Internal Medicine Residency News: December 16, 2013

By admin3

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hello! Countdown to mid-year is on. Look for next year's schedule request forms in your email this week. Ok, now that I have your attention ..... Thank you to Dr. Klotman and the Department of Medicine for a fantastic holiday party, and a well deserved celebratory break for residents, fellows and faculty. It was wonderful to have a chance to see you all there. Many of us were sure this was the best attended and most energetic holiday party in years.  Pictures  will be posted on our website soon - #bestholidaypartyever! Kudos this week to Rebecca Sadun from the VA for her care of a very ill veteran, and to Kim Bryan for similar excellent care. Also to Iris Vance for her work in the CCU last week from her colleagues. Also to our resident recruitment share participants Kristen Glisinski, Andrea Sitlinger, Marc Samsky, Jenn Rymer, Kevin Shah, Nick Rohrhoff and Adrienne Belasco.  Also, awesome SAR talks by Bronwen Garner and Alex Fanaroff? The December JAR dinner at Local 22 kitchen was a blast with Amit Bhaskar and the ladies (Erin Boehm, Carli Lehr, Sajal Tanna and Adrienne Belasco).  The January invite will be out soon. Recruitment continues this week - it has been fantastic to see you all talking with all the applicants. See you again at lunch tomorrow! Pubmed from the program this week goes to John Stanifer for his article in AJKD:  Inrig, Julia, Robert Califf, Asba Tasneem, Radha Vegunta, Christopher Molina, John W Stanifer,Karen Chiswell, and Uptal Patel. “The Lanscape of Clinical Trials in Nephrology: A Systematic Review of ClinicalTrials.gov.” Am. J of Kidney Disease. 2013 Dec; 13: S0272-6386. Have a great week! Aimee

QI Corner (submitted by Joel Boggan, MD)

Thanks! Thank you to everyone who submitted abstracts to either the Duke Patient Safety and Quality Conference and the NC ACP state meetings this week! Resilience Mini-Course This Tuesday at 5:30, Dr. Bryan Sexton will be leading a session on resiliency in Duke North 2003.  All are welcome. Thanks! Joel   [box]

What Did I Read This Week?

Submitted by Vaishali Patel, MD

“Assessing Physician Leadership Styles: Application of the Situational Leadership Model to Transitions in Patient Acuity.”

Skog et al. Teaching and Learning in Medicine: An International Journal, 24:3, 225-230 (Brigham and Women’s Hospital, Boston MA)

[/box] As we approach the holidays and transition to the second half of the year, I have been thinking about what my New Year’s Resolution is going to be for 2014.  My initial thought was “I will make a resolution to actually stick to my other resolutions for longer than the first two weeks of January.”  When I pushed myself a bit more to get past the resolutions about obligatory reductions of chocolate and caffeine intake and promising my husband to develop a healthier sleep schedule, I started to think about what I could do to improve my communication and leadership skills – not just for the second half of this year, but also as an upper level GI fellow running the endoscopy unit, as an attending rounding on a Gen Med service or a consult service, and as a teacher for trainees and students.  One of the things (of the many, many things!) that has been really fun for me this year has been watching the JARs transform into team leaders on Gen Med at the VA.  It is a fascinating leap to go from intern to JAR/team leader – one that I would argue is a more transformative transition than going from medical student to intern.  While observing the JARs during work rounds, I’ve learned a lot about the pressures of learning how to lead a team and become a teacher in the busy workflow of Gen Med while also trying on top of learning how to take care of patients, and I’ve been amazed (and proud!) to see how the JARs are able to adapt to deal with some of these challenges.  We are in the exciting process of expanding the simulation center at the VA, which has made me think about whether we could use it as a venue for team leadership simulation. We use the simulation lab for team leader training for a code blue, but we could expand this to other situations such as leadership training for changes in patient acuity, or patient transitions, if this is something that the rising JARs would find helpful in the spring. Skog et al. at Brigham and Women’s Hospital were interested in assessing the situational leadership model (developed by Hersey and Blanchard) during transitions in patient acuity.  The situational leadership model is based on the idea that an effective leader is one that can change their leadership style to match the level of understanding and experience of their followers (recognizing the strengths and weaknesses of the learners on your team and adopting a leadership style that will best serve them and your patients).  The model describes four leadership styles that focus on both task-driven and relationship behaviors depending on the ability and willingness of your learners: directing, supporting, coaching, and delegating.  These styles range over a continuum that allows the leader to be dynamic and adopt an authoritative or a “hands-off” style when appropriate. It has actually been applied to nurses, but has not been validated with medicine residents. In this study, Skog et al. used a simulation center to create hospital-floor-based scenarios. The residents at Brigham participate in simulated patient scenarios as part of a 1-month rotation on the Coordinated Medicine Teaching Unit (CTU). The senior resident was identified as the leader on a team with a variable number of 1st or 2nd year residents, medical students, and one nurse.  114 residents, students, and nurses participated in 20 scenarios.  The scenarios were taped, and consisted of 10 simulated patients with respiratory distress and 10 of patients with complete heart block which varied in acuity throughout the scenario.  The cases were graded for acuity using the Emergency Severity Index (validated in assessing patient acuity in the emergency triage process), where Level 5 represents the lowest acuity and Level 1 the highest.  To assess leadership styles, a research associate selected clips of the taped scenarios: at least one clip for every acuity level was included during which the team leader had physical behaviors or verbal statements (or personally performed a clinical task).  Two physician raters independently analyzed these clips to determine the leadership style demonstrated (each of whom had more than 20 years of experience teaching leadership skills and treating patients in medical teams, and board certified in Internal Medicine).  They also graded the senior residents on overall leadership effectiveness on a scale of 1-10, with 10 being most effective (the authors do not mention whether they used a previously validated assessment tool for this grading – my guess would be they did not). The average acuity of the scenarios was 2.73 (range = 2-4).  Figure 5 shows the leadership styles that were observed during times of acuity change – the most dominating style was supportive (38.02%).  The weighted kappa coefficient for interrater reliability was high (r=0.81).  The mean leadership effectiveness score was 6.55 (range 3-8), with moderate interrater agreement (r=0.74).  The mean number of times the leadership style changed for those residents who scored below the average for leadership effectiveness was 1.9, compared to 2.6 for those who scored above average for effective leadership.  The authors suggest that there may be a correlation between effective leadership and increased changes in leadership style, although conclusive data was not demonstrated (unclear whether there was enough data for regression modeling).There are some limitations of the study, like not controlling for the variability in the ability and willingness of the rest of the team members, or how familiar the team leader may have been with their abilities prior to the scenario, as both of these things would impact their leadership effectiveness and style and introduce confounding. It may have been better to Skog 1observe the scenarios in real time as opposed to rating pre-determined clips.  However, considering that there is no previous validation of this leadership model for medical residents, this study does provide some fodder for considering whether the model can be validated in different clinical situations with medical residents and establish a framework to help residents develop their leadership styles.In the figure below, D 1-4 describe the learner, and S 1-4 show the appropriate leadership style to match ability and willingness of the learner. Skog 2   If you’re interested in reading more about the situational leadership model, see the following citations from this article: 1. Hersey P, Blanchard KH, Johnson DE. Management of organizational behavior: Utilizing human resources. 7th ed. Englewood Cliffs, NJ: Prentice Hall, 1996. 2. Blanchard KH, Zigarmi P, Zigarmi D. Leadership and the one minute manager: Increasing effectiveness through situational leadership. New York, NY: William Morrow, 1988. 3. Northouse, PG. Leadership: Theory and practice. 3rd ed. Thousand Oaks, CA: Sage, 2004.

From the Chief Residents

SAR Talks

    Thursday, December 19:  Mandar Aras and Jeremy Halbe

Grand Rounds

Speaker: Dr. Larry Goldstein TOPIC: Cryptogenic stroke

Noon Conference

Date Topic Lecturer Time Vendor
12/16 INTERVIEW
12/17 MED   PEDS INTERVIEW OR Difficult Death Debrief Galanos
12/18 12:00 Cosmic   Cantina
12/19 SAR   talks: "Biomarkers in Heart Failure" / Mandar   Aras / Jeremy Halbe 12:00 Domino's

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From the Residency Office

Rising JAR - SAR Preferences

Hard to believe, but the time has come to start thinking about the next academic year.  Access links to the on-line preference forms will be distributed via email on Monday.  Please read the directions carefully, and take note that the deadline for submission is right after the holiday break.

Cookies Anyone?

GME will be hosting the FIRST ANNUAL Cookie Extravaganza on Tuesday, December 17th, 1:00-3:00 p.m. in the bunker!  Please stop by and enjoy some sweet treats and holiday cheer, courtesy of GME and your Program Coordinators!

Message from Duke HR

“As we approach the Holiday Season and look to spend time with family and loved ones, Duke University Hospital would like to take the opportunity to recognize our employees for their continued commitment to our core value: caring for our patients, their loved ones and each other.  On December 20th from 11:00 am to 2:00 pm; 4:00 pm-8:00 pm and 11:00 pm-12:30 am in the Searle Lecture Hall  and December 21st from 1:00 pm – 4:00 pm Duke University Hospital will hold a Winter Reception for employees that work at Duke University Hospital.” You will need a ticket to attend the event (please plan on attending only one).  Lynsey in the MedRes office has the tickets available for you to pick up during normal business hours.

Winter Reception Flyer 2013

Medhub Resource Documents

Reminder: We keep many useful scheduling documents on Medhub in your resource documents section. There are very helpful PDFs including “First Day of Rotation – Where do I go?” as well as all of the rotation schedules for the current block, the previous block and the upcoming block. I recently condensed all of the scheduling documents into one folder titled “Schedule Resources.” I am always here to answer any of your scheduling questions/concerns as well. Thanks! – Lauren Dincher

Planning a future in the outpatient setting? Consider the ACLT. Have fun, too! submitted by Kim Bryan, MD

K Bryant"The Ambulatory Care Leadership Track (ACLT) has been a very fun and worthwhile experience.  The program has allowed me to spend extra time taking care of patients in the clinic setting which I truly enjoy.  In addition, I have had the opportunity to work closely with primary care leaders, develop friendships with fellow residents, and to explore various subspecialties such as dermatology, women's health and sports medicine that will help me to provide comprehensive outpatient care." Four JAR spots and two SAR spots are now open for the 2014-15 academic year.  The track is designed not only for residents interested in primary care, but for those interested in ambulatory subspecialty careers, too.  And social events with like-minded residents and faculty are organized by Sharon Rubin and others. If interested or if you have questions please contact current ACLT leaders Alex Cho, Stephen Bergin, and Daniella Zipkin.  A brief, one-page application will be due Monday, December 30.  You can also go to http://residency.medicine.duke.edu/duke-program/training-pathways/ambulatory-care-leadership-track for more information.  Thanks! ACLT application form

Holiday PartyOffice staff

One picture to share of the program front office staff having fun at the Washington Duke Inn Saturday evening.  Hoping everyone had as much fun as this group did - and to all,  best to you and your families as we approach the holiday break and prepare for the new year!  

Chief Resident - Immersion Training (CRIT) Reception

Immersion Training  

Information/Opportunities

  Aspirus Internal Medicine Opportunities 12.9.13 Doctor Loan Presentation

Upcoming Dates and Events

  • January 15th:  "Voices in Medicine"

Useful links

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