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Weekly Updates: August 12, 2013

From the Director

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

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

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

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

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

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

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

Have a great week!

Aimee

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

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

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

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

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

From the Chief Residents

Grand Rounds

Date:  August 16, 2013

Presenter:  Dr. Sway Desai

Noon Conference

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

Interns Selected to Residency Council:

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

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

Coffee at the DOC

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

Comments overheard this week:

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

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

Brice Lefler: “Heaven”

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

 

From the Residency Office

QI Corner

Medicine Residency Patient Safety and Quality Council

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

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

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

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

QI Craigslist

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

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

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

New Phone # for Lauren Dincher

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

MKSAP

Last week to submit requests for MKSAP.

How?

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

https://www.surveymonkey.com/s/SBL8C7B

How much does it cost?

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

Note – ACP has made either option the same price

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

Summary:

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

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

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

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

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

Internal Medicine Residents who have successfully completed PGY1 are eligible to apply.  Send all application materials electronically to cecelia.pezdek@duke.edu.

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

Contact Information/Opportunities

IM or FP needed in RI      Cardiologist Opportunuity Texas

Idaho Hospitalist        North Dakota Internal Medicine

Idaho Internal Medicine     July 2013 – Hosp Opp Flyer

Upcoming Dates and Events

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

Useful links

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

Weekly Updates: August 5, 2013

From the Director

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

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

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

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

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

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

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

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

Have a great week!

Aime

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

Background:

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

Methods:

•              Design – cohort (prospective database)

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

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

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

•              Outcome – Risk of death at 1 year after transplantation

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

Results:

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

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

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

Comments:

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

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

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

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

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

From the Chief Residents

Grand Rounds

Date:  August 9, 2013

Presenter:  Dr. Jennifer Green

Noon Conference

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

Chief Residents – Get to Know us Better!

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

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

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

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

Joel

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

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

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

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

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

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

From the Residency Office

QI Corner

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

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

If you missed it and would like to watch online, the link is below.
https://meded-media.duhs.duke.edu/Mediasite/Login?ReturnUrl=%2fMediasite%2fCatalog%2fFull%2f80e6c8ac20b04a88bee5c9fec486c7c721%2f%3fstate%3dsX1EcDKPbaFbRH0M0waS

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

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

Stay tuned for our next Quality and Safety Conferences:

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

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

Rotation Burnout Assessment

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

GME Incentive Program/Hand Hygiene

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

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

QI Craigslist Update

HELP WANTED:

Patient Safety Case Reviews:

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

Possible academic output = poster +/- publication

Estimated 3-4 hours/work/month

Contact Jon Bae <jon.bae@duke.edu> if interested.

Bears Pulling Trash Cans

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

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

Where Can I Find Lauren Dincher?

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

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

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

LaurenCONGRATULATIONS, and thanks for all that you do!!

MKSAP

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

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

Associate membership costs $109/yr https://www.acponline.org/membership/dues/new_us.htm . Please make note to record your ACP # – you will need it to complete our online request form

  • Which MKSAP format do you want?

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

https://www.surveymonkey.com/s/SBL8C7B

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

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

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

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

Summary:

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

Inservice Training Exams (ITE’s)

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

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

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

Learning Portfolio – Residents AND Core Faculty

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

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

Now Accepting Applications for Global Health Elective Rotations

hyc_logo_med_trans

Now Accepting Applications for Global Health Elective Rotations

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

Global Health 8-5(Application addendum is available by request – tara.pemble@duke.edu)

 

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

 

 

Contact Information/Opportunities

130729 – INTERNAL MEDICINE

 

Upcoming Dates and Events

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

Useful links

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

Weekly Updates: July 29, 2013

From the Director

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

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

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

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

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

Have a great week!

Aimee

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

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

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

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

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

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

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

From the Chief Residents

Grand Rounds

Date:  August 8, 2013

Presenter:  Dr. Mark Lanasa

Topic:  CLL

Noon Conference

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

 

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

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

Ambulatory Updates

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

From the Residency Office

QI Corner

Quality Improvement & Patient Safety Noon Conference

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

When: Thursday, August 1, 2013; Noon Conference

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

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

Come for the QI, stay for the AUDIENCE RESPONSE SYSTEM

Rotation Burnout Assessment (submitted by Hany Elmariah

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

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

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

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

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

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

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

If you have any questions, please contact Hany Elmariah (hany.elmariah@duke.edu).Thank you all very much for participating!

QI Craigslist – HELP WANTED

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

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

If interested, please contact Aubrey Jolly Graham (jolly007@mc.duke.edu) ASAP!  We are excited to get the students exposure to a variety of clinicians and residents during these sessions, and to give residents invaluable teaching experience!

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

 

Now Accepting Applications for Global Health Elective Rotations

hyc_logo_med_trans

Boggan Global HealthThe Hubert-Yeargan Center for Global Health (HYC) is now accepting applications for Global Health Elective Rotations for July 2014 and March 2015. Application is open to residents from Departments of Medicine: Internal Medicine (PGY 2); Med-Peds (PGY 3) and Med-Psych (PGY 4).  Access the application form and FAQ at http://dukeglobalhealth.org/education-and-training/global-health-elective-rotation.  (Application addendum is available by request – tara.pemble@duke.edu)

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

Picture from Kenya

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

Kenya Picture - 7-2013

 

TSMA (work done inside Duke for extra compensation)

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

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

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

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

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

TSMA Updates:

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

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

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

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

 

Contact Information/Opportunities

Advertisement for DRMC 6-26-2013

Upcoming Dates and Events

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

Useful links

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

Weekly Updates: July 22, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi everyone! We’ve continued to be quite busy in the hospitals and in the clinics. Many thanks for your hard work. Upcoming this week is “physical exam week” at noon conference – Dr. Arcasoy has put together a great series of demonstrations/lectures so we hope to see you there. This reminds me that we need our first trivia question of the year…

Which Duke resident diagnosed RBBB by physical exam … While in clinic? Bonus if you can tell me how to make that diagnosis. Email me with your answers.

Kudos this week come from Scharles Konadu to Myles Nickolich for his stellar work on 9100 nights, and to Jim Lefler from his colleagues at the VA for his exemplary patient care. And a very belated thank you to Chris MERRICK and his team of Aparna Swaminathan, DeAnna Baker, and Kedar Kirtane for planning and running intern practicum. And a final thank you goes to Dr Klotman for hosting a fantastic intern welcome party, with great representation from our faculty, residency council and ACRs as well.

Pubmed from the program goes to Marc Samsky for his recent article with mentor Adrian Hernandez:  Cardiohepatic interactions in heart failure: an overview and clinical implications, Samsky MD, Patel CB, Dewald TA, Smith AD, Felker GM, Rogers JG, Hernandez AF.

J Am Coll Cardiol. 2013 Jun 18;61(24):2397-405. doi: 10.1016/j.jacc.2013.03.042. Epub 2013 Apr 17.

Please fill out your info for Erin for the website- she sent you an email survey. Venu Reddy is helping us shape things up for recruitment (yes, the year just started). Not surprisingly, our prospective Duke residents want to know about you!

As you may have heard, both Laura and Shawna will be taking new positions at Duke. We will truly miss them and all the contributions they have made to our residency family. Please stop by the office this week and wish them well.

Have a great week

Aimee

To admit or not to admit?  That is the age-old question plaguing gen med residents, particularly those with the privilege of covering 1010.  At its core, the question is really asking, “Is there something that can be offered to patient, therapeutically or diagnostically, that cannot be offered safely and timely in an outpatient setting?”  That this question is oftentimes very difficult to answer should come as no surprise.  What may be a surprise is how little standardization and training exists to help docs make these decisions.  Despite my tours of duty as a gen med house officer, and now after 4 years of hospital medicine, I still struggle with this determination.  Yet, even this is an over simplification as it does not account for “observation” or outpatient status.  Getting an admission consult from the ED becomes minefield of confusing terminology as we decide to admit, observe, or place in outpatient status.  How do we make sense of this?  Perhaps CMS will enlighten us with their definition of observation care:

Observation care is a well-defined set of specific, clinically appropriate services, which include… treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital…(and) in the majority of cases, the decision…can be made in less than 48 hours, usually in less than 24 hours. In only rare and exceptional cases do… outpatient observation services span more than 48 hours.

Clear as mud.  Perhaps we can define observation care by what it is not – an inpatient admission.  Medicare uses a number of screening tools to determine if a hospital admission is medically necessary (i.e. does a patient meet any “admission criteria”).  The principal tool used is the McKesson InterQual criteria, a large tome of algorithms and scenarios that attempt to use “intensity of service” and “severity of illness” to determine medical necessity.  There has been an increasing role for hospitals to employ Utilization Management to help sort this out, but ultimately it comes down to physician judgment.  Reflecting on this, it makes me cringe thinking of the times when I may have made the claim “this patient doesn’t meet any inpatient criteria”.  Did I even know what that meant?

This decision, made by providers of highly variable experience, can have profound impact on patient care downstream that is often underappreciated.  For example, many of our patients have complicated medical needs post-hospitalization (e.g. nursing, wound care, IV antibiotics, physical therapy, or occupational therapy) that may be best provided in skilled care centers.  Yet, as a pre-requisite to qualify for this level of care, they must have three inpatient days (as opposed to three observation days).  What kind of unconscious (or conscious) incentivization does this promote?  For these patients, do we upcode to help those patients who don’t meet inpatient criteria to get them those precious 3 inpatient days?  More importantly, placement in observation may mean a greater degree of cost is placed on the patient.  For Medicare Part A patients who do not meet admission criteria, observation care is not covered.  Medicare Part B patients will cover some observation services although with higher deductibles, additional copays, and uncovered inpatient pharmacy charges.   And what about the patient’s experience in all of this?  For patients who are observed in the hospital, they go to the same patient rooms, interact with the same nurses/physicians, and receive the same therapies as the admitted patients.  How do you explain to them that “well, yes, technically you are a patient IN the hospital, but we are just observing you so you are not admitted”?  Confused yet?

So, that brings me to the article in question in which the authors purport to describe the characteristics of patients admitted under observation status.  The study took place at University of Wisconsin Hospital and involved the review of 43,000 hospital stays (inpatient and observation).  Approximately 10% of the stays were for observation and encompassed 1,141 distinct diagnosis codes.  The mean LOS for observed patients was 33.3 hours with 16.5% lasting longer then 48 hours; for general medicine patients, 26.4% stayed >48 hours.  General medicine patients compromised the bulk of these observation stays (52.5%) with ¼ of medicine stays classified as observation.   Most interestingly, the authors found that there was a net loss of $331 per encounter for each observation case compared with a net gain of $2163 per encounter for an inpatient stay.  This was particularly exacerbated on medicine services where the net loss was $1378 per encounter.  As observation care has increased (from 3% of all inpatient stays in 2006 to 11% in 2011), it has resulted in financial losses for hospitals, which subsequently affects their capabilities for caring for populations of patients and a transfer of costs to patients.  All told, the authors concluded that observation status is not well defined.  Furthermore, the high proportion of observation patients with LOS >48 hours were not “rare and exceptional cases”, but rather quite common, particularly on general medicine services.  This is unlikely what CMS had intended when they originally proposed the definition of observation care.

In an accompanying editorial (“Observation Status for Hospitalized Patients: A Maddening Policy Begging for Revision”), Bob Wachter (recent chair of the ABIM) highlights the inconsistencies in the CMS policy and discusses proposed changes.  These changes are needed and are clearly a step in the right direction. But in the meantime, we are still left with the lingering question of whether to admit (or obs) or not to admit?  And in the evolving, cost conscious world of healthcare, this makes sense.  Much of the focus on admission versus observation does come down to costs – to the payers, to the hospitals, and to the patients themselves.  And while I do believe that cost recognition has a role in our delivery of patient care, this focus highlights for me the potential pitfalls in cost conscious care delivery.  Specifically, how powerful are the drivers of cost consciousness (read “reduction”) in influencing the decision making of caregivers (especially trainees) when making determinations for whether patients should be admitted to the hospital?  What are the unintended (unforeseen?) consequences?  And why should the question be anything but “can we help this patient with our hospital care?”  That, my friends, is the real question.

 

From the Chief Residents

Grand Rounds

Date:  July 26, 2013

Presenter:  Dr. Todd Kiefer

Topic:  Adult Congenital Heart Disease

Noon Conference

This week is dedicated to enhancing physical examination skills.

Date Topic Lecturer Vendor
7/22 PE Week – Intro and CV Exam Arcasoy/Chetan Patel Pita Pit
7/23 PE Week – Daily inpt and new outpt exams Zaas/Arcasoy Jersey Mike’s
7/24 PE Week – Abdominal and MSK exams Alastair Smith/Irene   Whitt Moe’s burrito
7/25 PE Week – HEENT and Respiratory exams Simel/Hargett Domino’s pizza
7/26 PE Week – Neurologic Exam Morgenlander Chick-Fil-A

From the Residency Office

QI Corner

Updates from GME Patient Safety and Quality Council  (Jenn Rymer, GME PSQC representative)

The first meeting of the academic year got off to a great start this past Tuesday, July 16th. Residents, fellows, and attendings from all departments were in attendance. We would like to have increasing involvement from our medicine residents in the five task forces created by this council. Each of these task forces will take on several projects throughout the year, and you have the opportunity to help with the selection of these projects. One exciting new task force is the Incentive Plan task force, led by Jon Bae and George Cheely. The GME targets for this year will be patient satisfaction, 30-day readmission rates, housestaff immunizations, and hand ashing with the potential for an extra $600 dollars at the end of new year. Other task forces are listed below:

1)    Handoff Task ForceAaron Mitchell and Deana Miller plus Joel Boggan. This task force will look at issues surrounding housestaff handoffs. In particular, they will be reviewing how handoffs affect RRTs.

2)   Supervision Task Force- Tian Zhang. This task force primarily focuses on whether housestaff have appropriate supervision during their training. A focus is on issues of compliance with ACGME regulations.

3)   Resiliency Task Force- Sarah Dotters-Katz. Exciting work has been done at Duke in this area, particularly by Dr. Sexton and Dr. Bae. You may remember the 3 Good Things Initiative as a part of efforts to improve resiliency and decrease burnout among the housestaff. This task force will focus on ways to improve resiliency and decrease burnout among housestaff.

4)   Education Task Force- Sarah Dotters-Katz. Several initiatives have come from the efforts of this task force, including increased roll-out of the TeamSTEPPS program to housestaff, as well as the creation of badge cards which discuss components of SBAR and how to reach translation services.

There are opportunities within each of these areas to initiate your own project ideas. If you have any questions or are interested in any of the above areas, please contact Jon Bae, George Cheely, Jenn Rymer, or Nick Rohrhoff.


QI Craigslist:

We are beginning to assemble a list of QI projects and resident interests.  From time to time, you may see postings here in weekly updates about project opportunities.  If interested in getting involved or if you have project ideas/interests, please contact Joel Boggan or Jon Bae

Help Wanted

Project: DOC Discharge Clinic

Needed: 1-2 DOC residents

Roles:

  • -participate in chart reviews/data extraction
  • -participate on Discharge clinic committee
  • -assist with project academic work (posters, abstracts)

Time commitment: 2-3 hours/month

Follow Us on Twitter

  • @DukeMarines – Duke Chief Resident Updates
  • @JonBae01 – QI and patient safety (general news and program updates)
  • @bcg4duke – maestrocare and health informatics.

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

 

Now Accepting Applications for Global Health Elective Rotations

hyc_logo_med_trans

 

 

 

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

Shiprock Farewell 027(Application addendum is available by request – tara.pemble@duke.edu)

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

How to Prepare for Professional Job Interview

What questions interviewee should ask and get answered?

What questions should interviewee be prepared to answer?

InterviewSponsor: American College of Physicians North Carolina chapter

  • When: Friday August 2, 2013
  • Where: Duke Medicine Resident Library 8th floor
  • Time: 7pm (Dinner provided)

This is a great opportunity to find out first hand what works – and what doesn’t. The panelists include:

  • Dr. David Gallagher Hospitalist Medicine Duke
  • Dr. Lalit Verma Hospitalist Duke Regional Hospital
  • Dr. Saumil Chadgar Hospitalist Medicine/Academics
  • Dr. Jonathan Bae Hospitalist Medicine/Academics/Quality Improvement
  • Dr. Amy Rosenthal (Federal government/VA/Private Practice)
  • Dr. Sharon Rubin Primary Care/Outpatient

Please RSVP to Dr. Sharon Rubin sharon.rubin@dm.duke.edu by Friday July 26, 2013

The following attachment provides a list of some of the discussion topics:

Thinks to know about a job and questions to ask

 

Invitation to the Chapel Hill CareerMD Career Fair for Residents & Fellows

Physicians-in-training are invited to attend the Chapel Hill CareerMD Career Fair for residents and fellows on the evening of Thursday, September 12, 2013.

Those who would like to attend are asked to RSVP online at www.CareerMD.com/ChapelHill or by emailing me at lesley.forsythe@CareerMD.com.

Representatives from leading hospitals, practices, and healthcare organizations from around the country will attend the Chapel Hill CareerMD Career Fair to meet residents and fellows in all specialties and in all years of training. Residents and fellows who are nearing completion of their program will find the event instrumental to their job search, and those who are in earlier years of training can network with prospective employers and learn about stipend opportunities that may be available to them as they complete their training.

Date & Time
Thursday, September 12, 2013
Residents and fellows may attend any time between 5:00 PM to 9:00 PM
Spouses and significant others are also welcome to attend

Location
Sheraton Chapel Hill Hotel
One Europa Drive
Chapel Hill, NC 27517

Cost
Free-of-charge for all residents and fellows

RSVP & Additional Information
RSVP online at www.CareerMD.com/ChapelHill or by email to lesley.forsythe@CareerMD.com

 

Contact Information/Opportunities

Internal Medicine OP Opportunities Carolinas HealthCare System 7-13-2013

MHC Internal Medicine Program Flyer

 

Upcoming Dates and Events

  • July 22-26     Physical Exam Series Week (Noon Conference)
  • August 16th  Program Wide “Summerfest Party” at the Zaas’s

Useful links

by · Posted on July 21, 2013 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Weekly Updates July 15, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)

Hi everyone! Hope you are all settling in to a nice routine. We’ve got all the fellowship letters uploaded, and Bill Hargett and I will be hosting a noon meeting for all who are applying this year to talk about interview preparation in the med res library on 7/30. Regular noon conference for JARs and interns. Kudos this week for all – Duke and VA services are at near record high numbers and you are all providing outstanding care to your patients.

Please take the time to fill out your self eval in medhub. We also sent you the video that we made (kudos to Bill Hargett!) to train attendings to use the new evaluations. It’s about 5 min long, and definitely worth watching. We will begin our minicex campaign this week, so please also remind your attendings to fill out a minicex as they work with you on rounds.

Upcoming events include intern party at Dr Klotman’s on Thursday and physical exam week starting July 22. For those of you interested, we have a great volunteer opportunity – physician volunteers needed at the Russel E Blount Track Meet.  See details below.

Have a great week!

Aimee 

The Durham Striders Track Club will once again host the Russell E Blunt East Coast Invitational Track Meet which celebrates the legacy of the late Coach Russell E Blunt, Durham’s most honored athletic coach and member of the NC Hall of Fame. The meet which will be held July 19-21 at Durham County Memorial Stadium, now in its 22nd year attracts the country’s most talented track and field athletes to what has become the country’s premiere summer developmental track competition for youth. The meet occurs strategically JUST BEFORE the USATF and AAU Junior Olympic National Championships and is therefore highly sought after as a “preparation” for these final championships of the summer track season.

The meet this year is being held at Durham County Memorial Stadium,  which was recently completely renovated with a state of the art track and field venue. Thanks to the generous support of the County of Durham and its stadium authority,  we are able to put on what is considered the “class” of track and field competition in the country. The meet is free and open to the public. 

I am writing to request your help with potential volunteers from your housestaff and faculty who might be willing to help staff one of the shifts for First Aid/Sports Medicine or volunteer for one of the many tasks necessary for the meet to run efficiently. We can only offer to feed, provide parking and volunteers meet shirts for their efforts. But they will see and meet some of the most talented young athletes from around the US as well as from Bermuda, Trinidad/Tobago, Mexico, the US Virgin Island, Jamaica, and the Bahamas. 

We are anticipating almost 2000 athletes for the meet, plus their coaches, parents, as well as many local spectators, college scouts and coaches. There will be two large teams arriving to Durham from Bermuda and Mexico earlier in the week of the meet, and this year we are also anticipating teams from Trinidad/Tobago, the US Virgin Islands, the Bahamas and potentially a very strong team from Jamaica. We anticipate more than 100 teams from across the country to also send their very best athletes from 7-18 years old to participate in the 3 day meet. 

We have broken the 3 days into shifts for first aid and sports medicine. Those wishing to volunteer should contact me, and plan to register at the Stadium at the President’s Box on the East Side of the Stadium to pick up credentials, etc. 

July 19
10AM-2PM
2PM-6PM

July 20
8:30AM-12:30
12:30-4:30
4:30-7:30PM

July 21
9:00AM-1:00PM
1:00PM-5:30PM

Please contact Brenda Armstrong (Brenda.armstrong@dm.duke.edu) if interested

This week’s Pubmed from the Program goes to recent graduate (and current Penn Cardiology Fellow) Jon Menachem..

Recurrent Cerebral Abscess Secondary to a Persistent Left Superior Vena Cava Congenital Heart Disease; epub before print May 28, 2013 

Jonathan N. Menachem, Senthil N. Sundaram, and  John F. Rhodes

What Did I Read This Week

by Nick Rohrhoff, MD

Making Residency Work Hour Rules Work

Journal of Law, Medicine and Ethics, Vol. 41, No. 1, 2013

Why did I read this article: We have to log our duty hours every week and sometimes I forget to do it.  A red message pops up on MedHub, a “friendly reminder” email from the program office hits the inbox and if I’m really delinquent, there’s the dreaded text page.  People seem to care a whole lot about how much I’m working and well, I’m working a whole lot.  To this day, whenever I’m asked to do something, the 7-year old boy in me always asks, with varying volume and intonation, “…and what If I don’t?!”  Having recently become eligible to work up to 30 hours consecutively (longer than the intern 16, a day on Earth, a day on Mars and a Law & Order SVU marathon) and having deep interest in how we educate ourselves and learn from each other, I thought I’d look into it. Since a quasi-national conversation has erupted about graduate medical education, work hours, health care quality and patient safety, it wasn’t surprising to me that there’s very little known about what could happen…but plenty of opinions about what should.

Summary: In this paper, Harvard sleep scientist Christopher Landrigan and colleagues outline the problem of resident duty hour non-compliance and present three possible enforcement alternatives to the mechanism currently in place.  Most of their discussion of the problem relies on data from after the 80-hour work week was implemented in 2003 and acknowledges the limited data available after the 2011 updates that included 16-hour intern work limits.  Right now, the only duty hour compliance enforcement mechanism in place is removal of a program’s accreditation by the ACGME.  That is a huge punishment.  So huge that it’s never really been doled out…to anyone.  So the authors suggest that other mechanisms would not only increase compliance but are necessary to do so.

The first mechanism they suggest is what I call the “How to make Tom Owens show up at my apartment” whereby the Center for Medicare and Medicaid services would make Duke Hospital’s compliance with ACGME regulations a “condition of participation” and therefore required for reimbursement – in part or in whole.  The hospital would have a huge interest in compliance on the front end because if we were found to be non-compliant on the back end while receiving money from the federal health insurance programs, we’d be liable under the False Claims Act…which is the federal health regulatory version of backing into a parked car at  105 mph.

Secondly, Congress could withhold funding for GME (derived mostly from the Medicare budget to the tune of nearly $10 billion per year) under the Taxing and Spending clause of the US Constitution to enforce compliance.  I call this the “Congress gets to do whatever it wants” – because it usually does.  And if there’s something bad out there, in this case duty hour reporting, there are 535 elected representatives ready to make it worse.  This mechanism was used most famously in 1984 when Congress withheld federal highway funding from states like Wisconsin where it was legal to buy alcohol under the age of 21 (then 18 in WI.)  And that explains Philip Lehman.

Finally, individual states could make laws that make failing to comply with duty hour restrictions equivalent to “negligence per se” in a medical malpractice case.  This is the “Judge Judy” rule because in this case, the plaintiff would only have to prove that you worked more hours than you should have, NOT that you provided any less than the expected standard of medical care in order to find you medically negligent and thus guiltier than anyone who has ever been on Nancy Grace, Dr. Phil or Maury Povich.

Conclusion: There is an interest by legislators, regulators and bureaucrats to control the practice of medicine broadly and specifically the education and training of the next generation of physicians.  As a profession, we need to bring moral accountability, scientific validity and community responsibility to this issue before we lose the opportunity to do it. 

We need to push the ACGME for the freedom within the 80-hour workweek framework to experiment with alternative call schedules that don’t limit interns to 16 arbitrary hours.  Then we could compare similar programs in resident size, patient acuity and volume to see if less really is more.  We could add patient satisfaction data to quantify how much more patients like knowing exactly who their doctor is and what they look like (even at 3am in 8109 when the corner light is out and you feel like you’re walking into Narnia.)  And maybe we’d be wrong.  But the only thing worse than being wrong is knowing that we don’t know and refusing to do anything about it.

Doing anything to physicians in the name of “patient safety” will always be a political winner regardless of how good an idea it is.  “We need more data” does not afford us a similar appeal.  We have to get the data first, and then make the argument.  Maybe the way to get it is to offer stricter compliance with ACGME rules and corresponding appropriate penalties, less severe than loss of accreditation, in exchange for the freedom to experiment.  Then maybe this national conversation would become something to talk about.

From the Chief Residents

Grand Rounds

Date:  July 19, 2013

Date Topic Lecturer  
7/19 Kidney Disease/Public Health Dr. Himmelfarb  

 

Noon Conference

Date Topic Lecturer Vendor
7/15 GI Bleeding Dan Wild Picnic Basket
7/16 Library Overview Megan Vonisenberg Bullock’s
7/17 Cirrhosis Andrew Muir Saladelia-sandwiches
7/18 Stroke  Larry Goldstein  Sushi
7/19 Chair’s Conference Chiefs Rudino’s

 

From the Residency Office

QI Corner

 Med Res Patient Safety and Quality Council

The Med Res PSQC (Patient Safety and Quality Council) had its first meeting this past week.  We had a great turnout, especially from our new intern class.  We reviewed last year’s successes (DOC Discharge Clinic project, Outside Hospital Transfers project), shared some of our interests, and began thinking about how to focus efforts this coming year.  If you’re interested in any particular topic but forgot to send me an email, now’s the time!  Also, look for the minutes coming out program-wide in an email early this week. 

We’re going to be consolidating everyone’s interests over the next 1-2 weeks and then hopefully start connecting people with particular interests to start planning some projects for this year. 

Potential areas for project focus:

1.     ‘We Follow-Up’ project for 2nd and 3rd years
2.     Hand hygiene and improvement
3.     EM-IM communications
4.     High-value, cost conscious care

Let me know if you have any other specific interests at bogga002@mc.duke.edu (or joel.boggan@duke.edu) or Jon at jon.bae@dm.duke.edu.

And join us for our next meeting Wednesday August 14th, 5PM in Med Res (2nd Wednesday of Each Month)

Medicine Residency Rotation Burnout Assessment

Be on the lookout for a program wide rotation burnout assessment led by Dr. Hany Elmariah.

In order to better understand the impact of different rotations and work structures on resident fatigue and burnout, you will soon be seeing surveys (5 questions, < 1 min to complete) to assess your perceptions at rotation end. More details coming soon but for those seeking more info or who wish to get involved, please contact Hany.

 Follow Us on Twitter!

 For program specific and general patient safety and QI news, follow us @JonBae01

Contact Information/Opportunities

Spartanburg Regional

 

hyc_logo_lrg

 

 

 

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

Now Accepting Applications for Global Health Elective Rotations

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

(Application addendum is available by request – tara.pemble@duke.edu)

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

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

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

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

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

Internal Medicine Residents who have successfully completed PGY1 are eligible to apply.  Send all application materials electronically to cecelia.pezdek@duke.edu.  

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

 

Duke University’s Human Simulation and Patient Safety Center is recruiting residents for an Army sponsored study of our sedation training software, PDAATS.  We would like to reach the broadest possible set of non-anesthesia residents and fellows for our 60 person study. Participants who are selected will be compensated $500. Interested residents and fellows, can take a pretest by clicking on the link in this document.  If they are selected, then participants attend a training session at our lab on Duke Campus and take a post test. There is a long term post test that will be held at our center in Sep. It is critical that study participants commit to coming back for the long term post.    

 

Ambulatory Updates

Picket Road Information and Updates

1.  Please speak up if a computer is NOT working. I know the one computer in the dog house (close to the window) has not been printing letters. If computer or printer not working, start to trouble shoot, REBOOT or turn off/on the printer, check the connections. IF that fails, inform your attending and GLENN. This is a work stoppage and we want to keep you productive and working.

2. UGG Labs have not consistently going to residents. With the 6/22/13 upgrade we have been unhappy with this new feature, all the resident labs go to the attendings. The attendings need to forward the labs to the residents. Residents now have to check their patients labs the next day. One feature from maestro is create a patient list and put pt in there to keep tract of labs, studies. This is not ideal and a ticket has been placed but I doubt this is going to change soon or ever:(  The residents need to be VIGILANT for any lab drawn and to look in EPIC OUTPATIENT at least ONCE a week. The attendings will forward labs to the residents.

 How to annotate when labs are NOT in new results folder

If non portal patient, then go to chart, letters, new letter blank (I recommend making this a favorite). then you can put in .lastlabs or copy labs into letter.

You can place your comments

If portal patient, go to chart, go to More activities My Chart Utilities My chart Results Release (I would recommend starring this then this can stay on the left hand side at all times). Then annotate and accept. 

 3. Interns: remember first and second session 2 patients, third session 3 patients, fourth session 4 patients.

This is the time to learn budgeting time. Use the computer, budget your time with your patient 20 minutes (further divide into history/PE/wrap up before sign out) and sign out about 5-10 minutes. That will keep you on 30 minutes. The attending can be busy signing out other patients, going in with other residents.

 a. Make sure they attach to EVERYONE in the clinic (use the codes, faster than typing in names;the list is in the Pickett road handbook but Ila Mangum is wrong code)

b. complete the quest around Pickett

c. work their sign out list from the outgoing SARS. Create new message to Pickett Road PCP Front desk to bring the patients in for visit (if indicated). As you are going through their list, Change PCP (Snap shot, care teams communication, new PCP)

Takeover list  
Chung a-m Zhu
Chumg n-z Ng’eno
Day a-m Cupp
Day n-z Verma
George a-m Ray
George n-z Eisenberg
Goodwin a-m Matta
Goodwin n-z Nichloich
Westphal all Erdmann

4. Resident lists: I would LOVE for each resident to run a report listing them as PCP in EPIC. :( Residents are unable to use Dashboard. Dashboard is NOT activated for the residents. Shira is aware. The only work around I can think of is to create a Patient LIST to start keeping tract of Patients YOU ARE PCP until Dashboard eventually gets activated.

Your attending and other residents are your EPIC superusers. ASK LOTS OF QUESTIONS: about inbox, messaging,  building a template, how to do things faster, orders, stealing smart phrases…

Sharon Rubin, MD, FACP

Assistant Professor, Duke University Medical Center

Residency Director at Pickett Road

 

Ordering White Coats/Uniforms

All continuing trainees will be able to order uniforms online through the Medical Center Bookstore beginning July, 1, 2013.  Orders must be placed by December 31, 2013.  

Each individual department and/or program selects the style and quantities available to you and is provided to you at no cost. This is a one time opportunity to order GME provided uniforms for the current academic year.

Go to https://shopgmeuniforms.dukestores.duke.edu to place your order.

You will need to use the email address that is in MedHub to be able to log into the dukestores web site.

 

Upcoming Dates and Events

  • July 18th        Intern Welcome Party at Dr. Klotman’s
  • July 22-26     Physical Exam Series Week (Noon Conference)
  • August 16th  Program Wide “Summerfest Party” at the Zaas’s

Useful links

by · Posted on July 15, 2013 in Internal Medicine Residency, Medical Education, Weekly Update · Read full story · Comments { 0 }

Global Health-Internal Medicine Residency Program recruiting eligible candidates

Internal Medicine Residents who have successfully completed PGY1 are eligible to apply for the Duke Global Health Residency, an extended residency that leads to a Master of Science in Global Health and a total of nine months providing clinical care and conducting mentored research at a Duke University international partner site.

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

Watch current global health resident John Stanifer, MD, discuss his decision to pursue global health training at Duke:

Send all application materials electronically to cecelia.pezdek@duke.edu.

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

by · Posted on July 11, 2013 in Global Health, Internal Medicine Residency, Medical Education · Read full story · Comments { 0 }

Weekly Updates: July 8, 2013

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Happy 4th of July and happy and successful first week of the 2013-14 academic year! Interns are settling in very well, Maestro is becoming the new normal and it’s great to see the JARs and SARs in their new roles. Special thanks to our first week conference presenters, including Adva Eisenberg with the first intern report and Christine Bestvina with the first chairs conference.  Attendance and participation have been stellar for week one!

Be on the lookout for the milestone based self-evaluation coming in MedHub, including an instructional video made by our very own tech genius, Bill Hargett. 

In maestro – please use pagingweb to contact a consult service if you don’t hear back in a timely manner using the maestro page – a fix is on the way, but some pages aren’t going thru. We will keep you posted when the fix happens.

This week’s pubmed from the program goes to Matt Summers. Congrats Matt and mentor Manesh Patel. …  Curr Cardiol Rep. 2013 Jul;15(7):379. doi: 10.1007/s11886-013-0379-x.  Appropriateness of percutaneous coronary intervention: a review. Summers MR, Patel MR.

Enjoy some 4th of July photos. It’s not going to surpass seersucker but it’s pretty awesome.

Have a great week

Aimee

JARQOutfit - HatPants

 

 

 

 

 

 

 

 

 

“Best Care at Lower Cost”…an IOM Report; chaired by Mark D. Smith, MD, MBA

Aimee Zaas, MD

No, no…don’t fall asleep already.  This is good stuff, and we are going to be hearing, talking and learning more about it over the course of this year, and years to come.  One of the best things about the whole concept of high value cost conscious care and learning health systems (aside from providing great care to our patients and not bankrupting them and the country in the process) is that these concepts are relatively new to all of us.  During much of our training, no one talked about cost of care very much, and often the “best” workup was the most comprehensive, ordering the most tests, etc.  Clearly, this is no longer the case and as responsible physicians, we must consider (and involve our patients in the decisions) the relative costs and values of the care we provide.  Best quality is really doing the right test or right medicine for the right person at the right time. And the idea of a learning health system simply didn’t exist, or wasn’t on the minds of practicing clinicians or learners.  But, things are changing…

This year, we will be bringing you the ACP’s High Value Cost Conscious Care Curriculum through the noon conference lecture series.  We are also developing opportunities for you to get involved in learning health care, and how to look at data from your own practice.  Stay tuned for more information in the coming weeks/months!

So, what does the IOM have to say? They want to develop a continuously learning health care system and have formed a committee charged with outlining the key elements of learning health care.  The committee has the following mission..

Effectiveness. The Committee will define the foundational elements of a learning system for health care that is effective and continuously improving

Efficiency. The Committee will define the foundational characteristics of a healthcare system that is efficient, delivers increased value, and is continuously innovating and improving in its ability to deliver high value to patients

Why is this important?  Medical care is becoming increasingly complex (obvious point to those of you who are taking care of patients with medication lists of 20+ meds for 4+ chronic and 2 acute problems, or when you have to arrange follow up with one PCP, 3 specialists and home PT).  This complexity results in FRAGMENTED CARE, WASTE, LOST OPPORTUNITY TO IMPROVE HEALTH and POSSIBLE HARM

What is Learning Health Care?  A health system that captures real time data, aggregates the data, and provides feedback to providers and patients based on this data so that providers can then ACT on the data to modify practice.

(a simple example:  You admitting a patient with a fever.  They are stable, have no cough, no central lines, and have no urinary symptoms.  You are told that they have a UA that “looks like a UTI” and they have already received one dose of antibiotics.  You wonder how many UA’s that look like UTIs really turn out to be UTIs…and how many even have a urine culture paired with them so that you can get the “gold standard” answer.  IN A LEARNING HEALTH SYSTEM, you could query (quickly, easily, and in the future, automatically) how many UA’s were ordered for indication “evaluate for UTI”, how many had a paired culture with them, how many had pyuria, and how many had a + culture.  Even better, a learning health system could then help change your practice.  You might find that the ordering practice should change to force a paired urine culture to go with any UA ordered for “evaluate for UTI”.  Or you might find that the system should cancel urine culture orders for clean UA.  Or you might be pleasantly surprised to note that your team ALWAYS matches the reason for sending a UA with the need for a culture.  But the information you gain could allow a change in practice across the system.)

What is happening in society that makes Learning Health Care possible?  EHRs that reliably capture and aggregate data, better computing power, empowered patients, value based incentives, transparency, and an involved leadership are all part of what will make this possible.

Where can you go if you want to learn more about these concepts? 

  1. Read the attached article by Friedman, et al “Achieving a Nationwide Learning Health System” Science Translational Medicine Nov 2010; 2; 57-59
  2. Read the attached article by Ginsburg, et al “Academic Medical Centers: Ripe for Rapid Learning Personalized Health Care” Science Translational Medicine  2011; 3:101cm27

academicmedcentersANDrapidlearning

Best care at lower cost[1]     BestCareReportBrief[1]

fundamentalsofRLHS

From the Chief Residents

Grand Rounds

Date:  July 12, 2013

Drs.   Anderson/Moehring Infection Control

 

Noon Conference

Date Topic Lecturer Vendor
7/8 Rheumatologic Emergencies Lisa Criscione Pita Pit
7/9 Acute Renal Failure John Middleton Moe’s- casadilla
7/10 Schwartz Rounds Lynn Bowlby, Lynn   O’Neill Jersey Mike’s
7/11 Antibiotic   Stewardship Dev Anderson Domino’s pizza
7/12 Chair’s Conference Chiefs Chick-Fil-A

Residency Council

Please help congratulate the following members of the Residency Council for FY 14.

Note that although not yet selected, the Intern class will soon have the oppotunikty to select representatives to the Council.

Co Chairs:  Armando Bedoya and Chris Hostler

Bedoya   Hostler

SAR Class:   Laura Caputo, Jeremy Halbe, Brian Miller, Kevin Shah

JAR Class:  Katie Broderick-Forsgren, Ryan Huey, Erin Boehm, and Nicholas Rohrhoff.

Interns:  tbd

Med-Peds:  Timothy Mercer

Med-Psych:  Amy Newhouse

From the Residency Office

To Order New Lab Coats

Answers to the questions that have come in from our JAR’s and SAR’s -

All residents MUST place order ONLINE first.  If you want the same exact sizes that you already have, email Rebecca.dincher@duke.edu directly with the information that your want embroidered. Your email address will be your  signature so in case there are any discrepancies. If you want something different, please go to the store to get fitted and then fill out the embroidery in the store. Rising JARs and SARs have to put their order in BEFORE they go to the store.

https://shopgmeuniforms.dukestores.duke.edu

Rheumatology Fellowship info session

LIVE ONLINE INFORMATION SESSION: Thursday, July 18th,  7:00pm-8:00pm (Eastern Time)

Please join us for a live online information session with faculty, chief fellow, and the Program Director from Duke’s Rheumatology & Immunology Fellowship Program. This is an excellent opportunity to learn more about the fellowship training program and to have any questions answered in real time. If you are interested in participating, please send an email to Amy  Coppedge:  amy.coppedge@duke.edu so that she can get you registered and send you the necessary information for joining the online session. Please RSVP by Tuesday, July 16th.

How to Prepare for Professional Job Interview

What questions interviewee should ask and get answered?   What questions should interviewee be prepared to answer?

InterviewSponsor: American College of Physicians North Carolina chapter

  • When: Friday August 2, 2013
  • Where: Duke Medicine Resident Library 8th floor
  • Time: 7pm (Dinner provided)

This is a great opportunity to find out first hand what works – and what doesn’t.  The panelists include:

  • Dr. David Gallagher Hospitalist Medicine Duke
  • Dr. Lalit Verma Hospitalist Duke Regional Hospital
  • Dr. Saumil Chadgar Hospitalist Medicine/Academics
  • Dr. Jonathan Bae Hospitalist Medicine/Academics/Quality Improvement
  • Dr. Amy Rosenthal (Federal government/VA/Private Practice)
  • Dr. Sharon Rubin Primary Care/Outpatient

Please RSVP to Dr. Sharon Rubin sharon.rubin@dm.duke.edu  by Friday July 26, 2013

The following attachement provides a list of some of the discussion topics:  Thinks to know about a job and questions to ask

Poster Competition, SoM Clinical Science Day

October 18,2013

The third Clinical Science Day will take place during Medical Alumni Weekend with the goal of bringing together alumni, faculty, and trainees to celebrate clinical research and the vast and diverse array of activities taking place across our campus, showcase these activities, and encourage collaborations.

Registration is required.

Visit the website to register and for poster rules and instructions.

The abstracts will be emailed to Dr Arcasoy at arcas001@mc.duke.edu by July 14, 2013. Any questions can be directed to his attention.

Poster criteria for submission:

  1. Must be original Duke research
  2. Research must have been completed during the last 18 months
  3. Research must have a pre-specified data/statistical analysis plan
  4. Resident/fellow must be the primary author
  5. An abstract must be submitted with the nomination

Abstract format (500 words):  Background, Hypothesis, Methods, Results, Conclusion

Posters will be judged by reviewers on the following criteria:

  1. Is there a defined hypothesis
  2. Is the study designed to answer a specific question
  3. Are there sufficient observations for statistical evaluation
  4. Have the data been appropriately analyzed
  5. Are the conclusions appropriately derived from the data
  6. Is the work novel

Contact Information/Opportunities

Idaho Hospitalist      Idaho Internal Medicine

Pennsylvania Internal Medicine

Cornerstone Internal Medicine at Premier, Outpatient Only

 

Upcoming Dates and Events

  • July 18th        Intern Welcome Party at Dr. Klotman’s
  • August 16th  Program Wide “Summerfest Party” at the Zaas’s

Useful links

Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response.

by · Posted on July 7, 2013 in Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Rheumatology & Immunology Fellowship Program to hold online information session

The Rheumatology & Immunology Fellowship Program will hold a live online information session from 7-8 p.m. (EST) on Thur., July 18, for anyone interested in learning more about the program.

The session will give prospective applicants a chance to chat with faculty, the chief fellow and program director, learn more about the fellowship training program and have questions answered in real time.

If you are interested in participating, please email Amy Coppedge, to register and get login information. Please reserve a spot by Tues., July 16.

by · Posted on July 3, 2013 in Fellowship programs, Internal Medicine Residency, Rheumatology & Immunology · Read full story · Comments { 0 }