From the Director
Hi everyone! Pumpkin spice lattes are back (and it's apparently the 10th anniversary for them). Don't mind my shameless advertising…with PSL's (not to be confused with one of our favorite attendings PSK), there are a lot of things "fall" happening! See below for information about the flu blitz as well as fleece orders. Haiku's (in honor of Chris Hostler) have been flying around regarding both of these events…SAR Phil Lehman offers the following…"On Tuesday I cried; for the obvious reason; Bye stripes, its been fun". Of course, we can remember "Fear not, preppy ones; Seersucker makes a comeback; Memorial Day", and the all important "Alas, it is fall; no more white striped pants for me — MUST ORDER DUKE FLEECE!"
You will hear about flu shots until you feel flu-like from hearing about them. Many of you are aware that the medicine residency program has led the way in getting 100% of the house staff vaccinated for the past 2 years (when it wasn't a mandatory condition of employment). Last year, we were able to reach our 100% vaccination status by OCTOBER 23rd! This year, we are setting the ambitious goal of vaccination by OCTOBER 1st! As a Stead competition, the Kerby Society (led by Heather Whitson) has won both years by being the society to have all members vaccinated first. Competition is on, and Matt Crowley and the Kempner Society are starting to talk some trash. "Flu season awaits; vaccines remain free this year; Steads, immunize fast!"
Kudos this week go to our 5 gold star winners — Nancy Lentz, Matthew Summers, Trevor Poseneau, Armando Bedoya and Lindsay Boole! Gold stars were awarded by patients who appreciate your care. Congratulations to you all! Also congratulations to Med Peds 2013 graduate Steve Dolgner and Med Peds SAR Anna Teeter Dolgner on the birth of Andrew. We are excited to welcome another baby into the Duke family.
Pubmed from the program this week goes to JAR Mike Woodworth for his article in Academic Medicine! "The Design of a Medical School Social Justice Curriculum" Alexandra Coria, T. Greg McKelvey, Paul Charlton, Michael Woodworth, MD, and Timothy Lahey, MD, MMSc Academic Medicine 2013; 88.
Have a great week!
Aimee
QI Corner (submitted by Joel Boggan, MD)
Final Policy Flyer 2013 Med Res
https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
Patient Safety and Quality Council Meeting We will be having our next monthly meeting this coming Wednesday, 9/11, at 5:30 in the Med Res Library. Come and check out the latest Sharknado sequel follow-up and create your own animal-natural disaster hybrid. Also, we'll discuss high value, cost-conscious care projects and how to get information to residents. Hand Hygiene and the Incentive Program You'll be seeing information out in front of you soon from our Hand Hygiene Champions, Emily Ray, Jessica Seidelman, Stephanie Giattino, and Jonathan Hansen. Here's just a taste - the August monthly aggregate data - we were close (total observations = 120), but not there yet! Actual Hand Washing Rate = 86% Goal = 91% Follow Us on Twitter - @DukeMarines - Duke Chief Resident Updates - @JonBae01 - QI and Patient Safety (general news and program updates) - @DukeDOMQuality - Duke DOM Quality Updates - @bcg4duke - Maestrocare and health informatics [box]What Did I Read This Week
Submitted by Murat Arcaosy, MD
“Physical Examination Education in Graduate Medical Education- a systematic review of the literature” by Mookherjee et al. Journal of General Internal Medicine 28: 1090-1099, 2013
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What did the authors do?
The authors from three academic centers reviewed the literature (1951-2012) to determine effectiveness of published methods to teach PE in GME, focusing on the use of deliberate practice. In this method, the trainee repetitively practices skills and undergoes assessment with feedback, resulting in observed improvement of the skills. The eligibility criteria for studies included description of GME study population, description of an intervention, assessment of efficacy, inclusion of a control group and report of data analysis. Out of 15,759 articles, it was striking that only 14 studies met inclusion criteria (only 8 included Internal Medicine residents).
Why did the authors perform this review?
Training in PE skills is a core element of undergraduate medical education, but in GME, the teaching of PE is inconsistent. PE skill deficiency in GME does not only involve issues with performance of maneuvers or identification of abnormalities. Residents sometimes struggle to understand the significance of PE findings, tend to have low confidence in their PE skills, and may spend a short time actually performing a PE. Going through a residency training program in itself is not expected to resolve these deficiencies, therefore, PE education must be improved. The question is which PE teaching methods are optimal in the GME setting (this review did not answer this question).
What did the authors find?
Twelve studies assessed knowledge and skill. Two studies assessed changes in behavior. Seven studies examined resident and human examinee interaction and four of these were actual patients in a clinical context (genital exam in continuity clinic, bedside rounds with medicine residents (yaay!), breast exam in breast care clinic, pelvic exams in pediatric clinic). Two studies used teaching associates (as examinees) who were also responsible for teaching the residents. Seven studies targeted cardiac exam and the educational material did not involve patient interaction. Of the seven studies where residents interacted with human examinees as part of curriculum only one did not show improved educational outcomes. The great majority of studies with definite use of deliberate practice showed beneficial outcomes.
What did the authors conclude (or not)?
The authors could not conclude that one teaching method is superior to others. They suggested “attention to deliberate practice when designing PE curricula and that interaction with human examinees may be useful to residents” (Hmmm).
What is my take?
I read this article as part of an effort to educate myself on the published experience on the teaching of PE skills and to learn about novel methods of PE skills education, an area of medical education I have felt so passionate about throughout my career. I remember how I learned (and continue to learn) PE skills during med school and beyond, the faculty and patients who so graciously taught me, so that I could formulate a reasonable clinical diagnosis, order laboratory investigations rationally, and perhaps most importantly, to make that essential human connection to the patient, thus laying the foundation of a doctor-patient relationship based on mutual respect and trust.
What do you think ?
May I suggest please that you take a moment to reflect upon how it is that you were taught PE skills and how you continued to learn/improve? If you are a current Intern, how do you teach your med student at the bedside? how do you teach PE skills to multiple junior trainees as a team leader JAR at the VA or a SAR at Duke? how do you make time during the day to keep going back to your patients, resisting the multiplicity of forces that pull us away from the bedside? how do you prepare for bedside rounds as team-leader and encourage deliberate practice of PE skills?
..” the best way to learn is to teach, the best way to teach is to keep learning, and that what counts in the end is having had a shared, reflected experience.” …(attributed to Frank Oppenheimer (1912-1985), Science magazine, 1998)
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From the Chief Residents
Grand Rounds
Date: September 13, 2013 Presenter: Dr. Rob Keenan, Division of RheumatologyNoon Conference
| Date | Topic | Lecturer | Time | Vendor | Room |
| 9/9 | PWIM noon conference | Chad Kessler | 12:00 | The Picnic Basket | 2002 |
| 9/10 | Evidence Based Hypertension Mgmt | Daniella Zipkin | 12:00 | Moe's Burritos | 2002 |
| 9/11 | Schwartz Rounds | Lynn O'Neill, Lynn Bowlby | 12:00 | Jersey Mike's | 2002 |
| 9/12 | How To Give a Talk | Zaas | 12:00 | Sushi | 2001 |
| 9/13 | Chair's Conference | Chiefs | 12:00 | Rudinos | MEDRES |
Time for PAINTBALL (submitted by Chris Hostler)
Reminder to sign up today for the upcoming White Coat Paintball Game on 9/28/13 from 12-4. Either respond to the calendar event via Outlook or email Chris Hostler by 9/21.
Thanks, Chris
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From the Residency Office
Conference Recordings/Presentations
Did you know we upload conference recordings to MedHub? Do you know where to find them, and do you find them useful? We really would like to know. If you would, please take 20 seconds to click on the following link and give us your feedback. Just 3 questions, but your answers will help keep us going in the right direction.https://www.surveymonkey.com/s/Conference_Recordings
Duke Internal Medicine Residency Program Fleece – Time To Place Your Order
The sun is settling lower in the sky, the seersucker is safely tucked away, and the mornings are starting to get chilly - which can only mean one thing - time to pull out your Med Res Fleece. Back by popular demand our office will again facilitate collecting fleece orders. We will be sending an email to our residents and senior leadership on Monday with the details - including the link and detail directions as to how to place orders. Sample jackets will also be available to check out/try on first of the week in our office. Lynsey will be the point person managing the project this year. NOTE: Fleece orders will only be collected for the next two weeks, so PLEASE watch your email so you do not miss this opportunity.
Developing the next generation of globally educated, socially responsible healthcare professionals dedicated to improving the health of disadvantaged populations.
Accepting Applications for Global Health Elective Rotations The Hubert-Yeargan Center for Global Health (HYC) is accepting applications for Global Health Elective Rotations for July 2014 and March 2015. Application is open to residents from Departments of Medicine: Internal Medicine (PGY 2); Med-Peds (PGY 3) and Med-Psych (PGY 4). Access the application form and FAQ at http://dukeglobalhealth.org/education-and-training/global-
health-elective-rotation.
(Application addendum is available by request – tara.pemble@duke.edu)
Application deadline is September 17, 2013. Interviews will be held in late September/early October. We encourage you to speak with past participants to get a better idea of what daily life is like on the wards of your top sites. For more information, contact Tara Pemble, Program Coordinator at tara.pemble@duke.edu or 668-8352.
Crime Prevention Briefings
In light of the incidences that took place this summer, the Duke University Police Department will be offering safety briefings at three different locations and times on campus. The briefings will cover building safety, parking deck safety and personal safety. Friday - Sept 13 from 11 - 12 in MSRB 1, Room 001 Tuesday - Sept 17 from 1:30 - 2:30 in 143 Jones Building Wednesday - September 18 from 11 - 12 in Classroom 4, Trent Seamans Center For more information, contact Duke Crime Prevention at (919) 684-2444.Contact Information/Opportunities
Global Health Hospitalist Position -- Harvard Medical School & Nyaya Health
Nyaya Health and Harvard Medical School are excited to announce that we are now accepting applications for a position that will be divided half-time between the Brigham & Women's Hospital (Boston, USA) and Bayalpata Hospital (Achham, Nepal). This is an ideal position for an Internal Medicine or Medicine/Pediatrics-trained physician interested in launching a career in global health hospital medicine and medical education. While in Boston, the candidate will serve as an associate physician at Brigham & Women's Hospital -- a Harvard University teaching hospital. In Achham, the candidate will be responsible for programmatic development, medical education of Nepali clinical staff, quality improvement initiatives, and implementation research regarding best practices for healthcare in resource-poor settings. Applications will be accepted from August 26th, 2013 on a rolling basis. The interview and hiring process will be finalized by October, 2013. Start date will be July, 2014, and minimum contractual agreements will be for one year (12 months); however, longer contractual agreements are preferred. For more information about the position, please see attached, or: http://bit.ly/16vvWf9 For additional information about Nyaya Health and Bayalpata Hospital: http://www.nyayahealth.org For additional information about the Brigham & Women's Hospital: http://www.brighamandwomens.org/ Interested applicants should send a cover letter and CV to hospitalist@nyayahealth.orgNyaya Health Clinical Advisor & BWH Hospitalist RFA 2013
Chapel Hill CareerMD - Career Fair:
physicians-in-training will be able to connect with representatives from leading healthcare organizations across the country and learn about the career opportunities available to them. RSVP by emailing charles.howell@CareerMD.com or through their website at www.CareerMD.com/ChapelHill| Location: | Sheraton Chapel Hill Hotel, One Europa Drive, Chapel Hill, NC | |
| Date/Time: | Thursday, September 12, 2013; arrive any time between 5:00 PM and 8:00 PM | |
| Details: | Casual attire, complimentary light refreshments, spouses and significant others welcome |
Upcoming Dates and Events
- September 17: Application deadline for Global Health Electives
- September 18/19: Flu Shot Blitz
- October 1: Duke’s Global Health-Internal Medicine Residency deadline to submitt applications
- October 18: SoM Clinical Science Day
- October 28: Annual Recruitment Kickoff
- November 28: Annual "Turkey Bowl"
- December 4: "Voices in Medicine"
Useful links
- https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
- August 2013 Resp Fit Testing-T-Dap-TB Skin Testing Flyer
- 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.