brian Miller and Marianna Papademetriou for outstanding SAR talks.  Kathy Andolsek from GME sends kudos to Nick Rohrhoff, Liz Campbell, Brian Kincaid and John Wagener for their assistance in hosting the congressional staffers who were visiting to learn more about GME.  She tells me that the staffers were VERY impressed with our their knowledge, compassion and ability to discuss the issues affecting GME.  Lynn Bowlby sends kudos to Alex Clark, Suma Das and Bronwen Garner for outstanding work at DRH!

Another HUGE KUDOS to Lindsay Boole for winning the ACP National Abstract Competition…Lindsay presented the data from our QI/PS Afternoon Report held on Thursdays at Duke with Jon Bae.  Fantastic work Lindsay.  Look for her work to be featured in the Med Res Library soon..her work features a great example of how all of our SARS participate in ROOT CAUSE ANALYSIS and help solve the safety issues affecting our patients.

Hold tight….the schedule will be released THIS WEEK!!  We are making a couple final edits and you should receive your JAR/SAR schedule on Tuesday.  Thank you VERY MUCH to Krish, Stephen and Vaishali for your hard work on such an important but time consuming part of being chief.

What’s coming up???  This week we have the CPC on April 22nd at THE PIT!!! Please RSVP to the evite if you are planning on attending…a great crowd has already signed up.  Next is the AMAZING THIRD ANNUAL STEAD TREAD — time to get your running shoes on, get some exercise and support a great cause (the Lincoln Community Health Center!).  Sign up at….ASAP to be sure to get a T-shirt!!  Can you be faster than Meredith Clement?  Can Brian Schneider run with a jogging stroller and still beat you? Blink and miss Ethan (Bowlby) Ready? Whether you run faster or slower than your program director, we would love to see you there!

This week’s pubmed from the Program goes to John Wagener for his article with Sunil Rao!  Strategies to Avoid Bleeding in the Management of ACS.” Medscape Online. Released July 30, 2013.

Have a great week!



What Did I Read This Week?

Depression as a risk Factor for Poor Prognosis Among patients with Acute Coronary Syndrome: Systematic Review and Recommendations. A Scientific Statement from the American Heart Association.

Lichtman JH, Froelicher, Blumenthal J et al. Circulation 2014;129:1350-1369

Submitted by Sarah Rivelli , MD

RivelliWhy Did I Read This?

A variety of types of studies, including prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations. However, whether or not depression should be considered as a recognized risk factor for poor prognosis in patients with acute coronary syndrome has remained controversial. The purpose of this Scientific Statement by the American Heart Association was to review available evidence and conclude on whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome.


A systematic literature review was performed with clearly defined search strategies and terms.   Articles were limited to the English language and were reviewed in a consistent manner. Search terms for the risk factor of interest included depression, depressive symptoms, dysthymia, mood or depressive disorder. Adverse medical outcomes after acute coronary syndrome included all-cause mortality cardiac mortality, and composite outcomes for mortality and nonfatal events.

The strength, consistency, independence, and generalizability of the studies were assessed.   Studies included were those with prospective design, >=100 patients, systematic established assessment of depression and included a nondepressed comparison subgroup.


A total of 53 studies were included

Depression and all-cause mortality

Out of 32 such studies, 17 reported a significant risk-adjusted association between depression and elevated all-cause mortality and an additional 4 studies found similar results in unadjusted analyses.

Depression and Cardiac Mortality

Seven of 12 studies reported a significant risk-adjusted association and one reported a significant unadjusted association between depression and increased cardiac mortality.

Depression and composite of mortality and nonfatal events

Out of 22 studies, 15 reported a significant risk-adjusted association and 2 additional studies reported a significant unadjusted association between depression and a composite of mortality and nonfatal events. These studies represented analysis of 14 of 18 unique cohorts.

Four meta-analyses were also reviewed. The overall unadjusted effect of depression on all-cause mortality was 1.8-2.6 and 2.3 to 2.9 for cardiac mortality.


The authors did a good job of systematic literature search and evaluating the quality of the studies included. They took care to consider that some publications were based on the same cohort of patients, which could lead to overstating of the results. Moreover, they excluded studies with small sample sizes, which tend to lack sufficient power to detect differences and may have false negative results.  The inclusion of English language-only studies may have biased towards positive studies as negative studies may be more likely to be published in a language other than English.

Studies were heterogenous with respect to sample demographics, measurement of depression, length of follow-up, and the other risk factors included in multivariate models which limits the results. Covariates were not necessarily consistent across studies, and the severity of a co-occurring risk factor was not always included. The variability in covariate adjustment may contribute to the overestimation of depression as a risk factor above and beyond established post-ACS risk factors. The strength and precision of the positive studies varied, however only a minority of studies published were negative.


Should we screen for depression post-ACS? Yes, especially because it is an important condition to treat in its own right.

Will treating depression post-ACS save lives or prevent cardiac events? We don’t know that yet. There is really only one study to date adequately powered to detect the effect of depression treatment (ENRICHD) and in intention-to-treat analysis, it was negative. However, post-hoc analyses suggested that adequate treatment of depression leads to better survival, which is intriguing.

It will be interesting to see how we integrate this Scientific Statement in clinical practice.


The “Clinic Corner – VA PRIME”

(submitted by Sonal Patel, MD )

News from the VA…

Well the VA is abuzz with rumors that we will soon be visited by our friends at The Joint Commission (formerly known affectionately as JCAHO). I wanted to take a minute and discuss what The Joint Commission is and the invaluable service it provides. Founded in 1951, The Joint Commission is the nation’s oldest and largest standards-setting and accrediting body in health care . It is an independent, not-for-profit organization that accredits and certifies more than 20,000 health care organizations and programs in the United States.   Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. Their mission statement is to “To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.”

To earn and maintain the The Joint Commission’s Gold Seal of Approval, an organization must undergo an on-site survey by a Joint Commission survey team at least every three years. (laboratories must be surveyed every two years). Driven by a commitment to honor America’s Veterans by providing exceptional health care that improves their health and well-being, the Durham VA Medical Center is readying itself for our upcoming visit.

What that means for you and me: The 2014 Hospital National Patient Safety Goals include:

  1. Identify patients correctly: 2 out of the 3- FULL name, DOB, FULL SSN whenever you bring a patient to your clinic room. Yes, that means asking the patient 2/3 questions above before starting your visit with the patient.
  2. Improve Staff communication: critical test results conveyed to the correct provider- If you get a page or call about a critical result, be aware that you are expected to repeat the results over the phone and then document the results with a plan of action in CPRS immediately.
  3. Use Medications Safely- label medications in syringes if you are not going to use immediately for a procedure, take precautions with patients on blood thinners and perform a thorough medication reconciliation with each visit
  4. Use alarms safely- medical equipment alarms are heard and responded to on time- important in inpatient setting, not so much in clinic
  5. Prevent infection- hand hygiene, use guidelines to prevent infections from catheters, central lines, surgery
  6. Identify patients at high risk for suicide and refer patients appropriately to mental health, provide crisis number, counseling- remember we have PRIME-Psych residents that work with us in PRIME and have same day access most of the time
  7. Prevent Mistakes in surgery (or for our case in clinic procedures, ie joint injections)- all patients need “TIME OUT” procedure which includes: identify the correct patient, discuss procedure site and laterality, obtain consent, position the patient appropriately, stop and take a “TIME OUT” to review with everyone (including patient) the plan. When everyone is agreement, proceed with procedure ( you do NOT need to mark the site as long as the consent process PRECEDES the procedure in a NON-OR setting by the same provider obtaining the consent)

In addition, please remember if you are approached by any of the surveyors and you do NOT know the answer to the question, please state verbatim( if you can), “I do not have the answer but I know where to find it” and then come to either myself or Renee Shopshire or one of the nurses.

  • Please also wear your VA PIV ID badges in clear site
  • Please lock your computers
  • Keep all patient paperwork on your person and not in the clinic room.
  • NO food or drinks in the patient exam rooms- this one is difficult, please try to avoid this…
  • Lastly if nothing else, please CLOSE YOUR EXAM ROOM DOOR when you leave the room

The Durham VA is continuously working to strengthen the quality and safety of healthcare offered at our facilities. We look forward to a great visit from The Joint Commission and welcome any suggestions, improvements that are recommended to provide exceptional care to our veterans. Thanks and please be aware and ready for visitors soon….

QI Corner (submitted by Joel Boggan, MD)

Resident M&M Noon Conference Stephen Bergin is going to be leading us through a case on Thursday, the 24th, at noon. 

We Follow-Up project Here are the actual numbers from your hard work contacting your patients about lab results and documenting it this year during the first half of the year and since the holiday break.

DOC:  Increased from 70% during the first half of the year to 76% during the second half

Pickett:  Increased from 89% to 94%

PRIME:  Increased from 84% to 92%


From the Chief Residents

SAR Talks

April 22:  Sarah Wingfield, Matt Summers

Grand Rounds

Dr. John Williams

Topic: Shared Decision Making

Noon Conference

Date Topic Lecturer Time Vendor Room
4/21 MKSAP Mondays – ID Chiefs 12:00 Subway 2002
4/22 SAR TALKS Sarah Wingfield / Matt Summers 12:00 Pita Pit 2003
4/23 Essentials of Antifungal Therapy Zaas 12:00 China King 2002
4/24 M and M Bergin 12:00 Domino’s 2001
4/25 Research Conference 12:00 Panera 2002

From the Residency Office


For those of you who haven’t already registered, wanted to take a second to invite you all to come support the Stead Tread, Kempner Society’s annual charity event.  It was a blast this year, and since we’re due for some good weather this year, I’m sure it will be even better this time around.

Some additional information:

  • Please access the Stead Tread 2014 website ( for additional details, to securely register ($25), or make a donation
  • Race date/time: Saturday, May 3rd, 2014 at 10AM
  • Race location: Al Beuhler Trail (on our USATF-certified course around the Washington Duke Inn and Golf Course)
  • Race beneficiary:  Lincoln Community Health Center
  • Your registration fee includes an official Stead Tread 2014 T-shirt – register ASAP to reserve your size, they are going fast!
  • Participants are welcome to run or walk, and strollers are permitted – kids under 12 can run/walk for free, so bring your families!
  • In case you cannot make the race this year, individual and corporate donations can be made securely through our website

Thank you for considering supporting the Stead Tread – we really hope to see you there this year.  For any questions, please contact us through our website (, via e-mail at, or by replying directly to me.

Thanks, Matt

Parking Question

Last week we received the following question regarding parking on the confidential comment line:

Will interns be moved to the PG2 parking deck in July? (This is where current JARs and SARs park). My hope is this will be the case, as parking in the research drive parking garage with all the construction has been a huge hassle this year?

Answer:  No definitive answers yet, but we anticipate that the incoming interns will also be assigned to the research drive lot.  We are not aware of any plans to try and relocate anyone to PG2.

We will share any further updates as they are received.

Who Cleans Up After You?

Did you know that if you chose to leave a mess behind you at noon conference, or at ANY time in the Med Res Library or office, it is the office staff who most often pulls things back together and makes it look presentable.  And in case you were wondering, this really is not our job.  Please do not leave lunch dishes on the floor, or walk away from something you dropped or spilled.

Clinical Pathology Conference (CPC)

Reminder: CPC will be held at The Pit next Tuesday, April 22nd at 7pm! The one and only, incredible Allyson Pishko will be presenting the case. Come enjoy a delicious plate of food and drinks; the presentation will start at 7:15pm. If your RSVP has changed, please contact Erin Payne directly at Enjoy!!

Do you have patients with chronic pain?

The IOM in 2011 called for a “population health-level strategy for pain prevention, treatment, management, education, reimbursement and research.”  On May 2-4, Duke and UNC will be co-sponsoring a joint symposium on Pain, Addiction, and the Law – which includes an intensive, boot camp-style mini-course on pain management the evening of Friday, May 2.  Residents can register for the mini-course and the meeting free of charge, but spots are limited.  Click the link to the attached brochure for more information.  Interested residents should contact Lynn Bowlby for more information.



Los Angeles RSA-105 Flyer

Upcoming Dates and Events

  • April 22: CPC Event, 7 PM @ The Pit
  • May 2: Faculty/Resident BB Game on Coach K Court
  • May 3: the Stead Tread 5K
  • May 30: Program pictures @ Duke Chapel 9:15
  • May 31: SAR Dinner, Hope Valley CC
  • June 3: Annual Resident Research Conference
  • June 6: Serve dinner at the Ronald McDonald House

Useful links

by · Posted on April 20, 2014 in Chief Residents, Internal Medicine Residency, Medical Education, Weekly Update · Read full story · Comments { 0 }

4/18/14: Duke Medicine Charity Auction


Tickets are available in the Medicine Residency office or at Medicine Grand Rounds for $20, and each ticket includes heavy hors d’oeuvres and 2 drink tickets. All items go to the highest bid. Items from past events included restaurant gift certificates, artwork, weekend getaways and more.

by · Posted on April 14, 2014 in Events, Internal Medicine Residency · Read full story · Comments { 0 }

Internal Medicine Residency News: April 14, 2014


From the Director

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

Vacation was great, but it is also good to be back.  I feel a bit of pressure to be as funny as Dr. Hargett writing for updates…thanks again Bill for doing an amazing job filling in.  I also got to spend a few days at the Program Director’s meeting in Nashville with Drs. Woods, Trinh and Rivelli.  We learned a lot about the milestone based evaluations and residency accreditation, as well as some exciting new curriculum that we hope to bring to you in the next few months.  Be sure to talk with me or your advisor about the summative “reporting” milestone evaluations we complete for each of you…its a good opportunity to set goals for your upcoming rotations.

The first How to Be A JAR was a great success…many thanks to Vaishali and Krish for putting together fantastic sessions on Leadership and Dealing with Uncertainty, as well as to Cory Miller and Rob Harrison for running the Code Blue Simulation.  Thanks also to Bobby Aertker, Aparna Swaminathan, Adrienne Belasco and Kevin Shah for providing JAR/SAR input and to all the participating interns for asking questions and allowing for excellent discussion.  Next session is Monday, so remember to check Medhub to see if you are scheduled.

Lots of kudos to be given this week.  First to Lindsay Boole who was left off (sorry!!) the ACP announcement last week.  Lindsay had a platform presentation of the QI Afternoon Report data..great work Lindsay.  Ashley Bock and Amanda Verma both received gold stars based on excellent patient comments.  Many of our residents were mentioned by name by the medical students in the July-January clerkship evaluations….congratulations to the following residents for your recognition by the second year med students!

Bobby Aertker, Mandar Aras, Shailesh Balasubramaniam, Armando Bedoya, Adrienne Belasco, Amit Bhaskar, Hal Boutte, Schell Bressler, Kimberly Bryan, Laura Caputo, Meredith Clements, Mallika Dhawan, Alex Fanaroff, Sarah Goldstein, Jonathan Hansen, Chris Hostler, Scharles Konadu, Ashley Lane, Howard Lee, Jim Lefler, Philip Lehman, Carli Lehr, Angela Lowenstern, Jay Mast, Alyson McGhan, Brian Miller, Aaron Mitchell, Laura Musselwhite, , Ragnar Palsson, Rebecca Sadun, Paul St. Romain, John Stanifer, Matt Summers 
Aparna Swaminathan, Sajal Tanna, Carling Ursem, Jonathan Yates, Jason Zhu 

Also kudos to Howard Lee and Chris Hostler for fantastic SAR talks (although I missed them being at APDIM, I hear the Brian Miller especially loved Chris’s talk).  More kudos as well to Brian Sullivan for his Chair’s Conference presentation, and to Lauren Porras for her noon conference on shoulder exams.  Cary Ward sends kudos to Amy Lee, Jonathan Hansen, Sarah Goldstein, and Yvonne Baker for their outstanding work on CAD.  Congratulations to Armando and Jennifer Bedoya on their marriage — we all had a fantastic time celebrating with you on Saturday! Congratulations as well to Tyler Black on the birth of Davis Black!  Mom, Dad and baby are all doing well!

Can’t wait for the AUCTION this Friday!!! Hope to see you all there!!!  While you are at it, go ahead and sign up for the STEAD TREAD as well.

This weeks Pubmed from the PRogram goes to Amy Newhouse for her work with Dr. Wei Jiang. Newhouse Jiang – Heart Failure and Depression

Have a great week


What Did I Read This Week?

Submitted by Bill Hargett, MD

If you missed our interdisciplinary discussion at the joint IM/EM Conference on Wednesday, this is an important article that every one of our residents should read:   The ProCESS Investigators. A Randomized Trial of Protocol-Based Care for Early Septic Shock. N Engl J Med. 2014 Mar 18. [Epub ahead of print] PubMed PMID:24635773.

There’s a lot of information in this trial (you can also read the Supplementary Appendix) so I’ll try to reduce the burden and simplify a few things.

Background and Question:

Sepsis is among the most common reasons for ICU admission and a top-10 cause of death in the United States.  The Surviving Sepsis Campaign (SSC) Guidelines have successfully called attention to the delay in the recognition of and initiation of appropriate therapy for sepsis and septic shock.  Furthermore, the Guidelines are endorsed by multiple professional and regulatory organizations, achieving de facto “standard-of-care” status.  However, the evidence base for major components of the SSC is poor, and there remains significant controversy surrounding the initial hemodynamic resuscitation “bundle” (based upon early goal directed therapy (EGDT)).

The ProCESS Trial is the first published of three major trials assessing EGDT in sepsis.  So what did they find?  What is the efficacy of early, protocol-based, targeted resuscitation in patients with septic shock?


Investigators randomized 1341 patients with septic shock at emergency departments in 31 U.S. academic, tertiary care hospitals to one of three 6-hour resuscitation arms:

  1. EGDT a la Rivers (n=439)
  2. Standard therapy (protocol-based, IVF until clinical euvolemia, transfusion threshold Hgb < 7.5 g/dl, and CVC/inotropes/ScVO2 not mandatory, n=446)
  3. Usual care (no protocol or directed intervention, n=456)

The primary outcome was 60-day mortality.  Regarding validity, groups were similar at baseline (e.g. APACHE II ~ 21) and there was no evidence of contamination.


There were no differences between groups in 60-day mortality (19-21%), 90-day or 1-year mortality. Protocol adherence was very good (89.1% in EGDT, 95.6% in standard therapy).

Table 2 (Article) further details the outcomes and Table S4 (Supplement) nicely delineates the resuscitation and overall care from enrollment to 72 hours.


The results of this trial are unsurprising to many emergency or critical care providers and I could go on and on regarding the shortcoming of the SSC resuscitation bundle and the “one size fits all approach” for the treatment of severe sepsis and septic shock (e.g. transfusion threshold in critically ill patients, ScVO2 as a physiologic surrogate, inotrope selection, etc.).  However, I think it’s important to emphasize a couple of major take-home points:

  • There was no clear superior resuscitative approach for septic shock (i.e. “more” is not always “better”)

This may be, in part, explained by the underlying “pre-randomization protocol,” whereby most study participants, by virtue of the enrollment process, received early recognition of sepsis and antibiotic administration, which are likely the most important components of care.

  • Overall, sepsis outcomes have improved over recent years (mortality is much lower than reported in Rivers, 2001)

Indeed, this earlier identification of septic patients and aggressive treatment may be the greatest product of the Rivers trial and the SSC… “knowing is half the battle,” as they say.  Increased awareness and early treatment clearly saves lives.

For future studies, how about some more data to look more closely at individual bundle elements?  Well, that may be coming – keep an eye out for the ProMISe trial in the UK and the ARISE trial in Australasia, both of which are also examining EGDT and which have been designed collaboratively to allow the results to be pooled for all three RCTs on EGDT.

The “Clinic Corner – DOC”

(submitted by Dr  Sharon Rubin )

Rubin picture 2 - Jake in FloridaHello from sunny Orlando. Attached is a picture of Sam and Jake at Hollywood Studios (he is dressed as a Star Wars padawan with a Jake doll!)

This is a reminder for the SARs. make sure you are letting your patients know you are leaving in June and that a great new doctor will be assuming their care. As soon as I have names I will give to each SAR. We will have 6 new interns to replace the 6 SARS. Then you can put their name on the AVS. Please RSVP for the Pickett Senior Dinner in June on the Doodle pool (let me know if you need the link).

Running your panel is possible. When you are on Administration time or as a SAR for your last clinic session will be Admin and will run your own panel. I have made instructional videos where you can

1. Run your own  panel

2. Run your panel for Diabetics or hypertensives

3. Run another resident’s panel

Due to HIPPA, Sharee has access to these videos and will release them to you if you are on ADMIN or if you want to run your panel.

Please pay attention to Marie Evangelista’s emails  for Maestro updates as she is our superuser.

Good news the Rapid flu works! Bad news this is a little late coming. Rubin picture 1I had a patient, in APRIL, who had classic Flu symptoms. The NURSES run the flu (order POC FLU), this takes 10 minutes but better than 2 days. At least we will be ready for next flu season.

I am proud to see the Duke residents and medical students posters at ACP. Attached are Julia and Wassim’s posters from the North Carolina ACP.

See you when I get back!


QI Corner (submitted by Joel Boggan, MD)

The Importance of Coding
Many thanks to Dr. Momen Wahidi, who led us through a discussion (and some examples) of how our documentation affects overall patient care and safety.  You will be hearing more about this topic as we move into the next academic year.

We Follow-Up project
The first look at the Sharepoint project during Phase 2 is done, and it appears we are improving our rates of notifying patients about lab results.  We have picked up about 6% in absolute notifications at the DOC, 5% at Pickett, and 8% at PRIME.  Overall, PRIME and Pickett are neck-and-neck reporting >90% of results back within two weeks, while the DOC is lagging a little behind.  Keep up the good work!

From the Chief Residents

SAR Talks

April 17:  Brian Miller / Marianna Papademetriou

Grand Rounds

Dr. Frank Neelon  — Obesity

Noon Conference

Date Topic Lecturer Time Vendor Room
4/14 MKSAP Mondays – Cardiology K Patel / Chiefs 12:00 Picnic Basket Med Res Library / 8262
4/15 MED-PEDS Combined: HPV Screening and Vaccination OR Difficult Death Debrief Chip Walter / Galanos 12:00 Saladelia Wraps 2002 OR DN9242
4/16 Nephrology Board Review K Patel / Butterly 12:00 Cosmic Cantina Med Res Library
4/17 SAR TALKS Brian Miller / Marianna Papademetriou 12:00 Sushi 2001
4/18 Chair’s Conference Chiefs 12:00 Rudino’s 2002


From the Residency Office

Califf Medicine Resident Research Award

Internal Medicine Residency Program and the Department of Medicine would like to invite you to submit an abstract of your research project for:  The Califf Medicine Resident Research Award competition.  Abstracts are due on May 5, 2014

Please see attached request for applications and abstract preparation instructions, also included within our Resident Research website link:

All abstracts submitted for competition will also be presented as posters during Resident Research Night on June 3, 2014 at the TRENT SEMANS Center 5 pm – 7 pm.

 The top 3 abstracts will be selected by a faculty committee for the Califf Research Awards and these research projects will be presented as 15 minute talks.

The best poster will be selected by the Chief Residents during the poster viewing session.

In addition, we invite all of you to present your scholarly activities during Resident Research Night as posters :

  1. Basic, clinical and translational research projects
  2. ase studi
  3. QI projects

To discuss any issues related to the application process or once you have decided to submit an abstract, please e-mail to declare your intention to submit, your research mentor’s name and the title of your poster.  Please contact the MedRes office staff (Ms. Lynsey Michnowicz) for assistance with the poster preparation process.

LPS Snapshot (submitted by Dr. Wei Duan-Porter)











Please provide feedback about your continuity clinic experiences, and help earn $$ for the charity supported by your Stead Society! Only 10 more responses per Stead will get you $150 for each of your great causes!

Thank you to all those who have already responded!


Medical Education Grand Rounds:  “MAKING THE MOST OF MILESTONES” 

Presented by Dr. Aimee Zaas (Program Director, Internal Medicine)

  • Monday, April 14th 4pm – 5pm 
  • Tuesday, April 15th 7am – 8am 
  • Wednesday, April 16th 12noon – 1pm  

Registration for can be completed using the follwoing link: 

Upcoming Sessions: 

“Due Process or Don’t Process: Medical Education & The IRB” with Dr. Mitch Heflin

  • Monday, May 12th 4pm – 5pm 
  • Tuesday, May 13th 7am – 8am & 12noon – 1pm 

“Longitudinal Curricula” with Dr. Barbara Sheline

  • Monday, June 2 4pm – 5pm 
  • Tuesday, June 3 7am – 8am 
  • Wednesday, June 4 12noon – 1pm 

Financial Planning Seminar at Duke for Residents and Fellows April 22 – Register Now

Financial Planning Seminar for Residents and Fellows

Gerald A. Townsend, a nationally recognized financial advisor,  will be at Duke on April 22nd to talk with Duke’s residents and fellows about the fundamentals of building a successful financial plan.   He will cover topics such as budgeting, investing, protecting assets, retirement, and estate planning.  The objective of the seminar is to provide attendees with an overview of the essential considerations  necessary  for creating a  comprehensive financial plan and to provide a level of comfort for taking the next steps towards creating a secure financial future.

Time/Location:  April 22nd  at 6:30 PM in North Duke Lecture Room 2002


Changes in USMLE Step 3 for 2014-14

Please note the changes to the Step 3 test for next year.  As a reminder, you cannot advance to PGY3 until you pass Step 3.  We STRONGLY ENCOURAGE you to register as soon as possible and take the test as soon as possible.  Please remember to clear your dates with the Chiefs and send them to me when you have them!

Changes in the USMLE Step 3 Examinations

  • Registration for the current Step 3 examination will end July 18, 2014.
  • Registration for the restructured Step 3 examination will begin August 2014.
  • No Step 3 examinations will be administered during most or all of October 2014.
  • There will be a substantial score delay following introduction of the restructured Step 3 examination in November 2014. The duration of the score delay will be determined by examinee volume during the early months of exam administration. Based on historic trends, we estimate that the first scores for Step 3 exams taken on or after November 1, 2014 will be released during the first week of April 2015.

For more information, please review the Changes to USMLE 2014-2015 document on the USMLE website.

You may contact us with any questions at

The link containing this info:


Florida Internal Medicine

Idaho Hospitalist

South Texas Internal Medicine Outpatient

Alabama Physician Needs

Upcoming Dates and Events

  • April 17:  Financial Planning Seminar
  • April 18:  Charity Auction
  • April 18:  SAR Class Picture (rescheduled)
  • April 22:  CPC Event, 7 PM @ The Pit
  • May 2:  Faculty/Resident BB Game on Coach K Court
  • May 3:  the Stead Tread 5K
  • May 30:  Program pictures @ Duke Chapel 9:15
  • May 31:  SAR Dinner, Hope Valley CC
  • June 3:  Annual Resident Research Conference
  • June 6: Serve dinner at the Ronald McDonald House

Useful links



by · Posted on April 13, 2014 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Internal Medicine Residency News: April 7, 2014

HargettFrom:  Bill Hargett, MD

Associate Program Director

Dr. Zaas hasn’t retired from the Internal Medicine Residency News but she continues her “Conscious Un-blogging” this week and you are stuck with me again… (thanks Jimmy Fallon, and Aimee will be back from vacation next week).  All kidding aside, this was another great week in our program – here’s a few highlights: Rupp Fredrick

From the Residency Baby Blog (your source for the latest news on our mamas and papas…)  Congratulations to Marcus Ruopp and Nicki Frederick and lots of air hugs for Allie Michaela Ruopp.

ErdmannWarmest wishes to the Erdmann’s as they welcome baby Henry into the world.  Alan and his wife are now outnumbered 3 to 2 and forced to brush up on their zone defense.  I don’t have a photo but, with Alan’s baby-face good looks, I can only imagine…  (kidding, love ya Alan and sorry, Amanda)

KotW – Many kudos this week – the accolades for our group are flying so fast that I can barely keep up… (and likely missed quite a few!)

Special thanks to Caroline Lee, Monica Tang, Jesse Tucker, and Nancy Lentz, who all demonstrated the quintessential pull-list attitude when covering for their colleagues.

Marcus Ruopp received some good-nature ribbing as Duke ACR while Aimee and Krish were away but he really did a tremendous job in helping to lead the GenMed teams during a busy week.

Takes a TeamThis via Jon Bae – the DOC and their Care Transitions Effort is outta control, taking home the hardware by grabbing the DUH “It Takes a Team” Annual Award for their overall redesign efforts, as well as the top prize Kirkland Award at the Duke Patient Safety Conference.

Stay on top of what’s happening in your back yard and check out Laura Musselwhite’s Point of View in the News and Observer on NC Medicaid expansion.

On Wednesday, Dr. Ken Lyles earned the IronDuke Omnipresent Award, given to attendings who precept report at all sites all in one day (DRH AM report, VA Report, Duke GM SAR report, and Duke GM intern report).  That’s quite the feat!

9100From Kathleen Kiernan Harnden “My Amazing, Karaoke 9100 Interns” singing Happy Birthday to a patient (though I didn’t hear the tune, kudos to Amy Jones, Marc Samsky and Joanne Wyrembak)

The ACP is celebrating the academic excellence of “Young Achievers” for Internal Medicine 2014 in Orlando and we should too!  Kudos to:

  • Jennifer Anne Rymer, MD (Quality Improvement/Patient Safety, Clinical Research)
  • Joseph D Brogan, MD (Clinical Vignette)
  • Michael Woodworth, MD (Clinical Vignette)

And last, but not least, we’re also incredibly proud of our team’s record showing in the poster competitions at the Society of Hospital Medicine Annual Conference in Las Vegas, with the tally including:

A) 20 Posters from our group

-7 QI/Research (with 3 Finalists!)

-13 Clinical Vignettes

B) 11 Hospitalists represented

– 7 DUH, 3 DRH, 1 DRAH

– Many posters included residents and medical students

C) All 3 Sites Represented

-14 DUH Posters

– 5 DRH Posters

-1 DRAH Posters

Here is a complete list:  SHM Posters 2014


The “Clinic Corner – DOC”

(submitted by Dr Bronwen Garner)

The April News Letter for the DOC is attached below.  Among the items listed check out the annoucement about the procedure clinic opening in May.

DOC April News Letter

QI Corner (submitted by Joel Boggan, MD)

PSQC Special Meeting
For our next PSQC meeting, we’re going to be meeting at 5:30 in the Med Res Library on Wednesday, 4/9.  We’ll talk briefly about some updates before being led by Dr. Momen Wahidi at 6 pm (with food courtesy of the PRMO!) on the following topic:

What: “How documentation reflects your care : it matters to you and your patient”

  • When: April 9th, 6pm (during PSQC meeting)
  • Where: Med Res Library
  • Who: Momen Wahidi, MD, PRMO, and PSQC
  • Pizza (courtesy of PRMO/Dr. Wahidi) will be available for those that attend

Hand Hygiene Updates
March was our best month yet – out of 68 MD observations on our floors, we were compliant with 67!  That’s 98% for the month and brings our aggregate  compliance to > 89% on the year (SO CLOSE TO 90%)!  Keep up the good work!

From the Chief Residents

SAR Talks

April 8: Chris Hostler / Howard Lee

Grand Rounds

Dr. Carl Berg:    Topic – UNOS

Noon Conference

Date Topic Lecturer Time Vendor Room
4/8 SAR TALKS Chris Hostler /   Howard Lee 12:00 Pita Pit 2002
4/9 MSK Exam Part 3 Irene   Whitt & Lisa Criscione 12:00 Subway Med Res Library
4/10 Practical Approach to   Shoulder Pain Porras 12:00 Domino’s Med Res Library
4/11 Chair’s Conference Chiefs 12:00 Chick-Fil-A 2002

From the Residency Office

Strength, Hope, and Caring Award  (submitted by Drs Bowlby, Greenblatt, and Zipkin)

Please join us in congratulating the Duke Outpatient Clinic residents, pharmacists, faculty, clinic leadership, nurses, and staff on winning both the quarterly and YEARLY Strength, Hope, and Caring Award this week.  The award is given by Duke Hospital Leadership to a single clinical unit that demonstrates outstanding teamwork and innovation. The Duke Outpatient Clinic was recognized for its innovative transitional care program for patients who have recently been discharged and for our extensive clinic redesign efforts. Our residents serve an integral role in providing comprehensive and evidence-based transitional care and contributed greatly to the development of this program.  Clearly, it is a team effort and we appreciate the ongoing effort from all members of the staff to ensure that our patients are seen promptly and we are doing all possible to  help the patients recover and avoid repeat hospitalization.  Come by and check out our gigantic trophy!


LPS Snapshot (submitted by Dr. Wei Duan-Porter)

LPS Snapshot Update–Kirby is leading, Kempner is close behind!  Don’t miss this opportunity to provide feedback about your continuity clinic experiences, and earn $400 for the charity supported by your Stead Society!

  • $250 for the highest response rate – and
  • $150 for every Stead above 75%

Thank you to all those who have already responded!

ACP Celebrates Young Achievers (Submitted by the American College of Physicians)

“I am writing to share with you that the College will be celebrating resident(s) from your program as part of our ACP Celebrates Young Achievers initiative during Internal Medicine 2014, from April 10-12, in Orlando, Florida.

ACP is proud to have such high caliber Resident/Fellow Members, including the following from your program:

QI/Patient Safety – Jennifer Anne Rymer, MD
Clinical Research – Jennifer Anne Rymer, MD
Clinical Vignette – Joseph D Brogan, MD
Clinical Vignette – Michael Woodworth, MD

This group of early career internists demonstrates academic excellence and represents the best of what the future of internal medicine holds. We hope that you will recognize their achievements in your program. In turn, we will celebrate them at our meeting and urge our ACP chapters to celebrate them locally in any future activities being held for residents in the chapter.”

Maestro Care Mobile Apps Now Available For Providers and House Staff

Maestro Care mobile apps, Haiku and Canto, are available to providers and house staff across Duke University Health System. The apps have been developed by Epic to allow access to a subset of Maestro Care features while on-the-go. Haiku is available for iOS and Android smartphones, while Canto is available for iPad.

In addition to providing convenient access to view patients’ charts, these apps also allow providers to:

  • Manage In Basket messages
  • View clinical schedules
  • e-Prescribe outpatient medications
  • Take clinical images and save to a patient encounter
  • E&M and procedure charge capture (coming soon)

To get started, simply visit the Maestro Care Mobile Device Support website from your mobile device while on the hospital intranet (i.e., “clubs” network) and follow the three simple steps to download, configure and log in to the apps.

If you have any questions regarding app configuration, please refer to the “Frequently Asked Questions”’ section on the support page. Please note that the Duke Medicine Service Desk cannot provide assistance with downloading and installing the apps on your device. Finally, prior using the apps, be sure to complete the 7-minute LMS training entitled “Maestro Care Mobile Apps Security and Compliance Considerations,” which highlights proper use of the applications. You will also receive an email reminder to complete the training within 30 days.



Upcoming Dates and Events

  • April 11:  Final Faculty Resident Research Grant applications

  • April 17:  Financial Planning Seminar
  • April 18:  Charity Auction
  • April 18:  SAR Class Picture (rescheduled)
  • April 22:  CPC Event, 7 PM @ The Pit
  • May 2:  Faculty/Resident BB Game on Coach K Court
  • May 3:  the Stead Tread 5K
  • May 30:  Program pictures @ Duke Chapel 9:15
  • May 31:  SAR Dinner, Hope Valley CC
  • June 3:  Annual Resident Research Conference
  • June 6: Serve dinner at the Ronald McDonald House

Useful links



by · Posted on April 6, 2014 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Internal Medicine Residency News: March 31, 2014

HargettFrom:  Bill Hargett, MD

Associate Program Director

In the midst of rounding on Duke GenMed this week (go team 1A/1B!), I’m pinch-hitting Updates for Dr. Zaas.  Aimee and the Zaas family say “Hi” from Caesaria and the Rosh Hanikra caves—you can see that she’s enjoying a well-deserved vacation!


The ACC built on their dismal first week in the NCAA tournament with Virginia falling to Michigan State in the Sweet 16.  If your bracket is busted and you’ve shed #DukeTears, then maybe bidding on a pair of autographed, game-worn Bat Shoes at the upcoming charity auction will remind you of the glory years….  Also, the kids tell me that wearing tight kicks like these help when you’re versing the attendings at the upcoming annual Housestaff vs. Faculty Basketball game (though I suppose not many of us wear a size 14 shoe…).

Gotta give props to Trevor Posenau, Lindsay Anderson, Mike Shafique, and Kaley Tash for fantastic SAR talks (thanks, Vaishali).  KotW (Kudos of the Week) @DinushikaMohottige, who wins the Feedback Triple Crown, receiving praise from a patient, a peer, and a supervising physician.  Notes from Laura Musselwhite and Josh Thaden and a letter from a patient frame a wonderful narrative describing Dinushika’s hard-work, compassion, and excellent clinical care.  There are other stories heard too – thanks to all of you for the extraordinary things, big and small, that you do each day here at Duke.

The proverbial cup continues to runneth over with resident accolades and accomplishments and there were several excellent choices for PubMed of the week.  Take some time to check out an article by one of your colleagues:

Mitchell AP, Hirsch BR, Abernethy AP. Lack of timely accrual information in oncology clinical trials: a cross-sectional analysis. Trials. 2014 Mar 25;15(1):92. [Epub ahead of print] PubMed PMID: 24661848.

The “Clinic Corner”

(submitted by Alex Cho, MD)

When was the last time you saw someone in clinic (or ACC at the VA) who presented for STI screening/diagnoses/treatment?

April happens to be National Sexually Transmitted Infection Awareness Month, and to commemorate this, I wanted to follow on Sharon Rubin’s mention of HIV screening in last week’s excellent WDIRTW (re: hepatitis C prevalence and the USPSTF recommendation to screen all adults born between 1945 and 1965 at least once), by sharing a framework for using these problem-focused STI-related visits as “teachable moments” to inquire about and counsel patients about potentially high-risk sexual behaviors.

This framework comes from the RESPECT Program, an RCT-validated approach to HIV prevention.  And even though this and other available evidence of the benefit of counseling has been for relatively high-intensity interventions; the same principles can be translated into your own practice.

1. Introduce and orient the patient

“I’m glad you are here.” “What would you like to know before you leave here today?” “What are your specific concerns?” “In addition to addressing today’s issue, would it be ok to use this opportunity to explore together what you might be able to do to stay safe/prevent another occurrence?”

2. Identify client’s personal risk behaviors and circumstances

(Risk Behaviors: Sex or drug use actions that in and of themselves can result in transmission of HIV/STI.)  “How did you decide to get tested/treated today?” “Tell me about the event(s) that brought you to the clinic today?” “How many different people do you have sex with and how often?” “How often do you use drugs or alcohol, and how does this affect who you might have sex with, and whether you use protection?”

3. Identify potential safer goal behaviors

(Safer Goal Behaviors: These are specific actions that directly prevent or greatly reduce HIV/STI transmission and that the client is willing to try to adopt.) “Is there a specific time that you remember where you were able to practice safer sex (used needles safely, used a condom)? What did you do? What made it possible for you to do it?” “What are you presently doing to protect yourself?” “What would you like to do to reduce your risk of HIV/STI?” 

4. Develop patient action steps
(Action Steps: Specific incremental steps a client can/is willing to take (and reasonably confident in their ability to carry out) to help him or her adopt a safer goal behavior.) “What do you think you can do in the next few days/weeks to reduce your risk of HIV/STI?”

5. Make any referrals necessary and provide support

6. Summarize and close visit, telling patient how you will follow up (re: test results, et al.)

Although it is obviously difficult to add yet another item to a long list of recommended prevention-related tasks, for these focused visits having a go-to “script” or routine can make it a more natural conversation, and the visit more efficient and potentially more impactful overall.

And you can always ask patients to come back to address their other sets of issues (chronic disease management, health maintenance) – particularly if you sense a real opportunity to nudge a patient towards less risky behaviors.  Just take a minute to make sure they come back to you by putting down a range of dates in your follow-up instructions, as well as confirming with patients and writing out in your plans the issues you will tackle next time.  (Shorter follow-up times for more frequent “prepared” visits will also increase the likelihood you will see your own patients in general, because your clinic schedules are available to the clinics about 3 months in advance.)

Lin J, Whitlock E, O’Connor E, and Bauer V. Behavioral counseling to prevent sexually transmitted infection. Ann Intern Med 2008;149:497-508.

Navy and Marine Corps Public Health Center. Fundamentals of HIV-STI Prevention Counseling Student Manual. October 2012. Available at:

QI Corner (submitted by Joel Boggan, MD)

Three dates to keep on your calendar:

  • 4/10, 6-7:30 pm in the Med Center Board Room in Duke South – Dr. Dev Sangvai speaking on ‘Accountable Care Organizations’
  • 4/12, 5:30-6:30 pm in the Med Res Library – next Medicine PSQC meeting, food provided.
  • 4/24, 12-1 pm, our next Resident M&M conference.

From the Chief Residents

SAR Talks

 April 1: Armando Bedoya;  Jennifer Chung

Grand Rounds

Dr. Elva Arrendondo (visiting professor) .

Noon Conference

Date Topic Lecturer Vendor Room
3/31 MKSAP Mondays – GI V. Patel/Chiefs Chick-Fil-A Med Res Library / 8262
4/1 SAR TALKS Armando Bedoya Jennifer Chung Bullock’s BBQ 2002
4/2 IM-ED Combined Conference Trowbridge/EM Cosmic Cantina 2002
4/3 Essentials of Acute Pancreatitis Vaishali Patel Saladelia Wraps 2001
4/4 Chair’s Conference Chiefs Rudino’s 2002

From the Residency Office

Charity Auction!!!

The auction is just two weeks away (April 18th).  Lauren Dincher will be selling tickets at Grand Rounds and also during regular office hours in suite 8254.

What’s new this year?  We now have our own credit card machine, Battierwhich means you can buy your tickets with Visa or Master Card (sorry, we do not accept payment by bitcoin yet – but who knows. maybe in 2015!)

And, as special attraction for the basketball fans out there, take note that we will be putting up for bid a pair of signed basketball shoes worn by Shane Battier!!

Mini CEX Madness – Week 4

Thank you to everyone for another great March “Mini CEX” Madness!  We had Foster33 completed, and Jenn Chung was selected is the winner for the 4th and final week of CEX Madness.

As to the grand prize winner (the $50 dinner), that now belongs to Gena Foster!  Congratulations!!

Additions to the Event Calendar

Take note of the following additions to the event calendar that we post each week:

  • Clinical Pathology Conference:  April 22
  • Faculty Resident Basket Ball Challenge:  Friday, May 2 – in Cameron Indoor Stadium
  • Ronald McDonald House:  June 6 (providing dinner to patient’s families, coordinated by Steve Crowley)

Housing Information (submitted by Jen Averitt)

As  a reminder for both incoming and outgoing trainees, the Duke GME website includes a link for current housing both for rent and to own:

If you are interested in posting a listing, please follow the instructions on the site and if you are interested in new housing, please check the site regularly for updates.  In addition, the MedRes office will create a Resource/Document folder in MedHub for housing options, where we can also post available properties for all trainees to access.  If you have a property you would like to post, please email for more information.

ACLS/BCLS Reminders (submitted by Lauren Dincher)

I just wanted to send a reminder out to everyone reiterating our policy for taking ACLS/BLS training. Before scheduling the class, please get approval from the Chiefs. Once approved, send me your date and time so that I can update your schedule. I need to do this for scheduling and location reporting purposes.

If you have recently taken one or both of the classes and it is not on your Amion/Medhub schedule, please send me the day and time frame that you took the class so that I can update your schedule. Thanks so much!

Stead Tread – Sign up!

The Kempner Stead Society invites you to participate in the the 3rd annual Stead Tread 5k Run/Walk on May 3rd at 10AM, with all donations benefitting the Lincoln Clinic.  This 5k Run/Walk was first organized two years ago and has been a great success, raising over $10,000 for Lincoln.  We’ve had over 100 residents, faculty, staff and patients run with us each year, and we are looking to make this year’s race an even bigger success!

Go to to register or donate!

NC Medicaid Expansion

On April 8th, students from the Sanford School of Public Policy will present a proposal for expanding Medicaid in North Carolina.  This proposal was developed through a Medicaid Practicum course facilitated by Professor Don Taylor. The purpose of the course was to craft recommendations for the NCGA-appointed Medicaid Reform Advisory Group to consider as they looked at different ways to reform Medicaid in North Carolina.  This is a unique opportunity to better understand Medicaid policy in North Carolina, and how it may affect our patients.

When: April 8, 5:30PM – 6:30PM

Where: Rhodes Conference Room, Sanford School of Public Policy


Upcoming Dates and Events

  • April 11:  Final Faculty Resident Research Grant applications
  • March 31:  GI Interest Meeting (contact Jill Rimmer, GI PC)
  • April 17:  Financial Planning Seminar
  • April 18:  Charity Auction
  • April 18:  SAR Class Picture (rescheduled)
  • April 22:  CPC Event, 7 PM @ The Pit
  • May 2:  Faculty/Resident BB Game on Coach K Court
  • May 3:  the Stead Tread 5K
  • May 30:  Program pictures @ Duke Chapel 9:15
  • May 31:  SAR Dinner, Hope Valley CC
  • June 3:  Annual Resident Research Conference
  • June 6: Serve dinner at the Ronald McDonald House

Useful links


by · Posted on March 31, 2014 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Internal Medicine Residency News: March 24, 2014

From the Director


So, clearly a HUGE week for our residency program family! Cannot possibly explain how excited we are about the new interns.  And another THANK YOU to our incredible team of residents, chief residents, APDs (especially “King Of RecruitmentDavid Butterly), staff (especially “Goddess and Ambassador of RecruitmentErin Payne), faculty and Dr. Klotman for showing our newest team members why Duke Medicine is the greatest.   See below for the AMAZING class list!

2014 – 2015 Categorical      2014 – 2015 Prelim

2014 – 2015 Med-Peds         2014 – 2015 MedPsych

We have another new member of our family….William Shumate! Congratulations Jenn Rymer IMG_0217and Daniel Shumate on the birth of your son!Cameron Hostler told me at the recruitment party that he plans to tease his “little chief” brother mercilessly, since he learned this from his dad.

Lots of kudos came my way this week about our current residents….from a patient (via Dr. Aimee Chung) to Amanda Verma for outstanding and compassionate care on Gen Med, to Ashley Bock, CeCe Zhang and Sarah Goldstein from Stephanie Norfolk for outstanding “JAR level” work in the DRH MICU, from Susan Spratt to Monica Tang, Alex Clark and Amanda Elliott for their work on the diabetes phenotyping project, to John Stanifer for his work screening for renal disease in Tanzania on WORLD KIDNEY DAY, to Laura Musselwhite, Kevin Trulock, Allyson Pishko and Venu Reddy from Kedar Kirtane for being a great Duke Night Resident team, to Joel Boggan for leading our resident M and M, to Anne Mathews and Ashley Lane for excellent SAR talks, and to Andrea Sitlinger from Alice Grey for excellent work on the pulmonary transplant service.

Things start to move really quickly at this point in the year….How to Be A JAR is coming soon, as is the auction, and a CPC, and next year’s schedule, and many other end of year activities.  Keep up the MINI CEX work during CEX madness.  It’s not brackets, but it’s important to your learning and development!

This week’s pubmed from the program goes to Phil Lehman, to be presented at the  2014 AHA Quality of Care and Outcomes Research Conference in June, 2014!

Title: Early Telephone Follow-up Fails to Reduce Readmission Rates for CHF & AMI;  Authors: Lehman EP, Granger BM, Pura J, Lohknygina Y, McCarver C, Shah B.

HAVE A GREAT WEEK….next week, updates come at you from guest writer BILL HARGETT!



The “Clinic Corner – PRIME Clinic – VA Medical Center”

(submitted by Sonal Patel, MD)

I can’t believe Spring is here and hopefully no more snow or ice.  You would think living in Chicago for 12 years would make me immune to the weather but unfortunately not the case.  I also can’t believe it is March and the year is wrapping up.  It has been my absolute pleasure to work in PRIME clinic with you residents and while it will be bittersweet to see the seniors graduating and moving  on it has also been gratifying  seeing the interns  and juniors graduating and gaining self confidence in their skills.

During this last month I have noticed a few things that I wanted to share:

1.       All of you have been so gracious helping  out your fellow residents when  unforeseen hitches in clinic require another residents assistance

2.       The number of ACS messages you receive are TNTC (too numerous to count) and  you have been able to manage them so seamlessly with all of your other responsibilities

3.       Each and every resident that has voiced a problem in clinic has also brought up possible suggestions for improvement, which is so appreciated.  Please continue to think outside the box and be innovative with solutions.

4.       All of the residents that are  helping  implement changes in  PRIME clinic are doing them willingly and with full effort.  I am in awe of your dedication and willingness to help

On to the updates:

1.       Monday AM huddles-  The PRIME staff have enjoyed getting the residents perspectives during our Monday am huddles, please continue to speak up and voice any suggestions either in the meetings or outside of them

2.       FLOW analysis- Data was gathered on Wednesday March 18, thanks to everyone in clinc that day entering the data, I will keep you posted on the results

3.       Our 3rd LPN will be joining us shortly, we are so excited to have our full complement of nurses, our MSAs (Clerks) are still short staffed but hopefully we can get those positions filled ASAP

4.       Chronic Pain Management- we have moved to the first of the month, seems to be working well, please let us know of any issues/suggestions

Looking forward to wrapping up the year with you.

What Did I Read This Week?

Submitted by Sharon Rubin, MD

Denniston, Jiles, Drobeniuc, Klevens, and Others. “Chronic Hepatitis C Virus Infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010.” Annals of Internal Medicine. 2014;160:293-300.

When I first read on the USPSTF web site in 2013, I was skeptical. Was Hepatitis C so prevalent that now every adult born between 1945 to 1965 should be offered Hepatitis C screening?

The USPSTF recommends screening for hepatitis C virus (HCV) infection in persons at high risk for infection. The USPSTF also recommends offering one-time screening for HCV infection to adults born between 1945 and 1965. 

Grade: B Recommendation (which will be covered by Affordable Care Act)

There is an estimated  >3 million people in the US have chronic HCV infection (this was extrapolation from blood samples in NHANES  which  underestimates the number as this did not include homeless or the incarcerated). Now with current treatments of pegylated interferon, ribavirin, and a protease inhibitor (either boceprevir or telaprevir) especially for genotype 1 can cure HCV, decrease HCC and death. There are new drugs coming down the pipeline which can improve compliance and down stream effects. Many people are unaware of their status as they are asymptotic. There are more HCV deaths now than HIV.

This NHANES study looked at data from 2003 to 2010, blood samples and interviewed patients to determine risk factors for HCV. The estimate is 1.3% patients = 3.6 million people had past or current HCV; 1%= 2.7million people have chronic HCV which is actually a decrease from past estimates (they do not attribute this decrease to treatment as people who know they have HCV do not go for further treatment). They postulate that deaths from HCV were underreported and mortality from people with HCV has increased. They attribute more of theses deaths from the “Baby Boom” generation (1945-1965).  Identified risk factors were still the same: injection drug users, person who received blood transfusions before 1992. Their analysis showed that people born between 1945 -1965 had 6x greater prevalence (making up 81% of all the people with HCV). The hope is to identify 800,000 more people with HCV, guide them to treatment and save 120,000 deaths.

I needed to put this information into the perspective of HIV. HIV was a new and scary disease in the 1980 that received generous media coverage and funding for virology and for treatment. Taken from USPSTF “An estimated 1.2 million persons in the United States are currently living with HIV infection, and the annual incidence of the disease is approximately 50,000 cases. Since the first cases of AIDS were reported in 1981, more than 1.1 million persons have been diagnosed and nearly 595,000 have died from the condition. Approximately 20% to 25% of individuals living with HIV infection are unaware of their positive status.” The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults ages 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened.  Grade: A Recommendation The USPSTF recommends that clinicians screen all pregnant women for HIV, including those who present in labor who are untested and whose HIV status is unknown. Grade: A Recommendation

For HCV there is estimated 2-3% =130-170 million people world wide with HCV and 500,000 died of HCV related conditions A YEAR compared to the 595,000 HIV deaths that in the US in total from HIV. 2.7 million people with HCV vs 1.2 million people with HV. Focusing on patients who have risk factors (homeless, incarcerated, instutionalized, IV drug abuse, blood transfusions) is a start but I understand now to at least offer the Hepatitis C screen to patients born between 1945-65 without risk factors. I am relieved that insurance, the affordable care act, will cover the screening for HCV but I do worry about the cost of evaluation and treatment of HCV as these are still new treatments, not generic, who will pay then? I understand the hopes of the CDC. HCV is a disease that can be easily identified, possibly treated, and hopefully eradicated.


QI Corner (submitted by Joel Boggan, MD)

High Value Care Lecture Series and QI Conferences
Wednesday, the 26th, features a couple of QI conferences.  At noon, Dr. Alex Cho will be leading us in the next of the High Value, Cost-Conscious Care series, on ‘Balancing Benefits with Risks and Harms’ in 2002.  Please be there right at noon so we can get started on time!

That evening, Dr. Bimal Shah will be presenting ‘Quality in HealthCare’ for the Incentive Task Force’s High Value Care series in Trent Semans Classroom 3 from 7-8 pm. 

Hand Hygiene Update
For those of you unable to make it to M&M this week, here are our ward numbers for February.  March updates will be out in two weeks . . .

Ward  Compliance Rate
7100        23 / 25         92%
7300        21 / 24         88%
7800        18 / 19         95%
8100         9 / 11          82%
8300      21 / 21       100%
9100         8 / 9            89%
9300         9 / 10          90%

OVERALL:          91.5%
AGGREGATE:   88.6%


From the Chief Residents

SAR Talks

March 25:  Lindsay Anderson / Trevor Posenau

March 27:   Kaley Tash / Mike Shafique

Grand Rounds

Dr. John Williams – General Medicine

Topic: Shared Decision Making

Noon Conference

Date Topic Lecturer Time Vendor Room
3/24 MKSAP Mondays – GIM Bergin/Chiefs 12:00 Picnic Basket 2002
3/25 SAR TALKS Lindsay Anderson / Trevor Posenau 12:00 Pita Pit 2002
3/26 QI Patient Safety Noon Conference Alex Cho 12:00 China King 2002
3/27 SAR TALKS Kaley Tash /         Mike Shafique 12:00 Domino’s 2001
3/28 Research Conference 12:00 Panera 2002


From the Residency Office

Mini CEX Madness – Week 3

Week # 3 of Mini CEX Madness.  We had 7 CEXs completed this week , and our winner is Stephanie Giattino!  We’ve got one more week to go – let’s keep those CEXs coming!  As a reminder, everyone who has at least one completed during the month of March will be entered in a drawing to win a $50 dinner to a local restaurant of your choice (alcohol not included)!


World Kidney Day (submitted by John Stanifer)

Take note that the World Screening Kidney Day made it to the ISN website.




Upcoming Dates and Events

  • April 11:  Final Faculty Resident Research Grant applications
  • March 31:  GI Interest Meeting (contact Jill Rimmer, GI PC)
  • April 17:  Financial Planning Seminar
  • April 18:  Charity Auction
  • April 18:  SAR Class Picture (rescheduled)
  • April 22:  CPC Event, 7 PM @ The Pit
  • May 3:  the Stead Tread 5K
  • May 30:  Program pictures @ Duke Chapel 9:15
  • June 3:  Annual Resident Reseach Conference
  • May 31:  SAR Dinner, Hope Valley CC

Useful links


by · Posted on March 23, 2014 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Celebrating Match Day 2014

The Internal Medicine Residency Program filled all of its spots – 41 categorical, 9 preliminary (6 neurology, 1 radiation diagnostic, 1 radiation oncology, 1 ophthalmology), 6 med/peds and 2 med/psych – with outstanding applicants. The categorical interns will come from 30 different institutions, including six from Duke, one from Duke-NUS and one from Beirut. Twenty of the categorical interns are female, 21 are male.

The names and medical schools of this incoming class will soon be added to the map on the Residency website. Take a look and see the geographic diversity of our residents – Duke draws from an impressive expanse of the nation.

by · Posted on March 21, 2014 in Internal Medicine Residency · Read full story · Comments { 0 }

DoM posters recognized at Duke Medicine Patient Safety and Quality Conference

UnknownThe Department of Medicine and Internal Medicine Residency Program were well-represented at the 9th Annual Duke Medicine Patient Safety and Quality Conference. Below find a list of DoM winners and participants:

Winner: Rebecca Kirkland Award
Cefaretti, M, Smith, B, Causey, H, Bowlby, L, Cheely, G, Cho, A, Dillard, J, Johnson, B, Knutsent, K, Rutledge, C, Simo, J, Bae, JG.
“Impact of Transitions of Care Services in an Internal Medicine Clinic Population.”

Jolly Graham A, Bae JG, Clark A, Timberlake S, Isaacs P, Chen L, Wright S, Buckner C, Thompson L, Martt R, Clausen J, Stillwagon MJ, Spurney Y, Setji N.
“A Flash in the (Bed) Pan or Sustained Success? The ‘Just Pull It’ Campaign One Year Later.”

Broderick, K, Hunter, W, Sharma, P, Schulteis, R, Zaas, A, Bae, JG.
“Doctor Who? A Study of Patient Provider Awareness.”

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by · Posted on March 19, 2014 in Awards - honors, Internal Medicine Residency, Quality Initiatives, Research · Read full story · Comments { 0 }