From: Bill Hargett, MD
Associate Program Director
In the midst of rounding on Duke GenMed this week (go team 1A/1B!), I’m pinch-hitting Updates for Dr. Zaas. Aimee and the Zaas family say “Hi” from Caesaria and the Rosh Hanikra caves—you can see that she’s enjoying a well-deserved vacation!
The ACC built on their dismal first week in the NCAA tournament with Virginia falling to Michigan State in the Sweet 16. If your bracket is busted and you've shed
#DukeTears, then maybe bidding on a pair of autographed, game-worn
Bat Shoes at the upcoming charity auction will remind you of the glory years.... Also, the kids tell me that wearing tight kicks like these help when you’re versing the attendings at the upcoming annual Housestaff vs. Faculty Basketball game (though I suppose not many of us wear a size 14 shoe…).
Gotta give props to Trevor Posenau, Lindsay Anderson, Mike Shafique, and Kaley Tash for fantastic SAR talks (thanks, Vaishali). KotW (Kudos of the Week) @DinushikaMohottige, who wins the Feedback Triple Crown, receiving praise from a patient, a peer, and a supervising physician. Notes from Laura Musselwhite and Josh Thaden and a letter from a patient frame a wonderful narrative describing Dinushika’s hard-work, compassion, and excellent clinical care. There are other stories heard too – thanks to all of you for the extraordinary things, big and small, that you do each day here at Duke.
The proverbial cup continues to runneth over with resident accolades and accomplishments and there were several excellent choices for PubMed of the week. Take some time to check out an article by one of your colleagues:
Mitchell AP, Hirsch BR, Abernethy AP.
Lack of timely accrual information in oncology clinical trials: a cross-sectional analysis. Trials. 2014 Mar 25;15(1):92. [Epub ahead of print] PubMed PMID:
24661848.
The "Clinic Corner"
(submitted by Alex Cho, MD)
When was the last time you saw someone in clinic (or ACC at the VA) who presented for STI screening/diagnoses/treatment?
April happens to be National Sexually Transmitted Infection Awareness Month, and to commemorate this, I wanted to follow on Sharon Rubin’s mention of HIV screening in last week’s excellent WDIRTW (re: hepatitis C prevalence and the USPSTF recommendation to screen all adults born between 1945 and 1965 at least once), by sharing a framework for using these problem-focused STI-related visits as “teachable moments” to inquire about and counsel patients about potentially high-risk sexual behaviors.
This framework comes from the RESPECT Program, an RCT-validated approach to HIV prevention. And even though this and other available evidence of the benefit of counseling has been for relatively high-intensity interventions; the same principles can be translated into your own practice.
1. Introduce and orient the patient
“I’m glad you are here.” “What would you like to know before you leave here today?” “What are your specific concerns?” “In addition to addressing today’s issue, would it be ok to use this opportunity to explore together what you might be able to do to stay safe/prevent another occurrence?”
2. Identify client’s personal risk behaviors and circumstances
(Risk Behaviors: Sex or drug use actions that in and of themselves can result in transmission of HIV/STI.) “How did you decide to get tested/treated today?” “Tell me about the event(s) that brought you to the clinic today?” “How many different people do you have sex with and how often?” “How often do you use drugs or alcohol, and how does this affect who you might have sex with, and whether you use protection?”
3. Identify potential safer goal behaviors
(Safer Goal Behaviors: These are specific actions that directly prevent or greatly reduce HIV/STI transmission and that the client is willing to try to adopt.) “Is there a specific time that you remember where you were able to practice safer sex (used needles safely, used a condom)? What did you do? What made it possible for you to do it?” “What are you presently doing to protect yourself?” “What would you like to do to reduce your risk of HIV/STI?”
4. Develop patient action steps
(Action Steps: Specific incremental steps a client can/is willing to take (and reasonably confident in their ability to carry out) to help him or her adopt a safer goal behavior.) “What do you think you
can do in the next few days/weeks to reduce your risk of HIV/STI?”
5. Make any referrals necessary and provide support
6. Summarize and close visit, telling patient how you will follow up (re: test results, et al.)
Although it is obviously difficult to add yet another item to a long list of recommended prevention-related tasks, for these focused visits having a go-to “script” or routine can make it a more natural conversation, and the visit more efficient and potentially more impactful overall.
And you can always ask patients to come back to address their other sets of issues (chronic disease management, health maintenance) – particularly if you sense a real opportunity to nudge a patient towards less risky behaviors. Just take a minute to make sure they come back to you by putting down a range of dates in your follow-up instructions, as well as confirming with patients and writing out in your plans the issues you will tackle next time. (Shorter follow-up times for more frequent “prepared” visits will also increase the likelihood you will see your own patients in general, because your clinic schedules are available to the clinics about 3 months in advance.)
References
Lin J, Whitlock E, O'Connor E, and Bauer V. Behavioral counseling to prevent sexually transmitted infection. Ann Intern Med 2008;149:497-508.
Navy and Marine Corps Public Health Center. Fundamentals of HIV-STI Prevention Counseling Student Manual. October 2012. Available at:
http://www.med.navy.mil/sites/medicine.duke.edumedicine.duke.edunmcphc/Documents/health-promotion-wellness/reproductive-and-sexual-health/student-manual-hiv-sti-prevention-counseling.pdf.
QI Corner (submitted by Joel Boggan, MD)
Three dates to keep on your calendar:
- 4/10, 6-7:30 pm in the Med Center Board Room in Duke South - Dr. Dev Sangvai speaking on 'Accountable Care Organizations'
- 4/12, 5:30-6:30 pm in the Med Res Library - next Medicine PSQC meeting, food provided.
- 4/24, 12-1 pm, our next Resident M&M conference.
From the Chief Residents
SAR Talks
April 1: Armando Bedoya; Jennifer Chung
Grand Rounds
Dr. Elva Arrendondo (visiting professor) .
Noon Conference
| Date |
Topic |
Lecturer |
Vendor |
Room |
| 3/31 |
MKSAP Mondays - GI |
V. Patel/Chiefs |
Chick-Fil-A |
Med Res Library / 8262 |
| 4/1 |
SAR TALKS |
Armando Bedoya Jennifer Chung |
Bullock's BBQ |
2002 |
| 4/2 |
IM-ED Combined Conference |
Trowbridge/EM |
Cosmic Cantina |
2002 |
| 4/3 |
Essentials of Acute Pancreatitis |
Vaishali Patel |
Saladelia Wraps |
2001 |
| 4/4 |
Chair's Conference |
Chiefs |
Rudino's |
2002 |
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From the Residency Office
Charity Auction!!!
The auction is just two weeks away (April 18th). Lauren Dincher will be selling tickets at Grand Rounds and also during regular office hours in suite 8254.
What's new this year? We now have our own credit card machine,
which means you can buy your tickets with Visa or Master Card (sorry, we do not accept payment by bitcoin yet - but who knows. maybe in 2015!)
And, as special attraction for the basketball fans out there, take note that we will be putting up for bid a pair of signed basketball shoes worn by Shane Battier!!
Mini CEX Madness - Week 4
Thank you to everyone for another great March “Mini CEX” Madness! We had
33 completed, and
Jenn Chung was selected is the winner for the 4th and final week of CEX Madness.
As to the grand prize winner (the $50 dinner), that now belongs to
Gena Foster! Congratulations!!
Additions to the Event Calendar
Take note of the following additions to the event calendar that we post each week:
- Clinical Pathology Conference: April 22
- Faculty Resident Basket Ball Challenge: Friday, May 2 - in Cameron Indoor Stadium
- Ronald McDonald House: June 6 (providing dinner to patient's families, coordinated by Steve Crowley)
Housing Information (submitted by Jen Averitt)
As a reminder for both incoming and outgoing trainees, the Duke GME website includes a link for current housing both for rent and to own:
https://gme.duke.edu/prospective-trainees/housing
If you are interested in posting a listing, please follow the instructions on the site and if you are interested in new housing, please check the site regularly for updates. In addition, the MedRes office will create a Resource/Document folder in MedHub for housing options, where we can also post available properties for all trainees to access. If you have a property you would like to post, please email
jen.averitt@duke.edu for more information.
ACLS/BCLS Reminders (submitted by Lauren Dincher)
I just wanted to send a reminder out to everyone reiterating our policy for taking ACLS/BLS training. Before scheduling the class, please get approval from the Chiefs. Once approved, send me your date and time so that I can update your schedule. I need to do this for scheduling and location reporting purposes.
If you have recently taken one or both of the classes and it is not on your Amion/Medhub schedule, please send me the day and time frame that you took the class so that I can update your schedule. Thanks so much!
Stead Tread - Sign up!
The Kempner Stead Society invites you to participate in the the 3rd annual Stead Tread 5k Run/Walk on May 3rd at 10AM, with all donations benefitting the Lincoln Clinic. This 5k Run/Walk was first organized two years ago and has been a great success, raising over $10,000 for Lincoln. We've had over 100 residents, faculty, staff and patients run with us each year, and we are looking to make this year's race an even bigger success!
Go to
www.steadtread.org to register or donate!
NC Medicaid Expansion
On April 8th, students from the Sanford School of Public Policy will present a proposal for expanding Medicaid in North Carolina. This proposal was developed through a Medicaid Practicum course facilitated by Professor Don Taylor. The purpose of the course was to craft recommendations for the NCGA-appointed Medicaid Reform Advisory Group to consider as they looked at different ways to reform Medicaid in North Carolina. This is a unique opportunity to better understand Medicaid policy in North Carolina, and how it may affect our patients.
When: April 8, 5:30PM - 6:30PM
Where: Rhodes Conference Room, Sanford School of Public Policy
Information/Opportunities
Upcoming Dates and Events
- April 11: Final Faculty Resident Research Grant applications
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- March 31: GI Interest Meeting (contact Jill Rimmer, GI PC)
- April 17: Financial Planning Seminar
- April 18: Charity Auction
- April 18: SAR Class Picture (rescheduled)
- April 22: CPC Event, 7 PM @ The Pit
- May 2: Faculty/Resident BB Game on Coach K Court
- May 3: the Stead Tread 5K www.steadtread.org
- May 30: Program pictures @ Duke Chapel 9:15
- May 31: SAR Dinner, Hope Valley CC
- June 3: Annual Resident Research Conference
- June 6: Serve dinner at the Ronald McDonald House
Useful links
