Internal Medicine Residency News, August 15, 2016

From the Director

Hope you all had a good week! I know the chiefs and JARs had a lot of fun at their happy hour at Bull McCabe’s, and Leah Machen, Stephen Kimani, David Beavers, Megan Dupuis and I had a great August JAR dinner at the Little Dipper (although the menu is somewhat overwhelming!). Joel Boggan and the Kirby Society had a fantastic group head to the Durham Bulls game on Sunday night as well. The Chief-Intern night out is coming up as well!

Kudos this week go to our departing ACRs – Zach Wegermann (with special shout out from Luke Cerbin and the VA GM JARs for general excellence and formally introducing them to Cookout Milkshakes!), Kara Wegermann and Taylor Bazemore. Additional kudos from Nilesh Patel to Jenny Van Kirk and Vedran Oruc for their flawless care of some complex patients on Duke Gen Med, to Lindsay Shantzer, Nick Shelburne and Jasmine Washington from 9300 fellow Myles Nickolich for great teamwork and patient care, and to Juan Magana from Rheumatology fellow Steph Giattino for going above and beyond to take care of a patient overnight on Duke NF.  Also kudos to Pascale Khairallah for her outstanding SAR talk and to Dan Maselli for an educational, funny and legendary chair’s conference. 

The chiefs are beginning to make the holiday schedules, so please respond to their mini-survey for your preferences. 

You may have noticed some duty hours-related emails going out. We are very motivated to learn from you what works and what does not work on our various rotations. Lynsey will be checking in throughout the week, and either Madi or I will be sending some summary emails at the end of each month (we are in the midst of sending July, so keep an eye out). These will go to everyone on our major inpatient rotations, to keep you up to date on any adjustments made to the rotations and to check in on your feedback. Thanks to everyone that is getting back to Lynsey and me!

This week’s PubMed from the program goes to Tessa Genders for her abstract “External Validation of the CAD Consortium Prediction Models for the Presence of Coronary Artery Disease in Patients with Stable Chest Pain” accepted at the AHA conference, and to graduate and current Heme-Onc fellow Ben Heyman (sent to me by graduate and VA hospital medicine attending Laura Caputo) for his paper in Blood Cancer, Double IGHV DNA gene rearrangements in CLL: influence of mixed-mutated and -unmutated rearrangements on outcomes in CLL.

And check out the awesome fashion sense of our residents and department chair in the photo above.

Have a great week,

Aimee

What did I read this week?

Contributed by Aparna Swaminathan, MD

Kyu Hmwe H. et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013, BMJ 2016; 354:i3857

Watching the Olympics makes me want to read about exercise! This study performed a meta-analysis of the association between the amount of total physical activity and the risk of certain diseases: breast and colorectal cancers and diabetes, ischemic heart diseases, and ischemic stroke. The cool thing was that they looked for a dose-response relationship using metabolic equivalent of tasks (MET). As a reminder, a MET is the ratio of the metabolic rate during an activity compared to the metabolic rate when resting. The World Health Organization recommends at least 600 MET minutes of total activity per week (such as 150 minutes of brisk walking, which is 4 METs x 150 min = 600 MET minutes). 

Article highlights:

  • Using fancy data handling, the authors converted the results of all of the 173 included studies into MET minutes/week.
  • There were significant reductions in the risks of the above conditions at around 4000 MET minutes/week compared to 600 MET minutes/week. For example, individuals with a total activity level of 600 MET minutes/week (the minimum recommended level) had a 2% lower risk of diabetes compared with those reporting no physical activity. An increase from 600 to 3600 MET minutes/week reduced the risk by an additional 19% (Figure).
  • The risk reduction at higher levels of activity (12000 MET minutes/week) was not as dramatic among all of the above diseases: an increase of total activity from 9000 to 12 000 MET minutes/week reduced the risk of diabetes by only 0.6% (Figure).
  • We still don’t know whether risk reductions would be different with short durations of intense physical activity or longer durations of light physical activity
  • We also don’t know what confounders the article is missing. Still, I thought this was pretty impressive! 

Clinic Corner: Pickett Road

Contributed by Sharon Rubin, MD, FACP

We recently had a Pickett Road outing at AMC Lanes. Jeremy Cypen won both games! Our work culture celebrated Chocolate Chip day with cookie cake and relaxation day with Adult Coloring pages. Our garden is still growing tomatoes and peppers. In the clinic for the past 4 weeks during admin session, we have practiced incision and drainage on oranges. The hardest part is finding the key to get the lidocaine out of the medication closet. Also having fun as Josh who is 6'4" switched white coats with me (5"11"). We are also starting Test Yourself questions on the board. I have placed 3 MKSAP #17 questions related to the week's topic. Last week's topic is treatment of UTIs. We are planning for a team at the American Heart Walk on October 2, and sending a team to the Stead Tread 5K Fun Run on October 8.

QI Corner

Save-The-Date! Our next Patient Safety & Quality Council Meeting will be on Wed., Sept. 7 at 5:30 p.m. Food will be provided. The location will be somewhere on the 8th floor (med res vs other). We will be firming up plans for our projects for the year. 

We will also be starting a QI curriculum to be given during PSQC meetings. To start each meeting, we will spend 10-15 minutes discussing a concept, tool, or other topic related to patient safety and QI. Our goal is that by the end of the year, council members will have received a fairly solid foundation in quality improvement basics.

Free Advertising! (for the over-achievers): The Institute for Healthcare Improvement has an extremely well-done set of free online courses on QI topics called the IHI Open School. Highly recommended!

From the Chief Residents

Morning Report and MGR: August 8-12, 2016
Date Topic Lecturer Time Location
8/15/16

CKD

David Butterly

 7:15 a.m. DUH 8253
8/16/16

Immunizations

Aimee Zaas

 7:30 a.m.

DUH 8253
8/17/16

Megan's case

Ken Lyles

 7:15 a.m. DUH 8253
8/18/16

Hypertension

Daniella Zipkin

 7:15 a.m. DUH 8253
8/19/16

Medicine Grand Rounds: Durham Diabetes Coalition and Southeastern Diabetes Initiative: Using Data to Understand the Health of Populations

Susan Spratt, MD
Associate Professor of Medicine
Endocrinology, Metabolism, and Nutrition

 8:00 a.m. DUH 2002

 

Noon Conference: August 8-12, 2016
Date Topic Lecturer Time Location Lunch
8/15/16

MKSAP Renal

Alyson McGann

 12:00 p.m. DUH 2002 Domino's
8/16/16

SAR Lecture Series: Electrolyte Disorders - Hyperkalemia and Hypokalemia

Peter Hu

 12:00 p.m. DUH 2002 Nosh
8/17/16

ACR/Chief Lecture: Acid/Base + New Epic Rollout

Aparna Swaminathan and David Claxton

 12:00 p.m. DUH 2002 Chick-Fil-A
8/18/16

M&M

Ashley Spann

 12:00 p.m. DUH 2001 Subway
8/19/16

Chair's Conference

Maggie Moses

 12:00 p.m. DUH 2002 Bullock’s BBQ

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!

 

Office hours for program leaders

Please feel free to stop by during these times and of course always feel free to reach out to program leaders to set up a meeting outside of these times if needed.

  • Aimee Zaas: Every Monday from 3:00 p.m. to 4:00 p.m. and Thursday from 10:00 a.m. to 11:00 a.m.
  • Dave Butterly: Wed., Aug. 17 from 3:00 p.m. to 4:00 p.m. in DN 8291
  • Dani Zipkin: Wed., Aug. 31 from 2:00 p.m. to 3 p.m. in VA Prime clinic; Wed., Sept. 7 from 11 a.m. to 12 p.m. in Pickett Rd.

 

Attend the 2016 Annual Kidney Week Meeting for Free

Any Duke Resident interested in pursuing a nephrology fellowship is invited to attend the annual American Society of Nephrology Kidney Week Meeting (at Chicago, IL from Nov 15-20). Airfare and lodging expenses will be covered by the Division of Nephrology. This is the 50th anniversary for ASN. Duke will also host a reception at the event as well. If interested, contact Matt Sparks (matthew.sparks@duke.edu) for more details.

“More than 13,000 other kidney professionals from across the globe will attend Kidney Week 2016 in Chicago, IL. The world's premier nephrology meeting, Kidney Week provides participants exciting and challenging opportunities to exchange knowledge, learn the latest scientific and medical advances, and listen to engaging and provocative discussions with leading experts in the field.”

 

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 Pathway for Residents and Fellows, 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. Visit www.dukeglobalhealth.org for an in-depth description of the core curriculum including sites, global health competencies, and program requirements as well as application instructions. Watch past global health internal medicine resident John Stanifer discuss his decision to pursue global health training at Duke in this video. Applications will be accepted on a rolling basis until Sept. 1, 2016. 

 

Next Book Club Event

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!

 

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 31 - Stead Trivia Night (Warren Society)
  • September 1 - deadline for applications to the Global Health Pathway
  • September 7 - Special lecture by Duke Nobel winner Paul Modrich. Registration is required.

  • September 7 - Chief Happy Hour w/ Interns - Hope Valley Brewing

  • October 8 - Stead Tread 5K Fun Run (Kempner Society)

Useful links

Opportunities

 

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