Internal Medicine Residency News: March 10, 2014

By admin3

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Hi everyone! Happy daylight savings time! #bestnighttobeonnightfloat! Thanks to the chiefs for a hilarious face melding Trivia Bowl and for organizing intern day off! Gena Foster's disbelief at the final jeopardy question was priceless. Glad to hear fun was had by all! Week 1 of Mini CEX Madness and we are off to a great start – 10 completed!  Of those, Kristen Glisinski is our first winner!  Myles Nickolich and Ben Peterson share the award for “1st Trainee to have all 6 CEXs done.”  Just a reminder, at the end of the month, everyone who has had a Mini CEX completed on them and submitted in MedHub will be eligible for the Grand Prize – a $50 dinner at the restaurant of your choice (alcohol not included).  Many thanks to our amazing faculty for completing and submitting the evaluations as well. Other kudos this week go to Yi Qin from Dr. Joe Rogers for a great diagnostic effort on CAD, to Jenn Rymer for a fantastic SAR talk, and to Bassem Matta and Dana Clifton from Dr Oddone for great work at the VA! On Wednesday, we have our mock ACGME CLER visit, run by our DIO Dr. Cathy Kuhn.  The real CLER visit is when the ACGME comes to see how our institution is meeting the goals of graduate medical education, and this Wednesday is our practice run.  The visit will focus on patient safety (specifically how do you contribute to patient safety efforts at the hospital), supervision, fatigue management, and professionalism. What is your role? If a CLER team comes to talk to you while you are working, talk to them! Answer their questions. Be informed! Know what resources are available to you, such as the taxi service or PAS.  When the real visit happens (we get 2 weeks notice), there will be a peer selection process for choosing residents to meet with the ACGME visitors. This week's pubmed from the program goes to Dinushika Mohogitte:  Mohottige, D., Austin, C., and Hanson, L. C. (, May). Systematic Review of Decision Aids for the Seriously Ill. American Geriatric Society Annual Meeting, Orlando Florida. Have a great week !! And, Go Duke! Aimee

The "Clinic Corner"

We have two submissions this week, including a brief update from the Duke Outpatient Clinic (DOC) DOCMarchNews , submitted by Bronwen Garner, MD, and a 2nd submission from Alex Cho, MD, Associate Program Director for Ambulatory Care   Cho Hi all! For this week's Clinic Corner, on Amb Care in general, wanted to reflect briefly on some of the changes in the ambulatory curriculum -- and thank Stephen Bergin and Dani Zipkin for their leadership in kickstarting a makeover, beginning last year with Academic Half-Day (AHD), that will continue into next year and beyond. The old (and wise) SARs may have dim memories of something called Pre-Clinic Conference, a case-based reading exercise that used the Yale Ambulatory Curriculum.  In the words of this year's Oscar-winning best original song, we let it go, to allow those who could to attend noon conference at DUH/DRH; and at the DOC, to enable resident participation in clinic meetings held over the noon hour, like Leadership every other Monday, and What's Up DOC. The focus of the general ambulatory curriculum  has instead shifted to the reinvigorated AHD led by Dani, and this  year, DRH/Ambulatory morning report -- co-hosted by Stephen and the DRH ACR -- which every week now highlights a different ambulatory topic.  Next year, our ambition will be to augment these with some curated readings and other resources on important ambulatory topics like women's health, which we (with Randy and Jen's  help) plan to make available in a central, universally accessible location like MedHub. And all this is in addition to the movement to milestone-based observations and evaluations in the clinic (tied to graduated increases in autonomy); the annual Ambulatory QI project, led by the indomitable Jon Bae; and the ACLT. Finally, for those who don't like waiting, wanted to share a few resources you can access now, for ambulatory care (and medicine in general):
  • The Stanford Medicine 25 website
-Murat brought this somewhat intimidating but awesome resource to my attention, which includes full-but-quick lessons on key portions of the physical exam, including video! http://stanfordmedicine25.stanford.edu/the25/
  • UW Primary Care Immersion Block Readings & Presentations
-Aimee found this gem, a digital reader covering 24 different commonly encountered situations in primary care https://depts.washington.edu/uwmedres/patientcare/Intern/intern-immersion.html
  • Yale Ambulatory Curriculum
-Last but not least, the Yale curriculum is yours to access freely -- brief case-based vignettes on different ambulatory topics that include a review of relevant literature -- and now we no longer have to withhold "the answers" from you! Login: duke11 Password for faculty section: bulldog7-5F Password for resident section: robin7-5R Have a great week!   Alex   [box]

What Did I Read This Week?

Submitted by Lynn Bowlby, MD

Urinary Tract Infections in Older Wome, A Clinical Review

 JAMA  Feb 26, 2014  Vol 311 No 8  pp 844-856

[/box] We often read and think about unusual diseases and cases. Equally important to get right is what we see every day. Often we become comfortable with those common conditions and don't question our approach. But everything changes in medicine, and reviewing new information in common diseases that we think we know well is important! This JAMA review is based on a Medline search for articles about UTI and older adults, 1946-2013. The clinical spectrum of UTI ranges from:
  • Asymptomatic bacteruria--transient, no morbidity or mortality issues
  • Symptomatic UTI--lab evidence : UC with <or equal to 2 pathogens and pyuria and
  • 2 of these clinical features:  fever, urinary urgency or frequency, acute dysuria, suprapubic or CV tenderness
Risk factors for recurrent symptomatic UTI:  DM, disabled, recent sexual intercourse, urogyn surgery in past, urinary retention and incontinence. Chronic urinary incontinence can make it very difficult to differentiate asymptomatic bacteruria from symptomatic UTI. Symptoms of urgency and incontinence can fluctuate in older women, even without infection. One of the mainstays of evaluation,and so simple to use, the urine dipstick! There are important test characteristics to keep in mind--the sensitivity and specificity for a positive test is 82%, negative predictive value is 92-100%, so do it to R/O UTI, not necessarily to diagnose! New dysuria is a sensitive indicator of symptomatic UTI in older women. When to test urine in the lab? A clean catch, mid-stream, with properly cleaned labia, is the most effective, but rarely done properly. The predominant pathogens remain E-coli at 50%,  with other pathogens, Klebsiella, Proteus, and Enterococcus each < 10%. Flouroquinolone resistance is greatest in pts aged 65 and older. 3 days of trimethoprim-sulfa is recommended as standard UTI therapy for otherwise healthy women.  Nitrofurantoin is one of the first line agents for UTI, if CrCl > 60.  Current evidence shows cranberry products may be helpful in prevention in older women, not so for oral estrogen. Topical estrogen may be beneficial. Chronic, suppressive antibiotics for 6-12 months can help with recurrent infections. As simple as UTI can be, in older women especially, it can be complex to determine if a patient actually has an infection, and what the best testing and treatment can be. Challenging to make the best decisions for our patients.

From the Chief Residents

SAR Talks

March 11:  Marcus Ruopp / Jeremyh Gillespie

Grand Rounds

Dr. Timothy Collins – Neurology Topic: Migraine Evaluation

Noon Conference

Date Topic Lecturer Time Vendor Room
3/10 MKSAP Mondays -   Bedoya's Infections Bergin/Chiefs 12:00 Picnic Basket 2002
3/11 SAR   TALKS Marcus   Ruopp / Jeremy Gillespie 12:00 Pita   Pit 2002
3/12 "What   about my future?  Do I know what money   is?" - OR - Schwartz Rounds Galanos   / Heffelfinger 12:00 China   King MedRes   OR 2002
3/13 PWIM   Conference: Difficult Conversations Ann   Brown 12:00 Domino's 2001
3/14 Chair's   Conference Chiefs 12:00 Chick-Fil-A Med   Res Library
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From the Residency Office

Noon Conference:  What About My Future

Noon conference on the 12th will offer you the opportunity to explore some of the things you might need to consider when you finish residency, including such topics as:
  • Do I need tail insurance
  • What is protected time and how to I pay for it
  • Am I a cFTE and what does this mean
We don't assume that we know ALL of the questions you might want to ask, so to help make sure yours in on the list,  here is a chance to submit your question ahead of time using the following link: https://www.surveymonkey.com/s/What_About_My_Future

Snyderman Research in Medical Education Award - Submissions due April 4, 2014

The Ralph Snyderman MD GME Research Award was established in 2004 with a goal of encouraging and recognizing excellence in research involving GME. Winners are acknowledged with a prize of $1000 and their name on a plaque and will present at the May or June ICGME Meeting. The project must have substantial contributions from at least one GME Trainee (intern, resident or fellow) Examples of eligible projects include: evaluation of the impact of a new curriculum on resident knowledge and skills, using technology to increase quality of trainee "hand offs" at the end of call, using standardized patients to measure trainee's skills at "communicating bad news", using the patient simulator to teach and assess anesthesia. Past winners and their topics can be found at https://gme.duke.edu/trainees/snyderman-research-medical-education-award/snyderman-award-winners Full Submission information at: https://gme.duke.edu/trainees/snyderman-research-medical-education-award/snyderman-award-submission-information  

Interested in Hematology Onclology Fellowship?

Carlos DeCastro, MD, Fellowship Program Director, has arranged two times this month to meet with residents who would like to know more about Duke's fellowship program.  Both session, scheduled for March 11th and March 25th, are scheduled to be held in the Med Res Library at 4:00.  For more information feel free to contact Sarah Overaker, Program Coordinator.

On-Call Meal Benefit Times

Reminder that the on-call meal benefit is available to Housestaff from 7pm – 5am daily for residents who are working in house overnight. The purpose of providing a meal benefit to trainees has always been, and continues to be, to provide a meal to those trainees who are working in the hospital at night for the entire night. (e.g., at least 8 hours of continuous in-house work past 7 pm). The meal benefit is not intended for use on the way home, or at other times of day.  If you have questions, concerns, or suggestions, please contact your ICGME representatives or Dr. Christopher Hostler, head of the Resident Environment section.  

Information/Opportunities

 

Upcoming Dates and Events

  • BLS Blitz 3-2014:  March 17 - 20
  • March 21:  Match Day CELEBRATION !!
  • March 22:   Gastrointestinal Cancers Program 1st Annual 5K Run/Walk   DukeCRC5K.org
  • April 11:  Final Faculty Resident Research Grant applications
  • March 31:  GI Interest Meeting (contact Jill Rimmer, GI PC)
  • April 18:  Charity Auction
  • April 18:  SAR Class Picture (rescheduled)
  • May 3:  the Stead Tread 5K
  • June 3:  Annual Resident Reseach Conference
  • May 31:  SAR Dinner, Hope Valley CC

Useful links

 

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