Internal Medicine Residency News, September 8, 2015

Tuesday, September 8, 2015

From the Director

We had a one of the most difficult weeks possible for our Duke IM family, made a bit easier by the tremendous support we all received from within our Duke IM family as well as from the rest of our Duke family.  I have no adequate words to say how proud I am of the legacy we have built.  Special thanks to Jake Feigal for his leadership, Jenny Van Kirk, Mikey Graham, Alana Lewis, John Musgrove, Amanda Verma, Marc Samsky, Div Patel, Alan Erdmann, Dani Zipkin and Ralph Corey as well as the DVAMC Hospital Medicine team for coverage, and to anyone else I missed in that list.  
We do have a busy (if short) week this week, with ongoing ITEs, as well as the FOURTH ANNUAL STEAD TREAD this Saturday.  This 5K Fun Run benefits the Lincoln Community Health Center, which is our local federally qualified health center, and the likely site of our major Social Action Council evening clinic this year.  Come out and join us for a bit of exercise for a great cause.  Plus, if you haven’t seen last year’s VA QI Chief Aaron Mitchell run, you should get there early because he is likely to finish the 5K in 15 minutes.  
We also welcome a new member of the Duke family, Caleb Hitchcock.  Congratulations to Matt (Class of 2015) and Jenny Hitchcock, who now reside in Palo Alto, CA.  Pics below! 
Thank you to all the residents who submitted Stead Research grants this year – Murat is busy getting your reviews underway.  We also have an opportunity to serve as mentors for the Triangle Health Innovation Challenge.  Please see below from Tanmay Gokhale, also known as Mr. Dr. Manisha Bhattacharya ..
We cordially invite you to participate in the the Triangle Health Innovation Challenge (THInC), held on Duke’s campus from September 18th-20th. THInC is a three-day health hackathon that will bring together 200 students, clinicians, engineers, designers and others from the Triangle area to form teams and tackle issues facing our healthcare system. Over the course of three days, participants will develop, implement, test and pitch solutions to address selected pain points in healthcare. Participants will have an opportunity to compete for prizes up to $4000. Our goal is to leverage the brightest minds in the Triangle to tackle real health challenges. We hope you join us! 
In addition, we welcome residents and faculty to join us as mentors to help our participants validate and refine their ideas. Mentors will be scheduled for 2-hours of “office hours” where they will meet one-on-one with teams and provide feedback on their problem statement, solution and pitch. Clinical mentors are needed on Saturday Sept 19th from 9am to 12pm.  Finally, if you’ve seen something that’s broken in healthcare, but you can’t commit to joining us that weekend, submit your ideas and one of our teams may take on your challenge! Visit for more information!
THis week’s Pubmed from the Program goes to Jon O’Donnell for his recent article that was published online in Medgadget!
Newest addition to the #dukefamily, Caleb Hitchcock!

What did I read this week?


Submitted by Dr. Chris Hostler

What did I read this week?  Well my 19 month old got a couple new books, so Goodnight, Goodnight, Construction Site and Little Blue Trucks’ Beep-along Book have featured prominently in the Hostler Household this week.  The first is a fascinating tale of a bunch of construction vehicles that work hard all day long and then go quickly to sleep at night in preparation of the next day’s hard work, not unlike most of you.  The latter is a melody set to the tune of “If you’re happy and you know it” about all of the animals that are friends with the little blue truck.  It seems dangerous to mix farm animals and vehicles, but what can I say? My kid likes to live dangerously.

I did manage to also read a couple things in the medical literature.  Let’s talk about contact isolation for a minute.  We’ve all been there – right after lunch, you go to see Ms. Smith, who is on contact isolation for the blend of VRE, MRSA, and MDR Acinetobacter that’s been colonizing this poor lady for the last 5 years.  You put on the yellow gown, tie it on securely, wash your hands, put on some gloves, knock on her door, wait 2 minutes for her to get back from the bathroom, then step in her room to ask if she prefers a Monday or a Tuesday appointment with her PCP.  You realize that repeated trips into her room might take up a lot of time, so you spend a minute trying to think if there’s anything else you need to ask her, and remember to ask if her nausea is better after the zofran you gave her.  Then you take off the gowns and gloves, throw them away, walk out of her room, wash your hands, and get ready to sign out your team, since that took up most of your afternoon. Was all of that really necessary? That’s a topic for another WDIRTW (but the answer is a firm maybe).  But the real question is does having that patient on contact isolation really detract from their care?  A 2003 retrospective cohort study (Stelfox et. al. JAMA. 2003; 290(14): 1899-1905) suggested that patients on contact isolation experience more preventable adverse events, express greater dissatisfaction with their treatment, and have less documented care.  Makes sense, right?  We’re isolating our patients, so they feel isolated and fewer people look in on them because…they’re isolated.

Well in the words of Lee Corso, not so fast, my friends.  The Stelfox study was a retrospective review of 144 patients and their definition of adverse events included abnormal lab values without clinical evidence of harm – hardly strong enough evidence to hang our hats on.  The past month has seen 2 good studies come out of the infection control group up at University of Maryland, Baltimore with regards to contact precautions and their effect on frequency of hospital adverse events.  We’ll talk about one of them, Croft et. al. ICHE. 2015 Aug 17:1-7. E-pub ahead of print, which is an individually matched prospective cohort study of 296 medical or surgical inpatients admitted to non-ICU hospital wards between January and November 2010.  Patients on contact isolation were matched with those not on isolation by a minimum 3-day hospital length of stay and by admitting service, and adverse events were defined using the Institute for Healthcare Improvement (IHI) Global Trigger Tool, which is a well validated method to detect adverse events. Overall, patients on contact isolation experienced fewer noninfectious adverse effects than those with standard precautions.  This was the opposite effect from even what the study investigators expected.  They postulated that either patients did better and were more satisfied with their hospitalization when they saw fewer healthcare workers (probably not buying this) or the cognitive process required for considering entering their room led to more thoughtful assessment while in the room with the patient (I’d buy this).

So does this mean we should wear gowns and gloves when we see every patient?  Probably not, and actually the second study by the UMB group – Croft et. al. CID. 2015 Aug 15 (61):545-563 – looked at exactly that in a randomized trial in ICU patients. We won’t go into detail on their findings, but essentially they found no difference in adverse events whether you required gowns/gloves for all patients or only those on contact isolation.  But maybe it means that we should approach every patient with the same thoughtfulness as we do Ms. Smith.

Well that’s all I have for this edition of WDIRTW.  I’ll end with an adapted version of Goodnight, Goodnight, Construction Site:

These smart, strong residents, so tough and loud
They work so hard, so rough and proud.
Tomorrow is another day,
Another chance to work and play.
Turn off your lights, stop your scopes,
Relax your legs, your arms, and backs.
No more diagnosing and treating, team.
It’s time to rest your heads and dream.
Duke Medicine, all tucked in tight.
The day is done, turn off the light.
Great work today! Now…shh…goodnight.





The Patient Safety and Quality Committee meets THIS THURSDAY, September 10th at 5:30pm in the Med Res Library. Please join us! Dinner will be provided!

The 'Making Wise Choices Easier' High Value Care Quality Improvement Project competition is up and running... see the flier, attached at the bottom of this Weekly Updates, for details. And come to PSQC to find team members, project ideas, and proposal advice! Submission deadline is October 19th.



Hi DOC residents!!

The summer is almost over…fall is a wonderful season here in NC!

We welcomed a new attending based at the DOC last month, Dr Patrick (John Patrick in Maestro/email) Hemming.

He just completed a GIM fellowship at Hopkins, will have his own clinic, precept and work with the Live Donor program for Renal Transplants.

You should be seeing him soon.

CEX time! Interns—one by the end of the month if you are at DOC!! SARs and JARs, ask the attending, generally the first or second pt of your session works best. We will go in with you for the history.

Procedure Clinic and Consult Clinic—now with visit types, so should be easier to see if it is you or not.

Procedure—Monday PM

Consult-first and third Wed PM

Consult Clinic is a second opinion, one hour and one time apt, pts from outside the Trianagle area. Drs Paat or Boulware are the attendings, have the note template.

Continue to refer for suboxone and nexplanon to me.

As you know, Brandie left earlier this month for a role in Oncology. We are interviewing for her role (SAM—service access manager, or front desk sup. )

Gina Green, our wonderful nurse manager and the front desk staff are filling in the gaps until we fill her role.

Thanks all!!

See you at the DOC!

Lynn, Dani, Larry , Natashsa, Patrick and the DOC team!


From the Chief Residents


Grand Rounds

Friday, September 11 - Drs. Jamie Fox, David Gordon, and Lindsay Boole

Noon Conference

Date Topic Lecturer Time Vendor
9/07/15 Labor Day Holiday


9/08/15 No Conference--lunch provided

Med Res Lib

12:00 Dominos
9/09/15 SAR Emergency Lecture Series:  Calcium Disoders

Alana Lewis

12:00 Cosmic Cantina
9/10/15 SAR Emergency Lecture Series: CAP/HCAP

Gena Foster

12:00 Hungry Leaf
9/11/15 Chair's Conference (ITE) Chiefs 12:00 Nosh

From the Residency Office


BLS Blitz - November 2015

Just a reminder that the bi-annual BLS Blitz is coming up in November.  The flier posted at the end of this blog has the dates.  REMEMBER - Duke only holds BLS classes during the November and March blitz each yer, so if your BLS is expiring before March, PLEASE sign up for one of the dates in November!!


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

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

Send all application materials electronically to

Applications accepted on a rolling basis until October 1, 2015.  Offers will be made in November.

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 2016 and March 2017.
Application is open to Duke Cardiology Fellows (PGY 5 & 6) and Duke residents from the Departments of Medicine and Pediatrics: Internal Medicine (PGY 2); Med-Peds (PGY 3); Med-Psych (PGY 4); Neurology (PGY 2), Pediatrics (PGY 2).
The application is attached and available at
(For detailed site information, send request to
Interviews will be held in October. For more information about this opportunity, contact Tara Pemble, Program Coordinator at or 668-8352.
Application Deadline: October 5, 2015



Wanted to take a second to invite you all to come support the Stead Tread, the Kempner Stead Society's annual charity event, which benefits Lincoln. It was a blast this year, and since we're due for some good weather this year, I'm sure it will be even better this time around.

Some additional information:

Please access the Stead Tread 2015 website ( for additional information, to securely register ($25), or make a donation
Race date/time: Saturday, September 12th, 2015 at 10:00AM (registration from 8:45-9:45)
Race location: American Tobacco Trail, starting at Solite Park on Fayetteville Road in Durham (
Race beneficiary: Lincoln Community Health Center (and all Lincoln patients walk/run for free)
Your $25 registration fee includes an official Stead Tread 2015 T-shirt – shirts are going fast, so register ASAP to reserve your size!
Participants are welcome to run or walk, and strollers are permitted - kids under 12 walk/run for free (but should be registered by their parent/guardian)
In case you cannot make the race this year, donations can be made securely through our website

Thank you for considering supporting the Stead Tread – we really hope to see you there this year. For any questions, please contact us through our website (, via e-mail at, or by replying directly to me (Matt Crowley, M.D. <>).


Book Club

Every few months, the Department of Internal Medicine Book Club joins together residents, fellows, and attendings to discuss the humanistic side of medicine through reading.  Please join us for our first event of this academic year on Tuesday, September 8th from 5:30 - 7:30 pm in the Faculty Lounge! This time we're reading Changing the Culture of Academic Medicine by Linda Pololi, which tackles the changing roles of women and minorities in medicine and what ground is still left to cover.

The best news:  all are welcome to attend, and thanks to help from the Program for Women in Internal Medicine and the Trent Memorial Foundation, this year books are free to ALL participants who RSVP (while supplies last)!   Food and drinks will be provided.

For more questions or to RSVP, please email to reserve a spot now!  We're looking forward to seeing you all there!

Thank you!

Laura M. Caputo, MD

Hospital Medicine, Durham VA Medical Center


Upcoming Dates and Events

September 12 - Stead Tread

December 12 - DOM Holiday Party


Useful links
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