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Internal Medicine Residency News: December 23, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)

Hello everyone! Can’t believe we are closing out 2013. I hope you all enjoy a well deserved holiday with your family and friends – I also look forward to seeing half of you on the Xmas block! We will enjoy dinner from Dr Klotman on the 24th and the other tradition of Chinese food on the 25th with PSK and me.

Kudos this week to Liz Kotzen, Bobby Aertker and med student Tom Lefevre on their gold stars. Also to Marc Samsky from Allyson Pishko for his work at the VA and to the Duke NF crew  of Nick Rohrhoff, Iris Vance, Rachel Titerance and John Yeatts for handling the deluge with smiles. We heard great SAR talks from Mandar Aras and Jeremy Halbe as well.  Thanks also to Chris Hostler, Aparna Swaminathan, Jesse Tucker, Emily Ray, Jenn Rymer and Carli Lehr for resident share on Friday. And, finally, congrats to Dr Simel on receiving a congressional award for his longstanding achievements at the VA!

And – awesome job Steve Bergin, Meredith Clement and Mike Shafique for our first high value cost conscious morning report followed by a similar noon conference.  Team Klotman beat Team Zaas in the morning and team Lehman was victorious at noon. Overall, we all worked hard to bring stewardship into our work ups. More of these to come!

PubMed from the program: Carling Ursem, MD, PGY3, Poster presentations (two) at the San Antonio Breast Cancer Symposium December 2013  Mentor: Gretchen Kimmick, MD

“Does socioeconomic status influence receipt of guideline concordant care in older women with breast cancer: Findings from a Centers for Disease Control and Prevention National Program of Cancer Registries (NPCR) patterns of care study”

Have a great week and an even better Christmas/New Year!

Aimee

 

2015-16 Chief Residents for the Internal Medicine Residency Program

chiefs15_16It is with great pride that we announce the 2015-16 Chief Residents for the Internal Medicine Residency Program.  We are proud to partner with the Durham VA Medical Center and Duke Regional Hospital in selecting these outstanding individuals who join in an important and longstanding tradition of leadership in medicine.

The Chief Residents are chosen for their leadership skills and clinical acumen and are the most representative faces of the Internal Medicine Residency program for the year. The Chief Residency represents the largest investment in leadership made by the Department of Medicine, however the return on this investment is several-fold.

We look forward to our 2015-16 Chief Residents serving as teachers, role models and colleagues to our residents:

Jennifer Rymer MD, MBA – Duke University Hospital
Dr. Rymer is a graduate of Vanderbilt University, Vanderbilt University School of Medicine and the Vanderbilt Owen Graduate School of Management. She will be a fellow in the Cardiovascular Medicine training program beginning in July 2014.

Christopher Hostler MD, MPH – Durham VA Medical Center
Dr. Hostler is a graduate of the United States Military Academy at West Point, the Duke University School of Medicine and the UNC Gillings School of Global Public Health. He will be a fellow in the Division of Infectious Diseases and International Health beginning in July 2014.

Armando Bedoya, MD – Duke Regional Hospital/Ambulatory Medicine
Dr. Bedoya is a graduate of Brown University and the Warren Alpert Medical School of Brown University. He will be a fellow in the Division of Pulmonary and Critical Care Medicine beginning in July 2014.

 

QI Corner (submitted by Joel Boggan, MD)

Online module for specimen collection/labeling training:

Here is the link to the course. http://www.safety.duke.edu/OnlineTraining/SPEC100/

Specimen Labeling Error Process

 Please note the target start date is Monday 12/23/13.

What Did I Read This Week?

Submitted by Lynn Bowlby, MD

“Opioid Prescribing: A Systematic Review and Critical Appraisal of Guidelines for Chronic Pain”

Annals of Internal Medicine  12 November 2013 (online first)

As many of you know , chronic non cancer pain management is one of our major challenges at the DOC.  I had recently reviewed the literature for a noon conference presentation. This recent review reviews the current guidelines and assesses their use of the evidence. 1270 documents were found from Jan 2007 to July 2013, 1132 were screened, with 13 eligible for review. bowlbyphotoAnnual fatalities from opioids have increased from 4000 in 1999 to 14, 200 in 2006. Treating chronic pain during those years changed from little use of opioids to active encouragement of their use.  Long term use is defined as 3-6 mos or longer. Most of the studies of opioids are based on < 6 mos of use.AGREE II (Apprasial of Guidelines for Research and Evaluation ) and AMSTAR (A measurement tool to Assess Systematic Reviews) were used to evaluate the quality of the guidelines. Ratings were highest for the guidelines by the American Pain Society , the American Academy of Pain Medicine and the Canadian National Opioid User Guideline.  > 50% of the appraisers voted to use these guidelines without modification.  These guidelines linked evidence to recommendations to reduce the risk of opioids the most frequently.10 guidelines agree that benzodiazepine and opioids are a very high risk combination, especially the elderly. As the risks of opioids become more well understood, the dose recomendations have been put into effect.The conclusions?The guidelines agreed to avoid > 90-200 mg of morphine /day, advanced knowledge needed to prescribe methadone, knowledge needed of risks of fentyl patches, titrate cautiously, reduce dose 25-50 % when changing opioids, use opioid risk assessment tools, use written agreements and UDS to reduce the risks of opioids.  Much of these reccomendations are based on observational data or expert opinion.This guideline does not address the fundamental issue of using opioids for chronic non cancer pain. Studies are very limited, often < 6 mos of treatment, and greatly underestimate the risk of addiction and diversion.

From the Chief Residents

SAR Talks

SAR talks resume January 9th, 2014

Grand Rounds

Grand rounds resumes January 10th, 2014

Noon Conference

Noon conference resumes on January 8th with the first Schwartz Rounds of the new year

From the Residency Office

Rising JAR – SAR Preferences and Clinical Epidemiology

To those who have already submitted preferences – and there are a surprising number of early birds – please note that Lauren has made the following changes to allow you to update your selections even after hitting the “send button”.

The survey will now to allow you to use the same link that was emailed to you to go back in and edit the survey at any time up until the survey is closed on 1/8/14.

JARS — the Clin Epi applications will be sent out right after the new year.  Instructions for eligibility will be included with the application. If you apply, we assume that you are preferencing this over any other elective, so please don’t feel the need to put “points” towards Clin Epi.

Please address any questions you may have to Dr Zaas or the Chiefs.

MedHub Resource Documents

Reminder that all schedule resource documents are now located in a tab labeled “Schedule Resources” on your home page in MedHub, including details as to your current schedule and future block schedules as they are completed. 

 

Planning a future in the outpatient setting? Consider the ACLT

submitted by Lauren Porras, MD

“I applied to join the Ambulatory Care Leadership Tract in order to broaden my experiences and learning in ambulatory topics. During my JAR year, I was able to audit a course in the PorrasMaster’s of Clinical Leadership program which was a great way to learn how to adapt to various learning scenarios. The residents in ACLT also have a separate ambulatory curriculum together that is more streamlined throughout the experience. My favorite part about ACLT is the fact that your experiences can be very flexible, especially in the third year. This has been phenomenal option to help address the deficiencies I felt I had in ambulatory topics. I would encourage everyone to consider applying to ACLT and please let me know if you have questions!”

Four JAR spots and two SAR spots are now open for the 2014-15 academic year.  The track is designed not only for residents interested in primary care, but for those interested in ambulatory subspecialty careers, too.  And social events with like-minded residents and faculty are organized by Sharon Rubin and others.

If interested please contact Alex Cho, Stephen Bergin, or Daniella Zipkin.  A brief, one-page application will be due Monday, December 30.  You can also go to http://residency.medicine.duke.edu/duke-program/training-pathways/ambulatory-care-leadership-track for more information.  Thanks!

ACLT application form

Information/Opportunities

 Florida Internal Medicine
Corpus Christi Hospitalist
Pediatric Hospitalist-Houston Texas
BC_FlyerTemplate_Billings Internal Medicine 2013

Upcoming Dates and Events

  • January 15th:  “Voices in Medicine”
  • April 18th:  Charity Auction

Useful links

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

Chief Residents for 2015-16 announced

Mary Klotman, MD, chair of the department, Aimee Zaas, MD, MHS, program director of the Internal Medicine Residency Program, and David Simel, MD, vice chair for Veterans Affairs, have announced the Chief Residents for the 2015-16 academic year:

It is with great pride that we announce the 2015-16 Chief Residents for the Internal Medicine Residency Program. We are proud to partner with the Durham VA Medical Center and Duke Regional Hospital in selecting these outstanding individuals who join in an important and longstanding tradition.

The Chief Residents are chosen for their leadership skills and clinical acumen and are the most representative faces of the Internal Medicine Residency program for the year. The Chief Residency represents the largest investment in leadership made by the Department of Medicine, however the return on this investment is several-fold.

We look forward to our 2015-16 Chief Residents serving as teachers, role models, and colleagues to our residents:

Duke University Hospital Chief Resident

Jennifer Rymer MD, MBA, is a graduate of Vanderbilt University, Vanderbilt University School of Medicine and the Vanderbilt Owen Graduate School of Management. She will be a fellow in the Cardiovascular Medicine training program beginning in July 2014.

Durham VA Medical Center Chief Resident

Christopher Hostler MD, MPH, is a graduate of the United States Military Academy at West Point, the Duke University School of Medicine and the UNC Gillings School of Global Public Health. He will be a fellow in the Division of Infectious Diseases and International Health in July 2014.

Duke Regional Hospital/Ambulatory Chief Resident

Armando Bedoya, MD, is a graduate of Brown University and the Warren Alpert Medical School of Brown University. He will be a fellow in the Division of Pulmonary and Critical Care Medicine beginning in July 2014.

Please give Jenn, Chris and Armando your congratulations! We look forward to their leadership.

chiefs15_16

by · Posted on December 20, 2013 in Chief Residents, Medical Education · Read full story · Comments { 0 }

Faculty group repeats donation to support resident research

Faculty Connection, LLC – a consulting group made up of Medicine faculty members Danny BenjaminRob CaliffChris O’ConnorKevin Schulman and Ken Lyles, as well as former Duke faculty member Bob Harrington – once again will donate a portion of their profits to the Department of Medicine to help support resident research projects.

“We are glad to be able to make a small contribution to our Medicine Resident’s careers,” said Dr. Lyles on behalf of the group. They have donated $30,000 this year.

Faculty Connections gave $25,000 in 2012, and $22,500 in 2011.  Those funds helped support many of the projects presented at the Resident Research Night in 2013 and 2012.

“This is such a strong show of support for our house staff,” acknowledged Mary Klotman, MD, chair of the department, in a message to the group.

“Thank you for encouraging and supporting our house staff to pursue research projects, which continue to be of high quality and quite successful,” added Aimee Zaas, MD, MHS, program director for the Internal Medicine Residency Program.

Learn more about resident research projects, and the publications that result, on the Internal Medicine Residency Program site.

by · Posted on December 18, 2013 in Awards - grants, Internal Medicine Residency, Medical Education, Research · Read full story · Comments { 0 }

Internal Medicine Residency News: December 16, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hello! Countdown to mid-year is on. Look for next year’s schedule request forms in your email this week. Ok, now that I have your attention …..

Thank you to Dr. Klotman and the Department of Medicine for a fantastic holiday party, and a well deserved celebratory break for residents, fellows and faculty. It was wonderful to have a chance to see you all there. Many of us were sure this was the best attended and most energetic holiday party in years.  Pictures  will be posted on our website soon – #bestholidaypartyever!

Kudos this week to Rebecca Sadun from the VA for her care of a very ill veteran, and to Kim Bryan for similar excellent care. Also to Iris Vance for her work in the CCU last week from her colleagues. Also to our resident recruitment share participants Kristen Glisinski, Andrea Sitlinger, Marc Samsky, Jenn Rymer, Kevin Shah, Nick Rohrhoff and Adrienne Belasco.  Also, awesome SAR talks by Bronwen Garner and Alex Fanaroff? The December JAR dinner at Local 22 kitchen was a blast with Amit Bhaskar and the ladies (Erin Boehm, Carli Lehr, Sajal Tanna and Adrienne Belasco).  The January invite will be out soon.

Recruitment continues this week – it has been fantastic to see you all talking with all the applicants. See you again at lunch tomorrow!

Pubmed from the program this week goes to John Stanifer for his article in AJKD:  Inrig, Julia, Robert Califf, Asba Tasneem, Radha Vegunta, Christopher Molina, John W Stanifer,Karen Chiswell, and Uptal Patel. “The Lanscape of Clinical Trials in Nephrology: A Systematic Review of ClinicalTrials.gov.” Am. J of Kidney Disease. 2013 Dec; 13: S0272-6386.

Have a great week!

Aimee

QI Corner (submitted by Joel Boggan, MD)

Thanks!
Thank you to everyone who submitted abstracts to either the Duke Patient Safety and Quality Conference and the NC ACP state meetings this week!

Resilience Mini-Course
This Tuesday at 5:30, Dr. Bryan Sexton will be leading a session on resiliency in Duke North 2003.  All are welcome.

Thanks!
Joel

 

What Did I Read This Week?

Submitted by Vaishali Patel, MD

Assessing Physician Leadership Styles: Application of the Situational Leadership Model to Transitions in Patient Acuity.”

Skog et al. Teaching and Learning in Medicine: An International Journal, 24:3, 225-230 (Brigham and Women’s Hospital, Boston MA)

As we approach the holidays and transition to the second half of the year, I have been thinking about what my New Year’s Resolution is going to be for 2014.  My initial thought was “I will make a resolution to actually stick to my other resolutions for longer than the first two weeks of January.”  When I pushed myself a bit more to get past the resolutions about obligatory reductions of chocolate and caffeine intake and promising my husband to develop a healthier sleep schedule, I started to think about what I could do to improve my communication and leadership skills – not just for the second half of this year, but also as an upper level GI fellow running the endoscopy unit, as an attending rounding on a Gen Med service or a consult service, and as a teacher for trainees and students.  One of the things (of the many, many things!) that has been really fun for me this year has been watching the JARs transform into team leaders on Gen Med at the VA.  It is a fascinating leap to go from intern to JAR/team leader – one that I would argue is a more transformative transition than going from medical student to intern.  While observing the JARs during work rounds, I’ve learned a lot about the pressures of learning how to lead a team and become a teacher in the busy workflow of Gen Med while also trying on top of learning how to take care of patients, and I’ve been amazed (and proud!) to see how the JARs are able to adapt to deal with some of these challenges.  We are in the exciting process of expanding the simulation center at the VA, which has made me think about whether we could use it as a venue for team leadership simulation. We use the simulation lab for team leader training for a code blue, but we could expand this to other situations such as leadership training for changes in patient acuity, or patient transitions, if this is something that the rising JARs would find helpful in the spring.
 
Skog et al. at Brigham and Women’s Hospital were interested in assessing the situational leadership model (developed by Hersey and Blanchard) during transitions in patient acuity.  The situational leadership model is based on the idea that an effective leader is one that can change their leadership style to match the level of understanding and experience of their followers (recognizing the strengths and weaknesses of the learners on your team and adopting a leadership style that will best serve them and your patients).  The model describes four leadership styles that focus on both task-driven and relationship behaviors depending on the ability and willingness of your learners: directing, supporting, coaching, and delegating.  These styles range over a continuum that allows the leader to be dynamic and adopt an authoritative or a “hands-off” style when appropriate. It has actually been applied to nurses, but has not been validated with medicine residents.
 
In this study, Skog et al. used a simulation center to create hospital-floor-based scenarios. The residents at Brigham participate in simulated patient scenarios as part of a 1-month rotation on the Coordinated Medicine Teaching Unit (CTU). The senior resident was identified as the leader on a team with a variable number of 1st or 2nd year residents, medical students, and one nurse.  114 residents, students, and nurses participated in 20 scenarios.  The scenarios were taped, and consisted of 10 simulated patients with respiratory distress and 10 of patients with complete heart block which varied in acuity throughout the scenario.  The cases were graded for acuity using the Emergency Severity Index (validated in assessing patient acuity in the emergency triage process), where Level 5 represents the lowest acuity and Level 1 the highest.  To assess leadership styles, a research associate selected clips of the taped scenarios: at least one clip for every acuity level was included during which the team leader had physical behaviors or verbal statements (or personally performed a clinical task).  Two physician raters independently analyzed these clips to determine the leadership style demonstrated (each of whom had more than 20 years of experience teaching leadership skills and treating patients in medical teams, and board certified in Internal Medicine).  They also graded the senior residents on overall leadership effectiveness on a scale of 1-10, with 10 being most effective (the authors do not mention whether they used a previously validated assessment tool for this grading – my guess would be they did not). 
The average acuity of the scenarios was 2.73 (range = 2-4).  Figure 5 shows the leadership styles that were observed during times of acuity change – the most dominating style was supportive (38.02%).  The weighted kappa coefficient for interrater reliability was high (r=0.81).  The mean leadership effectiveness score was 6.55 (range 3-8), with moderate interrater agreement (r=0.74).  The mean number of times the leadership style changed for those residents who scored below the average for leadership effectiveness was 1.9, compared to 2.6 for those who scored above average for effective leadership.  The authors suggest that there may be a correlation between effective leadership and increased changes in leadership style, although conclusive data was not demonstrated (unclear whether there was enough data for regression modeling).There are some limitations of the study, like not controlling for the variability in the ability and willingness of the rest of the team members, or how familiar the team leader may have been with their abilities prior to the scenario, as both of these things would impact their leadership effectiveness and style and introduce confounding. It may have been better to Skog 1observe the scenarios in real time as opposed to rating pre-determined clips.  However, considering that there is no previous validation of this leadership model for medical residents, this study does provide some fodder for considering whether the model can be validated in different clinical situations with medical residents and establish a framework to help residents develop their leadership styles.In the figure below, D 1-4 describe the learner, and S 1-4 show the appropriate leadership style to match ability and willingness of the learner.

Skog 2

 

If you’re interested in reading more about the situational leadership model, see the following citations from this article:

1. Hersey P, Blanchard KH, Johnson DE. Management of organizational behavior:

Utilizing human resources. 7th ed. Englewood Cliffs, NJ: Prentice

Hall, 1996.

2. Blanchard KH, Zigarmi P, Zigarmi D. Leadership and the one minute manager:

Increasing effectiveness through situational leadership. New York,

NY: William Morrow, 1988.

3. Northouse, PG. Leadership: Theory and practice. 3rd ed. Thousand Oaks,

CA: Sage, 2004.

From the Chief Residents

SAR Talks

    Thursday, December 19:  Mandar Aras and Jeremy Halbe

Grand Rounds

Speaker: Dr. Larry Goldstein

TOPIC: Cryptogenic stroke

Noon Conference

Date Topic Lecturer Time Vendor
12/16 INTERVIEW
12/17 MED   PEDS INTERVIEW OR Difficult Death Debrief Galanos
12/18 12:00 Cosmic   Cantina
12/19 SAR   talks: “Biomarkers in Heart Failure” / Mandar   Aras / Jeremy Halbe 12:00 Domino’s

From the Residency Office

Rising JAR – SAR Preferences

Hard to believe, but the time has come to start thinking about the next academic year.  Access links to the on-line preference forms will be distributed via email on Monday.  Please read the directions carefully, and take note that the deadline for submission is right after the holiday break.

Cookies Anyone?

GME will be hosting the FIRST ANNUAL Cookie Extravaganza on Tuesday, December 17th, 1:00-3:00 p.m. in the bunker!  Please stop by and enjoy some sweet treats and holiday cheer, courtesy of GME and your Program Coordinators!

Message from Duke HR

“As we approach the Holiday Season and look to spend time with family and loved ones, Duke University Hospital would like to take the opportunity to recognize our employees for their continued commitment to our core value: caring for our patients, their loved ones and each other.  On December 20th from 11:00 am to 2:00 pm; 4:00 pm-8:00 pm and 11:00 pm-12:30 am in the Searle Lecture Hall  and December 21st from 1:00 pm – 4:00 pm Duke University Hospital will hold a Winter Reception for employees that work at Duke University Hospital.”

You will need a ticket to attend the event (please plan on attending only one).  Lynsey in the MedRes office has the tickets available for you to pick up during normal business hours.

Winter Reception Flyer 2013

Medhub Resource Documents

Reminder: We keep many useful scheduling documents on Medhub in your resource documents section. There are very helpful PDFs including “First Day of Rotation – Where do I go?” as well as all of the rotation schedules for the current block, the previous block and the upcoming block. I recently condensed all of the scheduling documents into one folder titled “Schedule Resources.” I am always here to answer any of your scheduling questions/concerns as well. Thanks! – Lauren Dincher

Planning a future in the outpatient setting? Consider the ACLT. Have fun, too! submitted by Kim Bryan, MD

K Bryant“The Ambulatory Care Leadership Track (ACLT) has been a very fun and worthwhile experience.  The program has allowed me to spend extra time taking care of patients in the clinic setting which I truly enjoy.  In addition, I have had the opportunity to work closely with primary care leaders, develop friendships with fellow residents, and to explore various subspecialties such as dermatology, women’s health and sports medicine that will help me to provide comprehensive outpatient care.”

Four JAR spots and two SAR spots are now open for the 2014-15 academic year.  The track is designed not only for residents interested in primary care, but for those interested in ambulatory subspecialty careers, too.  And social events with like-minded residents and faculty are organized by Sharon Rubin and others.

If interested or if you have questions please contact current ACLT leaders Alex Cho, Stephen Bergin, and Daniella Zipkin.  A brief, one-page application will be due Monday, December 30.  You can also go to http://residency.medicine.duke.edu/duke-program/training-pathways/ambulatory-care-leadership-track for more information.  Thanks!

ACLT application form

Holiday PartyOffice staff

One picture to share of the program front office staff having fun at the Washington Duke Inn Saturday evening.  Hoping everyone had as much fun as this group did – and to all,  best to you and your families as we approach the holiday break and prepare for the new year!

 

Chief Resident – Immersion Training (CRIT) Reception

Immersion Training

 

Information/Opportunities

 
 Aspirus Internal Medicine Opportunities 12.9.13
 
Doctor Loan Presentation

Upcoming Dates and Events

  • January 15th:  “Voices in Medicine”

Useful links

by · Posted on December 15, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Voices of Medicine, Weekly Update · Read full story · Comments { 0 }

DoM welcomes incoming fellows to its 11 training programs

The Duke Internal Medicine Residency Program celebrated with the senior assistant residents last week when they learned their placement into many of the nation’s top fellowship training programs.

The Department of Medicine will welcome fellows from across the country to its 11 fellowship programs. See where the fellows are coming from:

Fellows coming to Duke

Cardiovascular Disease
Drew Ambrosy – Stanford
Alex Fanaroff – Duke
Stephen Gaeta – UCSF
Ajar Kochar – Johns Hopkins
Philip Lehman – Duke
Adi Mandawat – Brigham and Women’s
Jennifer Rymer – Duke
Nishant Sekaran – University of Washington
Endocrinology
Elizabeth Campbell – Duke
Kyle Jackson – Wake Forest
Abby Tubman – Brown
Gastroenterology
Scharles Konadu – Duke
Gabe Mansouraty – Mass General
Yuval Patel – Johns Hopkins
Rey Quevedo – Tulane
Hem/Onc
Sarah Anand – University of Michigan
Jennifer Choe – Baylor
Carter Davis – Duke
HeJeremy Force – Indiana
Syed Hassan – Wayne St
Michael Humeniuk – Mayo Clinic
Infectious Diseases
Meredith Clement – Duke
Christopher Hostler – Duke
Stacey Maskarinec – UCLA
Austin Chan – Emory
Nephrology
Shalini Bumb – Case Western
Robert Olivo – Vanderbilt
Supreet Sethi – Arkansas
John Stanifer – Duke
Pulmonary, Allergy & Critical Care
Sailaja Allamneni – Alabama
Armando Bedoya – Duke
Stephen Bergin – Duke
Anne Matthews – Duke
Roozbeh Shariff – University of Texas Medical Branch
Interventional Pulmonology
Mary Elmasri – UCSD
Rheumatology & Immunology
Samya Mohammad – VCU
Nichols Holdgate – MUSC
by · Posted on December 9, 2013 in Fellowship programs, Internal Medicine Residency · Read full story · Comments { 0 }

Internal Medicine Residency News: December 9, 2013

From the Director

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

Seems like winter is officially here!   December generally flies by, and this is no exception.  Thanks to everyone for keeping up the recruitment spirit.  This was a great week for our SARs, with the announcement of an absolutely SPECTACULAR fellowship match.  See the list below for where our fellowship-bound and job-bound Class of 2014 will be heading! We are all extremely proud of you.

SARS 2013-2014 MATCH LIST

Kudos this week go to Rebecca Sadun for her help with a coverage situation at the VA, to Meredith Clement and Aaron Mitchell for fantastic SAR talks, to Kim Bryan for a great Chair’s conference and to Hal Boutte and Jenn Rymer for speaking to the applicants at the end of recruitment day on Friday.  CONGRATULATIONS to Marcus Ruopp and Nikki Frederick on their engagement!  We also got to see 2013 graduate Mandy George on Friday, who came in town for 2013 graduate and heme onc fellow Megan Diehl’s wedding.  Congrats Megan!

This is the last week to submit your abstracts to the NCACP meeting.  Many of you have already done so.  Please let the me or the chiefs know if you need any help with the submission process. We look forward to having a strong presence in Greensboro at the meeting.  There is no Jeopardy competition this year, so unfortunately we cannot defend our title.  Wait til next year!

This week’s Pubmed from the Program goes to 2013 graduate Adam Garber for his abstract presented at the recent AHA meeting.  This work was supported by a resident research grant:  Predictors of left ventricular thrombus formation following ST segment elevation myocardial infarction : findings from the Duke databank for cardiovascular disease and the Duke echocardiography database;  poster presentation at the annual meeting  of the American Heart Association in Dallas Texas November 2013, By Adam Garber   Mentor: Eric Velazquez,MD.

We look forward to seeing you all at the Medicine Holiday Party on Saturday night!

Aimee

 

QI Corner (submitted by Joel Boggan, MD)

Duke Quality and Safety Conference
Abstracts are due Monday, 12/9.  Thanks to all our residents who are submitting – we’ll send out a list next week.  Please let us know if you need a last minute review of your work!

Medicine PSQC Wednesday

We’ll have our next Medicine PSQC meeting on Wednesday at 5:30 pm in the Med Res Library.  Food will be provided, please RSVP to Jon and I so we can keep an accurate count . . .

Medication Safety Alert

The FDA has recently advised for a change in the coloration and labeling of fentanyl patches for patient use, which will make them more identifiable when used.  However, not all these may have been switched over by companies yet, so beware of the appearance of these patches!!!  If any similar patch/dressing is on a patient (especially if transferred from an outside facility), think about the possibility of it being a fentanyl patch

Institute for Healthcare Improvement

The annual IHI conference is this Tues/Wed, and Jon Bae is giving a presentation about our Incentive Program.  Congrats to Jon – if you’re interested in watching any or all of the conference at the Duke South Amphitheatre, you may register at this link . . .

http://raleigh.eventful.com/events/duhs-satellite-broadcast-ihis-25th-national-forum-qi-/E0-001-060922075-0

 

What Did I Read This Week?

By Jen Averitt, Sr. Program Coordinator, Internal Medicine Residency Program

Closing Address for Former President Nelson Mandela

XII International AIDS Conference, July 14, 2000, Durban, South Africa

 With the passing of Nelson Mandela this week, people and nations around the globe are mourning the loss of a man who embodied moral courage.  An activist and leader in the anti-apartheid movement, his ascension from prisoner to the first black president of South Africa illustrate the remarkable journey of a man whose life was spent in the pursuit of freedom, dignity and equality for all.  As such, I felt compelled to read not one of the many well-deserved tributes written in his honor, but rather the words of the man Nelson Mandelahimself.  In doing so, I selected his closing address at the XII International AIDS Conference, held in 2000 in Durban, South Africa, both as a topic that I hoped would resonate with members of the medical community and to remember the role he played in the fight against HIV/AIDs, specifically in Africa.While Mandela’s closing remarks in Durban are considered by some to be a “watershed” moment in the fight against HIV/AIDS, he was also widely criticized for the lack of attention he paid to the spread of the disease in South Africa in the 1990s during his presidency.  At the time of this conference, South Africa was the worst-affected country on the planet, with more than 4 million people infected and rising.  Directing his attention towards the political infighting that existed at the time, both within government and scientific communities, he reminds his audience of the devastation the disease has caused on a human level, and the unspeakable toll it has taken on his own country of South Africa.  The weight of the man can be felt in his words; they are direct, powerful and forceful in their impact.The import of this speech is not about numbers, or statistics, or even the politics of the moment.  This speech is, in my opinion, a beautiful reflection of the greatness of the man giving it.  Nelson Mandela spent his life reminding us all of the importance of humanity, in every sense of the word. His remarks that day have their greatest impact when he reminds us not only of the human cost of the disease on its victims, but of the cost inaction will have on humanity as a whole.We all have heroes – men and women who have impacted us as individuals and as a society.  I know that for a great many people, and nations, Nelson Mandela is true a hero.  I think the conclusion of his speech reminds us why:“…it is the humble men and women that you find in all communities but who have chosen the world as the theatre of their operations, who feel the greatest challenges are the socio-economic issues that face the world like poverty, illiteracy, disease, lack of housing, inability to send your children to school-those are my heroes.”
 

From the Chief Residents

SAR Talks

   Thursday, December 12, 2013

     Bronwen Garner and Alex Fanaroff

 

Grand Rounds

Dr. Larry Goldstein PFO and Cryptogenic Stroke

Noon Conference

Date Topic Lecturer Time Vendor
12/9 INTERVIEW
12/10 MED   PEDS INTERVIEW
12/11 Lipid   Management Update Daniella Zipkin 12:00 Baked Potato Bar
12/12 SAR   talks: Physician’s Guide to the Affordable Care Act / Bronwen Garner / Alex Fanaroff 12:00 Bullock’s BBQ
12/13 INTERVIEW

From the Residency Office

Wanted: Future leaders in ambulatory care

Have you thought about how your training provides the kinds of knowledge and skills you’ll need in your career?  For many medicine residents, a background in leadership, clinical teaching, advanced EBM, GreenblattLarry08communication, and strong ambulatory clinical skills will best support their career.  This is particularly true for our residents wanting to pursue careers in academic medicine or perhaps as physician leaders — which led me to create the Ambulatory Care Leadership Track (ACLT) a few years ago, with the support of Aimee and Randy and the MedRes Office.

Four JAR spots and two SAR spots are now open for the 2014-15 academic year.  I encourage you to consider applying, and talk to residents in the program or ambulatory faculty to see if the ACLT is the right choice for you.  The track was designed not only for residents interested in primary care, but also for those of you who are interested in ambulatory subspecialty careers.  We can promise you social events and camaraderie with like-minded residents and faculty, too, organized by Sharon Rubin and others.

If interested or if you have questions please contact current ACLT leaders Alex Cho, Stephen Bergin, Daniella Zipkin, or me.  A brief, one-page application will be due Monday, December 30. You can also go to http://residency.medicine.duke.edu/duke-program/training-pathways/ambulatory-care-leadership-track for more information.  Thanks!

ACLT application form

Technology Survey (University of California, San Diego)

Since August 2010 our program has participated year study examining smartphones and tablets as reference devices among medical providers (references below).  This study is IRB approved (UCSD Project #110845XX) and all results will be published in the peer-review literature and publicly available.

Prior published results: http://www.ncbi.nlm.nih.gov/pubmed/23321961  or http://www.ncbi.nlm.nih.gov/pubmed/22052129,

Please consider minute survey examining smartphone and tablet use in hospitals that can be found HERE.
Sincerely,
Orrin Franko, MD
Resident Physician, Post-Graduate Year 5
University of California, San Diego

USMLE 3 – Changes

PLEASE note and review the changes to the Step 3 coming for the 2014-15 year, in particular the substantial score delay beginning for test takers in November 2014!

Changes_to_USMLE_2014-2015_handout_FINAL

 

Information/Opportunities

 California IM        Idaho Hospitalist
 
Idaho Internal Medicine
 
IM flyer2
 

Upcoming Dates and Events

  • December 14:  DoM Holiday Party
  • January 15th:  “Voices in Medicine”

 

Useful links

by · Posted on December 8, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Mitchell selected as 2014-15 VA chief resident for quality improvement and patient safety

Mitchell_Aaron_172_5_2Aaron Mitchell, MD, senior assistant resident, has been chosen to be the Durham VA Medical Center chief resident for quality improvement and patient safety for 2014-15.

Dr. Mitchell will be part of a network of such chief residents across the country who will be leading QI projects, receiving expert training from mentors and participating in a national curriculum meant to help usher in a new generation of QI leaders who will help residents implement QI initiatives. He will work closely with David Simel, MD, vice chair for Veterans Affairs in the Department of Medicine, Ryan Schulteis, MD, the first to serve in the chief resident role, and current chief Joel Boggan, MD, MPH.

Dr. Simel said second- and third-year residents interested in the chief resident position should have a passion for quality improvement, teamwork and systems thinking.

“Residents also need to be committed to doing the didactic work that it takes to learn the skills and techniques required for understanding statistical process control, team building, and negotiating to get to consensus,” Simel said. “Aaron fit all those parameters and Drs. Schulteis, Boggan, and I are looking forward to working with him in the coming year.”

by · Posted on December 6, 2013 in Chief Residents, Durham VA Medical Center, Internal Medicine Residency · Read full story · Comments { 0 }

2013-14 Fellowship Match success

Congratulations to our senior assistant residents who have placed into many of the nation’s top fellowship training programs today, including our own. Find a list of where they are headed below.

Where the residents matched for fellowship

Bobby Aertker – Cardiology at Texas Heart Institute
Lindsay Anderson – Hospital Medicine/Primary Care at Indiana
Mandar Aras – Cardiology at UCSF
DeAnna Baker – Rheumatology at MUSC
Armando Bedoya – Pulmonary-Critical Care Medicine at Duke
Stephen Bergin – Pulmonary-Critical Care Medicine at Duke
Tyler Black – GI at UAB
Kimberly Bryan– Primary Care at Alabama
Elizabeth Campbell – Endocrine at Duke
Laura Caputo – Hospital Med at DVAMC
Wendy Chan – Hospital Med at Taiwan
Jennifer Chung – Geriatrics at Washington University, St. Louis
Matt Chung – Cardiology at Washington University, St. Louis
Alex Clark – Endocrine at University of Pittsburgh
Meredith Clement – Infectious Diseases at Duke
Carter Davis – Hem/Onc at Duke
Mallika Dhawan – Hem/Onc at UCSF
Hany Elmariah – Hospital Medicine
Amanda Elliott – post-doc research at Duke
Alex Fanaroff – Cardiology at Duke
Nikki Frederick – Pulmonary-Critical Care Medicine at Boston University
Bronwen Garner – Hospital Medicine at Duke
Jim Gentry – Cardiology at Cleveland Clinic
Jeremy Gillespie – Hospital Medicine at Northwestern
Jodel Giraud – Hospital Medicine
Jeremy Halbe – Hospital Medicine
Benjamin Heyman – Hospital Medicine
Christopher Hostler – Infectious Diseases at Duke
Scharles Konadu – GI at Duke
Ashley Lane – GI at Wake Forest
Howard Lee – Hospital Medicine at Taiwan
Philip Lehman – Cardiology at Duke
Nancy Lentz – GIM at Navy
Anne Matthews – Pulmonary-Critical Care Medicine at Duke
Audrey Metz – Primary Care
Brian Miller – Hem/Onc at Dana Farber
Aaron Mitchell – DVAMC chief resident for quality improvement
Marianna Papademetriou – GI at NYU
Lauren Porras - Sports Medicine
Trevor Posenau – Cardiology at Washington University, St. Louis
Marcus Ruopp– Hospital Medicine at Boston
Jennifer Rymer – Cardiology at Duke
Mike Shafique – Hem/Onc at University of South Florida
Wassim Shatila – Cardiology at Texas Heart Institute
John Stanifer – Nephrology at Duke
Matt Summers – Cardiology at Cleveland Clinic
Kaley Tash – Infectious Diseases at University of South Florida
Carling Ursem – Hem/Onc at UCSF
Sarah Wingfield – Geriatrics at Duke
by · Posted on December 4, 2013 in Fellowship programs, Internal Medicine Residency, Medical Education · Read full story · Comments { 0 }