Internal Medicine Residency News: January 20, 2014

By admin3

From the Director

DUKE.RESEARCH.NIGHT.03 (1)It's been a great week for the program! We are winding down an incredible recruitment season…next Friday is our last day.  Thank you all for your ongoing support and enthusiasm as we work to bring in an incredible intern class for 2014-15.  Thanks to our tour guides, to Lindsay Boole for helping us get applicants where they need to go on rounds, to our gen med SARs, MICU residents and 9300 interns (as well as the attendings on these services!) for taking applicants on rounds, to Brian Miller and Shrey Purohit for report and chair's  and to our resident share participants…Brian Miller, Kevin Trulock,  Andrea Sitlinger, Meredith Clement, Ryan Huey and Rajiv Agarwal. Humanities and Medicine was a phenomenal night! With RECORD BREAKING attendance, and spectacular performances, we had the opportunity to share in the many talents of our residents and faculty.  Thank you so much to Vaishali Patel, Anton Zuiker, Lynsey Michnowicz and Erin Payne for planning a wonderful evening, and to the following residents and faculty for sharing their performances with us – Ben Lloyd, Carling Ursem, Scott Evans, Aaron Mitchell, Dave Karol (alum!), Josh Briscoe, Amy Rosenthal (mentor emeritus!), Ben Peterson, Tony Galanos and Tiffany Christenson.  And a special recognition to event founder, residency and chief alum, and geriatrics faculty member Juliessa Pavon!  Members of our residency community were also honored at the University and Health System level as well.  Shelia Gainey received a distinguished service award for her work administering the medical student clerkships — she received as book with the many letters written about her by students and former students.  Erin Payne was a nominee for the Dr. Martin Luther King, Jr. Community Service award for her work with the North Street Community.  Check out the medicine blog for more information about Erin's award.   I am very proud of how many of you have brought your community service efforts into the program, and with the National Day of Service coming up on Dr. Martin Luther King Jr's birthday, it is time to recognize you all as well. Kudos to Ashley Bock who was recognized by the 8100 nurses for her outstanding communication and patient care skills! Dr. Setji tells me that this is the FIRST time the 8100 nurses have taken time to write him a note about the excellent work of our residents.  Excellent job, Ashley.  Both Liz Campbell and Mallika Dhawan gave fabulous SAR talks this week as well! Congratulations to Lauren Porras on her match into UNC's Sports Medicine fellowship.  This is a tremendous accomplishment! Stephen Bergin and I had a great time visiting the Pickett Road Clinic this week for leadership rounds with Bruce Peyser and Sharon Rubin.  We got to see Kedar Kirtane and Audrey Metz working hard there as well and hear about all of the great work going on at Pickett Road.  We look forward to visiting PRIME and the DOC in the upcoming weeks. In other news, we have a large number of residents who will be presenting at the upcoming Patient Safety Symposium and also the NC ACP meeting in Greensboro.  You will all get announcements in our Pubmed from the Program, but deserve special recognition for your outstanding academic efforts. This week's pubmed from the program goes to many of our residents who have a paper accepted to The American Heart Journal – congratulations Adrienne Belasco, Aparna Swaminathan, Alex Fanaroff and Med Peds Alum Ann Marie Navvar Boggan!   “The Impact of a Measurement and Feedback Intervention on Blood Pressure Control in Ambulatory Cardiology Practice."  Navar-Boggan AM, Fanaroff A, Swamithan A, Belasco A, Stafford J, Zimmer L, Shah B, Peterson ED.  American Heart Journal 2014; in press. PLEASE TAKE TIME TO FILL OUT YOUR ACGME SURVEY!  THIS IS CRITICALLY IMPORTANT TO THE PROGRAM and to the ACGME!  And finally, it's already time to think about those New Years resolutions that are not being kept! Join me in the first Raleigh Rock and Roll Half (or full if you are Carling, Brian Miller or Kristen Glisinski!) marathon. Let's make the Duke IM residency a big presence at this fun event! RR flyer 1 Have a great week! Aimee [box]

What Did I Read This Week?

"Submitted by Saumil Chudgar, MD."

Two brief perspective pieces:

Gurpreet Dhaliwal and Karen E. Hauer. “The Oral Patient Presentation in the Era of Night Float Admissions: Credit and Critiques.”  JAMA 2013; 310(21): 2247-48.

Kelley M. Skeff.  “Reassessing the HPI: The Chronology of Present Illness (CPI).”  J Gen Intern Med 2014; 29(1): 13-5. 

[/box] Why did I read these? I was recently on service and thinking about how presentations are different on “overflow” patients admitted by night residents and patients that the day team admits.   Additionally, I was thinking about how we teac133410_saumil_chudgar_prdh medical students to write H&Ps and do presentations before they come onto the wards and the feedback we given them afterward.  We’re taught in medical school to write-up and present a detailed account of the patient from HPI to assessment and plan.  However, much data is now collected (and hopefully verified/confirmed) from other sources rather than the patient with problem lists, medications, social and family history, and allergies prepopulating into notes.  How does this change what we teach our students and residents. What I learned from reading these/thoughts on the articles? The perspective on oral presentations in the era of night floats is fascinating.  It brings up the point that attendings have often read the written H&P or learned about the patient through sign-out prior to rounds.  In this situation, simply regurgitating the written H&P is not a good for learning or for efficient patient care.  Rather, the authors suggest the presentation should focus on several things: a brief HPI followed by interval events and then a discussion of what was done, what new data has come in, and how that has shaped the initial thoughts and plan.  This should be done in a respectful way with discussions about reasoning and systems-based practice.  It allows for discussion of clinical reasoning and teaches those skills to the presenters and team.  Many of us are doing this informally when we round, but it begs the question of does this need to be formally taught to residents?  Do we take it one step further and teach this in the latter part of medical school—on the subinternship or in a Capstone course, for example)? Dr. Skeff’s article was also quite interesting.  It proposes a change from the HPI being told as a detailed story in narrative style to a “chronology of present illness” that is written in tabular or bullet form with the dates in a column to the left side of the page and the history elements on the right.  He emphasizes the increased organization for the writer and the ease of reading for other people caring for the patient by allowing for a stepwise analysis.  He also emphasize that this method should not diminish taking a patient-centered history and using effective listening.  I am not sure if this method will be adopted moving forward.  I haven’t seen it much to date other than in a complex long-stay ICU transfer or hospitalization. It is a learned skill, and perhaps the narrative should be taught first with a CPI used by more advanced learners.  Regardless, a very interesting idea and one that may also begin to be taught in medical school or to residents. Both articles taken together make me consider how medical education is changing – are some of the things we have been teaching because that is how they have always be done now still the right way to teach?  Or, do we continue to teach them and add some of these newer methods moving forward?

QI Corner (submitted by Joel Boggan)

Congratulations! Congrats to the following residents for having QI-related posters accepted at either the NC ACP meeting and/or the Duke Patient Safety and Quality Conference:  Lindsay Boole, Katie Broderick, Alexandra Clark, boggan_1Hany Elmariah, Jim Gentry, Steph Giattino, Jeremy Halbe, Ryan Huey, Phil Lehman, Tim Mercer, Aaron Mitchell, Emily Ray, Marcus Ruopp,  Jessie Seidelman, Kevin Shah, and Aparna Swaminathan!  Strong work, guys! QI Conference Our very own Dr. George Cheely will be giving our next QI noon conference on 'Overcoming Barriers to High Value, Cost-Conscious Care' on 1/29 in 2002.  Food TBD. . . Hand Hygiene The mid-month update shows us at 94% aggregate performance  on the 7 seven wards through Jan 16th.  Keep up the good work! And, finally . . . The Health System is sponsoring a session on 'Understanding Quality Reporting', led by Kevin Sowers, President of DUH, and Jennifer Rose, the Director of Performance Services for DUHS on Wed., 1/22, at 1-2 pm in 2002 and again on Thurs., 1/23, from 6:15-7:15 am, again in 2002.  Link here to learn more . . . https://intranet.dm.duke.edu/hospitals/duh/SitePages/Livestream.aspx

From the Chief Residents

SAR Talks

SAR Talks: January 21, 2014 Nancy Lentz / Wendy Chan

Grand Rounds

January 24, 2013: Dr. Joel Boggan/Dr. Peter Ubel – M&M Topic: Cost

Non Conference

Date Topic Lecturer Time Vendor Room
1/20 HOLIDAY NA
1/21 SAR talks OR Difficult Death Debrief Nancy Lentz /   Wendy Chan 12:00 Bullock's BBQ 2002 OR DN9242
1/22 12:00 China   King 2002
1/23 12:00 Domino's 2001
1/24 INTERVIEW

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From the Residency Office

 

Death Certificates - New Requirements

Dear Duke Physicians: As part of our effort to educate physicians about completing death certificates, we want to alert you about the new death certificate form required in North Carolina beginning January 1, 2014.  Like the previous form, the new form includes instructions for completion, but we believe it may be helpful to highlight some significant changes.  Attached is a "Note on the New Death Certificate," which includes information about the state's new online training.  Also attached is a PDF image of the new death certificate, and a "Quick Guide to Signing a North Carolina Death Certificate" that we have prepared. Of note, physicians are now required to provide their NC medical license number in part 33b.  Note: Post-graduate trainees who only have a “Resident Training License” should put “RTL” in this space. Please note that we have also prepared a detailed module on completing death certificates, produced through a Duke Graduate Medical Education Innovations grant.  Many of you will be soon be receiving an invitation to review this module, which comes with brief, case-based pre and post tests. Mitch Heflin, MD and Michael Arges, PhD Death_Cert_FIN_20130906_fill-in Notes on New Death Certificate_January 2014 QUICK_GUIDE_TO_SIGNING_A_NORTH_CAROLINA_DEATH_CERTIFICATE_Jan2014  

Clinical Care Memo:

The EKG Support has an ongoing problem with getting orders for ECGs.  They are performing the ECG but then it takes multiple calls to get the order placed and sometimes it is never ordered.    This is a huge problem for charging as well as taking a lot of time for the ECG techs that could be performing ECGs in a more timely manner.   As of yesterday, Dr. Freedman and Dr. Grant have put a policy in place that an order will be in Maestro PRIOR to the ECG being performed (Now that Epic has been in use throughout our Health System for more than 6 months, no ECG will be performed until the order for that ECG is placed in Epic.  This rule will be enforced by all ECG technicians to keep the EKG Support Unit in compliance with contemporary policies.) Exemptions are Code Blue and RRTs.  Because the ICUs have emergency situations they have decided to extend a temporary exemption and monitor over the next 2-4 weeks to look at compliance.  If  the orders are being placed, the exemption will become permanent.  If the orders are not being placed, the no order, no ECG policy will go into effect.  

Cardiovascular Research Center Seminar Series 4pm 143 Jones

January 15, 2014 4:00pm; 143 Jones Matthew Sparks, M.D., Medical Instructor, Department of Medicine, Duke University “Role of Vascular Angiotensin Receptors in Blood Pressure Control” Presenter Disclosure Information:  None. January 29, 2014 4:00pm; 143 Jones Charles E. Murry, M.D., Ph.D., Director, Center for Cardiovascular Biology, University of Washington “Regenerating the Heart” Presenter Disclosure Information:  TBA February 1, 2014 8:30am-12:30pm CVRC Retreat - Mary Duke Biddle Trent Semans Center for Health Education - Great Hall Keynote speaker will be David A. Kass, M.D., Abraham and Virginia Weiss Professor of Cardiology, Professor of Medicine, Professor of Biomedical Engineering, The Johns Hopkins University Medical Institute – “TRPing Up Heart Disease With PKG”. Anyone who will be attending must RSVP no later than January 27, 2014 to DUKECVRC@dm.duke.edu No CME credit offered for this event Flyer Matthew Sparks Flyer David Kass Flyer Charles Murry  

Information/Opportunities

  teaching fellow Cary Medical Group, MD position, 2014 flyer  

Upcoming Dates and Events

  • January 31:  Medicine Research Conference at 12 noon in DUH 2002.
  • April 18th:  Charity Auction

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