From the Director
It’s December! SO hard to believe that we are nearly halfway through the year. Seriously. December is really busy, so we will be at the holiday schedule before you know it! Plus, the shaving will begin in earnest tomorrow morning, thankfully!
Turkey Bowl was an amazing success all around (I know, Marines, despite the score). Beautiful day, huge turnout, no major injuries, and Josh Lee has been renamed Odell. Many many thanks to those who covered for their colleagues who wanted to play (Nick Turner and Ashley Bock, as well as others who I don’t know about), and attendings (Adam Wachter, Rodger Liddle, and others), and to our fearless coaches Dr. G and Ryan ‘Mafia’ Schulties, and our referees Harvey Cohen, Don Heglund and Dave Butterly. Nice to see the mini-Manesh Patel in vintage TB gear, as well as the many friends and families (and future Duke residents) who came out to cheer on the Marines and the victorious Jets. The banner and confetti was a nice touch, I will admit!
This week, we have the fellowship match on Wednesday, as well as a visiting professor, Dr. Neil Stone, for grand rounds. Recruitment resumes on Friday, so please work with Madi to sign up for tours and ‘My Take’.
Our charitable project for December is a TOY DRIVE as well as collections to benefit our patients at the DOC and VA for the Christmas holiday. There will even be collection boxes for toys at the FAMOUS Department of Medicine Holiday Party, so bring them into the Med Res office or to the Wa Duke for the party. Let’s do our best to make the holiday season a little brighter for those who need it.
Our social action council is working very hard to get our Lincoln Clinic volunteer opportunity up and running for January! Please contact me, Lauren Collins, Dinushika Mohottige or Jake Feigal with questions.
This week’s pubmed from the program goes to our former resident and current endocrinology fellow Liz Campbell for her recent publication in the American Journal of Medical Quality with mentor Matt Crowley!
Diabetes Quality of Care Before and After Implementation of a Resident Clinic Practice Partnership System.
Campbell EA, Crowley MJ, Powers BJ, Sanders LL, Olsen MK, Danus S, McNeill DB, Zaas AK.
Am J Med Qual. 2015 Nov 24. pii: 1062860615615210
Have a great week!
Aimee
What did I read this week?
Submitted by Armando Bedoya, MD
Prostate Cancer Incidence and PSA Testing Patterns in Relation to USPSTF Screening Recommendations
JAMA 2015;314(19):2054-2061
Why did I read this?: Multiple and contradictory prostate screening guidelines exist. How they actually affect clinical practice is a controversial topic.
Background:
In 1992, the American Urological Association (AUA) and the American Cancer Society (ACS) recommended annual prostate screening for men 50 years and older. During this time, PSA screening was widely adopted and was associated with increases in prostate cancer incidence.
The US Preventive Services Task Force (USPSTF) recommended against PSA-based screening for men 75 years and older in 2008, and for all men in a publicly announced draft form in October 2011 and final form in May 2012, concluding that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.
In contrast to USPSTF, the AUA and ACS currently recommend that PSA testing be offered to asymptomatic men aged 55 to 69 years (AUA) or men older than 50 years with a minimum 10-year life expectancy (ACS) after patients receive information about the harms and benefits associated with screening.
Objective:
To examine recent changes in stage-specific prostate cancer incidence and PSA screening rates following the 2008 and 2012 USPSTF recommendations.
Methods:
Invasive prostate cancer incidence data from 2005 through 2012 were obtained from Surveillance, Epidemiology, and End Results program.
Incidence was adjusted for delays in reporting.
Used data from 2005, 2008, 2010, and 2013 National Health Interview Surveys, a nationally representative household cross-sectional sample survey of adults, to estimate the rate of self-reported PSA testing in the past year for screening and for any reason by age
Results:
Prostate cancer incidence per 100000 in men 50 years and older was 534.9 in 2005, 540.8 in 2008, 505.0 in 2010, and 416.2 in 2012; rates began decreasing in 2008 and the largest decrease occurred between 2011 and 2012.
The number of men 50 years and older diagnosed with prostate cancer nationwide declined by 33 519, from 213 562 men in 2011 to 180 043 men in 2012.
The percentage of men 50 years and older reporting PSA screening in the past 12 months was 36.9% in 2005, 40.6% in 2008, 37.8% in 2010, and 30.8% in 2013. In relative terms, screening rates increased by 10% between 2005 and 2008 and then decreased by 18% between 2010 and 2013.
Conclusions
Report reductions in early-stage prostate cancer incidence and PSA-based screening rates in men 50 years and older, coinciding with the 2012 USPSTF recommendation against PSA-based screening.
Declines in incidence and PSA testing preceding the 2012 USPSTF recommendation, although the decreases in PSA screening were not significant.
The potential emerging trends in prostate cancer incidence and PSA-based screening following the 2012 USPSTF recommendation against screening could have significant public health implications. Fewer men nationwide received a diagnosis of prostate cancer in 2012 than in 2011. Over-diagnosis and overtreatment may be reduced in view of the substantial proportion of prostate cancer cases detected through PSA testing that would not cause harm if left undetected. On the other hand, less screening or discontinuing screening may lead to missed opportunities for detecting important lesions at an early stage and preventing deaths from prostate cancer.
QI CORNER
This feature will return next week!
CLINIC CORNER
Clinic Corner
Ambulatory Updates
Ambulatory Care Leadership Track (ACLT):
ACLT applications are currently being accepted, through December 31 – please see recent newsletters for details or email Dani Zipkin! Expand your exposure to clinical medicine, curricula in teaching, support for scholarship, and health policy/advocacy! And, mark your calendars for an ACLT social event the evening of January 5th, to hang out and get to know more about the track with current ACLT residents! Thanks to Sharon Rubin for organizing!
New Clinic Cancellations Policy:
Armando has shared new information on a plan to get all three continuity sites in line with both VA and PDC policies which emphasize not cancelling clinics sooner than 45 days prior to the clinic. The focus is on delivering good patient care! Because we have “special needs” in the residency program and “stuff happens” sometimes, we will first check with the clinic around its capacity to absorb those patient slots on that day, and we will then go to a new team coverage model where you may sometimes be asked to fill in for someone else’s clinic slot. Thanks in advance for those rare times when this will be needed!
DOC Call Got You Down?
We hear your feedback that DOC call can be a burden sometimes, especially when you are called for non-urgent items in the middle of the night, as can sometimes happen. We are working on a plan to better prepare and educate patients about what constitutes an appropriate urgent call, and will share when we are ready to roll it out!
See you in clinic!!
Dani
From the Chief Residents
Grand Rounds
Friday, December 4 - Guest Speaker, Dr. Neil Stone
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 11/30/15 |
5 Things to Remember about Anti-Fungals and Fungal Infections |
Dr. Zaas |
12:00 | Domino's |
| 12/1/15 | MedPeds Recruitment-Lunch with Applicants | 12:00 | Saladelia | |
| 12/2/15 |
Fun Lunch - Fellowship Match Day! |
|
12:00 | Chick Fil A |
| 12/3/15 |
Common Curbsides in ID |
Chris Hostler |
1:45 | Firehouse |
| 12/4/15 |
Chair's Conference -11:30 Lunch with Applicants follows |
12:15 | Picnic Basket |
From the Residency Office
Annual Toys for Tots Holiday Toy Drive
As is becoming a holiday tradition, the Department of Medicine and Internal Medicine Residency Program will be sponsoring a Toys for Tots Campaign Drive.
All toys will be donated to the 2015 Marine Corps Reserve Toys for Tots Campaign! A donation to Toys for Tots would give toys to needy families in the local area just in time for Christmas. You can drop off your toy in the Medical Resident's Office between now and December 13th (all toys have to be collected and returned to the Marine Corps by December 14th). In addition, there will be donation boxes at the entrance to the DOM Holiday Party on December 12, 2015!
Details:
- Unwrapped
- New/Unused
- No guns
- Accepting toys for all ages including stuffed animals (really need toys for ages 6-8 and 9-13)
Did you know? One in five Durham residents live in poverty while 65 percent of children attending Durham Public Schools qualify for free or reduced-price lunches. That's more than 21,000 kids whose contemplation of the future is led by concern for food and shelter instead of the periodic table and book reports.
The U.S. Marine Corps Reserve Toys for Tots program collects messages of hope for these young people in the form of new, unwrapped toys for the holiday season. So please - if you can – donate today!
Thank you and Happy Holidays!
Hematology Division Newsletter
Please note that we will now include a copy of the Hematology Division Newsletter, published monthly, at the end of this post - check it out!
ACLT Applications Now Being Accepted!
Ambulatory Care Leadership Track (ACLT) Applications Due December 31, 2015:
Calling all interns who may be interested in either general internal medicine or a subspecialty where your focus will be ambulatory medicine, please consider applying to the ACLT. It’s a foundation for careers in general medicine leadership, primary care, academic ambulatory subspecialties, research, or education. Program highlights:
- Three blocks of ambulatory medicine throughout JAR and SAR years, with dedicated didactic time following four key themes:
- Clinical: Expanded clinical options in fields inside and outside of medicine: sports medicine, ENT, ophtho, dermatology, obesity medicine, as well as all medicine subspecialties. Maximum 4 weeks in any one medicine subspecialty (plus subspecialty continuity clinic), minimum 4 weeks general medicine ambulatory, over a total of 24 weeks.
- Teaching: Curricula in teaching and opportunities to teach in small group as a SAR
- Scholarship: Support for preparing and presenting scholarship, ambulatory journal club
- Advocacy and health policy: seminars given by faculty in government relations and health policy throughout the year, and an advocacy trip in the spring to both Washington DC and Raleigh, NC, alternating year.
Please fill out the application linked at the end of this post and submit to Armando Bedoya and Dani Zipkin before the end of the year!
Duke Narrative Writing Project
Dear Medical Trainees,
We invite you to participate in the inaugural Duke Narrative Medicine Project.
This initiative includes a special Medicine Grand Rounds by invited speaker Anna Reisman, MD from Yale School of Medicine (Director of Yale Internal Medicine Residency Writers' Workshop) as well as a one-day workshop focused on honing the craft of writing.
Duke medical students, residents, and fellows across all departments are invited to submit narrative or reflective writing samples in advance of a one-day workshop in which participants will engage in critical and constructive feedback of each other's writing.
The writing workshop will be moderated by Dr. Anna Reisman as well as Duke faculty members who will work with you to prepare your narrative writing pieces for publication.
Please see the attached flyer as well as the application link below for additional details.
Duke Narrative Medicine Project: Writing Workshop
Saturday, February 6th 2016
Duke Medicine Pavilion
Pre-workshop dinner February 5th, 2016
Application details:
https://duke.qualtrics.com/SE/?SID=SV_2fUx5jKrPKf9ZhH
Application deadline:
Rolling submissions until January 15th 2016
Please contact DukeNarrativeMedicine@duke.edu with any questions!
Sincerely,
Duke Narrative Medicine Project Team
Amy L Jones, Dinushika Mohottige, Lakshmi Krishnan, Anubha Agarwal
Attention Medicine Residents!
We're excited to announce our next Department of Medicine book club event will be held on Wednesday, Dec. 2nd from 5:30 - 7:30 pm in the Searle Center Faculty Lounge. This time we'll be reading Abraham Verghese's book, Cutting for Stone, an award-winning novel about the orphaned twin children of a surgeon and his assistant in a war-torn Ethiopia, and how love, medicine, and family impact their decisions and lives.
As always, we have a limited number of copies available to those who would like to attend the event. If you are interested in attending, please email Laura Caputo at laura.caputo@duke.edu to reserve your copy while supplies last. We're excited to see you there!
NC ACP Call for Poster Abstracts
The North Carolina Chapter is excited to announce the Call for Poster Abstracts for the 2016 Chapter Scientific Session, taking place February 26-27 at the Grandover Resort in Greensboro, NC. As always, registration fees for the Scientific Session are waived for all Residents, Fellows and Students.
The poster competition is open only to Resident/Fellow and Medical Student members of the ACP North Carolina Chapter. First authors must be Medical Students or Resident/Fellow-level members of ACP or have made official application for membership in order to enter this competition. There will be no exceptions to this requirement. If you have not joined ACP (medical students join for free; Residents/Fellows should contact their residency program directors), please visit ACP Online to find out more and apply.
Each abstract will undergo careful review and will be ranked for scientific merit, originality, proper presentation, and clinical application. To view ACP's guidelines and tips on preparing an abstract, click here.
We will accept as many posters for display and judging as time and space permit.
The deadline for submitting entries is Friday, December 11, 2015, at midnight.
Abstracts can only be submitted electronically online. To electronically submit an abstract, go to http://www.acponline.org/about_acp/chapters/nc/abstract15.htm.
Why Submit?
Educational opportunity to showcase your work.
Best Clinical or Basic Research, Clinical Vignette, Quality Improvement, High Value Care, and Student Poster will each receive a cash award of $300 and reimbursement of travel expenses to the 2016 ACP Internal Medicine Meeting to present their poster.
Best Overall Poster will receive an additional cash award and reimbursement of travel expenses to the 2016 ACP Internal Medicine Meeting to present the winning poster.
For questions concerning this poster competition or the Scientific Session, please contact Nancy Lowe, CMP, Associate Director of the North Carolina Chapter, at nlowe@ncmedsoc.org.
Thank you,
Peter Lichstein, MD, FACP
ACP Governor, North Carolina Chapter
General Medicine Health Services Research Fellowship at Duke (Attention SARS!)
Health services research (HSR) is multi-disciplinary and focuses on the impact of systems of care, access, cost, quality, behavior and other factors on health care outcomes. We have a very robust network of support and outstanding faculty in HSR at Duke. Here is an introduction to our fellowship, courtesy of David Edelman. The application cycle begins in January!
The Division of General Internal Medicine collaborates with the Center for Health Services Research in Primary Care in the Durham VA Medical Center to offer fellowships for MD and PhD scholars with an interest in training in clinical or health services research. The fellowship is ordinarily a two year program, though three year fellowships may be available to certain candidates. Training grants are funded by the VA Office of Academic Affairs (OAA). We have trained more than 100 fellows in our 30-year history, including many leaders in Health Services Research and many of our core faculty in General Internal Medicine.
The primary goal of the post-doctoral fellowships is for fellows to perform high-quality, mentored clinical or health services research working closely with a mentor from the Division of General Internal Medicine. MD fellows ordinarily obtain a Masters in Clinical Research from Duke’s CRTP program, with tuition paid by the fellowship. All fellows also participate in a Faculty/Fellow Development Seminar Series, a set of weekly, one-hour discussions addressing a variety of career development topics. Stipend is at the appropriate PGY level.
Senior Residents wishing to apply for July 2016 should contact Dr. David Edelman, Fellowship Director (David.Edelman@duke.edu) no later than Friday, January 9 to express interest. Written application will be due February 1 with interviews competed by the 3rd week in February and applicants notified of their status by March 1.
Click the link for more info:
http://www.durham.hsrd.research.va.gov/MD_fellowship.asp.
Or, contact David Edelman, MD, Fellowship Director (david.edelman@duke.edu).
Annual Call for New Ideas
The Journal of Graduate Medical Education is seeking brief articles on novel ideas in curricula, teaching, assessment, quality and safety, program evaluation, or other topics relevant to graduate medical education. Selected papers will be published in the July 2016 issue.
Criteria
New Ideas must describe an intervention that is novel.
The intervention must have been implemented at least once; longer implementation is preferable. While outcomes data may be preliminary; feasibility (effort, costs) and acceptability (to subjects) must be discussed.
Preliminary evidence should suggest the intervention is successful.
The intervention can be replicated in other specialties.
New Ideas manuscripts must
Follow required manuscript format
No more than 650 words
Organized into 3 parts:
Setting and Problem
Intervention (the “New Idea”)
Outcomes to Date
May include 1 figure or table
Descriptions should not include a literature review or references
Be submitted via the online editorial management system by 8:00 am CT, Monday, November 16, 2015.
Acceptance decisions will be communicated by January 31, 2016.
NOTES:
Due to the brevity of these submissions, manuscripts that are not accepted will not receive editor comments.
Manuscripts not following the required submission format and/or submission deadline will not be considered.
If you have additional questions, please contact the Journal office.
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
December 2 - Fellowship Match Day!
December 12 - DOM Holiday Party
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
www.bidmc.org/CentersandDepartments/Departments/BIDHC
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