From the Director
Hello everyone!
Happy Week 2 of Doctoberfest! What a beautiful weekend for Turkey Bowl practice! Our "Go Green" tree and our recycling corner in the med res office look great — stop in and let us know what you do to "Go Green". We will be having some drawings for prizes from the "Bleed Blue, Go Green" team at Duke. Other Doctoberfest prizes will go to those with best attendance at noon conferences and Grand Rounds. Don't forget "We Care Wednesday" this week –we will announce the winners of our charity vote. And, of course, more trivia!
Believe it or not, less than one month til recruitment officially begins! Please look for emails from Erin regarding signing up for dinners, for resident share, and for sending in pictures for our lunchtime slideshow. If you haven't updated your profile on the website, now is a great time to do so!
Congratulations this week to our recipients of the first annual Stead Research Grant Awards, sponsored by the Stead Scholarship Fund. Special thanks to Chris Woods, Ravi Karra and Karen Alexander for offering us this fantastic opportunity. Our recipients this year are Dinushika Mohottige, Kahli Zietlow, Ben Peterson, Lindsay Boole, Ryan Jessee, Jessie Seidelman, Julia Cupp, Aparna Swaminathan and Amanda Verma. Fantastic work, and thank you to your mentors Dani Zipkin, Ebony Boulware, Mitch Heflin, Al Sun, Nathan Thielman, Kim Huffman, Cary Ward, Jeffrey Crawford, Jon Bae and Mike Felker.
Other kudos this week to Brian Sullivan from Steve Telloni for an outstanding transfer summary, as well to Ryan Jessee and Paul St Romain for outstanding work at the DOC.
Also please welcome the newest member of the Duke Family….Ezra Oliver Peterson! The whole family is doing great.
What Did I Read This Week?
Submitted by: Murat Arcasoy, MD
Rethinking the Social History
Behrorouz et al. NEJM 371:1277, 2014 October 2
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This was a wonderful article in last week’s NEJM discussing how social factors may influence the effectiveness of health care delivery. In our busy daily practices, pressed for time, we frequently focus on racial/ethnic background, occupation, and the common “TED” questions ie the use of tobacco, ethanol, and drugs, as major social determinants of health. All too often, other important social factors that may influence health outcomes may not be discussed during patient encounters. In this article, the authors advocate for adopting “ the social medicine framework- that enables us to contextualize patient care to achieve more sustainable and equitable health outcomes.” The task of social medicine as described by the authors is “ to elucidate how patients’ environments influence their attitudes and behaviors and how patients’ agency- the ability to act in accordance with their free choice- is constrained by challenging social environments.” The authors recommend that we as providers obtain a more comprehensive social history to strengthen our therapeutic alliance with patients and in turn improve health outcomes. The list of topics is quite extensive, so I listed a few examples, grouped under 6 categories: 1-individual characteristics (self-defined race, language, literacy…) 2- life circumstances (family structure, housing environment, legal/immigration issues..), 3-emotional health (emotional state, stressors..) , 4-perception of health care (life goals and priorities, alternative care practices..), 5-health-related behaviors (diet and exercise, barriers to medication adherence…), 6-access to and utilization of health care (insurance status, medication access and affordability..) There are many challenges (other than being pressed for time) for the clinician to obtain a more comprehensive and proper social history. What is the appropriate timing, first visit, return appointment, annually…? Have we explored our own prejudices that influence our ability to obtain proper social history ? Do we possess (or have we been taught) the interviewing skills to deliberately extract this information from patients? This article encourages me to pay more in-depth attention to the social forces that influence my patients’ lives and their health outcomes and serve as better advocates for them. I hope I can take advantage of every opportunity to provide more personalized care through effective shared decision making, taking into account my patients’ complex social environments. Rudolph Virchow, while contributing greatly to our understanding of cells and pathology, was also concerned with improving public health. He wrote “ if medicine is to fulfill her great task, then she must enter the political and social life. Do we not always find the diseases of the populace traceable to defects in society? ” The authors end their article with a quote by William Osler: “The good physician treats the disease; the great physician treats the patient who has the disease”[divider]
Clinic Corner
QI Corner
[caption id="attachment_16361" align="aligncenter" width="141"]
Aaron Mitchell, MD[/caption]
First, I want to give a “final” call for anyone who is interested in leading a project for the Duke Choosing Wisely campaign. Several of the low-value items that your peer residents have named as important areas to target as improvement include excessive daily labs, overuse of telemetry, and non-indicated hyper-coagulability workups, to name a few. If you want to join in the effort to cut out the waste and improve patient care, please let me know ASAP.
Second, a reminder that the next PSQC meeting will be this week, Wednesday at 5:30pm in the med res library. We will probably spend a good amount of the time organizing for the Choosing Wisely campaign, so this would be another great way to get involved.
Finally, an update on the SRS reporting for the GME incentive program. Through September, we are up to 110 total SRS reports by trainees…but that leaves 1,862 more for the rest of the year to reach our goal (and get the $200). They don’t take much time at all to do, and you don’t have to wait until something bad actually happens to submit! You can use them for near-misses and unsafe situations as well.
| Jul-14 | Aug-14 | Sep-14 | |
| SRS by Trainee | 23 | 45 | 42 |
| SRS ALL | 1447 | 1459 | 1398 |
| % by Trainee | 2% | 3% | 3% |
| Total Submitted by Trainees (YTD) | 23 | 68 | 110 |
| Total Trainees | 986 | ||
| Average report per trainee | 0.023326572 | 0.068965517 | 0.111561866 |
| Goal (2/trainee) | 1972 | ||
| Total Remaining Needed | 1949 | 1904 | 1862 |
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From the Chief Residents
Grand Rounds
Fri., Oct. 10: Hematology, Dr. Thomas Ortel
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 10/6/14 | MKSAP Mondays: Hepatology | B.Oloruntoba | 12:15 | Cosmic Cantina |
| 10/7/14 | MED-PEDS Combined: Global Health GallopsDr. G's Briefing | Dr. Galanos | 12:1512:15 | Domino'sRm. 8277 |
| 10/8/14 | Approach to Abnormal LFTS | V. Patel | 12:15 | We Care Wednesday |
| 10/9/14 | Complications of Cirrhosis: Management & Pearls | B.Oloruntoba | 12:00 | China King |
| 10/10/14 | Chair's Conference | Chiefs | 12:00 | Mediterra |
From the Residency Office
Doctoberfest is Here!
DOCTOBERFEST IS HERE! “This is OUR Community” October 1-31, 2014
Join the Internal Medicine Residency Program in our 3rd annual Doctoberfest celebration! This year our continued focus will be on building and strengthening our community – both locally and on a global scale!
October 1, 2014 will mark the start of our Doctoberfest celebration with “We Care Wednesdays.” A special treat will be provided during Noon Conference to kick things off!
How Do YOU Go Green? – Ride a bike to work? Use a recyclable water bottle? We want to hear how YOU Go Green both at home and at work! Please feel free to come by the MedRes office and post your ideas on our Go Green wall, or submit them online using the link below. All submissions will be entered in our weekly drawings for gifts and prizes and all of the ideas will be compiled and shared at the end of the month. Bleed Blue/Live Green!!
https://duke.qualtrics.com/SE/?SID=SV_9TBHGku53op13uJ
October 20 Join us for a special lunch to honor our house staff. Eat, relax and re-connect with your friends and colleagues! More details to follow!
October 22 A special German beer garden-style treat!
October 31 As Doctoberfest 2014 draws to a close, enjoy some Halloween treats of donuts and cider as we welcome our first group of applicants on our 1st official recruiting day!
Flu Vaccination Update
If you have not yet gotten your shot, please see the information below for locations where you can have it done. If you have any questions, please call EOHW 684-3136A schedule of vaccination clinics is posted on the employee intranet at https://intranet.dm.duke.edu/influenza/Lists/Calendar/calendar.aspx. This list will be updated throughout the flu season. Vaccination is also available at Employee Occupational Health and Wellness (EOHW) during business hours.
If you have questions about the flu vaccine or its availability, please visit the DUHS Influenza Resource Guide or duke.edu/flu, ask your manager or contact EOHW.
Together, we can stop the flu. Thank you for your commitment to keeping our patients, and our community, safe and healthy.
Register Now for BLS Blitz - November 10-14, 2014
Use the Swank system to register for BLS classes. If you do not have an account in Swank contact the DHTS Service Desk 919-684-2243 to establish an account. You may register for one session. Detailed Registration Instructions and Informational Flyer When you attend class, arrive 15 minutes before session begins and you must have your:- Class Registration Confirmation
- Duke ID Badge
- AHA BLS Healthcare Provider Manual 2010
Women In Medicine Event
The Duke Medical Alumni Association invites you to join us for the inaugural Women in Medicine Luncheon and Program Friday, October 17, 2014 | 11:45am-1:45pm Great Hall, Trent Semans Center for Health Education The luncheon program features a panel discussion of Duke Medicine alumnae followed by roundtable conversations on issues specific to women in medicine.Medical Education Grand Rounds Session
Healthcare Simulation: Past, Present & Future with Dr. Jeffrey Taekman (Assistant Dean for Educational Technology; Director, Human Simulation and Patient Safety Center) Tuesday, October 7th 4pm – 5pm (DMP 2W96) Wednesday, October 8th 12noon – 1pm (DMP 2W96) Thursday, October 9th 7am – 8am (DMP 2W96) Session Objectives:- Discuss the essential features that define a MOOC (massive open online course).
- Discuss the opportunities for Duke Medicine faculty to participate in MOOCs as learner or instructor.
- Characterize the impact of the initial MOOCs for medical education.
ETHOS for Noon Conference Attendance Tracking!
You MUST have your Duke Unique ID entered in to you ETHOS account in order for the system to work properly! Please make sure that you enter your Duke Unique ID and NOT your Net ID! If your unique ID is entered incorrectly, you will not get credit for attending the conference!
Provider List for Housestaff
Just a reminder that a list of healthcare and dental services providers for house staff his provide here, as well as in the Resources area of MedHub. Many thanks to Dr. Sue Woods for her assistance in compiling this list!Information/Opportunities
CJW - Hospitalist (9-26-2014) http://www.endocrine.org/meetings/regional/endocrine-essentials-live/charlotte-october-25 http://www.merritthawkins.com/ www.mountainmedsearch.com www.nhpartners.comSeptember 14 Resp Fit Testing-T-Dap-TB Skin Testing Flyer2
2015 - 2017 Kraft Fellowship in Community Health (Deadline 10/15/14)
http://www.summitsps.com/Upcoming Dates and Events
October 27, 2014 - Recruitment Kick-Off Event
December 13, 2014 - DoM Holiday Party
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