Internal Medicine Residency News, June 25, 2018

Clinic Corner: Ambulatory

Contributed by Daniella Zipkin

Announcing: Ambulatory Threads Coming in July
(Repeating for the news for the interns, plus some additional details!)

The Duke internal medicine residency changed to a 4+2 format in 2016, a schedule where 4 week in-patient rotations alternate with two week rotations such as ambulatory, geriatrics, or consults. In the fall of 2017, we collectively engaged faculty across all divisions and residents in a review of the ambulatory education goals, objectives, and mission. Faculty requested continuity with learners, and residents requested a formal curriculum, bridging clinical experience with didactics. It became clear that revising the structure was imperative. The result of our effort to address these priorities is the Ambulatory Threads, which we will outline here.

The threads are designed to achieve the following goals:

1. Enhance longitudinal learning/engagement between a faculty and trainee, thereby improving the overall sense of investment in trainee education
2. Increase the breadth of exposure to subspecialty ambulatory training for residents
3. Provide early exposure to subspecialties that do not have inpatient services (lnfectious disease, Nephrology, Gastroenterology, Rheumatology, and Endocrine)
4. Improve the ability of both faculty and trainees to effectively and constructively evaluate the ambulatory learning experience

Threads Description:
Categorical interns and JARs will be scheduled into threads: In the threads, “Plus Two” blocks include clinics in specific sub-specialties, bundled together. During the Plus Two, you will also have continuity clinic and other important educational experiences.  

Threads run for six months, allowing each resident to experience two threads per year.

In the subspecialty clinics, residents will return to the same clinic approximately six times in a six-month period, to give better traction in the experience and better opportunities for teaching and engagement with faculty. Academic Half Day will be built to be thread specific, so the teaching will match the clinics experienced during the year.

Thread subspecialty bundles are:

• Intern Thread A: GI/ID/other VA clinics
• Intern Thread B: Renal/Rheumatology/Endocrine
• JAR Thread A: Hematology (benign and malignant)/Cardiology
• JAR Thread B: Oncology/Pulmonary

Curriculum Changes:
Teaching in Academic Half Day will match the clinical threads for the most part. Every division outlined the objectives for their area specifically as they pertain to the knowledge a general internist needs to be successful and adaptable in the outpatient setting. Each division has an education champion who will 1) facilitate faculty teaching in academic half day to meet the core teaching objectives and 2) populate curricular materials on the residency website. We encourage a “flipped classroom”, with didactic presentations and reading assigned through the website to residents, reserving academic half day time for cases and interactive techniques.

What about SARs?
SARs do not have a 4+2 schedule, per se, because of international rotations and other opportunities of varying lengths. SARs will still have ambulatory blocks frequently, and sometimes they will join a thread during a +2 block. Several other 2-week block options will remain intact and will be given primarily to SARs, including: Sports Medicine (GIM MSK), Women’s Health, Hospice and Palliative Care, Dermatology, and Gen Med blocks that are combined with other subspecialty providers.

Because Academic Half Day is now going to be thread specific, and SARs are not wedded to either thread, SARs will sometimes have a choice of which AHD session to attend, between the thread options. SARs on ambulatory will receive an email the week ahead requesting their selection, when this is the case. Attendance at AHD will be monitored.

Please also see the FAQ attached, and save a copy to your computer for future reference!

From the Chief Residents

Duke Gen Med Conference Schedule: June 25-28, 2018

From the Residency Office

Feeling down? Need to talk to someone? Opportunities for Wellness
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 25-29 - Intern Orientation

• June 29 - Big Sib Lunch

Opportunities

• ​https://www.phs.wakehealth.edu/public/edu.cfm
• http://www.careermd.com/employers/latestbulletins.aspx
• Fellowship Hall physician opportunity
• Duke Health Hospital Medicine Program
• Doctors Making House Calls
• FirstHealth Physician Group
• CompHealth
• ​Stanford University Clinical Excellence Research Center Design Fellowship

Useful links

• GME Mistreatment Reporting Site
• Duke Health Influenza Policy
• 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.)
• Updates from the Division of Hematology
• The Scope