From the Director
Happy August everyone! One month went by pretty fast. It was great to see everyone who could come out to our summer celebration at our house, and HUGE thanks to Madi and Lynsey for organizing, shopping, etc. Erin jumped in to change a lightbulb right before the party started. That’s teamwork! IF you happened to take any pictures on Friday, please send them to Madi. She is always collecting pictures for the recruitment slideshow.
Lots of kudos this week – to our Gen Med SARs Peter, Rachel, Kavisha, Christine and Jenny (see photo, from beginning to end), to Titus Ng’eno from the VA JARs for being an awesome dayfloat, to Daniel Turner from Jared Lowe for fantastic work on VA GM, and to Tim Hinohara for a really excellent SAR talk. Many thanks to our hosts of the Professional Development Friday … Dr. Galanos and Vickie Leff, Susanna Naggie and Heather Whitson, and the chiefs, Jeremy Force, Bonike Oloruntoba, Haider Warrach, Michael Nanna, Anne Mathews and Suchita Shah Sata for hosting the intern, JAR and SAR meetings.
ResCo elections for the interns should be ready soon – don’t forget to vote. The first townhall of the year was last week – if you couldn’t make it, please be sure to check in with your ResCo reps if you have any questions or concerns.
A reminder that Town Halls w/ Dr. Klotman are this week:
8/2 – 1-2 pm – Interns
8/4 – 8-9 am – JARs
8/4 – Noon - 1pm – SARs
Update your bio! Erin will be sending you a link to update your bio for the webpage AND for what you would like us to send to your attendings prior to a new rotation.
This week’s pubmed from the program goes to both Helen Zhang and Ashley Spann! Helen just published a paper “The challenges of maintaining good laboratory practice in low-resource settings” Helen L. Zhang, Michael W. Omondi, MSc, Augustine M. Musyoka, MSc, Isaac A. Afwamba, Remigi P. Swai, Francis P. Karia, MPH/MBA, Charles Muiruri, MPH, Elizabeth A. Reddy, MD, John A. Crump, MD, and Matthew P. Rubach, MD in the Am J Clin Pathol August 2016;146:199-206.
Ashley wrote a case for Global Morning Report!
Have a great week
Aimee
What Did I Read This Week?
Submitted by Matt Atkins, MD
Article
Clement et al. Treatment of Syphilis. A Systematic Review. JAMA. 2014;312(18):1905-1917
I take my ABIM boards on August 16th, so as you can imagine, I am in the midst of an accelerated study phase using MKSAP. This weekend, I had a question about a patient with early latent syphilis and it asked what the most appropriate treatment was:
Aqueous crystalline penicillin G intravenously for 10 days
Intramuscular benzathine penicillin G weekly for three doses
Oral doxycycline for 14 days
Single-dose intramuscular benzathine penicillin G
The correct answer was D, but the question made me recognize that my knowledge of syphilis is pretty weak. I remembered, however, that one of Duke’s own, Meredith Clement (Internal Medicine ’14 and current Duke ID fellow) had written a systematic review over the subject for JAMA less than 2 years ago. I intended to read the article at the time but never got around to it. But that has now changed!
For the 3 of you who have read this far, the tables and figures really give the highlights and explain Syphilis much better than I will be able to. Diagnosing the stage is very important as it determines the type, duration, and modality of therapy. The stages of syphilis are explained in table 1. Table 2 gives the primary treatment for each syphilis stage, and as the question taught me, a single IM BPG dose is appropriate for all early syphilis (less than 1 year of infection – includes primary, secondary, and early latent). When I was reading the article, I found table 5 quite helpful in explaining why the various regimens in table 2 were appropriate (e.g. can’t use BPG for neurosyphilis because it has low CSF penetration. Finally, the flowchart at the end provides a simple algorithmic way of approaching a patient with a new diagnosis of syphilis. If you take away anything from this, this flowscart is it!
Happy reading!
Matt
CLINIC CORNER
Hi all!
Welcome to the new interns!
We have not seen all of you at the DOC yet, but will soon!
Changes at the DOC…a new nurse manager, Brenda, starts Aug 22 and new front desk supervisor (aka SAM or Daniel/Brandie) Amy starts Sept 1….
We greatly look forward to their arrival!
We continue with HomeBASE, our high utilizer program, led by Marigny, with Greg Brown taking over for the California loving Natasha…see Greg’s suggestions attached at the end of this post.
Ashley and Joy, our behavioral health consultants, working with Jan for counseling, support, lifestyle changes like obesity and smoking…one is now often in the brand new precepting space…check it out!
The old rooms will be used for seeing patients..
Planning for Redesign 2, Intensive Primary Care continues..with start date January 1…
Thank you for all of your hard work at the DOC!
LB and team!
Lynn Bowlby MD FACP
Medical Director Duke Outpatient Clinic (DOC)
From the Chief Residents
Grand Rounds
Friday, August 5 - Heme/Cellular Therapy, Dr. Phuong Doan
Morning Report
Monday - Pascale's Case w/ Dr. Harvey Cohen
Tuesday - Matt Crowley on Thyroid Disorders
Wednesday - Tanya's Cost-Conscious Medicine case with Dr. Klotman
Thursday - Dave D'Allesio on Diabetes
Friday - Medicine Grand Rounds
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 8/1/16 |
PE Week: Neurologic Exam |
Morgenlander |
12:00 | Domino's |
| 8/2/16 |
PE Week: Inpatient Daily Exam/new patient exam in clinic |
Zaas/Arcasoy |
12:00 | Picnic Basket |
| 8/3/16 |
PE Week: Musculoskeletal Exam |
Lisa Criscione-Schreiber |
12:00 | China King |
| 8/4/16 |
PE Week: Respiratory system /Thorax exam |
Bill Hargett |
12:00 | Subway |
| 8/5/16 |
PE Week: Cardiovascular Exam |
Chet Patel |
12:00 | Bullocks |
From the Residency Office
Have You Logged Your Duty Hours??
With the start of the 2016-17 academic year, the residency program is asking all house staff to log their duty hours on a daily basis. This will allow us even closer oversight of duty hour compliance across the program. In order to use the MedHub mobile Duty Hour app, you will need to know your actual MedHub log in as it will not accept your NetID/password log in. If you have forgotten you main log in, please go to the main MedHub site, and select "Forgot my password." You will then be able to re-set it via email. Lynsey Michnowicz will be sending reminders each Wednesday to those who have not yet logged their duty hours for the week. Thank you in advance for your attention to this task!
NCSP Applications
The National Clinician Scholars Program (NCSP), a two-year research training fellowship (formerly known as the Robert Wood Johnson Foundation Clinical Scholars Program) for physicians and nurses, is now accepting applications for enrollment in July 2017. The NCSP provides mentored training in clinical, community, and health policy research, with a focus on supporting the development of change agents who will devote their careers to leading improvements in health and healthcare.
The NCSP, in partnership with the Department of Veterans Affairs, currently has training sites at the University of California at Los Angeles, University of Michigan, University of Pennsylvania, and Yale University.
Applications are due August 15th.
Medical Improv
Medical Improv Workshop being offered in the Triangle area. And it’s free!
Medical Improv is quickly gaining popularity as an innovative approach to teaching principles that are at the heart of patient centered care: Focused listening, collaboration and seeing things from another’s point of view. Medical Improv can help teach skills that will make you more present and aware during high stakes conversations with patients and colleagues. If you find yourself feeling overwhelmed by everything that’s coming at you during your time with patients, these skills can help things slow down a little so you can prioritize what’s most important and make better decisions.
This 3 hour workshop is free to all Duke Health Sciences’ students and clinicians on a first-come-first-served basis. The workshop will be capped at 15 students for more individualized attention. No observers will be allowed in these sessions. Everyone will be expected to participate. The sessions will not be recorded in any way and no grades will be given. The goal is to create a safe environment where people can play and speak freely.
These sessions will be led by Dan Sipp, a trainer for the Clinical Skills Program at Duke University School of Medicine. Dan has taught improvisation in Chicago and the Triangle for over 20 years. He’s trained with the creator of Medical Improv, Katie Watson from Northwestern University’s Feinberg School of Medicine*, and they have collaborated on projects for the University of Indiana School of Nursing. Dan is very excited to bring these sessions to medical learners in the Triangle. Duke Faculty members from The School of Medicine, Graduate Medical Education, The School of Physical Therapy and The Physician Assistant Program will be co-facilitating these and upcoming sessions.
You’re invited to register for this free workshop!
Saturday, September 24th from 10 a.m. to 1 p.m. @ Trent Semans Center for Health Education, 6th floor
To reserve your spot in the next Medical Improv Workshop please email Dan. Once he receives your email he’ll follow up with a confirmation of your spot, directions to the site and more information about the day.
Remember space is limited to 15 participants per session. We want to see you there. So sign up soon! You are also free to forward this email to friends or colleagues who you feel might be interested in this innovative training session.
*You can read more about Katie at her website. You can also read Katie’s paper on the applications for and the effectiveness of Medical Improv for clinicians at the Academic Medicine website.
Office Hours for Dr. Zaas
Dr. Zaas will have the following office hours. Please feel free to stop by during these times and of course always feel free to reach out to her office to set up a meeting outside of these times if needed!
- Monday - 3:00 p.m. to 4:00 p.m.
- Thursday 10:00 a.m. to 11:00 a.m.
Next Book Club Event!
Attention, Medicine Residents!
Welcome to the new academic year, and a particularly warm welcome to our new interns! We're excited to announce that the Duke Internal Medicine book club is back! Our first event will be on Thursday, August 18th from 5:30 - 7:30 pm in the Searle Center Faculty Lounge. At the request of the residents (that's you!), our structure is changing a bit. This time we'll be reading All the Light We Cannot See by Anthony Doerr, a NYT best seller and winner of the 2015 Pulitzer Prize for Fiction. Books are available at most local book stores or online. Snacks and drinks will be provided.
If you're interested in attending, or if you have any questions, please RSVP to me at laura.caputo@duke.edu. We're looking forward to seeing you there!
LiveSafe Mobile App
Duke is introducing a new mobile app called LiveSafe to put a powerful safety tool in the hands of the Duke community.
The app, available as a free download from Apple and Android app stores, enables smartphone users to submit real-time tips to Duke Police, virtually “SafeWalk” friends and family while traveling, place emergency calls, and access important resources for support.
You can find more information, including instructions on how to download the free app, on the DukeALERT website: http://emergency.duke.edu/notified/livesafe.
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.
https://www.hr.duke.edu/pas/
Upcoming Dates and Events
August 4 - Chief Happy Hour w/SARs - Ponysaurus
August 11 - Chief Happy Hour w/ JARs - Bull McCabe's
August 31 - Stead Trivia Night
September 8 - Chief Happy Hour w/ Interns - Hope Valley Brewing
October 8 - Stead Tread
Useful links
GME Mistreatment Reporting Site
https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
http://duke.exitcareoncall.com/
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
Opportunities
https://www.phs.wakehealth.edu/public/edu.cfm
www.bidmc.org/CentersandDepartments/Departments/BIDHC
http://www.careermd.com/employers/latestbulletins.aspx