Internal Medicine Residency News, July 25, 2016

July 25, 2016

From the Director

Happy last week of Block 1! We have a busy week this week with our first JAR dinner of the year tomorrow at Geer Street - (Madi will be sending the August signup soon too)-, the state of the program grand rounds, our professional development noon conferences on Friday and the summer celebration on Friday night! And then it's August...

Kudos this week to Ashley Spann on receiving a gold star from a patient (that's when a patient mentions you by name in the patient satisfaction survey), to Lauren Ring on a fantastic SAR talk and to Ankeet Bhatt for an awesome chairs conference. Peter Hu was put on the hot seat for reading the echoes and is clearly ready for his cardiology fellowship! Also kudos to David Beavers from Jenn Rymer for expert swan-floating in the CCU.

Thanks to Dr Klotman for sponsoring our Friday breakfast. Alyson and I took a walk to the MICU to drop off bagels and got to see some really compassionate bedside care by Josh Lee and Rachel Feder, with fellow extraordinaire Stephen Bergin supervising.

Fellowship interviews are starting! That's great! The schedule committee timelines are generally for non-urgent requests so please put your dates through the form but also let Erin Payne know of your dates/trades/coverage agreements. We will also be sending out a document to help alleviate the interview anxiety and are happy to answer any questions at any time.

Lots of dukefamily this past weekend at a class of 2014 reunion (with cameo appearances from Aaron Mitchell, Brian Miller and Marianna Papademitriou). Really fun to see everyone and their growing families!

Congratulations also goes to Jeremy Cypen and Sanja Galeb on their engagement!

Welcome to the dukefamily to Emma Klement, daughter of alum Adrienne Klement and Mitch Klement!

This weeks pubmed from the program goes to Michael Dorry - Post Transplant Pulmonary Embolism is Associated with Allograft Dysfunction and Worse Survival, Michael Dorry, Scott L. Shofer, Kamran Mahmood, Kristen Glisinski, Laurie Snyder

Have a great week

Aimee

What Did I Read This Week?

Rodger AJ, Cambiano V, Bruun T, et al. Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA. 2016;316(2):171-181.

Can you safely forgo using a condom if your partner has HIV? I read last week’s edition of JAMA (which is centered around HIV) after Sky Vanderburg presented a great case of acute HIV at morning report. There are three common ways to prevent the transmission of HIV among serodiscordant couples (couples where only one person has HIV): (1) Make sure the person who is already infected is on effective antiretroviral therapy (ART) to decrease viral load (2) Use condoms and (3) Have the partner who does not have HIV take prophylaxis. One problem is that many couples although well-intending to use condoms often times do not. What is the risk of HIV transmission through condomless sex from an HIV-positive person taking ART?

Population: 1,166 serodiscordant couples from 75 European sites
- The HIV infected partner was receiving ART
- The HIV infected partner had plasma HIV RNA levels less that 200 copies/mL
- All reported routine engagement in condomless penetrative (anal or vaginal) sex
Results:
- Final analysis included 888 couples (about 1/3 MSM) contributing to 1,238 couple-years of follow-up
- There were approximately 40,000 condomless sex acts throughout follow-up period
- 11 uninfected partners became infected- however none of these infections proved to involve viruses phylogenetically linked to the HIV-infected study partner
- No cases of within-couple HIV transmission (upper 95% confidence limit 0.30/100 couple-years of follow-up)
Implications:
- This is one more reason for all HIV-infected individuals to initiate and adhere to ART
- The overall risk for HIV transmission among serodiscordant couples in the setting of viral suppression appears quite low – however it is probably not zero and the actual number is not known, especially for higher-risk groups such as MSM
Limitations:
- Limited power to detect lower rates of HIV transmission (especially among MSM)
- High rates of ART adherence may exceed that seen in the community
- Frequent STI testing and treatment in the study could also reduce risk of HIV transmission

CLINIC CORNER

Clinic Corner 7/25/16

I know, you’ve been dying to know what we’ve been up to in the clinics, right?? Well, let me tell you, the year is off to an AMAZING start!!

Please stand (yes, right now) and give a round of applause for Jen Averitt and Lynsey M. (you didn’t think I was gonna try to spell her name, did you?), they have done an absolutely amazing job taking on the scheduling duties after staffing and software changes last year. Really, above and beyond. We are so lucky to have them at the helm. And now they are joined by Erin Payne, smiler extraordinaire, who will take on a lot of scheduling duties and make everyone feel just that much better when sauntering into the med res offices to grab a snack. Welcome back Erin!!!
Huge thanks go to our chief, Aparna Swaminathan, for her outstanding work in revising all of the ambulatory templates (did you know there are 14 different amb templates for the JAR/SAR amb weeks??). She is taking a hard look at where we currently send you guys, adding in more faculty based on who you like to work with, AND moving towards cohesive curricula for each experience (thanks for the proactive energy, Talal Dahhan, regarding the pulmonary block!!). Things are literally getting better by the minute.
JARs and SARs will now see a MedHub evaluation for their ambulatory weeks. Give us feedback!! Lots and lots of feedback!! If MedHub bugs you, just email us! That works too! Aparna and I spend our evenings with our laptops propped open, pining away, waiting for your emails. We are so lonely!! Really, though, it’s easier than putting the kids to bed.
Women’s health ambulatory block is on the verge of being a THING!! Some of you know that we have been struggling to build this for several years, because of all the other learners who compete for space. Aparna and I have met with the Ob-Gyn program leadership and networked with their chief residents and clinic leads, and we are building a template for Clinic 1J for you to get more gyn experience. Please note, we will not be sending you to gyn clinic arbitrarily, we want to HEAR from you if you’re interested in this. Several ACLT residents have expressed interest and we will offer space to them first, but ALL are welcome – just let us know if you want to go. Email Dani, Aparna, or Erin.
Did someone just say ACLT??? Wow, it’s going to be a great year for the Ambulatory Care Leadership Track. JARs and SARs in the ACLT will meet on amb blocks together for 12 weeks this year, and we are building curricula in teaching, population health, and health policy that are going to blow them away. Interns, heads up for more information coming soon on joining the ACLT!! We will share more in early fall and ask you to declare interest in the track by around December. Stay tuned!!

See y’all back at clinic!!

Dani

From the Chief Residents

Grand Rounds

Friday, July 29 - State of the Program, Dr. Aimee Zaas (Trent Semans Center)

Noon Conference

Date	Topic	Lecturer	Time	Vendor
7/25/16	MKSAP GI	Adam Banks	12:00	Domino's
7/26/16	SAR Lecture: GIB	Winn Seay	12:00	Nosh
7/27/16	ACR/Chief Lecture - Hospitalized IBD	Alyson McGhan	12:00	Firehouse
7/28/16	Residency Town Hall	ResCo	12:00	Chick Fil A
7/29/16	Professional Development	Pollack, Whitson, Dr. G	12:00	Picnic Basket

From the Residency Office

Have You Logged Your Duty Hours??

With the start of the 2016-17 academic year, the residency program is asking all house staff to log their duty hours on a daily basis. This will allow us even closer oversight of duty hour compliance across the program. In order to use the MedHub mobile Duty Hour app, you will need to know your actual MedHub log in as it will not accept your NetID/password log in. If you have forgotten you main log in, please go to the main MedHub site, and select "Forgot my password." You will then be able to re-set it via email. Lynsey Michnowicz will be sending reminders each Wednesday to those who have not yet logged their duty hours for the week. Thank you in advance for your attention to this task!

NCSP Applications

The National Clinician Scholars Program (NCSP), a two-year research training fellowship (formerly known as the Robert Wood Johnson Foundation Clinical Scholars Program) for physicians and nurses, is now accepting applications for enrollment in July 2017. The NCSP provides mentored training in clinical, community, and health policy research, with a focus on supporting the development of change agents who will devote their careers to leading improvements in health and healthcare.

The NCSP, in partnership with the Department of Veterans Affairs, currently has training sites at the University of California at Los Angeles, University of Michigan, University of Pennsylvania, and Yale University.

Applications are due August 15th.

Medical Improv

Medical Improv Workshop being offered in the Triangle area. And it’s free!

Medical Improv is quickly gaining popularity as an innovative approach to teaching principles that are at the heart of patient centered care: Focused listening, collaboration and seeing things from another’s point of view. Medical Improv can help teach skills that will make you more present and aware during high stakes conversations with patients and colleagues. If you find yourself feeling overwhelmed by everything that’s coming at you during your time with patients, these skills can help things slow down a little so you can prioritize what’s most important and make better decisions.

This 3 hour workshop is free to all Duke Health Sciences’ students and clinicians on a first-come-first-served basis. The workshop will be capped at 15 students for more individualized attention. No observers will be allowed in these sessions. Everyone will be expected to participate. The sessions will not be recorded in any way and no grades will be given. The goal is to create a safe environment where people can play and speak freely.

These sessions will be led by Dan Sipp, a trainer for the Clinical Skills Program at Duke University School of Medicine. Dan has taught improvisation in Chicago and the Triangle for over 20 years. He’s trained with the creator of Medical Improv, Katie Watson from Northwestern University’s Feinberg School of Medicine*, and they have collaborated on projects for the University of Indiana School of Nursing. Dan is very excited to bring these sessions to medical learners in the Triangle. Duke Faculty members from The School of Medicine, Graduate Medical Education, The School of Physical Therapy and The Physician Assistant Program will be co-facilitating these and upcoming sessions.

You’re invited to register for this free workshop!

Saturday, September 24th from 10 a.m. to 1 p.m. @ Trent Semans Center for Health Education, 6th floor

To reserve your spot in the next Medical Improv Workshop please email Dan. Once he receives your email he’ll follow up with a confirmation of your spot, directions to the site and more information about the day.

Remember space is limited to 15 participants per session. We want to see you there. So sign up soon! You are also free to forward this email to friends or colleagues who you feel might be interested in this innovative training session.

*You can read more about Katie at her website. You can also read Katie’s paper on the applications for and the effectiveness of Medical Improv for clinicians at the Academic Medicine website.

Office Hours for Dr. Zaas

Dr. Zaas will have the following office hours. Please feel free to stop by during these times and of course always feel free to reach out to her office to set up a meeting outside of these times if needed!

Monday - 3:00 p.m. to 4:00 p.m.
Thursday 10:00 a.m. to 11:00 a.m.

Next Book Club Event!

Attention, Medicine Residents!

Welcome to the new academic year, and a particularly warm welcome to our new interns! We're excited to announce that the Duke Internal Medicine book club is back! Our first event will be on Thursday, August 18th from 5:30 - 7:30 pm in the Searle Center Faculty Lounge. At the request of the residents (that's you!), our structure is changing a bit. This time we'll be reading All the Light We Cannot See by Anthony Doerr, a NYT best seller and winner of the 2015 Pulitzer Prize for Fiction. Books are available at most local book stores or online. Snacks and drinks will be provided.

If you're interested in attending, or if you have any questions, please RSVP to me at laura.caputo@duke.edu. We're looking forward to seeing you there!

LiveSafe Mobile App

Duke is introducing a new mobile app called LiveSafe to put a powerful safety tool in the hands of the Duke community.

The app, available as a free download from Apple and Android app stores, enables smartphone users to submit real-time tips to Duke Police, virtually “SafeWalk” friends and family while traveling, place emergency calls, and access important resources for support.

You can find more information, including instructions on how to download the free app, on the DukeALERT website: http://emergency.duke.edu/notified/livesafe.

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/