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DoM posters recognized at Duke Medicine Patient Safety and Quality Conference

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

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

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

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

Continue Reading →

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

World Kidney Day efforts featured on ISN blog

WKD_screening_MoshiThe International Society of Nephrology blog recently featured work by internal medicine resident John Stanifer, MD.

Dr. Stanifer contributed a post about a World Kidney Day screening event held at the Kilimanjaro Christian Medical Center in Moshi, Tanzania. Check out the post and view the photos.

by · Posted on March 17, 2014 in Global Health, Internal Medicine Residency · Read full story · Comments { 0 }

Internal Medicine Residency News: March 17, 2014

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi everyone! The year keeps flying by…hard to believe that Friday is MATCH DAY! We are looking forward to welcoming the newest members of the med res family, and celebrating with everyone on Friday night!

A continued thanks to everyone for participating in MiniCEX madness…a special thanks to Jon Bae for completing 6 Minicex’s this week while on gen med (and helping Brian Sullivan and Bassem Matta log 3 MiniCex’s each!).  How can you participate — ASK YOUR GEN MED, CLINIC or other ward service attending to record a MINICEX for a patient encounter they observe with you!  It’s that easy.

Speaking of Jon Bae, he also led our program to an amazing showing at the Duke Patient Safety Conference.  Presenters/poster authors included many from our hospital medicine group (Drs. O’Brien, Jolly-Graham, Setji,  Schulties, Clarke) as well as residents Lindsay Boole, Jenn Rymer, Katie Broderick, Jessie Seidelman, Hany El Mariah, Phil Lehman, Jeremy Halbe, Kevin Shah, Bonike Olorontoba, and Tim Mercer, and medical student Wynn Hunter.  Our DOC team won the highest award (the Rebecca Kirkland Award) for their work “Impact of transitions of care services on an IM clinic population” and Katie’s work on the patient centered business cards received a runner up award for best poster!  This is really amazing to see such strong IM representation at this symposium.

The mock CLER visit went well, and we should be receiving some feedback soon from GME.  Many thanks to Audrey Metz, Trevor Poseneau and Bobby Aertker who  helped guide the CLER team through the hospital. Remember, we get 2 weeks notice for the real CLER visit, so all I can tell you is that it is not happening this week or next! More information as we receive it.

Bill Hargett and I held the second fellowship information meeting – thanks to the JARs who attended.  Please look at the MedHub folder “Fellowship Information” for the roadmap to the application process.  For those applying to fellowship for the 2015 cycle, please set up an appointment with me (email Erin) for late April to go over your CV, personal statement, choices of places to apply and potential letter writers.

The residency council and I had a great meeting on Thursday night – if you want to hear more about it, please contact your class rep or contact me directly.

It’s coming….many of you have heard of the iCOMPARE study, which will compare 24+4 for interns versus 16 hour limits.  (see www.icomparestudy.com).  We just received notice on Saturday that the ACGME is prepared to fund the study.  Details to follow, but we have permission to participate, and hope to be part of the many programs who will be randomized to allowing 24+4 for interns in either 2015-16 or 2016-17, with a cross over to 16 hours in the other year.  While this affects none of you directly right now, my feeling is that this will be the most impactful graduate medical education study ever performed.  There is a similar study approved for general surgery as well.

Kudos this week go to Fola Babatunde who received accolades from a patient (sent to us by Lisa Pickett), and to Brian Sullivan, who was recognized by the 4300 nursing staff for great communication skills. Additional kudos to Matt Atkins for a fantastic chair’s conference, and to Jeremy Gillespie and Marcus Ruopp for their SAR talks.

This week’s pubmed from the program goes to 2 residents and one of our graduates! Bobby Aertker, Alex Clark and Dan Ong for their recently published paper “Radiation Associated Valvular Heart Disease” published in the Journal of Heart Valvular Disease J Heart Valve Dis Vol. 22. No. 5 September 2013.

Have a great week! GO DUKE, and keep counting down till MATCH DAY!

Aimee

The “Clinic Corner – Pickett Road” (submitted by Sharon Rubin, MD)

210_RubinSharonWe have sadly said goodbye to Dr. Tara Obrien who left Pickett on 2/28/14 to work in Montana. She will be missed! Dr. Jennifer Brown has started 3/3/14. She is a transfer from Durham Medical Center. She trained as a resident at John’s Hopkins and will start precepting Tuesday mornings in Dr. Obrien’s place in April. Dr. Rubin will be filling in Tuesday mornings for the month of March to give Dr. Brown time to adjust to the Brownnew clinic.

The door codes have been updated (ask the attendings for code- we cannot circulate on the Internal Medicine web site) Do not however share this code information with non-Pickett Road staff.

PECOS: as per GME, residents will not be signed up (this is still in negotiation). SO any Durable Medical equipment or medical supplies for Medicare patients may have to sent by your attending. Only small pharmacies are asking for PECOS for residents. The best course of action is to prescribe as normal but if you get a message from a pharmacy NOT allowing you to send in supplies, contact your attending or Dr. Rubin.

Please make sure you are signing in under the Pickett Road with your assigned attending. If you are signed in from inpatient, ANY order, lab or radiology, will default to the Inpatient attending. Also for Tuesday and Thursday, if you are here all day, you need to CHANGE from the morning to afternoon attending (log in and then out to attach the correct attending). Make sure you are marked as reviewed for Problem List. If in annual visit, please enter the family history and update PMH, PSH, Social history. We are required to use EPIC Patient information to count as mark as review (under References).

Reminder as per DPC policy, providers are still required to call their patients for HIV results. We can result them in My chart but as per policy patient will still need a phone call of their results.

PPDs: from DPC administration: see Dr. Rubin smart phrase SRTBFORM and the letter SRTBLETTER

We will like to provide an update in regard to the PPD shortage.  The manufacturer is able to fulfill orders for PPD derivative.  If your site has an adequate supply of PPD, please follow the State’s guidelines for administration:

1.       Resume testing for the previously deferred group, which includes –

a.       Staff with direct inmate contact

b.      Inmates in the custody of the Department of Correction (tested upon incarceration and yearly)

c.       Staff working in licensed nursing care homes

d.      Residents upon admission to licensed nursing care or adult care homes

e.      Staff in adult day care center providing care to patients with HIV/AIDS

2.       After verifying PPD supply level, resume regular employee testing per CDC and facility guidelines

3.       Continue adherence to the June 21,2013 memo regarding administrative PPD testing for low risk individuals (e.g., teachers, child care workers, etc.)

a.       Perform risk and symptom screen

                      i.      If the screen is negative; then no further testing is required

                      ii.      If the screen is positive; then perform a PPD test or an Interferon Gamma Release Assay

Thank you to Wassim for the HUGE poster in the resident work room. We are doing great with sending our patients new results. We can improve, especially with alert values. Always confirm with the patient when you are ordering any lab or radiology their phone number and encourage them to use my chart (use .mychart in patient instructions). You can addendum your note (you do not need a whole new telephone number for your conversation).

Thanks!

 

What Did I Read This Week?

Submitted by Vaishali Patel, MD

Singer AJ, Talan DA.  Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus.  N Engl J Med 2014;370:1039-47.

 

Why Did I Read It?   Skin abscesses are common, and are mostly managed by internists in clinic/urgent care, and ED physicians.  Knowing how to manage small, simple skin abscesses yourself, and knowing when to consult a surgeon for larger, complex cases is important.  Not surprisingly, the incidence of skin abscesses has increased with the incidence of community-acquired MRSA (caMRSA) – this has prompted reconsideration of the importance of adjunctive antibiotics with drainage.  This review is largely based on randomized trials, and some small, observational studies.

What Did I Learn? 

– In addition to increasing your ability to detect an abscess, bedside ultrasound can help you determine the need for further imaging, the need for incision and drainage (I&D), or for surgical consultation.  In a prospective study of 126 adults with a clinical diagnosis of cellulitis, ultrasonography resulted in a change in management for 56% of patients.

– Distinguish skin abscesses, furuncles, and carbuncles from folliculitis, hidradenitis suppurativa, and sporotrichosis.  In immunocompromised hosts, consider skin lesions due to Cryptococcus and Nocardia.

– Needle aspiration can make the diagnosis, but an absence of pus on aspiration does not rule out an abscess (staphylococcal abscesses have a lot of fibrin and have high viscosity, making it difficult to aspirate).  Needle aspiration is inferior to I&D for adequate drainage.

– Individuals at risk for endocarditis should receive antimicrobial prophylaxis prior to I&D (IV vancomycin, or single dose of oral anti-MRSA agent is also acceptable).

– Refer the following to a surgical specialist for I&D: large (>5cm), deep, complex/multiple collections, or recurrent abscesses, abscesses in certain areas, such as the hands, neck, face, breast, or genitourinary or perirectal area, areas with critical structures such as major vessels and nerves.

– The primary treatment is I&D (use 1% lidocaine and a scalpel).  The single incision should be long and deep enough to allow drainage; a small study suggested that a small incision is adequate (median length, 1cm).  Check out NEJM’s Videos in Clinical Medicine (http://www.nejm.org/doi/full/10.1056/NEJMvcm071319).  Small skin abscesses that you manage without surgical consultation do not need packing (associated with more pain but similar healing rates).

– Wound culture is not routinely needed for healthy patients who will not receive antibiotics, but should be done in patients with severe infection, sepsis, history of recurrent abscess, failure of initial antibiotic treatment, extremes of age, and immunocompromised states.

– Cure rates with I&D alone (without antibiotics) are high (>85%), however larger studies are needed to show smaller differences in response rates, especially in the era of ca-MRSA.  Some observational studies show I&D is sufficient for immunocompetent hosts with MRSA abscesses; other retrospective data suggests that antibiotics may help prevent recurrent infection.  Two large NIH RCTs are ongoing to investigate whether larger abscesses (>5cm) or surrounding cellulitis benefit from adjunctive antibiotics.

– IDSA recommends antibiotics with I&D for patients with severe disease (rapid progression, signs of systemic illness or sepsis), extensive disease, abscess>5cm, multiple sites of infection, immunosuppression, very young or very advanced age, associated septic phlebitis, or an abscess in an area that is difficult to drain (face, hands, genitalia).  Otherwise, avoid over-treatment (risk of increased resistance).

– Antibiotic therapy should cover ca-MRSA (TMP-SMX, clindamycin, and doxycycline are good choices — be aware of local resistance patterns for clindamycin and tetracyclines!).  For patients with systemic illness or extensive involvement, your options include vancomycin, linezolid, daptomycin, and ceftaroline.  5-7 days of therapy is usually sufficient; severe disease may need a longer duration (tailor to clinical response). For early abscess that cannot be distinguished from cellulitis, use agents with activity against MRSA and streptococci, such as TMP-SMX and a beta-lactam (like cephalexin).

 

QI Corner (submitted by Joel Boggan, MD)

Congrats to Patient Safety and Quality Conference Presenters
To our residents who had posters at the Duke Patient Safety and Quality Conference on Thursday.  ‘Check out a couple of our presenters!  Congrats as well Katie Broderick-Forsgren, who won a Runner-Up award for her poster on the business card initiative on Gen Med!Tim Poster

DSC09063
Hand Hygiene Update
We did really well with hand hygiene in February, with almost 92% compliance overall and 100% compliance on 8300 with > 20 observations.  Our aggregate rate since August is inching closer and closer to the goal of 90% for the year . . .

 

From the Chief Residents

SAR Talks

March 20:  Anne Mathews  /  Ashley Lane

Grand Rounds

Dr. Kimberly Blackwell – Breast Cancer

Noon Conference

Date Topic Lecturer Time Vendor Room
3/17 MKSAP Mondays Chiefs 12:00 Subway 2002
3/18 MED-PEDS Combined: Transitions of Care to Adulthood OR Difficult Death Debrief Carl Cooley / Galanos 12:00 Saladelia 2002 OR DN9242
3/19 M and M Boggan 12:00 Cosmic Cantina 2002
3/20 SAR TALKS Anne Mathews / Ashley Lane 12:00 Sushi 2001
3/21 Chair’s Conference Chiefs 12:00 Rudino’s Med Res Library

From the Residency Office

Mini CEX Madness

Week 2 of Mini CEX Madness saw a total of 14 CEXs completed!  Our winner for week # 2 is Alexandra Clark – congratulations!  A special shout-out to Basem Matta and Brian Sullivan who each completed THREE CEXs in week #2! As a reminder, everyone who has a CEX done during the month of March will be entered to win a $50 dinner at the restaurant of their choice (alcohol not included.)  Great job everyone!

SAR’s – Licensing and Credentialing

SARS — If you would, please give all forms you have for licensing and credentialing to Lynsey Michnowicz. She will make sure that Dr. Zaas fills them out and sends them in.  No need to email Dr. Zaas directly!  Actually if you do there be greater risk that they may be lost in the volume of email received.

Grand Rounds – Recording Attendance

Department of Medicine Grand Rounds is just one of the many learning opportunities that residents are strongly encouraged to attend.  It is also one of the events that for which we track and record attendance in Med Hub.  We understand that the changeover to ETHos in February may have caught a few residents off guard, which is probably why the conference attendance that we see in the data base has dropped, even though many residents can be seen sitting in the gallery.  For reference, click on the following link for the directions to set up an account in ETHos, and YES – you do need log in each time to record your attendance at Grand Rounds.   How to register with Ethos

Financial Planning Seminar

We are sponsoring a brief financial planning seminar sponsored by The Benefit Planning Group (www.myBPGinc.com).  BPG is the exclusive provider of disability and life insurance for residents and fellows at Duke. The firm works nationally with clients in every state and 600 cities.  The seminar will be conversational in order to best address your topics of interest and focus particularly on the specific needs of physicians transitioning from training to practice.

Topics will include:

  •  Debt Reduction for Home and School Loans
  •  Investment Strategy for Current Career Stages
  •  Risk Management through Insurance Solutions

Key Take-Aways:

  • Through BPG and this seminar, disability insurance is currently available at up to a 45% discount
  •  This discount is only available while you are still in training at Duke.
  •  Guaranteed issue options are available for departing trainees – no medical or financial underwriting
  •  The insurance marketplace is continually training and these opportunities may not exist in the future

Details:

April 17 @ 5:00 in the Med Res Library

Marc C. Flur, CFP
Vice President, The Benefit Planning Group, Inc.
3400 Croasdaile Drive Suite 206
Durham, NC 27705
919-489-1720
800-225-7174

Information/Opportunities

Frankfort IM Hospitalist Flyer (3-6-2014)
LGMC & Pulaski IM Hospitalist Flyer (3-5-2014)
SRMC – IM Hospitalist (3-6-2014)
Reston – IM Hospitalist (3-6-2014)
CJW – IM Hospitalist (3-6-2014)

Upcoming Dates and Events

  • BLS Blitz 3-2014:  March 17 – 20
  • March 21:  Match Day CELEBRATION !!

  • March 22:   Gastrointestinal Cancers Program 1st Annual 5K Run/Walk   DukeCRC5K.org
  • April 11:  Final Faculty Resident Research Grant applications
  • March 31:  GI Interest Meeting (contact Jill Rimmer, GI PC)
  • April 17:  Financial Planning Seminar
  • April 18:  Charity Auction
  • April 18:  SAR Class Picture (rescheduled)
  • April 22:  CPC Event, 7 PM @ The Pit
  • May 3:  the Stead Tread 5K   www.steadtread.org
  • May 30:  Program pictures @ Duke Chapel 9:15
  • June 3:  Annual Resident Reseach Conference
  • May 31:  SAR Dinner, Hope Valley CC

Useful links

 

by · Posted on March 16, 2014 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Internal Medicine Residency News: March 10, 2014

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi everyone! Happy daylight savings time! #bestnighttobeonnightfloat!

Thanks to the chiefs for a hilarious face melding Trivia Bowl and for organizing intern day off! Gena Foster’s disbelief at the final jeopardy question was priceless. Glad to hear fun was had by all!

Week 1 of Mini CEX Madness and we are off to a great start – 10 completed!  Of those, Kristen Glisinski is our first winner!  Myles Nickolich and Ben Peterson share the award for “1st Trainee to have all 6 CEXs done.”  Just a reminder, at the end of the month, everyone who has had a Mini CEX completed on them and submitted in MedHub will be eligible for the Grand Prize – a $50 dinner at the restaurant of your choice (alcohol not included).  Many thanks to our amazing faculty for completing and submitting the evaluations as well.

Other kudos this week go to Yi Qin from Dr. Joe Rogers for a great diagnostic effort on CAD, to Jenn Rymer for a fantastic SAR talk, and to Bassem Matta and Dana Clifton from Dr Oddone for great work at the VA!

On Wednesday, we have our mock ACGME CLER visit, run by our DIO Dr. Cathy Kuhn.  The real CLER visit is when the ACGME comes to see how our institution is meeting the goals of graduate medical education, and this Wednesday is our practice run.  The visit will focus on patient safety (specifically how do you contribute to patient safety efforts at the hospital), supervision, fatigue management, and professionalism. What is your role? If a CLER team comes to talk to you while you are working, talk to them! Answer their questions. Be informed! Know what resources are available to you, such as the taxi service or PAS.  When the real visit happens (we get 2 weeks notice), there will be a peer selection process for choosing residents to meet with the ACGME visitors.

This week’s pubmed from the program goes to Dinushika Mohogitte:  Mohottige, D., Austin, C., and Hanson, L. C. (, May). Systematic Review of Decision Aids for the Seriously Ill. American Geriatric Society Annual Meeting, Orlando Florida.

Have a great week !! And, Go Duke!

Aimee

The “Clinic Corner”

We have two submissions this week, including a brief update from the Duke Outpatient Clinic (DOC) DOCMarchNews , submitted by Bronwen Garner, MD, and a 2nd submission from Alex Cho, MD, Associate Program Director for Ambulatory Care

 

Cho

Hi all!

For this week’s Clinic Corner, on Amb Care in general, wanted to reflect briefly on some of the changes in the ambulatory curriculum — and thank Stephen Bergin and Dani Zipkin for their leadership in kickstarting a makeover, beginning last year with Academic Half-Day (AHD), that will continue into next year and beyond.

The old (and wise) SARs may have dim memories of something called Pre-Clinic Conference, a case-based reading exercise that used the Yale Ambulatory Curriculum.  In the words of this year’s Oscar-winning best original song, we let it go, to allow those who could to attend noon conference at DUH/DRH; and at the DOC, to enable resident participation in clinic meetings held over the noon hour, like Leadership every other Monday, and What’s Up DOC.

The focus of the general ambulatory curriculum  has instead shifted to the reinvigorated AHD led by Dani, and this  year, DRH/Ambulatory morning report — co-hosted by Stephen and the DRH ACR — which every week now highlights a different ambulatory topic.  Next year, our ambition will be to augment these with some curated readings and other resources on important ambulatory topics like women’s health, which we (with Randy and Jen’s  help) plan to make available in a central, universally accessible location like MedHub.

And all this is in addition to the movement to milestone-based observations and evaluations in the clinic (tied to graduated increases in autonomy); the annual Ambulatory QI project, led by the indomitable Jon Bae; and the ACLT.

Finally, for those who don’t like waiting, wanted to share a few resources you can access now, for ambulatory care (and medicine in general):

  • The Stanford Medicine 25 website

-Murat brought this somewhat intimidating but awesome resource to my attention, which includes full-but-quick lessons on key portions of the physical exam, including video!

http://stanfordmedicine25.stanford.edu/the25/

  • UW Primary Care Immersion Block Readings & Presentations

-Aimee found this gem, a digital reader covering 24 different commonly encountered situations in primary care

https://depts.washington.edu/uwmedres/patientcare/Intern/intern-immersion.html

  • Yale Ambulatory Curriculum

-Last but not least, the Yale curriculum is yours to access freely — brief case-based vignettes on different ambulatory topics that include a review of relevant literature — and now we no longer have to withhold “the answers” from you!

Login: duke11

Password for faculty section: bulldog7-5F

Password for resident section: robin7-5R

Have a great week!   Alex

 

We often read and think about unusual diseases and cases. Equally important to get right is what we see every day. Often we become comfortable with those common conditions and don’t question our approach. But everything changes in medicine, and reviewing new information in common diseases that we think we know well is important!

This JAMA review is based on a Medline search for articles about UTI and older adults, 1946-2013.

The clinical spectrum of UTI ranges from:

  • Asymptomatic bacteruria–transient, no morbidity or mortality issues
  • Symptomatic UTI–lab evidence : UC with <or equal to 2 pathogens and pyuria and
  • 2 of these clinical features:  fever, urinary urgency or frequency, acute dysuria, suprapubic or CV tenderness

Risk factors for recurrent symptomatic UTI:  DM, disabled, recent sexual intercourse, urogyn surgery in past, urinary retention and incontinence.

Chronic urinary incontinence can make it very difficult to differentiate asymptomatic bacteruria from symptomatic UTI. Symptoms of urgency and incontinence can fluctuate in older women, even without infection.

One of the mainstays of evaluation,and so simple to use, the urine dipstick! There are important test characteristics to keep in mind–the sensitivity and specificity for a positive test is 82%, negative predictive value is 92-100%, so do it to R/O UTI, not necessarily to diagnose!

New dysuria is a sensitive indicator of symptomatic UTI in older women.

When to test urine in the lab? A clean catch, mid-stream, with properly cleaned labia, is the most effective, but rarely done properly.

The predominant pathogens remain E-coli at 50%,  with other pathogens, Klebsiella, Proteus, and Enterococcus each < 10%.

Flouroquinolone resistance is greatest in pts aged 65 and older. 3 days of trimethoprim-sulfa is recommended as standard UTI therapy for otherwise healthy women.  Nitrofurantoin is one of the first line agents for UTI, if CrCl > 60.  Current evidence shows cranberry products may be helpful in prevention in older women, not so for oral estrogen. Topical estrogen may be beneficial. Chronic, suppressive antibiotics for 6-12 months can help with recurrent infections.

As simple as UTI can be, in older women especially, it can be complex to determine if a patient actually has an infection, and what the best testing and treatment can be. Challenging to make the best decisions for our patients.

From the Chief Residents

SAR Talks

March 11:  Marcus Ruopp / Jeremyh Gillespie

Grand Rounds

Dr. Timothy Collins – Neurology
Topic: Migraine Evaluation

Noon Conference

Date Topic Lecturer Time Vendor Room
3/10 MKSAP Mondays –   Bedoya’s Infections Bergin/Chiefs 12:00 Picnic Basket 2002
3/11 SAR   TALKS Marcus   Ruopp / Jeremy Gillespie 12:00 Pita   Pit 2002
3/12 “What   about my future?  Do I know what money   is?” – OR – Schwartz Rounds Galanos   / Heffelfinger 12:00 China   King MedRes   OR 2002
3/13 PWIM   Conference: Difficult Conversations Ann   Brown 12:00 Domino’s 2001
3/14 Chair’s   Conference Chiefs 12:00 Chick-Fil-A Med   Res Library

From the Residency Office

Noon Conference:  What About My Future

Noon conference on the 12th will offer you the opportunity to explore some of the things you might need to consider when you finish residency, including such topics as:

  • Do I need tail insurance
  • What is protected time and how to I pay for it
  • Am I a cFTE and what does this mean

We don’t assume that we know ALL of the questions you might want to ask, so to help make sure yours in on the list,  here is a chance to submit your question ahead of time using the following link:

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

Snyderman Research in Medical Education Award – Submissions due April 4, 2014

The Ralph Snyderman MD GME Research Award was established in 2004 with a goal of encouraging and recognizing excellence in research involving GME. Winners are acknowledged with a prize of $1000 and their name on a plaque and will present at the May or June ICGME Meeting. The project must have substantial contributions from at least one GME Trainee (intern, resident or fellow) Examples of eligible projects include: evaluation of the impact of a new curriculum on resident knowledge and skills, using technology to increase quality of trainee “hand offs” at the end of call, using standardized patients to measure trainee’s skills at “communicating bad news”, using the patient simulator to teach and assess anesthesia. Past winners and their topics can be found at https://gme.duke.edu/trainees/snyderman-research-medical-education-award/snyderman-award-winners

Full Submission information at:

https://gme.duke.edu/trainees/snyderman-research-medical-education-award/snyderman-award-submission-information

 

Interested in Hematology Onclology Fellowship?

Carlos DeCastro, MD, Fellowship Program Director, has arranged two times this month to meet with residents who would like to know more about Duke’s fellowship program.  Both session, scheduled for March 11th and March 25th, are scheduled to be held in the Med Res Library at 4:00.  For more information feel free to contact Sarah Overaker, Program Coordinator.

On-Call Meal Benefit Times

Reminder that the on-call meal benefit is available to Housestaff from 7pm – 5am daily for residents who are working in house overnight. The purpose of providing a meal benefit to trainees has always been, and continues to be, to provide a meal to those trainees who are working in the hospital at night for the entire night. (e.g., at least 8 hours of continuous in-house work past 7 pm).

The meal benefit is not intended for use on the way home, or at other times of day.  If you have questions, concerns, or suggestions, please contact your ICGME representatives or Dr. Christopher Hostler, head of the Resident Environment section.

 

Information/Opportunities

 

Upcoming Dates and Events

  • BLS Blitz 3-2014:  March 17 – 20
  • March 21:  Match Day CELEBRATION !!
  • March 22:   Gastrointestinal Cancers Program 1st Annual 5K Run/Walk   DukeCRC5K.org
  • April 11:  Final Faculty Resident Research Grant applications
  • March 31:  GI Interest Meeting (contact Jill Rimmer, GI PC)
  • April 18:  Charity Auction
  • April 18:  SAR Class Picture (rescheduled)
  • May 3:  the Stead Tread 5K
  • June 3:  Annual Resident Reseach Conference
  • May 31:  SAR Dinner, Hope Valley CC

Useful links

 

by · Posted on March 9, 2014 in Chief Residents, Internal Medicine Residency, Medical Education, Weekly Update · Read full story · Comments { 0 }

Grand Rounds 3/7/14: Trivia Bowl

Medicine Grand Rounds on Fri., March 7 at 8 a.m. in Duke Hospital room 2002 will feature a special presentation by the chief residents.

The topic for this week’s Medicine Grand Rounds will be the department’s Faculty v. Resident Trivia Bowl.

This week’s Grand Rounds will not be live streamed or recorded.

by · Posted on March 4, 2014 in Chief Residents, Grand Rounds · Read full story · Comments { 0 }

Internal Medicine Residency News: March 3, 2014

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Happy March! It’s the month of the match! And basketball! And hopefully warmer days! And, of course, MiniCEX Madness We ended February well with an extraordinarily great showing at the NC ACP meeting.  Congratulations to all of our presenters, and especially to Jennifer Rymer who won BEST RESEARCH POSTER, BEST OVERALL POSTER and THIRD PLACE for CLINICAL VIGNETTE and to Mike Woodworth who won BEST CLINICAL VIGNETTE.  As Vaishali said, we basically swept it.  Great work!ACP Posters

Kudos this week also go to Noah Kalman from the 8100 nurses for great communication, to Alan Erdmann from Brice Lefler for great work on VA Gen Med, and to Jennifer Creed, Lindsay Anderson, Carter Davis, Jeremy Gillespie, Trevor Poseneau, Michael Shafique and Kaley Tash for being part of DRH’s Maestro roll out! Hany El Mariah and Laura Caputo had fantastic SAR talks this week as well.  Also a huge thanks to our most recent ACRs Mandar Aras, Lindsay Boole and Carter Davis for your hard work these past two months.

We had a little “Throw Back Friday” here on Duke Gen Med while Maestro was down (See photo). As said by Amanda Verma, “How do I do paper orders anyway?”. Paper Maestro

 

Thanks to Bill Hargett for the first “preparing for fellowship” meeting.  A second meeting to replace the snow day will be announced ASAP.

This week’s pubmed from the program goes to Hany Elmariah for his resident burnout study poster accepted to the Duke Patient Safety and Quality Conference!

Have a great week — ask your attendings to fill out MINI CEX’s.  Jen will be checking the MiniCex count at the end of the week. Those with minicex’s completed will be eligible for prize drawings.

Aimee

 

What did the authors do?

The authors evaluated intern and patient outcomes associated with protected nocturnal nap periods of three Murat Arcasoyhours that do not require an additional house officer to provide coverage.  Two randomized controlled trials were conducted in parallel at an academic center university hospital and its affiliated VAMC.  They examined the impact of the protected nap intervention on intern sleep, periods of prolonged wakefulness, sleep disturbances, an objective measure of behavioural alertness, and patient outcomes during extended duty hours (30-hours) in 2010-2011.

Why did the authors perform this study ?

As our SARs will recall, concerns about prolonged duty hours had led to the 2011 ACGME requirements mandating that duty hours for residents in PGY-1 not exceed 16 hours.  For more senior residents who could still be scheduled to work 24 continuous hours + 4 hours for transfer of care, the ACGME strongly encouraged the use of alertness-management strategies such as “strategic napping” especially after 16 continuous hours of duty and especially between the hours of 10 pm and 8am.  The authors asked if strategic napping during 30 hour duty could be an alternative to mandatory short shifts.  Previous studies of protected sleep periods for interns resulted in increased amount slept and improved cognitive alertness but required supplemental personnel. The authors set out to determine whether a sequential protected sleep period of 3 hours (one intern sleeps from midnight to 3 am and the second sleeps from 3 am to 6 am) is feasible and effective in increasing the amount slept on extended duty overnight shift (30-hour) without extra personnel.

What was the methodology?

The authors assigned 94 interns at the VAMC and 61 interns at the university hospital to two randomized blocks during the study year, consisting of 12 four-week blocks. The standard schedule (control) months consisted of one resident and two interns on call on night float with both interns admitting patients throughout the night and responsible for cross-coverage until 7am, working a total of 30 hours (in 2010-2011). The intervention schedule incorporated the protected 3 hour nap periods as above  and the interns were assigned to alternate between the early (12 midnight-3am) and the late (3am-6am) protected period. During the protected period they gave their cell phone/pagers to the night float resident. Each intern wore an Actiwatch a device that contains a sensitive accelerometer to measure physical motion, collecting data in 1-minute epochs. They completed a 3 minute Psychomotor Vigilance Test each morning and every night and filled out an electronic sleep log. Patient outcomes included length of stay, discharge to the MICU, death and 30-day readmission.

What did the authors find?

Interns with protected sleep periods were less likely to have on-call nights with no sleep (6% vs 21%), significantly longer sleep durations compared to controls and had fewer attention lapses on the psychomotor test. Proportion of interns reporting sleep disturbance was significantly lower in each of the protected sleep periods(57% vs 89% P<0.0001). There were no differences in any of the patient-level outcomes except VAMC patients cared for by the control group compared with the intervention group had shorter length of stay. Interns in both groups left the hospital at the regular time.

What are the conclusions of this interesting study?

This is the first examination of a personnel-neutral protected sleep period during extended work periods (30 hours).  Strategic napping provides an alternative to mandatory short shifts, such as the 16 hour shifts, that create significant discontinuity in both care and education. Comparative effectiveness research of alternative forms of fatigue management would inform the optimum way of reducing house officer fatigue while preserving and enhancing the quality of education.

From the Chief Residents

SAR Talks

 March 4:  Amanda Elliott / Jenn Rymer

Grand Rounds

Chief Residents

Noon Conference

Date Topic Lecturer Time Vendor Room
3/3 MKSAP Mondays – General Internal Medicine Chiefs 12:00 Subway Med Res Library
3/4 SAR TALKS Amanda Elliott / Jenn Rymer 12:00 Bullock’s   BBQ 2003
3/5 IM-ED   Combined Conference 12:00 Cosmic   Cantina 2002
3/6 Christina Sarubbi from ID–topic TBD Christina Sarubbi 12:00 Saladelia 2001
3/7 Chair’s Conference Chiefs 12:00 Rudino’s Med Res Library

From the Residency Office

Hoops Watch

Hoops Watch Invitation/Reminder ….

Join local DukeMed alumni from the classes of 2004-13, current and recent house staff to cheer the Blue Devils on to victory over our Tar Heel neighbors!

Duke Blue Devils vs. UNC Tar Heels

Saturday, March 8  |  8:30 pm Tyler’s Taproom 324 Blackwell St Durham, NC 27701 (919) 433-0345

Complimentary appetizers and one drink ticket per person provided.

RSVP

See who’s coming.

 

Pain Narrative for Primary Care

Pfizer, Community Care of North Carolina and The Governor’s Institute invite you to attend an informational program on pain management:  Tuesday, March 4th, 2014

“Pain Narrative for Primary Care”, featuring Ashwin Patkar M.D.

  • 5:30 PM – Registration
  •  6:00 PM – Dinner and Informational Program

(Please use the registration link for this program)    https://prolazdurham.eventbrite.com

Immediately following the Pfizer presentation Community Care of North Carolina & The Governor’s Institute Presents:  A Guide to Rational Opioid Prescribing, featuring Ashwin Patkar, M.D.

7:00 PM – Informational Program

  • University Club
  • 3100 Tower Blvd. 17th Floor
  • Durham, NC  27707
  • 919.493.8099 club

Interested in Learning About GI Fellowship?

If you are thinking about completing a fellowship in GI, the following is an opportunity to add to your schedule.

  • What:  GI Interest Meeting
  • Date:   March 31, 2014
  • Location:  Tyor Conference Room
  • Time:  4:00pm

F0r more information feel free to touch base with Jill Rimmer, GI Program Coordinator

Health Care Value For Physicians: Understanding Quality and Cost

With recent health care reforms and changes in reimbursement impacting how we practice, understanding quality and cost is an increasingly important part of medical training.  The GME Incentive Plan Task Force is please to announce a 6-part lecture series: Health Care Value for Physicians: Understanding Quality and Cost led by representatives from the School of Medicine and health system administration. These lectures are geared towards house staff, but are open to anyone.

All lectures will be held in the Trent Semens Center:  Time: 7:00 – 8:00pm in the Trent Semens Center

Light refreshments will be served – including cheese from around the world

The complete schedule can be found on the following attachment:  Health Care Value Lecture Series

March 5: Pay for Performance under the Affordable Care Act

      Jennifer Rose, Director, Performance Services, DUHS

March 19:  Performance Measurement

     Bill Burton, Vice President, Performance Services, DUHS

March 26:  Quality in Healthcare

      Bimal Shah, Director of Quality, Department of Medicine

Liability Insurance Information

For those who are finding themselves filling out the vast packets of information required for fellowship or credentialing packets, please note the following information regarding liability insurance:

  • >> Name of insurance coverage provider:   Durham Casualty Company, Ltd.
  • >> Policy Number:  12PL1022-P
  • >> Mailing Address:  DUMC Box 3811, Durham, NC 27710
  • >> Phone Number:  919-684-3277
  • >> Fax Number:   919-684-6543
  • >> Per claim amount:  In excess of $3M
  • >> Aggregate amount:  In excess of $20M

Information/Opportunities

 CompHealth_Info res fellow
CompHealth_Locum_Tenens
Central Louisiana Internal Medicine
Los Angeles RSA-105 Flyer
South Texas Internal Medicine Outpatient 

Upcoming Dates and Events

  • March 8:  Duke Blue Devils vs. UNC Tar Heels
  • BLS Blitz 3-2014:  March 17 – 20
  • March 21:  Match Day CELEBRATION !!
  • March 22:   Gastrointestinal Cancers Program 1st Annual 5K Run/Walk   DukeCRC5K.org
  • April 11:  Final Faculty Resident Research Grant applications
  • April 18:  Charity Auction
  • April 18:  SAR Class Picture (rescheduled)
  • May 3:  the Stead Tread 5K
  • June 3:  Annual Resident Reseach Conference
  • May 31:  SAR Dinner, Hope Valley CC

Useful links

 

by · Posted on March 2, 2014 in Chief Residents, Internal Medicine Residency, Medical Education, Uncategorized, Weekly Update · Read full story · Comments { 0 }

Internal Medicine Residency News: February 24, 2014

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hello everyone! What a great game last night, and great turnout at Tobacco Road!  Krish is definately hoarse from cheering.  We are gearing up for March Madness, which also brings us to the time of year for “MiniCex Madness!”

As exciting as March Madness it is not, however direct observation and feedback from your inpatient and outpatient attendings is a critical component of your development as physicians, so we want to make an effort for everyone to have at least 2 (but hopefully more) minicex’s completed during March.  Each week we will check medhub, and whoever has had Minicex’s completed will be eligible for prizes, including Starbucks cards, new cars and tickets to the Duke Carolina game (well….maybe not).  SO…ask your inpatient and clinic attendings to do a MiniCex while you are working with them, or ask an APD or chief to come observe you if you are on a non-medicine service.

In other big news, the “Doximity” survey rated us as one of the top residency programs in the US.  They surveyed internists who are doximity members, and we did extremely well, and particularly well among program directors.  Very cool to see.  What they didn’t publish is what program has the best residents….clearly we are #1 in that regard!

Thank you again – we had 87% compliance on our ACGME survey! Results to come in June!

This week we have kudos to Hal Boutte for coming in on his day off to talk to some second look applicants, to Tony Lozano for his care of a patient overnight on Gen Med (from Tom Holland), and to Bobby Aertker, Jim Gentry, Alex Clarke and Lauren Porras for the past two weeks of outstanding SAR talks.

The NCACP meeting is Friday and Saturday in Greensboro! We are very proud of everyone who has posters to present! This week’s pubmed from the program goes to all who are preseentingt at the ACP – 27 posters in all, a record number.  Check out the following list:  ACP Presentations 2014

Have a great week!

Aimee

 

QI Corner (submitted by Joel Boggan)

Thank yous:  To Lish Clark, Alistair Smith, Drs. Teiling and Ossman from the ED, and Yvonne Spurney and Miranda from Nursing as they helped lead our first new Resident M&M discussion on Wednesday.  Our next date is Wednesday, March 19th, again in 2002.

Joel Boggan, MD, MPH

Joel Boggan, MD, MPH

Thanks also to Ryan Schulteis for accompanying me on High Value Screening and Prevention on Thursday – our next date is March 26th with Alex Cho.

Hand Hygiene:
Here are our totals through the end of January, by unit – help us make a strong, compliant push to the end!

Unit

Observations YTD

Compliance YTD

Non Compliance YTD

Hand Hygiene Rate YTD

7100

87

78

9

89%

7300

97

84

13

87%

7800

68

60

8

88%

8100

90

81

9

90%

8300

55

44

11

80%

9100

99

87

12

88%

9300

66

61

5

92%

COMBINED

553

487

38

88.1%

Submited by George Cheely, MD

Subject:  “Health Care Costs and the Future of Big Medicine”

What:   Guest Health Policy Lecture:  “Health Care Costs and the Future of Big Medicine:  Perspective of the Commonwealth of Massachusetts Health Policy Commission”

Who:   Stuart H. Altman, Ph.D.;  Sol C. Chaikin Professor of National Health Policy;  The Irving Schneider and Family Institute for Health Policy;  Heller School, Brandeis University

Where:  Room 3037, Duke Law School,  (Across Science Dr from Cameron)

When:  12:00pm on March 3rd

Why:   Come on now.  Health care?  It’s expensive.

 

Clinic Corner – Ambulatory Care

submitted by Alex, Cho, MD

On behalf of Sonal, Sharon, Lynn, Dani, and Larry, I wanted to again thank all the residents and attendings who have participated in the over 200 Ambulatory Mini CEXs completed thus far this year. Cho

As the email that went out earlier this month said, our desire was to reward residents who volunteered for at least three (3) Ambulatory Mini CEX observations — and who were rated to be at or above their expected level in the clinic for their stage of training — with advancement in the level of autonomy with which they would be able to practice in clinic.  Eligible residents should hear soon, if you have not already; and if you have not we encourage you to be proactive in reaching out to the site directors/clinic Stead leaders re: what areas you might work at a little more, both in additional Mini CEXs and in general.

And for those who still need more observations to qualify for consideration for advancement, the list of newly-eligible residents will be refreshed each month, for potential “promotion” the following month.

Finally, for your reference below are some links to a few documents: the Ambulatory Mini CEX form, a one-pager describing the three “precepting levels,” and courtesy of Larry Greenblatt, a brief summary of SNAPPS, one of the signout frameworks that promoted SARs can now use instead of the conventional narrative one.

In closing, I want to stress again that doing Mini CEXs is not meant to be a value statement on individual residents, but a standing invitation for mentored improvement.  Or, as Sharon Rubin sez: “We still believe in performing CEXs on our residents in the second half of the year.”  Because she, as all of the attendings do, believe in all of you, too.

Amb Milestone-Based Mini CEX (Sep 2013)

Ambulatory Care Precepting Levels v3

SNAPPS Card

What Did I Read This Week?

National Trends in Patient Safety for Four Common Conditions, 2005-2011

Yun Wang, Ph.D., Noel Eldridge, M.S., Mark L. Metersky, M.D., Nancy R. Verzier, M.S.N., Thomas P. Meehan, M.D., M.P.H., Michelle M. Pandolfi, M.S.W., M.B.A., JoAnne M. Foody, M.D., Shih-Yieh Ho, Ph.D., M.P.H., Deron Galusha, M.S., Rebecca E. Kliman, M.P.H., Nancy Sonnenfeld, Ph.D., Harlan M. Krumholz, M.D., and James Battles, Ph.D.

N Engl J Med 2014; 370:341-351, January 23, 2014

Why did I read this?  This article provides an interesting overview on the impact of the many patient safety initiatives on in-hospital adverse events in the U.S. over the past Vermadecade.  It takes a pooled analysis approach of the multitude of safety campaigns, program, and initiatives and drills it down to specific adverse events with 4 DRGs.  Specifically  twenty one well defined clinical outcomes (CLABSI, CAUTI, falls, hosp. acquired C Diff., VAP,  contrast nephropathy, hypoglycemic events and  Anticoagulant complications, hosp. Acquired MRSA/VRE etc.) are evaluated instead of more surrogate markers of quality such as readmit rates, length of stay  and ED throughput times.   I think of it as a report a card on U.S. hospitals. 

On a more personal note, this article also hit home because I started as a hospitalist just prior to this database and Hospital Medicine has often played a significant role in patient safety and quality.  Lastly I read this because being an AHRQ sponsored project I thought there may be some insight into the future direction CMS may take us.

Methodology: Data was abstracted from the Medicare Safety Monitoring System for 21 adverse events in patients hospitalized in the U.S. from 2005-2011.  The final sample size was 61,523 patients with 4 different conditions (AMI, PNA, CHF, and surgical conditions). Patients were from over 4000 U.S. hospitals representing a comprehensive view of care delivery in the U.S.   Events were trended over the course of 6 years, cohorts were broken up into 2 year subsets (2005-6, 2007 and 2009, 2010-11). There was additional stratification by age, race, gender, and comorbidities were also assessed.  In general, age and gender was generally consistent across the 3 cohorts, race was skewed with a predominantly white (85-90%) population. Patient comorbidities over time also showed mild increase as a general trends with increasing obesity (14 to 22%) being the most significant increase, there were also subtle increases in diabetes, cancer and renal disease.

What they Found: Overall, adverse event rates declined substantially among patients hospitalized for CHF and AMI but not for PNA or conditions requiring surgery.  For AMI the occurrence rate for adverse events decreased from 5 to 3.7 % and for CHF 3.7 to 2.7 % but for folks with pneumonia and surgical conditions the rates overall didn’t change.  Most of the deceases seen in AMI and CHF were similar to a particular adverse event (see table S5).

Looking at across different adverse events there were some trends regardless of the DRG.  There was a decease with digoxin related events, hypoglycemic agents, and warfarin but increased with LMWH and Factor Xa Inhibitors.  CAUTI, CLABSI, VAP and post op PNA decreased but C.Diff, MRSA, and VRE rates stayed about the same.

What is next:  This is a really fascinating article and I am really just scratching the surface here.  The article does not extrapolate as to why there was such a difference between DRGs and it is difficult to hypothesize why the pneumonia and surgical populations didn’t see a change in total adverse events.   Are these two DRGs different populations all together or are CHF and AMI patients “seeing” a different version of care in general?

Furthermore many of these adverse events in and of themselves are worth further detailed investigation as to why they have changed over the years.   Some may be explained simply by decrease usage (digoxin and IV heparin) or increased usage (LMWH and Factor Xa inhibitors) while others may be impacted by changes in the literature (hypoglycemia and the NICE-Sugar trial).

My general impression is that there have been improvements in adverse events in specific DRGs as well as in specific events (CAUTI for instance), but we are still learning how to manage newer medications such as LMWH and Factor Xa inh.  We also haven’t made great improvements in some of the common infection rates (Cdiff, MRSA and VRE) despite that being a focus in many hospitals. Maybe the fact that these infection rates are not increasing is a sign of improvement although it is worrisome regardless.

Patient comorbidities and complexity also seem to be increasing in both medicine and surgery which also may pose future challenges.  The jump in obesity was most alarming.  However the fact that we are seeing more complex patients maybe means we are doing a better job at treating illness and prolonging survival.  Its hard to say.

I suspect that once CMS teases out this data we will see a call to action and more initiatives or metrics around improving some of these opportunities.  However I feel that with this first round of initiatives we have made significant inroads in world of patient safety and we are making the hospital a safer place for our patients.

From the Chief Residents

SAR Talks

February 25, 2013:  Drs Dolger and Mouser

February 27:  Drs Caputo and Elmariah

Grand Rounds

February 28, 2014:  Dr. Lanasa

Noon Conference

Date Topic Lecturer Time Vendor
2/24 MKSAP Mondays – Pulmonary Chiefs 12:00 Picnic Basket
2/25 MED PEDS SAR TALK   (Dolgner/Mouser) 12:00 Chick-Fil-A
2/26 MSK Exam Part 2 Irene Whitt &  Lisa Criscione 12:00 Cosmic Cantina
2/27 SAR TALKS Laura Caputo / Hany   Elmariah 12:00 Pita Pit
2/28 Research Conference 12:00 Panera

From the Residency Office

I’m Clear, Your Clear, We’re All Clear About This Consultation – with Dr. Chad Kessler (Deputy Chief of Staff, Durham VA Medical Center). 

Wednesday, March 26th 12noon – 1pm (DN2003)

Registration link:

https://www.surveymonkey.com/s/MEGRregistration2013

Session Objectives: 

1. Develop a conceptual framework for communicating with and understanding different colleagues in medicine.

2. Demonstrate the 5-C’s of Consultation.

3. Integrate the clinical science of communication into daily practice. 

Also, please remember to join us for our regularly scheduled March session – “Risk Management Issues Involving Learners” with Barbara Hendrix (Director, DUHS Clinical Risk Management). 

  • Monday, March 10th 4pm – 5pm
  • Tuesday, March 11th 7am – 8am
  • Wednesday, March 12th 12noon – 1pm

Please use the following link to register: 

MedicalEducationGrandRoundsFlyer March14_June14

Stead Society Trivia Night!

The Warren Society is hosting a Trivia Night for all the Stead Societies this upcoming Wednesday, February 26, at 7PM at the Carolina Ale House (3911 Durham-Chapel Hill Blvd Durham, NC)! Dinner starts at 7PM and trivia starts at 8PM.  We’ll donate $100 to a charity chosen by the Stead Society with the most trivia points!

Hope you can make it!

Thanks!!   Steve Crowley

 

Hoops Watch invitation – Let’s try this again…

Join local DukeMed alumni from the classes of 2004-13, current and recent house staff to cheer the Blue Devils on to victory over our Tar Heel neighbors!

Duke Blue Devils vs. UNC Tar Heels

Saturday, March 8  |  8:30 pm
Tyler’s Taproom
324 Blackwell St
Durham, NC 27701
(919) 433-0345

Complimentary appetizers and one drink ticket per person provided.

RSVP

See who’s coming.

 

Duke-NUS Graduate Medical School Singapore:  Longitudinal Integrated Clerkship (LIC) Pilot Call for LIC Teaching Fellow (Academic Year 2014-2015)

Requirements:

  • Completion of Internal Medicine residency program by July 1, 2014
  • Strong interest in medical education
  • Willingness to live in Singapore (for one year)

INTERESTED PERSONS SHOULD CONTACT PATRICIA JOSEPH, DIRECTOR, OFFICE OF DUKE-NUS AFFAIRS AT patricia.joseph@duke.edu

Details can be found in the following attachment:  teaching fellow

 

Income-Driven Repayment Plans and Loan Forgiveness Programs

Wednesday, February 26    7:00pm – 8:00pm

The Learning Hall, Trent Semans Center for Health Education

You will not want to miss this presentation by Paul Garrard, an independent student loan consultant and national expert on educational debt management, scheduled for Wednesday night, February 26, 7:00p in the Learning Hall at TSCHE.

Mr. Garrard will be joined by Heather Jarvis (see www.askheatherjarvis.com), a national student loan expert and Duke University School of Law alumni, who does workshops nationwide on income-driven repayment and forgiveness programs.

Ms. Jarvis and Mr. Garrard will provide details on Income Based Repayment (IBR) and the new Pay As You Earn (PAYE) repayment plans, and the forgiveness programs associated with each, including Public Service Loan Forgiveness (PSLF).

This workshop is open to all residents, fellows, medical students, and health profession students at Duke.  Please sign up using the following link: https://www.surveymonkey.com/s/6QWPH72

Should you have questions, please contact Amy Coppedge at amy.coppedge@duke.edu.

 

Assigning Your DOC In-Basket When You Are Away   (submitted by Jessica Simo)

To assign your In Basket to another member of staff when you will be away from work for a while:

  • Go to In Basket. Click on the “Out” button.
  • Select New in the Out of Contact window
  • Enter begin and end date/time.
  • Enter delegates (the people who are going to cover for you).
  • Click Accept, then Close in the next screen.

  Epic                     

MKSAP / Board Review

By popular demand board review sessions are scheduled on the following dates:  March 13 and 27;  April 10 and 24;  May 15, 29;  June 12 and 19.  All sessions are held in the Med Res Library from 7-8 PM.  Light dinner is served.

The Commonwealth Fund: Pursuing a High Performance Health System in the ACA era”

Dr. David Blumenthalm President

February 26, 2014     4:30 – 6:00 pm  Rhodes Conference Room   Sanford Building, 2nd Floor   201 Science Drive

David Blumenthal, M.D., M.P.P., is president of The Commonwealth Fund, a national philanthropy engaged in independent research on health and social policy issues. He is formerly a Professor of Medicine at Harvard Medical School and Chief Health Information and Innovation Officer at Partners BlumenthalHealthcare System in Boston. From 2009 to 2011, he served as the National Coordinator for Health Information Technology, with the charge to build an interoperable, private, and secure nationwide health information system and to support the widespread, meaningful use of health IT. He succeeded in putting in place one of the largest publicly funded infrastructure investments the nation has ever made in such a short time period, in health care or any other field. He is the author of more than 250 books and scholarly publications, including most recently, Heart of Power: Health and Politics in the Oval Office. He is a recipient of the Distinguished Investigator Award from AcademyHealth, an Honorary Doctor of Humane Letters from Rush University and an Honorary Doctor of Science from Claremont Graduate University and the State University of New York Downstate.

RSVP           mary.grimm@duke.edu

 

Information/Opportunities

 
W-HOSP flier- 02 2014
W-IM OP flier- 02 2014
Tal and Associates

Upcoming Dates and Events

  • March 8:  Duke Blue Devils vs. UNC Tar Heels
  • BLS Blitz 3-2014:  March 17 – 20
  • March 21:  Match Day CELEBRATION !!
  • March 22:   Gastrointestinal Cancers Program 1st Annual 5K Run/Walk   DukeCRC5K.org
  • March 26:  Trivia Night
  • April 11:  Fiknal Faculty Resident Research Grant applications

Faculty Resident Research Grant Application Forms-2014

Faculty Resident Research Grant Instructions-2014

Human Subjects example

  • April 18:  Charity Auction
  • April 18:  SAR Class Picture (rescheduled)
  • May 3:  the Stead Tread 5K
  • June 3:  Annual Resident Reseach Conference
  • May 31:  SAR Dinner, Hope Valley CC

 

Useful links

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

Duke 6th in physician survey on the quality of postgraduate training programs

In the first-ever, large-scale survey of physicians on the quality of postgraduate training programs, Duke Internal Medicine Residency Program came in 6th.

Survey recipients were invited to name up to five programs they believe to offer the best clinical training in internal medicine. Doximity, an online network with more than 250,000 physician members, conducted the survey through a combination of Web notifications and emails sent to 18,695 members who have completed a U.S. residency in internal medicine. The response rate was 18.2 percent.

While the physician sample for the residency survey should not be considered a ranking, it appears to be the first major effort to measure doctors’ views on a formative part of medical training. In all, 2.2 percent of U.S. internists completed the survey. Read more about the survey and results.

by · Posted on February 20, 2014 in Internal Medicine Residency · Read full story · Comments { 0 }