Internal Medicine Residency News, August 4, 2014

By residency1

From the Director

DUKE.RESEARCH.NIGHT.03 (1) Happy August! Thank you to the JARs and SARs for your work in the 5 week "Block 1" - amazing job stepping up to your new roles.  I hope the interns have enjoyed their first week on new services – have heard some excellent compliments on great work by many of you! Kudos this week go to Matt Atkins and Ryan Huey for putting together pearls for us to learn from before the sessions, to Jake Feigal, Andy Mumm, Tim Mercer, and Adam Banks for serving as "models", and to Murat Arcasoy for planning the week! Other kudos this week go to Jesse Tucker from Coral Giovacchini for an "uber"-great job on VA Gen Med, to Ryan Jessee from Aimee Chung who heard from her patient that he provided great care while in the ED, to Dinushika Mohottige from Ann Marie Navar Boggan for great care of a cardiology patient, and to Sneha Vakamudi for spearheading the new AMAZING Duke Med jacket ordering for this year.  Kudos also to Dinushika Mohottige from Lakshmi Krishnan for helping care for a very sick patient and to Alan Erdmann from Ani Kumar for being an amazing VA JAR. And thank you to Drs. Greenfield and Corey for organizing our visiting professor, invited by 2013-14 Chief Resident Stephen Bergin. We all enjoyed meeting with Dr. Kollef and hearing a great grand rounds. Please keep sending me the great things your co-residents are doing… Thank you to Sharon Rubin for organizing the upcoming "How to Interview" seminar. Please see the bottom of Med Res News for more information. Also, if you are interested in a career in Cardiology, mark your calendars for August 27th at 5pm to meet Drs. Schuyler Jones and Manesh Patel at Alivia's to discuss careers in cardiology.  Interns, JARs and SARs are welcome. We are still working on getting the microphones fixed in the Med Res library…thank you for your patience as we work this out. We were hopeful to be able to broadcast to DRH by today, but we have another visit from the company this week, as two prior visits have not yet solved the issues. This past week the IOM published it's paper on GME reform and GME funding.  If you have a chance to read the summary, I'd recommend it highly.  We are working through what it means for us here, and GME in general and will certainly keep you posted on what is happening at the "big" GME level here, and to the program.  In our ongoing planning, we are working on how to continue to incorporate quality and outcomes into our assessments of our training program, and how to get more outstanding ambulatory experiences to be part of your training This week's pubmed from the program goes to 2013-14 VA QI Chief Joel Boggan for his article in the Journal of Graduate Medical Education! We are excited to see the story of "Sharepoint" in print! A Novel Approach to Practice-Based Learning and Improvement Using a Web-Based Audit and Feedback Module Joel C. Boggan, George Cheely, Bimal R. Shah, Randy Heffelfinger, Deanna Springall, Samantha M. Thomas, Aimee Zaas and Jonathan Bae JGME July 9, 2014. Have a great week! Aimee [divider] [box]

What Did I Read This Week?

submitted by: Saumil Chudgar, MD

An Innovation Report: Angus S, Vu TR, Halvorsen AJ, Aiyer M, et al. “What Skills Should New Internal Medicine Interns Have In July? A National Survey of Internal Medicine Residency Directors.” Academic Medicine 2014; 89: 432-35.

AND

 NY Times article

Denise Grady. “The Drawn-Out Medical Degree.” New York Times. Aug 1, 2014. Available at

http://www.nytimes.com/2014/08/03/education/edlife/the-drawn-out-medical-degree.html

[/box]210_ChudgarSaumil2010 Why did I read these? July is always an exciting time of year – congratulations to our interns for one month down! I ran across this article as I was reviewing the literature about the fourth year of medical school. Current interns remember well that the fourth year is what you make of it – you can coast through or make it fairly rigorous. There is more variation in expectations among schools as compared to the third year. With that in place, what do residency directors expect you to know when you start? And, as someone with a lot of interest in medical student education, what should we (as both attendings and residents) be teaching our students to get them ready for residency? It is the peak of sub-I season – how can you as residents help make our future interns ready? On the heels of this article was a perspective in the NYT that describes changes at some medical schools – including shortening medical school to three years. What does that mean for us – will students be ready to be interns? What I learned from reading these/thoughts on the articles? This study was a collaboration between the Internal Medicine Clerkship Director group and the Program Director group. The study design was fairly simple – a yearly survey goes out to residency program directors; one section of the survey focused on this topic where PD were asked to rate how important they felt a skill was for an incoming intern. Response rate was 75%, which is quite strong for a survey study. I think many of us could have predicted the skills found to be most important – listed below with the percentage that ranked it as “high priority” – corresponding to a 4 or 5 on a 5-point scale.
  1. “Knowing when to see assistance” – 95.7%
  2. “Communicating with nurse/nurse triage” – 89.0%
  3. “Time management” – 84.8%
  4. “Communicating in a culturally sensitive manner” – 80.5%
  5. “Information management – prioritizing skills” – 80.1%
Residency directors were also asked to give free-text responses of the two most importance skills an intern should possess. The top two among those were organization/prioritization/time management and clinical skills/history and physical examination. I found it interesting that medical knowledge and procedural skills fell much lower on this list; perhaps it is assumed that we can teach you this if needed once you’re here – the other skills are more complex to learn. Interestingly, another method could have been considered to rank these topics – Q methodology. Drs. Hargett and Zaas have used this effectively and published some interesting data – it is essentially a forced prioritization of a list of items. Some of you may have seen or done this before. This article along with several others start to define the level we hope a new intern/graduating medical student will be. The AAMC recently released the Core Entrustable Professional Activities for Entering Residency – 13 things medical schools should be able to show that their graduates can do. In the face of this increased accountability, the New York Times article discusses that some medical schools are advocating for shortening training. It is an interesting read if you have time. NYU enrolled 16 medical students into a 3-year track last summer – they must know what specialty they want to pursue when they start and will be guaranteed a residency slot in that specialty at NYU. It is a little reminiscent of the combined 6 or 7 year undergrad-medical school programs. The articles and others taken together make me consider how medical education is changing – we are asking for more defined expectations of graduating medical students at the same time that there are calls for shortened training. The next few years will be quite interesting to see how these two seemingly divergent ideas will come together. [divider]

Clinic Corner

zipkinDOC Clinic Corner

Hi Team!Thanks for making this a great start to the year. We realize that navigating Maestro in clinic, figuring out how to support our patients’ multiple needs, and learning where the bathroom is can be overwhelming when you’re also trying to learn clinical medicine!! You’re all doing it with grace and professionalism The DOC Newsletter 2014 August  is attached here! Please read!Here are some other key pearls:From the “Resource file”, Larry Greenblatt recommends this website as an entry point for a terrific set of on line resources, templates, guidelines, and tools amassed and organized by Community Care North Carolina (i.e. Medicaid care management) with Dr. Holly Biola as the lead. Check it out! http://communitycarenc.com/provider-tools/From the Pharmacy: Seeing a patient for a hospital follow-up visit? Look for telephone encounters in Maestro labeled "hospital follow-up" from Holly and Jan. We review the patient's chart and sometimes call the patients for medication reviews prior to their visit with you! Important info!Maestro Pearls:Get those notes done in 24 hrs! You KNOW you hate is when they stack up. Plus, we’ve got rules to followPlease cc your attending in the follow-up section, AND select your attending in the “providers” button in meds and orders. Yay!!Ordering labs while off site? Please always select “future” with no end date. Like, always. We may not know what the future holds, but, at least it can hold your labs.  Thanks so much! See you back at the homesteadDani[divider]

From the Chief Residents

Grand Rounds

Friday, August 8 - Dr. Joe Rogers, Cardiology

Noon Conference

Date Topic Lecturer Time Vendor
8/4/14 SAR Emergency Series: Acute Renal Failure Erin Boehm 12:15 Subway
8/5/14 SAR Emergency Series: Hip Fracture and Perioperative Mgmt Adrienne Belasco 12:15 Dominos
8/6/14 SAR Emergency Series: EKG Interpretation/Ischemia Aparna Swaminathan 12:15 Cosmic Cantina
8/7/14 IM-ED Combined Conference: Improving STEMI Care Michael Ward 12:15 Picnic Basket
8/8/14 AR Town Hall: Fellowship Interview Pearls  Chiefs 12:00 Chick Fil A
 [divider] 

From the Residency Office

 

MKSAP Ordering Now Open!

Please use the link below to order your MKSAP materials.  Just a reminder, you must be a current ACP member to order, and the program will only purchase one (1) copy per resident during residency.  The link to order (below) will be available until 8/22/14.  If you have any questions, please feel free to contact Erin Payne in the MedRes office. https://duke.qualtrics.com/SE/?SID=SV_6gIBENn00rxo6G1  

TSMA/Moonlighting Policy for Internal Medicine Residents

Please note that due to some confusion around the TSMA/Policy for the program, an updated policy has been posted as a Learning Module in MedHub.  This policy will be "assigned" to all current JARs/SARs in the program via MedHub and anyone interested in moonlighting will be required to review and accept the policy (electronically.)  Please look for an email from Jen Averitt this week with more details.  

Stead Resident Research Grants- Request for Proposals

For All Internal Medicine, Med-Peds, and Med-Psych Residents We are pleased to announce the Request for Proposals for the inaugural “Stead Resident Research Grant” applications. We are grateful to the leadership of the Stead Scholarship Society for their generosity to support resident research and our Stead Leaders for their mentorship and for promoting your scholarly activities ! The applications due on September 1, 2014 for a funding start date on October 1, 2014. Please find attached the Stead Resident Research Grant Instructions-2014, Stead Resident Research Grant Application Forms-2014, Human Subjects example,  and NIHSAMPLE Biosketch Form.   Please include your mentor’s NIH Biosketch and support letter with your application. Please see  link below for Biostatistical Support resources available to you for your projects and discuss with your mentor. http://residency.medicine.duke.edu/duke-program/resident-research/biostatistics-and-data-management-support Each proposal must have a Human subjects section that describes the protections of the patients and patient data, describe the consent procedure if applicable, status of IRB protocol (to be submitted, already submitted or already approved, as appropriate) etc. This section is required whether to not your project is a retrospective or prospective study, whether patient identifiers are exposed (or not) during data collection/analysis, whether consent is to be obtained or there is a waiver for consent. Please see attached example language that you can adapt to your own protocol after discussing with your research mentor who has already thought about the Human subjects issues. Wishing you continued success with your research projects ! Murat Arcasoy and Aimee Zaas  

Flu Vaccination Season 2014

As you know, Duke University Health System (DUHS) requires all healthcare workers who perform their duties in a DUHS facility or a community home-based setting to be vaccinated annually against the flu. This is in alignment with our core value of “caring for our patients, their loved ones and each other.” Annual vaccination against influenza, or policy compliance through a granted medical or religious exemption, is a condition of employment for all DUHS employees. Annual vaccination or policy compliance is also a condition of access to Duke Medicine facilities for those holding clinical privileges in a Duke Medicine facility and learners who wish to train in our facilities. With this in mind, please note these key dates for this flu vaccination season:
  • Start of Flu Vaccination Season: Thursday, September 18, 2014
  • Applications for Medical or Religious Exemption should be submitted before Friday, October 17, 2014.  This will allow sufficient time for review and for communication of the review decision. Please note: Due to the availability of an egg-free formulation of the flu vaccine, egg allergy will no longer be a valid reason for a medical exemption.
  • Policy compliance through vaccination or granted exemption by Monday, November 17, 2014
We will kick off our annual flu vaccination campaign with a 24-hour Duke Medicine Mass Flu Vaccination drill. The drill will begin on Thursday, September 18, 2014. Mass vaccination clinics will be available at each of the hospitals with peer vaccination available throughout DUHS. Following the drill, we will begin our annual flu vaccination program, during which time we will provide many additional opportunities for you to get vaccinated. A schedule of vaccination clinics is posted on the employee intranet at https://intranet.dm.duke.edu/influenza/Lists/Calendar/calendar.aspx.  This list will be updated throughout the flu season. Vaccination is also available at Employee Occupational Health and Wellness (EOHW) during business hours. If you have questions about the flu vaccine or its availability, please visit the DUHS Influenza Resource Guide or duke.edu/flu, ask your manager or contact EOHW. Together, we can stop the flu. Thank you for your commitment to keeping our patients, and our community, safe and healthy.

Provider Staff for House Staff

Thank you to Dr. Sue Woods for providing an updated list of Provider list for housestaff.  This list may also be found in the Resources/Documents area of MedHub.

New Jackets/Fleeces for 2014!

To Order your 2014 Duke Medicine Jacket please use this link: https://duke.qualtrics.com/SE/?SID=SV_eV6magzZYP906CV Jackets will be $52.50 each and monogramming will be an additional $2.75 per jacket!!  We will have samples in the Med Res Office to try on until August 18th!  Deadline to order and pay is August 18th!! Jacket will be Black with the Duke Medicine logo. photo

Interview Skills

Whether you are going to interview for hospitalist position, primary care or attending position after fellowship, there are some skills to learn for the interview and essential questions to ask. Come to this session for dinner, sponsored by the North Carolina American College of Physicians, and get the answers you need before your job interview. Welcome to all medical students, residents, interns and fellows. Panelists: Dr. Jon Bae, Dr. Saumil Chudgar, Dr. David Simel, Dr. Pooh Setji, Dr. Poonam Sharma, Dr. Bruce Peyser, Dr. Sharon Rubin Location: Duke Internal Medicine Library, Durham, NC Date: Wednesday August 6, 2014 Time: 7:00 PM to 8:30 PM Please RSVP to Dr. Sharon Rubin by August 4, 2014 Sincerely, Sharon Rubin, MD, FACP Assistant Professor, Duke University Medical Center Residency Director at Pickett Road  

Information/Opportunities

The Winston-Salem CareerMD Career Fair: Event Details Location The Hawthorne Inn and Conference Center, 420 High Street, Winston-Salem, NC Date & Time Wednesday, August 06, 2014; arrive any time between 5:00 PM and 8:00 PM Details Attire is casual and a complimentary buffet will be provided RSVP Requested Residents and fellows who would like to attend this event are asked to RSVP to charles.howell@CareerMD.com or online at www.CareerMD.com/Winston-Salem   Hospitalists Practice Opportunity in PA 7-2014 Announcement Geriatrician Opportunity Elkin Hospitalist Montana Hospitalist Summit Placement Service Washington State Opportunities Madison WI opportunities Community Health Network

Upcoming Dates and Events

August 6th- Interview Skills Session August 17th- Kerby Society Hosting Durham Bulls Game Gathering August 27th - Drs. Schuyler Jones and Manesh Patel at Alivia's  - Careers in Cardiology

Useful links

 

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