Internal Medicine Residency News: December 23, 2013

By admin3

From the Director

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Hello everyone! Can't believe we are closing out 2013. I hope you all enjoy a well deserved holiday with your family and friends - I also look forward to seeing half of you on the Xmas block! We will enjoy dinner from Dr Klotman on the 24th and the other tradition of Chinese food on the 25th with PSK and me. Kudos this week to Liz Kotzen, Bobby Aertker and med student Tom Lefevre on their gold stars. Also to Marc Samsky from Allyson Pishko for his work at the VA and to the Duke NF crew  of Nick Rohrhoff, Iris Vance, Rachel Titerance and John Yeatts for handling the deluge with smiles. We heard great SAR talks from Mandar Aras and Jeremy Halbe as well.  Thanks also to Chris Hostler, Aparna Swaminathan, Jesse Tucker, Emily Ray, Jenn Rymer and Carli Lehr for resident share on Friday. And, finally, congrats to Dr Simel on receiving a congressional award for his longstanding achievements at the VA! And - awesome job Steve Bergin, Meredith Clement and Mike Shafique for our first high value cost conscious morning report followed by a similar noon conference.  Team Klotman beat Team Zaas in the morning and team Lehman was victorious at noon. Overall, we all worked hard to bring stewardship into our work ups. More of these to come! PubMed from the program: Carling Ursem, MD, PGY3, Poster presentations (two) at the San Antonio Breast Cancer Symposium December 2013  Mentor: Gretchen Kimmick, MD "Does socioeconomic status influence receipt of guideline concordant care in older women with breast cancer: Findings from a Centers for Disease Control and Prevention National Program of Cancer Registries (NPCR) patterns of care study" Have a great week and an even better Christmas/New Year! Aimee  

2015-16 Chief Residents for the Internal Medicine Residency Program

chiefs15_16It is with great pride that we announce the 2015-16 Chief Residents for the Internal Medicine Residency Program.  We are proud to partner with the Durham VA Medical Center and Duke Regional Hospital in selecting these outstanding individuals who join in an important and longstanding tradition of leadership in medicine. The Chief Residents are chosen for their leadership skills and clinical acumen and are the most representative faces of the Internal Medicine Residency program for the year. The Chief Residency represents the largest investment in leadership made by the Department of Medicine, however the return on this investment is several-fold. We look forward to our 2015-16 Chief Residents serving as teachers, role models and colleagues to our residents: Jennifer Rymer MD, MBA – Duke University Hospital Dr. Rymer is a graduate of Vanderbilt University, Vanderbilt University School of Medicine and the Vanderbilt Owen Graduate School of Management. She will be a fellow in the Cardiovascular Medicine training program beginning in July 2014. Christopher Hostler MD, MPH – Durham VA Medical Center Dr. Hostler is a graduate of the United States Military Academy at West Point, the Duke University School of Medicine and the UNC Gillings School of Global Public Health. He will be a fellow in the Division of Infectious Diseases and International Health beginning in July 2014. Armando Bedoya, MD – Duke Regional Hospital/Ambulatory Medicine Dr. Bedoya is a graduate of Brown University and the Warren Alpert Medical School of Brown University. He will be a fellow in the Division of Pulmonary and Critical Care Medicine beginning in July 2014.  

QI Corner (submitted by Joel Boggan, MD)

Online module for specimen collection/labeling training: Here is the link to the course. http://www.safety.duke.edu/OnlineTraining/SPEC100/ Specimen Labeling Error Process  Please note the target start date is Monday 12/23/13.

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What Did I Read This Week?

Submitted by Lynn Bowlby, MD

“Opioid Prescribing: A Systematic Review and Critical Appraisal of Guidelines for Chronic Pain"

Annals of Internal Medicine  12 November 2013 (online first)

[/box] As many of you know , chronic non cancer pain management is one of our major challenges at the DOC.  I had recently reviewed the literature for a noon conference presentation. This recent review reviews the current guidelines and assesses their use of the evidence. 1270 documents were found from Jan 2007 to July 2013, 1132 were screened, with 13 eligible for review. bowlbyphotoAnnual fatalities from opioids have increased from 4000 in 1999 to 14, 200 in 2006. Treating chronic pain during those years changed from little use of opioids to active encouragement of their use.  Long term use is defined as 3-6 mos or longer. Most of the studies of opioids are based on < 6 mos of use.AGREE II (Apprasial of Guidelines for Research and Evaluation ) and AMSTAR (A measurement tool to Assess Systematic Reviews) were used to evaluate the quality of the guidelines. Ratings were highest for the guidelines by the American Pain Society , the American Academy of Pain Medicine and the Canadian National Opioid User Guideline.  > 50% of the appraisers voted to use these guidelines without modification.  These guidelines linked evidence to recommendations to reduce the risk of opioids the most frequently.10 guidelines agree that benzodiazepine and opioids are a very high risk combination, especially the elderly. As the risks of opioids become more well understood, the dose recomendations have been put into effect.The conclusions?The guidelines agreed to avoid > 90-200 mg of morphine /day, advanced knowledge needed to prescribe methadone, knowledge needed of risks of fentyl patches, titrate cautiously, reduce dose 25-50 % when changing opioids, use opioid risk assessment tools, use written agreements and UDS to reduce the risks of opioids.  Much of these reccomendations are based on observational data or expert opinion.This guideline does not address the fundamental issue of using opioids for chronic non cancer pain. Studies are very limited, often < 6 mos of treatment, and greatly underestimate the risk of addiction and diversion.

From the Chief Residents

SAR Talks

SAR talks resume January 9th, 2014

Grand Rounds

Grand rounds resumes January 10th, 2014

Noon Conference

Noon conference resumes on January 8th with the first Schwartz Rounds of the new year

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From the Residency Office

Rising JAR - SAR Preferences and Clinical Epidemiology

To those who have already submitted preferences - and there are a surprising number of early birds - please note that Lauren has made the following changes to allow you to update your selections even after hitting the "send button". The survey will now to allow you to use the same link that was emailed to you to go back in and edit the survey at any time up until the survey is closed on 1/8/14. JARS — the Clin Epi applications will be sent out right after the new year.  Instructions for eligibility will be included with the application. If you apply, we assume that you are preferencing this over any other elective, so please don't feel the need to put "points" towards Clin Epi. Please address any questions you may have to Dr Zaas or the Chiefs.

MedHub Resource Documents

Reminder that all schedule resource documents are now located in a tab labeled "Schedule Resources" on your home page in MedHub, including details as to your current schedule and future block schedules as they are completed.   

Planning a future in the outpatient setting? Consider the ACLT

submitted by Lauren Porras, MD

"I applied to join the Ambulatory Care Leadership Tract in order to broaden my experiences and learning in ambulatory topics. During my JAR year, I was able to audit a course in the PorrasMaster's of Clinical Leadership program which was a great way to learn how to adapt to various learning scenarios. The residents in ACLT also have a separate ambulatory curriculum together that is more streamlined throughout the experience. My favorite part about ACLT is the fact that your experiences can be very flexible, especially in the third year. This has been phenomenal option to help address the deficiencies I felt I had in ambulatory topics. I would encourage everyone to consider applying to ACLT and please let me know if you have questions!" 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 please contact Alex Cho, Stephen Bergin, or 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

Information/Opportunities

 Florida Internal MedicineCorpus Christi HospitalistPediatric Hospitalist-Houston TexasBC_FlyerTemplate_Billings Internal Medicine 2013

Upcoming Dates and Events

  • January 15th:  "Voices in Medicine"
  • April 18th:  Charity Auction

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