From the Director
Hi everyone! It's that time of year when a lot of surveys will be coming your way. Just a quick reminder to please, if you have not already done so, take a few minutes to complete the resident evaluation of our program assigned to via MedHub. Your feedback and comments are incredibly important to us and a critical part of our ongoing attempts to improve the program and your residency experience!
If you have any questions, or are unable to locate the evaluation in you MedHub Urgent Tasks, please feel free to contact Jen Averitt. Thanks to everyone who has completed the evaluation thus far – SARs are leading the way with the most responses. You will also be getting a clinic evaluation, and the hospital is sending out the SAQ (Safety Attitudes Questionnaire). Just think how much people value your opinion!!
The first 2014-15 intern was spotted on the 8th floor! Hello to Jordan Pomeroy – we are looking forward to the arrival of the rest of your class. Kudos this week go to Veronica Jarido from Nick Rohrhoff for "taking one for the team" on VA Gen Med, to Adva Eisenberg from Stephen Bergin for a fantastic DRH morning report and to Matt Atkins and Myles Nickolich for leading the revisions of the intern survival guide. Special congratulations to Lindsay Boole — both on her recent wedding to Ob Gyn resident Oussama Saleh and on her selection for the prestigious GME Snyderman Award. The Snyderman Award is given to the best GME-related research project for the year and Lindsay won for her analysis of our QI afternoon reports. Also congratulations to Saumil Chudgar who won the medical school Golden Apple Award for clinical teaching. Well deserved! Also a thank you to Alyssa Stephany (hospital medicine) for her help in supervising resident procedures this week while she was on the procedure service. Much appreciated, Alyssa.
Did you know that residents can become members of Duke AHEAD (Academy for Health Professions Education and Academic Development )? Visit http://medschool.duke.edu/faculty/duke-ahead/membership to learn about the benefits of joining a community of educators at Duke.
This week's pubmed from the program goes to Aaron Mitchell, who will be presenting his work at the upcoming ASCO meeting! "Clinical trial subjects compared to 'real world' patients: Generalizability of renal cell carcinoma trials.", Aaron Mitchell, Michael Harrison, Daniel George, Amy Abernethy, Mark Walker, and Bradford Hirsch.--
Have a great week!
Aimee
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What Did I Read This Week?
Somers BD, Long SK, Baicker K. Changes in Mortality after Massachusetts Health Care Reform: A quasi-experimental study. Ann Intern Med 2014; 160(9):585-593.
Submitted by Joel Boggan, MD
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Why did I read this? Every week or two, some article seems to light up Twitter, and this was the one this week. Most major journals have pretty good Twitter feeds (which means you can use Twitter as a tool professionally, not just personally), and they tweet out blurbs about their articles when they are released online. This article was picked up and commented upon and retweeted more than anything else in my feed recently. So, I decided to take a look. . . What is the question? Massachusetts underwent its version of health reform in 2006, which then served as a model for the ACA. As a result, researchers are interested in any health outcomes that may provide insight into what to expect from our current national policy over the next few years. In Massachusetts, the health insurance pool has increased somewhere between 3-8% in the years since health care reform there. What did the authors do? The authors compared average mortality in 14 counties in Massachusetts before and after the reform to similar populations in different states without reforms. Specifically, they looked at 513 counties with similar populations to those in Massachusetts using national datasets available through the CDC. Additionally, they used propensity scoring to match the distribution of prereform characteristics in Massachusetts counties with the comparison group. What does this add? Well, propensity scoring attempts to account for the fact that in observational cohorts the baseline characteristics of one part of the cohort (here, the Massachusetts population) are probably different if they received an intervention (here, additional health insurance) than the baseline characteristics in those that did not receive the intervention, and, therefore, the outcome of the intervention is not solely due to the intervention alone. A propensity score then can be calculated and added into the model to represent the likelihood of receiving the intervention based on baseline characteristics before doing matching. After doing all this modeling, the authors then looked at mortality as their primary outcome and mortality amenable to health care as a secondary analysis. This secondary analysis included heart disease, stroke, cancer, infections and referenced conditions that I did not investigate. The authors adjusted their analysis for race, age, sex, state, year, and economic factors specific to that county for each year in their regression models. What did they find? The researchers found that all-cause and health care-amenable mortality were similar in the Massachusetts and other cohort from 2001-2005, but that Massachusetts significantly diverged thereafter. Specifically, after running their adjusted model, they found all-cause mortality dropped from 2007-2010 by 2.9% in the Massachusetts cohort relative to the control group, while health care-amenable mortality decreased 4.5% relative to the control group (both with p<0.005). This represents a drop in mortality of 8.2 per 100,000 adults in Massachusetts annually. They then traced back insurance patterns and found an absolute 6.8% reduction in the uninsured rate (representing an additional 270,000 people with insurance coverage) within their Massachusetts population during that timeframe, corresponding to a NNT (with insurance) of 830 previously uninsured persons annually to prevent one death. Subgroup analysis trended toward larger mortality reductions in populations less likely to have had insurance beforehand, including those with lower incomes and in nonwhite racial groups, although these additional reductions were non-statistically significant. What can we conclude? Increasing access to care with increasing levels of insurance, not surprisingly, likely improves health-related outcomes. The NNT quoted by the authors represents a 30% reduction in individual-level mortality for persons gaining insurance, which corresponded well with previous estimates by the IOM. Additionally, these gains may be conservative estimates for what could be gained from wider insurance coverage, since Massachusetts started at a relatively high level of insurance status prior to their reform relative to many parts of the country. So, regardless of your preference for how insurance access is expanded, doing so probably will benefit many people we see (and likely have even more benefit for those we don’t see yet). How can this apply to your practice? First, you can advocate for better insurance coverage for your patients, regardless of how you wish to see it accomplished. Additionally, you can use technology to stay more closely attuned to newly-released literature and updates (and thoughts / interpretations from several of your faculty, including @az8012, @JonBae01, @bcg4duke, @Duke_Medicine, @dukemedicine, @EvidenceBasedMD, and @DavidLSimel).QI Corner (Joel Boggan, MD)
PSQC Meeting NEXT WEEK Please come out for our next-to-last PSQC meeting of the year this coming Wednesday, 5/14, to help us plan some work for the early part of next year. We'll be in the Med Res Library at 5:30, please RSVP if you can so I can order some food . . . Safety Attitudes Questionnaire Survey Every couple of years, Duke participates in the Safety Attitudes Questionnaire, and resident input is EXTREMELY IMPORTANT. Our goal is to reach > 60%. SAQ Data GME Concentrations We are approaching time to apply for the next round of GME Concentrations. These include Resident as Teacher; Law, Ethics, and Health Policy; and, of course,Patient Safety and Quality Improvement. Please send me or Jon Bae an email, if interested. Hand Hygiene This is our last counting month for the Hand Hygiene Incentive Program, and we are SO close to meeting our goal. Keep up the great handwashing!The "Clinic Corner" - Pickett Road
(submitted by Sharon Rubin , MD )
Hello from Pickett Road! We have finished the Nurse AZppreciation week but it's always good to thank the nursing staff. We have two new staff members: Connie is new LPN working in triage and Nicole working at the front desk. I will put their pictures up in the resident work room.
We are getting ready to say goodbye to our senior residents this week. We appreciate all their hard work and dedication.
Sars: soon you will be having an admin session to run your panel. Think about your patients. If you think the patient needs more careful follow up, consider assigning them to a rising Jar.
EKGS: please make sure you are ordering them as ROUTINE and NOT FUTURE. we are having many EKGs coming back and not getting captured by our billing and nurses.
That is all for now!
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From the Chief Residents
Grand Rounds
Dr. I-Min Lee – PWIM Clipp-Speer Visiting ProfessorNoon Conference
| Date | Topic | Lecturer | Time | Vendor | Room |
| 5/12 | MKSAP Mondays - Heme Malignancies | K. Patel / Chiefs | 12:00 | Picnic Basket | Med Res Library |
| 5/13 | 12:00 | Saladelia Wraps | 2002 | ||
| 5/14 | OR Schwartz Rounds | 12:00 | Cosmic Cantina | 2002 | |
| 5/15 | "Personal Story of Illness: No data, just one story" | Galanos | 12:00 | Sushi | 2001 |
| 5/16 | Chair's Conference | Chiefs | 12:00 | Rudino's | Med Res Library |
From the Residency Office
Master Clinician/Teacher Award
Residents are not the only members of the residency program who deserve special recognition. In case you missed it, Dr. Zaas received the Master Clinician/Teacher Award last week by the School of Medicine. And knowing Dr. Zaas you can bet that she probably tried to keep it quiet. Please help us congratulate her for being this year's recipient.Resident Evaluation of Our Program
Just a quick reminder to please, if you have not already done so, take a few minutes to complete the resident evaluation of our program assigned to via MedHub. Your feedback and comments are incredibly important to us and a critical part of our ongoing attempts to improve the program and your residency experience! If you have any questions, or are unable to locate the evaluation in your MedHub Urgent Tasks, please feel free to contact Jen Averitt. Thanks to everyone who has completed the evaluation thus far!REMINDER: Safety Attitudes Questionnaire
What is it: Culture of Safety Survey, second full cycle for DUHS When is it: Survey runs May 5-May 30. Who does it: All ACGME program members will be included (if at least 8 members); other clinical departments throughout the health system also doing survey How is it done: Participants will get an email from support@pascalmetrics.com,with subject “DUHS Safety Culture Survey from Pascal Metrics”; in the body of the email, the target/referent for the survey is listed. For GME it is the GME Program (e.g. GME-Medicine-Internal Medicine). Last cycle, GME participation rate was 71%. We are looking for at least 80% response rate from each program! Your input is very important.Diversity Survey for Residents
Institutional Quality Improvement Initiatives to Address and Reduce Healthcare Disparities
By the year 2050, it is estimated that 54% of the US population will be underrepresented minorities, the group most subject to the consequences of disparities in health care. Although surveys indicate that internal medicine program directors agree that knowledge about health care disparities is important, they also identify two major barriers to teaching effectively in this area: shortages of qualified faculty to teach about cultural competency and health care disparities and a lack of standardized curricula. Training programs will need to continue to adapt to meet this growing need.
AAIM is asking for your help to asses where we are now - and your perception as to how diversity impacts delivery of care. Please click on the following link to complete this brief survey:
https://www.surveymonkey.com/s/residents-diversity-survey2014
GME Concentration Applications (submitted by Alisa Nagler)
"We are excited to begin accepting applications from residents and fellows for the 2014 cohort of Duke GME Concentration participants. Please consider sharing this information with trainees or nominating those who you believe would benefit from this opportunity. GME Concentrations were developed, with support from the GME Innovation Fund, in response to resident/fellow and program feedback to provide critical content to better prepare physicians for practice in the current & future health care system. Four Concentrations are being offered as an optional "minor" for residents and fellows (PGY level 2 and above) across specialties at Duke. Residents/fellows will participate in a number of educational opportunities related to their concentration and develop a personal project with a identified mentor. Participation will span over the course of their training and last a minimum of one year (some exceptions may apply) resulting in the awarding of a Certificate of Completion. GME Program Directors must approve resident/fellow participation in order to ensure this commitment will supplement training and benefit the program overall. Expert champions have been identified to serve as part of an Advisory Committee for each concentration identifying and developing educational objectives, opportunities/assignments, and assessment strategies. Committees will guide and assess the work of residents/fellows participating in each concentration and determine individuals' successful completion. Concentrations include:- Resident as Teacher
- Patient Safety & Quality Improvement
- Law, Ethics & Health Policy
- Leaders in Medicine
Respiratory Fit Testing Schedule for May 2014 (attached)
May 14 Resp Fit Testing-T-Dap-TB Skin Testing Flyer Note that we are againincluding evening shifts for the 7PM-7AM workers. Fit Testing will be available at Duke North Room 4000C. (4th Floor beside service elevator) or at Duke South EOHW. Walk-in’s allowed. Also available: Color Vision, (T-Dap) vaccine (Diphtheria, Tetanus, Pertussis) Required for all employees working with Children 18 months of age or younger. TB Skin Testing if Required Fit Testing Schedule also available on the HR website--- http://www.hr.duke.edu/about/departments/eohw/Information/Opportunities
Hospitalist Practice Opportunity 5-2014 Postcard South Carolina IMUpcoming Dates and Events
- May 19: Hospital Medicine Social/ Interest Meeting
- May 23: Deadline to complete "Trainee Evaluation of Program" survey
- May 24: Housestaff Party - Elodie Farms
- May 30: Program pictures, Trent Semans West Steps, 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
- https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
- http://duke.exitcareoncall.com/.
- Main Internal Medicine Residency website
- Main Curriculum website
- Ambulatory curriculum wiki
- Department of Medicine
- Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response