Internal Medicine Residency News, January 25, 2016

Monday, January 25, 2016

From the Director

We’ve survived the SNOWPOCALYPSE!  We cannot thank you all enough for your amazing efforts to be here and take care of your patients and support your colleagues during the ‘weather’ this past weekend.  From offering to house applicants (Harvey Cohen, Larry Greenblatt, Gow Arepally, Diana McNeill), to coming in extra early to make sure the day teams could go home (Eric Black-Maier), to pushing someone’s car up a hill (Zach Wegermann), and many more examples that I don’t know about, you all have been just outstanding in your efforts and it is much appreciated.

Other kudos go to our CCU team from Maggie Moses (fellows Angela Lowenstern, Anant Mandawat and Sima Hodavance, and JARs Tim Hinohara, Drew DeMaio, Taylor Bazemore and Kahli Zietlow) for being generally awesome at supporting the interns this month, and to Rachel Feder, Robert Diep and Ali Saadi from Krish Patel for their fantastic work on 9300.  Also to Brian Andonian for a fantastic chair’s conference on Friday with great attendance despite the snow! Some additional kudos from Saumil Chudgar... " to Jonathan Buggey, Meg Steiner, and Kelly Ground for an amazing job on Duke GM this week. And an even bigger shou tout to Kelly for volunteering to pick up her snow-phobic Southern-raised attending  in her 4WD SUV on her way to work and dropping me back off today!"

The Duke Family keeps on growing!! Chris and Carol Hostler (and big brother Cameron) welcomed Eleanor (Ellie) Lynn Hostler on Sunday.  She was born at 0455, 8lb 13oz!  We can’t wait to meet her.  Baby-sized army fatigue onesies are now sold out. 

Our interview season is coming to a close today! Let’s all make sure to give a huge THANK YOU to Madi and the entire team for their hard work (behind the scenes and in front of the scenes!) to make this interview season spectacular. Can’t wait to meet our future Duke residents.  

SARs, please don’t forget to register for the ABIM exam before prices go up in mid-Februrary!

This week’s pubmed from the program goes to those whose abstracts were accepted to the NC-ACP meeting coming up in February!

Katrina Abril, Rajiv Agarwal, Taylor Bazemore, Ankeet Bhatt, Eric Black Maier, Amanda Boyd, Adva Eisenberg, Eric Fountain, Rachel Hu, Amy Jones, Emily Kinsey, Liz Kotzen, Sarah Nouri Tracey Liljestrom, Alyson Shogan, Joanne Wyrembak, Nick Turner, Jason Zhu and Kahli Zietlow!

Have a great week



Welcome Eleanor Lynn Hostler!

What Did I Read This Week?

Submitted by Murat Arcasoy, MD

Elevated blood lead levels in children associated with the flint drinking water crisis: a spatial analysis of risk and public health response. Am J Public Health 106:283, February 2016, by Hanna-Attisha and colleagues from Michigan State University College of Human Medicine.

Why did I read this article

I have been astonished at media reports describing the public health crisis in Flint, Michigan where drinking water was contaminated with lead after water source change from Detroit’s Lake Huron to Flint River water in 2015. The highly corrosive properties of Flint River water apparently allowed lead to leach from the aging lead pipe and lead plumbing distribution system into the water (plumbing” is derived from the Latin word for lead, plumbum). I performed a pubmed search, curious to see if an epidemiologic study had been performed to assess the effect on the population, ie on children on whom lead intoxication has devastating health consequences.

What did the authors do

They analyzed differences in pediatric elevated blood lead level (EBLL) incidence before and after water source switch without adequate corrosion control. They reviewed blood lead levels for children < 5 years age, before (2013) and after (2015) water source change in Greater Flint, MI.

What did the authors find

Incidence of EBLL in young children increased from 2.4% to 4.9% (P < 0.05) after water source change, and neighborhoods with the highest water lead levels experienced a 6.6% increase. No significant change was seen outside the city. However, I think the most frightening data was the baseline, pre-water source switch disparity in lead poisoning of 2.4% in Flint compared with 0.7% outside Flint !  Geospatial analysis identified socioeconomically disadvantaged neighborhoods as having the greatest EBLL increases and informed response prioritization during the now-declared public health emergency.


Lead intoxication is a major public health hazard, unfortunately affecting primarily the poor and the disadvantaged in a horrifying manner in Flint, and this time not due to lead in paint or petrol, but in drinking water. Although in decline, lead intoxication still affects more than half a million children (1 in 38) in the US after the CDC lowered the blood level threshold in 2013. Thanks to the Safe Drinking Water Act of 1974 one could find potable tap water almost anywhere in the US (this is not the case even in most developed countries elsewhere in the world). Children absorb 40-50% of an oral water-soluble dose of lead compared to 3-10% in adults. Devastating neurobehavioral illness, developmental delay, hearing loss, renal and hematologic manifestations are all preventable. In-utero exposure is associated with neuro-developmental complications at 24 months age and recent findings reveal epigenetic effects of lead exposure on one’s grandchildren. Our colleagues in Pediatrics screen for EBLL in at risk children and heightened vigilance is certainly indicated in view of the disaster in Flint.



This feature will return next week.




Scheduling News

Jen and Lynsey have been busy working on a new software program that will streamline the scheduling process. In the meantime please email them along with the chiefs if you have questions about your schedule.

Feedback Needed!

Did you know that when you have ambulatory, you can opt for a “gen med” themed block, in addition to the medicine subspecialties? We are currently updating and improving the block! I would like to hear your feedback on the ambulatory blocks in general and any site-specific issues. Please just drop an email and let me know what’s up.

Announcing next year’s ACLT group!

We are very excited to welcome an expanded crew into the ACLT next year! New JARs (in alphabetical order) will be:

Megan Gillum

Kelly Ground

Nicole Helmke

Jared Lowe

Leah Machen

Maggie Moses

Sarah Nouri

Jonathan O’Donnell

Annie Reihman

Caroline Sloan

Meghan Steiner


From the Chief Residents


Grand Rounds 

Friday, January 29 -  Heme/Cellular Therapy, Dr. Dorothy Sipkins

Noon Conference

Date Topic Lecturer Time Vendor



12:00 Nosh
1/26/16 How to Read a Chest Film

Philip Goodman

12:00/2002 Domino's

Diagnostic Radiology Essentials

Alexie Riofrio

12:00/2002 China King

Personal Journey

Anthony Galanos



Hungry Leaf

Research Conference

  12:00/2002 Panera


From the Residency Office


General Medicine Health Services Research Fellowship at Duke (Attention SARS!)

Health services research (HSR) is multi-disciplinary and focuses on the impact of systems of care, access, cost, quality, behavior and other factors on health care outcomes. We have a very robust network of support and outstanding faculty in HSR at Duke. Here is an introduction to our fellowship, courtesy of David Edelman. The application cycle begins in January!

The Division of General Internal Medicine collaborates with the Center for Health Services Research in Primary Care in the Durham VA Medical Center to offer fellowships for MD and PhD scholars with an interest in training in clinical or health services research. The fellowship is ordinarily a two year program, though three year fellowships may be available to certain candidates. Training grants are funded by the VA Office of Academic Affairs (OAA).  We have trained more than 100 fellows in our 30-year history, including many leaders in Health Services Research and many of our core faculty in General Internal Medicine.

The primary goal of the post-doctoral fellowships is for fellows to perform high-quality, mentored clinical or health services research working closely with a mentor from the Division of General Internal Medicine. MD fellows ordinarily obtain a Masters in Clinical Research from Duke’s CRTP program, with tuition paid by the fellowship.  All fellows also participate in a Faculty/Fellow Development Seminar Series, a set of weekly, one-hour discussions addressing a variety of career development topics.  Stipend is at the appropriate PGY level.

Senior Residents wishing to apply for July 2016 should contact Dr.  David Edelman, Fellowship Director ( no later than Friday, January 9 to express interest.  Written application will be due February 1 with interviews competed by the 3rd week in February and applicants notified of their status by March 1.

Click the link for more info:

Or, contact David Edelman, MD, Fellowship Director (


Book Club Event

Please join us for a special book club event on February 3rd from 5:30 - 7:30 pm in the Faculty Lounge.   We'll be reading Black Man in a White Coat by our own Duke author, Dr. Damon Tweedy, who has graciously agreed to join us for the event.   If you only make it to one book club event this year, make this the one! 

If you would like to attend, please email  As always, a limited number of FREE COPIES of the book are available so RSVP early to reserve your copy.  We look forward to seeing you there!

Thank you!

Laura M. Caputo, MD

Hospital Medicine, Durham VA Medical Center


Fellowship Program Info Sessions

Gastroenterology Fellowship Program
Monday, March 7th at 5:00pm in the Tyor Conference Room located in the GI Administrative Suite.

Teaching and Leading EBM: A Workshop for Educators and Champions of Evidence-Based-Medicine

Registration is now open!
Teaching and Leading EBM: A Workshop for Educators and Champions of Evidence-Based-Medicine
Duke Medicine, Durham NC
April 12-15, 2016
This workshop focuses not only on learning EBM skills, but also on teaching EBM. Previous participants have included rising chief residents, faculty charged with developing an EBM curriculum, librarians, and other clinicians and faculty passionate about applying the best evidence to patient care. The program includes large group sessions in the morning, then supportive, small group, learner-driven sessions for the rest of the day.
The workshop will take place on the Duke Medicine campus in the new Trent Semans Center for Health Education and the Duke Medicine Pavilion.
Workshop Objectives:

Train leaders in medicine to facilitate evidence-based clinical practice in their teaching and practice settings.
Practice the skills involved in evidence-based medicine including clinical question formation and acquisition of medical evidence from the literature.
Review and develop critical appraisal skills and application of available evidence to patient care and medical education.
Develop skills in teaching EBM in both large and small group settings.
Provide interactive experience with a variety of evidence-based resources guided by faculty with expertise in evidence-based practice.

Please contact Megan von Isenburg ( or Laura Huffman ( with any questions.


Opportunities for Wellness


Feeling down? Need to talk to someone? 
All trainees at Duke have FREE access to Personal Assistance Services (PAS), which is the faculty/employee assistance program of Duke University. The staff of licensed professionals offer confidential assessment, short-term counseling, and referrals to help resolve a range of personal, work, and family problems. PAS services are available free of charge to Duke faculty and staff, and their immediate family members. An appointment to meet with a PAS counselor may be arranged by calling the PAS office at 919-416-1PAS (919-416-1727), Monday through Friday between 8:00 A.M. and 5:00 P.M. For assistance after hours, residents and fellows can call the Blood and Body Fluid Hotline (115 inside DUH, 919-684-1115 outside) for referral to behavioral health resources. Another resource is Duke Outpatient Psychiatry Referrals at (919) 684-0100 or 1-888-ASK-DUKE.


Upcoming Dates and Events

February 17 - Duke vs UNC

March 2 - JAR Networking Event

March 5 - UNC vs Duke

March 18 - Match Day Celebration

April 29 -Charity Auction


Useful links

GME Mistreatment Reporting Site
Main Internal Medicine Residency website
Main Curriculum website
Department of Medicine
Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response