From the Director
Brr…it’s officially winter here now, I guess. Winter means flu season, so please please take care of yourselves. If you aren’t well, get yourself to your PMD or to an urgent care. While it seems like the right thing to do to come to work when we are feeling awful, it’s actually not the best thing for you or your patients. Please keep us informed if you aren’t well enough to do patient care!
Thanks to everyone who is keeping the interview season going! We really appreciate your time for dinners, tours, chatting with applicants and showing off our amazing program. Thanks to Luke Cerbin, Lakshmi Krishnan, Bill McManigle and Jesse Tucker for doing “My Take” on Friday and to our awesome tour guides Bassem Matta, Kevin Friede, Rajiv Agarwal, Emily Ray, and anyone who I accidentally left off this list! After today, we have 3 more so make sure to get a chance at dinner with applicants if you haven’t done so!
We are gearing up for the career planning series (aka – fellowships and jobs) for the spring. Please keep an eye out for the fellowship planning seminars, the job (primary care and hospital medicine) info sessions, as well as networking events. Bill and I are setting the dates for the fellowship seminars and will post the entire career planning calendar TOMORROW!
SO excited for our first Lincoln Community Health Center volunteer night on Wednesday! We had a fantastic intro to Lincoln last week, well attended by residents and faculty. This is tremendous, and an early thank you to all for your outstanding efforts to start this program.
SARS, don’t forget to sign up for the ABIM exam before the fees go up. No reason to pay any more for the exam than you have to. Schuyler Jones generously donated another MKSAP, so feel free to borrow the books from the Med Res office. Thank you Schuyler!
Kudos this week to Mike Powers for an amazing M and M conference, as well as to Pascale Khairallah for her outstanding chair’s conference as well.
This week’s pubmed from the program goes to LAUREN COLLINS for her paper in the Dec 8th issue of the Annals of Internal Medicine! Way to go Lauren,
Diagnosis of Latent Tuberculosis Infection: Too Soon to Pull the Plug on the Tuberculin Skin Test ONLINE FIRST
Lauren F. Collins, MD; Carolina Geadas, MD; and Jerrold J. Ellner, MD
Have a great week!
Aimee
What Did I Read This Week?
Submitted by Armando Bedoya, MD
Delivery Models for High-Risk Older Patients: Back to the Future?
JAMA. 2016;315(1):23-24. doi:10.1001/jama.2015.17029.
Necessity, as they say, is the mother of invention, and the growing focus on the need for high quality and cost-effective care is bringing “new innovation” to light or rather in the case of the extensivist model bringing back an “old innovation.”
Intended for the neediest patients, the extensivist model surrounds them
with a comprehensive care team (nurse practitioners, case managers, medical assistants, a social worker, and a nutritionist) that can address the full range of medical and social issues these patients face. Separate full-service clinics are set up to serve targeted patients exclusively, and extensivist physicians – who also follow the patients to other care settings (outpatient and inpatient) as needed have very small panels (<250 patients).
In the past, the primary care physician followed the patient across the sites of care with the belief that ‘they knew their patient best” due to longitudinal care. The hospitalist movement subsequently emerged because of the belief that primary care physicians may not be the right physicians to care for all hospitalized patients. The extensivist model is a “return to form” for a select patient population, i.e “high risk” that suffer the most from the transition from inpatient to outpatient and vice versa.
Improving care for high-risk older patients has been an area of health care system and policy-maker attention for nearly 2 decades. Despite widespread use, outpatient care management interventions focusing on care coordination, medication adherence, and self-management have produced mixed results. Within this population, programs focusing on transitions among inpatient, postacute, and community sites of care are often more successful. Medically fragile older patients at the greatest risk of discontinuity may be better served within a system reengineered for maximal continuity of an individual who transcends the ambulatory and inpatient domains.
This article is interesting because with the Affordable Care Act there has been a rapid change in care models that we as physicians can provide to our patients. All of which are unstudied and unproven but are geared to improve care.
QI CORNER
Join us this Thursday at 5:30pm in DN8262 for the next meeting of the PSQC! We're making great strides on the paging culture project and have just a few minor pieces to discuss this week. Dinner will be provided! In the meantime, the new paging template is being piloted on 4300. Keep in mind that with the number of nurses to educate, uptake will be ongoing. But expect to start seeing pages from 4300 nurses that look like this:
Pt name / team / rm # / 'STAT' or 'URGENT' or 'ROUTINE' / description of issue / RN name / call-back #
Here's the key: The nurses are standardizing their pages and avoiding 7-digit pages and HUC pages altogether. In exchange, we are standardizing our time-frame for response:
STAT = 5 min call-back or come to bedside
URGENT = 15 min call-back, bedside, or place order
ROUTINE = 1 hr call-back, bedside, or place order
Non-urgent "FYI" information to be passed along to the day team (things like suggesting a decrease in vital signs frequency, need order for home eye drops tomorrow, etc.) will go in the Team Communication box. So day teams, keep checking that communication at least daily.
Please send me & Lish your feedback as this rolls out! This is a pilot in the truest sense, and we will be looking for ways to tweak it as we go along.
CONGRATULATIONS to our HVCC proposal competition winners!!
1st place:
Reducing duplication of radiology orders for patients transferred to Duke from outside hospitals
Matt Atkins, Austin Dixon (Radiology), Alyson Shogan, Andrea Sitlinger, Jenny van Kirk, and Joanne Wyrembak
Runners up (tie):
Reducing inappropriate outpatient PPI prescriptions
Jessie Seidelman, Stephanie Li, and Rachel Feder
Improving accuracy of COPD diagnosis with inpatient bedside spirometry
Anne Reihman, Lukasz Cerbin, and Landon Brown
The winners will receive structured mentorship, funding for statistical support, and a nice chunk of pocket change on their next paycheck. Congratulate them next time you see them and wish them luck... these guys will be working hard as they get started in the next few weeks!
CLINIC CORNER
This feature will return next week!
From the Chief Residents
Grand Rounds
Friday, January 15 - Kevin Thomas
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 1/11/16 |
Recruitment-Lunch w/Applicants |
|
12:00 | Panera |
| 1/12/16 | MedPeds Recruitment-Lunch with Applicants | 12:00 | Saladelia | |
| 1/13/16 |
Schwartz Rounds |
DN 2002 |
12:00 | China King |
| 1/14/16 |
Introduction to Library Resources |
Megan Von Isenburg |
12:00 |
Firehouse |
| 1/15/16 |
Chair's 11:30 a.m., Recruitment lunch with Applicants |
12:15 | Picnic Basket |
From the Residency Office
Schwartz Rounds
Schwartz Center Rounds
Title: Caring for Our Own
Panelists:
Aimee Zaas, MD, Dept. of Medicine Program Director and Family Member
Tony Galanos, MD
Tom Holland, MD
Wednesday, January 13, 2016, Noon - 1 p.m., Duke South Amphitheater
About Schwartz Center Rounds:
All members of the Duke Medicine community are invited to attend an ongoing series of discussions called the Schwartz Center Rounds about the human side of patient care. Schwartz Center Rounds is a monthly interdisciplinary conference that offers all of us from no matter which discipline as well as non-clinicians who work closely with our patients a regularly scheduled time.... We are excited to have brought this program here to Duke and hope many of you will be able to join us on a regular basis.
Please contact, Lynn Bowlby, MD (lynn.bowlby@duke.edu), Nathan Gray, MD (nathan.gray@dm.duke.edu) or Bill Taub (arthur.taub@dm.duke.edu) with questions. There is no need to RSVP, but we do recommend that you arrive early as food and seats are at a premium!
Duke Narrative Writing Project
Dear Medical Trainees,
We invite you to participate in the inaugural Duke Narrative Medicine Project.
This initiative includes a special Medicine Grand Rounds by invited speaker Anna Reisman, MD from Yale School of Medicine (Director of Yale Internal Medicine Residency Writers' Workshop) as well as a one-day workshop focused on honing the craft of writing.
Duke medical students, residents, and fellows across all departments are invited to submit narrative or reflective writing samples in advance of a one-day workshop in which participants will engage in critical and constructive feedback of each other's writing.
The writing workshop will be moderated by Dr. Anna Reisman as well as Duke faculty members who will work with you to prepare your narrative writing pieces for publication.
Please see the attached flyer as well as the application link below for additional details.
Duke Narrative Medicine Project: Writing Workshop
Saturday, February 6th 2016
Duke Medicine Pavilion
Pre-workshop dinner February 5th, 2016
Application details:
https://duke.qualtrics.com/SE/?SID=SV_2fUx5jKrPKf9ZhH
Application deadline:
Rolling submissions until January 15th 2016
Please contact DukeNarrativeMedicine@duke.edu with any questions!
Sincerely,
Duke Narrative Medicine Project Team
Amy L Jones, Dinushika Mohottige, Lakshmi Krishnan, Anubha Agarwal
General Medicine Health Services Research Fellowship at Duke (Attention SARS!)
Health services research (HSR) is multi-disciplinary and focuses on the impact of systems of care, access, cost, quality, behavior and other factors on health care outcomes. We have a very robust network of support and outstanding faculty in HSR at Duke. Here is an introduction to our fellowship, courtesy of David Edelman. The application cycle begins in January!
The Division of General Internal Medicine collaborates with the Center for Health Services Research in Primary Care in the Durham VA Medical Center to offer fellowships for MD and PhD scholars with an interest in training in clinical or health services research. The fellowship is ordinarily a two year program, though three year fellowships may be available to certain candidates. Training grants are funded by the VA Office of Academic Affairs (OAA). We have trained more than 100 fellows in our 30-year history, including many leaders in Health Services Research and many of our core faculty in General Internal Medicine.
The primary goal of the post-doctoral fellowships is for fellows to perform high-quality, mentored clinical or health services research working closely with a mentor from the Division of General Internal Medicine. MD fellows ordinarily obtain a Masters in Clinical Research from Duke’s CRTP program, with tuition paid by the fellowship. All fellows also participate in a Faculty/Fellow Development Seminar Series, a set of weekly, one-hour discussions addressing a variety of career development topics. Stipend is at the appropriate PGY level.
Senior Residents wishing to apply for July 2016 should contact Dr. David Edelman, Fellowship Director (David.Edelman@duke.edu) no later than Friday, January 9 to express interest. Written application will be due February 1 with interviews competed by the 3rd week in February and applicants notified of their status by March 1.
Click the link for more info:
http://www.durham.hsrd.research.va.gov/MD_fellowship.asp.
Or, contact David Edelman, MD, Fellowship Director (david.edelman@duke.edu).
Book Club Event
Please join us for a special book club event on February 3rd from 5:30 - 7:30 pm in the Faculty Lounge. We'll be reading Black Man in a White Coat by our own Duke author, Dr. Damon Tweedy, who has graciously agreed to join us for the event. If you only make it to one book club event this year, make this the one!
If you would like to attend, please email laura.caputo@duke.edu. As always, a limited number of FREE COPIES of the book are available so RSVP early to reserve your copy. We look forward to seeing you there!
Thank you!
Laura M. Caputo, MD
Hospital Medicine, Durham VA Medical Center
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
February 17 - Duke vs UNC
March 2 - JAR Networking Event
March 5 - UNC vs Duke
March 18 - Match Day Celebration
April 29 -Charity Auction
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
www.bidmc.org/CentersandDepartments/Departments/BIDHC
http://www.careermd.com/employers/latestbulletins.aspx