Internal Medicine Residency News: February 17, 2014

Sunday, February 16, 2014

From the Director

DUKE.RESEARCH.NIGHT.03 (1)What a crazy week! An enormous thank you to the chiefs and the entire program for your hard work and resilience during the snow. Krish, Vaishali and Stephen showed incredible leadership and organization.  Special thanks to Lynsey Michnowicz for making sure you were fed during the day too! Let's hope for only warm weather and sunshine for awhile.

Other kudos this week to Brittany Dixon from Michael Minder for great patient care on cardiology, to Eric Pollack for his gold star, to Titus Ng'eno for getting the diagnosis of Amera Ramatullah's awesome DRH report case and to med student Adam Barnett from Michael Boniface  for great work in the ED.

We will be rescheduling the fellowship meeting so watch your email.

We hit our target of 85% for the ACGME survey! It closes at midnight tonight so there is still time to do even better - so if you haven't filled it out, please do. Thank you to everyone who filled it out - much appreciated. SARS have the best participation at 98%!   Results won't come back to us until July but we will be compiling other feedback for your review in the upcoming State of the Program.SAM_2356

This weeks pubmed from the program goes to John Stanifer and Scott Tolan. Included also is a photo of the first author atop Kilimanjaro!

The epidemiology of chronic kidney disease in sub-Saharan Africa: a systematic review and meta-analysis;  John W Stanifer, Bocheng Jing, Scott Tolan, Nicole Helmke, Romita Mukerjee, Saraladevi Naicker, Uptal Patel

Have a great week!


Joel Boggan, MD, MPHQI Corner (submitted by Joel Boggan)

New M&M Conference this week
This week we have two QI-related conferences.  First, on Wednesday, 2/19, Lish Clark will be debuting our new Resident M&M conference with a fantastic case.  Please be sure to come for what we hope will be a lively discussion.    Candidate 3


High-Value, Cost-Conscious Care Conference
On Thursday, 2/20, we have next installment of the HVCC series on High Value Screening and Prevention.  We'll also have hand hygiene and We Follow-Up updates to share beforehand. . .


NC ACP Posters
Just a reminder to congratulate your peers who have posters at the NC ACP meeting on 2/28!

Hand Hygiene Environmental Sampling
A special thank you to the dirtiest part of our daily hospital lives, the computer keyboard - here sampled by the incomparable Aimee Zaas!  Note the awesome CONS and Bacillus colonies growing a few days later!


What Did I Read This Week?

"Submitted by Sarah Rivelli, MD."

A Prospective, Randomized, Controlled Study Demonstrating a Novel, Effective Model of  Transfer of Care between Physicians: The 5 Cs of Consultation

Chad S. Kessler, MD, MHPE, Yalda Afshar, PhD, Gurkiran Sardar, MD, Rachel Yudkowsky, MD, MHPE, Felix Ankel, MD, and Alan Schwartz, PhD



Why did I read this?  I went to Medical Education Grand Rounds, and heard Dr. Chad Kessler of DVAMC (Emergency Dept and Deputy Chief of Staff) talk about his research in consultation – how to do it well and how to assess this.  Communication and interpersonal skills are core competencies, and the foundation of effective consultation with other providers and specialties.  We know that challenges in communication account for many medical errors, improving communication in consultation could improve patient safety.  Moreover, as medicine becomes more and more multidisciplinary, consultation is something we need to do well.Rivelli

As an IM/EM trained doc, Dr. Kessler recognized the importance of effective consultation - particularly in the ER where up to 40% of all ER patients get a consult.  He conceptualized a framework for consultation called The Five Cs of Consultation.  This framework can help you put a consult into words and elicit effective help from other specialties.  The 5 Cs of Consultation was developed from a prior study he conducted on qualitative analysis of ED consultations and was also shaped by a model existing in the business world.

Here is the framework:

The 5 Cs of Consultation

  •       Contact
  •       Introduction of consulting and consultant physicians. Building of relationship.
  •       State your name, service, program, attending who you are working with
  •       Communicate
  •       Give a concise story and ask focused questions.
  •       Core Question
  •       Have a specific question or request of the consultant.
  •       Decide on reasonable timeframe for consultation.  (How urgent is the consult?)
  •       Collaboration
  •       Discussion between the requesting physician and the consultant, including any alteration of management or testing of patient’s status.
  •       Closing the Loop
  •        Ensure that both parties are on the same page regarding the plan
  •        Maintain proper communication about any changes in the patient’s status

Methods:  In this study, they randomized 43 EM residents to an intervention or control.  The intervention was a 90 minute educational session on consultation, which included didactics on the 5Cs, role-playing, trying out the 5 Cs with a simulated case and direct feedback.  The control group received general education about consultation.  The residents tried calling consults on two simulated cases and were recorded.  The outcome measure was global ratings (GRS) by three blinded physicians who listened to the cases.

What they found:  Controlling for PGY level, case, and rater covariates, residents in the intervention group had significantly higher mean GRS scores than those in the unstructured group.  Interestingly, they found no progression in consulting skills with increasing PGY level, either overall or among residents unexposed to the intervention.  This suggests that effective consultation needs to be taught in a structured way as opposed to trainees picking it up on the fly.

What’s next?  Consider giving the 5 Cs a try next time you call a consult.  To help you out, there is a checklist evaluation for this process, which has also been published.  Check it out:

Validity Evidence for a New Checklist Evaluating Consultations,

The 5Cs Model

Chad S. Kessler, MD, MHPE, Priyanka S. Kalapurayil, Rachel Yudkowsky, MD, MHPE, and Alan Schwartz, PhD

Academic Medicine, Vol. 87, No. 10 / October 2012

 5c model


Ambulatory Care Leadership Track (ACLT)

Congrats and an official welcome to the newest members of the Ambulatory Care Leadership Track (ACLT)!

On behalf of Stephen, Dani, and Aimee; and the Amb Care faculty and the program as a whole, I wanted to welcome Ryan, Matt, Dinushika, Amy, Adrienne, Jim (for a second time), and Jake to the ACLT, which Larry had created a couple of years ago to give our residents interested in primary care and ambulatory subspecialties the opportunity to pursue those Chointerests through additional clinical, didactic, social and other experiences.  We are excited to have you all join next year’s ACLT SARs Claire Kappa and Brice Lefler for blocks beginning in August, giving us a strong cohort of four JARs, three SARs, and – for the first time, two of our Med/Psych colleagues as well, who will be participating when schedules permit.

We were also glad to have already had some of you with us for last month’s inaugural ACLT “mid-winter classic” at Alivia’s, and look forward to having you join us again in late May/early June for a year-end dinner event to honor current ACLT SARs Kim Bryan (who just gave birth to baby boy Jason, yay!), Alex Clark, Jen Chung, Jeremy Halbe, Jodel Giraud, and Lauren Porras.

The current ACLT group has just started their February block, pioneering a new take on applied EBM w/Dani Zipkin, as well as a new pain and addiction medicine clinical experience at AIM Health Services.  And we are already busy planning for the May block, which starting this year will feature a trip to DC with our government affairs office to provide experience in legislative advocacy.  So there’s lots to look forward to.

Let us know if you have any questions, and once again, welcome!


"Clinic Corner" - VA Medical Center PRIME Clinic

Thank you, thank you, thank you.  I wanted to take the time to write a personal note from me to you.  I would like to thank each and every one of you for contributing to being the best resident run clinic I have ever had the opportunity to be a part of.  Your dedication to this clinic has made it possible to carry on the VA’s mission to support the well-being and lives of our nation’s veterans.

In the past year you have been part of so many changes and accomplishments.  The PRIME clinic has been essential in providing more timely access for our veterans,  the percent of patients waiting >14 days for an appointment has decreased from 6% to 0.56%.  This was possible because of your hard work and dedication to the clinic, seeing new patients and transferred patients from other clinics that have lost Primary care staff.

My hope for the future is to work with all of you to build on...and continue to make this the best place to learn, grow and treat our patients.

Currently there are many projects in place that I will give you updates on as we get data.

  1. PRIME resident forum that will meet quarterly, we will work on issues and ideas to improve clinic- thanks to everyone that attended  and especially to Amy Newhouse, Hal Boutte and Marc Samsky for notifying all of the PRIME residents the results of the meeting
  2. Pilot changing patient appointment times to 15 minutes  earlier for nurse check-in so your appts will still be on the half-hour/hour-  to see if this improves our flow- thank you Trevor Posenau
  3. Changes in our Chronic PAIN/COMP program- thank you EVERYONE- I really appreciate everyone lending a hand and changing the culture of prescribing and monitoring these scheduled medications and helping build the spreadsheets, this has been trial and error process and we welcome your input
  4. Level 4/5 ER pilot- PRIME patients that show up in the ER with low acuity issues are referred to PRIME clinic if we have open slots, this will help your ACC colleagues and benefit our veterans in being seen in their primary care clinic
  5. Systems Flow Analysis with Dr. Taheri from NC State- working on identifying bottlenecks in clinic and improving flow-  if anyone is interested in working with him, please let me know
  6. Work under way developing a  PRIME Resident Folder under the shared drive- this folder will have clinic letter templates, CPRS shortcuts and timesaving tips- if you have any other ideas please let me know
  7. Revising PRIME  Clinic Note Template- thank you Jesse Tucker and Mattew Hitchcock

Thank you for your dedication and I look forward to working together to make PRIME clinic even better for you.


From the Chief Residents

SAR Talks

February 18 2013:  Alex Clark;  Lauren Porras

Grand Rounds

Dr. McMahon

Noon Conference

Date Topic Lecturer Time Vendor Room
2/17 MKSAP Mondays -   Nephrology Chiefs 12:00 Subway 2002
2/18 SAR   TALKS Alex Clark / Lauren   Porras 12:00 Bullock's BBQ 2002
2/19 M&M Alicia Clark/Alastair Smith 12:00 China King 2002
2/20 QI Patient   Safety Noon Conference - High Value Prevention and Screening Boggan / Schulteis 12:00 Domino's 2001
2/21 Chair's   Conference Chiefs 12:00 Rudino's 2002



From the Residency Office

SAR Class Pictures

To be rescheduled - will let you all know when asap!

Regional GI conference at the University of Virginia

"I am currently organizing a regional GI conference at the University of Virginia and wanted to be sure to reach out to you and your medicine program as we have added a new resident/fellow research symposium.

We will be accepting abstracts and the top 20 will be invited to present and receive a research award along with a free night of lodging at the conference executive inn.

Please accept our invitation below and the call for abstracts."

Thank you,

Neeral Shah
Assistant Professor, Gastroenterology and Hepatology
Associate Program Director, Internal Medicine Residency
Associate Program Director, Transplant Hepatology

Call for Abstracts 2014

Faculty Resident Research Grant applications are due on April 11, 2014.

Please use the following link to our website where the application instructions, forms and NIH format biosketch example can be downloaded .

Please feel free to email with any questions


 Alabama Physician Needs

Upcoming Dates and Events

  • SAR Class Pictures -  To be rescheduled
  • BLS Blitz 3-2014:  March 17 - 20
  • March 21:  Match Day CELEBRATION !!
  • March 22:   Gastrointestinal Cancers Program 1st Annual 5K Run/Walk
  • April 11:  Fiknal Faculty Resident Research Grant applications
  • April 18:  Charity Auction
  • May 3:  the Stead Tread 5K
  • June 3:  Annual Resident Reseach Conference
  • May 31:  SAR Dinner, Hope Valley CC

Useful links