From the Director
Thanks for your patience with the lack of news while I was away! Vacation was great, and it is good to be back as well. Thanks to all for holding down the fort while I was away.
Be sure to thank the chiefs this week … their last day is WEDNESDAY…thank you so much Jenn, Chris, Armando and Lindsay for your leadership this year. And welcome to Alyson, Adam, Aparna and Matt! New interns start their orientation on Friday and we will be sending out shadow day pairings for the outgoing interns by the end of the week!
Kudos this week go to Lauren Collins from Rob Olivo for great work on renal consults, to Jeremy Cypen from his CAD colleagues and Adam Banks for being a huge help overnight when the CAD teams were very busy, and to Tanya Aylward from Bill McManigle for compassionate patient care at the VA. Kudos also to Julia Xu for helping out at Lincoln last week from Jenny Van Kirk!
Congratulations to our resident elected end of year award winners - DRH Teaching Award – Amanda Jimenez; Ambulatory Teaching Award – Sharon Rubin; Bruce Dixon Award – Bassem Matta and Nick Turner (nominees included Sarah Goldstein, Adva Eisenberg, Jason Zhu, Paul St Romain and Jesse Tucker); Community Service Award – Lauren Collins (nominee – Eric Yoder, Andy Mumm, Jake Feigal and Jenny Van Kirk); Lecoq Award for Outstanding SAR Talk – Adva Eisenberg; Outstanding Chair’s Conference – John Musgrove; Haskell Schiff Award – Jason Zhu (nominees are Emily Ray, Jesse Tucker, Nick Turner, Dinushika Mohottige, Myles Nickolich and Ashley Bock) and the Amit Bhaskar Compassion in Medicine Award – Dinushika Mohottige (nominees are Gena Foster, ANubha Agarwal, Emily Ray, Andy Mumm and Jason Zhu).
Please make sure to attend Dr. Klotman’s grand rounds on Friday!
Guess what?! Dr. Washington (that’s the chancellor!) visited the DOC last week. Check in with Dani and Lynn to hear all the great things he had to say!
We are looking forward to the ongoing activity of the residency council-residency leadership committees – thanks to all who signed up. Please contact Jenny and Azalea if you wanted to sign up but didn’t for some reason! The current committees are INPATIENT, OUTPATIENT, EDUCATION, CAREER DEVELOPMENT and WELLNESS.
Have a great week!
Aimee
What Did I Read This Week?
Clinic Design and Continuity in Internal Medicine Resident Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative
Francis MD, Wieland ML et al., JGME March 2015
Continuity in resident clinics is the holy grail of the ambulatory experience, it’s a critical piece of resident and patient satisfaction as well as quality of care. This paper, which was highlighted at national SGIM’s Update in Medical Education in Florida last month, speaks to the
impact of ambulatory rotation design on continuity.
- Population: 12 IM programs participating in the Educational Innovations Project Ambulatory Collaborative (Banner Good Samaritan; Baystate; Hennepin; Henry Ford; Mayo Clinic; NYMC; Ohio State Wexner; Southern Illinois; Summa Health at Northeast Ohio; UCSF; U Cincinnati; U Wisconsin)
- Clinic Models:
- Traditional weekly
- Combination, some weekly plus blocks (closest to Duke?)
- Blocks with discrete inpatient and ambulatory
- Practice Metrics:
- Patient level continuity (“usual provider of care” UPC method, % time patient seen by their own doctor)
- Physician level continuity (% of visits where residents see their own patients)
- Results:
- Patient level continuity was highest in the block model (57%) and lowest in the traditional weekly (22%)
- Physician level continuity, conversely, was highest in the traditional weekly and combination (67%) and lowest in the block model (57%)
- Limitations:
- Not randomized, just observational. Obviously, a whole host of local factors will impact how these models play out in the real world. These sites were both university based and community based. The number of residents and the patient populations were also likely very different across sites.
- Discussion:
- This is interesting data, and follows the principles of supply and demand. When resident clinics are scheduled on a weekly basis only, then the limiting factor is resident availability and their schedules fill with their own patients, on average. Patients will see a doctor other than their own doctor 80% of the time, however. When resident availability increases in a block model, then their schedules also fill with other patients – but patients see their own doctor more often.
- Some blend of weekly clinics plus blocks during the year is probably ideal in our setting. The 4+2 model that we are introducing next year has the potential to balance out continuity from both the patient and physician perspective! Looking forward to seeing how it goes.
QI CORNER
Well, with the year winding down some more see-ya-laters are in order. Chief-dom is changing hands at the end of this week; you'll soon be joined by some real A-list chiefs, if ya know what I mean: Alyson, Adam, Aparna, & (Matt) Atkins. Armando might even note the pattern and stick around, but don't let him ;)
I've had a ton of fun taking you all through some great QI and patient safety experiences this year. From fabulous SAR safety reports (ask Alan Erdmann about how his case changed the hospital's supply chain!), to JAR QI CATs with Dr. Simel, to some really great & interactive M&Ms, to PSQC's impressive work to change nurses' paging culture, it has been such a fun year. We worked toward those GME incentives--enjoy your extra $400 this month! You all each QI'ed your own clinic practices vis-à-vis goals of care discussions. And we have ongoing high value care projects on the wards and in the clinics, bolstered by Lish's generous grant $$. It does take a team, and I want to once again thank Lish, Joel, Ryan, Jon and Dr. Simel for being mine.
You should be adequately psyched about Matt Atkins' entrance to this role. He is gearing up for another great year. Keep your eyes open and your can-do attitude engaged: QI opportunities are everywhere.
Over and out... See ya in the MICUs!
Clinic Corner
This feature will return next week
From the Chief Residents
Grand Rounds
Friday, June 24 - State of the Department, Dr. Mary Klotman
Noon Conference
| Date | Topic | Lecturer | Time | Vendor | |
| 6/20/16 |
Social Media |
Dr. Sue Woods |
12:00 | Dominos | |
| 6/21/16 |
MED-PEDS Combined: Congenital Heart Disease |
Dr. Krasuski/12:00 |
Cosmic |
||
| 6/22/16 |
Residency Council Townhall |
12:00 | Mediterra | ||
| 6/23/16 |
QI Patient Safety Noon Conference |
12:00 | Picnic Basket | ||
| 6/24/16 |
Chair's Conference |
12:00 | Nosh |
From the Residency Office
Lost Residency Jacket?
Have you lost you residency pull-over? If so, stop by Lynsey Michnowicz's office in MedRes - she has it!
Duke Hematology Newsletter
Clicker here.
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.
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/
Upcoming Dates and Events
June 24 - 30th - Intern Orientation Week
June 30th - Intern Shadow day
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
https://www.phs.wakehealth.edu/public/edu.cfm
www.bidmc.org/CentersandDepartments/Departments/BIDHC
http://www.careermd.com/employers/latestbulletins.aspx