The Internal Medicine Residency newsletter is posted each week to share important news, announcements and updates about the residency program. Please contact Randy Heffelfinger or Emily Strollo with corrections, contributions and suggestions.
From the Director
Another great week! It seems that everyone is settled in. It is great to see the teams rounding at the bedside, to overhear the CCU teaching residents talking with the CCU intern about common patient issues in the ICU, to hear about what is happening in the ambulatory clinics, and to see the gen med patients identifying with the interns as “their doctor” on rounds. There is still reasonable participation in “Seersucker Tuesday”, but let’s see if we can do a little better this week! Once we get Randy Heffelfinger to wear seersucker pants, we will know that we have truly arrived.
Stead Attendings started on Duke Gen Med (thank you to
Andrew Muir and
Chet Patel), the interns and chiefs enjoyed a fun evening out at Full Steam, and the “emergency lecture series” continued at Noon Conference with a particularly entertaining and informative talk by Tony Galanos regarding hazards of hospitalization. He reminded us that you are only as old as your “functional age”, and that some of the best research around comes from our own Duke trainees and attendings (One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study.
[box]Unroe M, Kahn JM, Carson SS, Govert JA, Martinu T, Sathy SJ, Clay AS, Chia J, Gray A, Tulsky JA, Cox CE. Ann Intern Med. 2010 Aug 3;153(3):167-75..[/box]
Fantastic leadership skills were shown by the VA Chief Resident
Tony Gutierrez, Assistant Chief Resident,
Leon Cannizzaro, and the VA Gen Med teams as they evaluated the new VA GEN MED structure and offered thoughtful suggestions for improvement. Direct observation began of interns in the clinics and on the wards, as well as team leadership assessments and observation of transitions of responsibility (aka “handoffs”) between interns and the night JARs on Duke Gen Med. Congratulations to Dale Okorodudu (PGY-2) on the birth of his son, Tony. Mom, Dad and baby are doing well.
What to look for in the week ahead…
- Continued direct observation of interns on the wards and in the clinics
- Noon conferences on Cross Cover Emergencies, CXR interpretation, Antibiotic Stewardship and Cirrhosis
- Chair’s Conference, presented by Lisa Vann
- Updates to our residency program website
Aimee
More direct observation!
In addition to Mini-Cex’s in the hospital, direct observation in the clinics is an important part of your professional development. Ambulatory preceptors will be doing MiniCex’s in the clinics for ALL trainees throughout the year. Ambulatory preceptors will also be coming in to observe various parts of the clinic visit, such as agenda setting, physical exam, medication counseling, etc. Asking for direct observation of your patient visits is a great way to get valuable feedback from your preceptors.”
[divider]
What I Read This Week “WIRTW” (submitted by Aimee Zaas)
[box]Bowen, JL. Educational Strategies to Promote Diagnostic Reasoning. N Engl J Med 2006;355:2217-25 and the accompanying editorial Norman G. Building on Experience – The Development of Clinical Reasoning. NEJM 2006 355;21[/box]
Why Did I Read This? It is one of my favorite articles, and very timely at the start of a new academic year. It is relevant to anyone who teaches on the wards or in the clinics, including JARs and SARs leading teams, and even interns who are interacting with medical students.
What I Learned from Reading This: Learning how to formulate a differential diagnosis is a complex process that relies on prior knowledge AND prior experience. As our expertise grows, we rely on “multiple, combined strategies to solve clinical problems, suggesting a high degree of mental flexibility and adaptability in clinical reasoning.”
More important than the excellent description of the development of diagnostic reasoning are the strategies Bowen offers to help teachers guide learners through the various stages of diagnostic reasoning development. See Table 1 for descriptions of the trajectory of skill development, and ways that supervising physicians can mentor learners to hone their skills.
Anything controversial? Not really, although the accompanying editorial suggests that you can’t codify learning medicine as neatly as Bowen does, and that we shouldn’t discount experience as the best teacher.
Physical Exam Week
I am pleased to announce that the program will host a unique series of conferences focusing on physical examination during the week of August 8, 2011. In preparation for the conference we are asking all residents in our program to complete a pre-conference survey (
https://www.surveymonkey.com/s/Physical_Exam_Assessment). This survey will be strictly confidential. Please complete the survey (how long? Under 5 minutes) as soon as possible, and watch for more information regarding the series in future “Weekly Updates.
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From the Chief Residents
Grand Rounds
| Date of Lecture: |
July 29, 2011 |
Learning Objectives: |
| Title of Lecture: |
Environmental and occupational lung diseases in the 21th century |
Following this activity series, learners should be able to:1. Recognize patients who may have lung diseases related to environmental or occupational exposures
2. Review the clinical approaches to diagnose and manage environmental and occupational lung diseases
3. Highlight common environmental and occupational lung diseases
4. Discuss emerging environmental and occupational lung diseases |
| Speaker(s): |
Yuh-Chin Tony Huang, MD, MHS |
|
Noon Conference
| Day |
Date |
Topic |
Lecturer |
Time |
Vendor |
Room |
| Monday |
7/18 |
Cross Cover Emergencies |
The Chiefs! |
12:00 |
Papa John's |
2002 |
| Tuesday |
7/19 |
CXR Intreptation |
Phil Goodman |
12:00 |
Dominos |
2002 |
| Wednesday |
7/20 |
Antibiotic Stewardship |
Deverick Anderson |
12:00 |
Bullock's BBQ |
2002 |
| Thursday |
7/21 |
Cirrhosis |
Andrew Muir |
12:00 |
The Pita Pit |
2002 |
Quality and Patient Safety
Attention house staff interested in quality measures and contributing to patient safety and quality!
You are invited to attend the next meeting of the GME Patient Safety and Quality Council (PSQC), at 7am on Tuesday, July 19th, in the Medical Center Board Room, Duke South Yellow Zone, Room 1170. There are several initiatives in which to become involved, including transitions of responsibility, resident supervision, and education on patient safety. If interested and cannot attend the meeting, please email Tian at
tian.zhang2@duke.edu. Thanks!"
Teaching Conferences
We have updated the list of teachnig conferences once more - with even more opportunties - which can be accessed with the following link:
Medicine House staff Teaching Conferences
Ambulatory Care Interest Group
Thinking about a career in primary care or an ambulatory subspecialty? Want to hang out with like-minded faculty and colleagues? Come to the Ambulatory Care Interest Group at the home of Larry Greenblatt on 7/27 from 7:00 to 8:30 PM. We'll have dessert and coffee, wine and beer, and some good conversation. Please rsvp via email to Larry Greenblatt.
green061@mc.duke.edu
Details: 1110 Minerva Avenue in Durham (Corner of Minerva and Buchanan, across from Duke East Campus, Blue-Green house with a big porch.) Lost? Call 688-4139
Upcoming Dates
August 5th - Liver Rounds at the Zaas' home
[divider]
From the Residency Office
Office Support
Please note that Rhea will be out of the office through August 3, 2011. The following is provided as a general guide as to office staff assignments. Please direct inquiries that would normally be addressed by Rhea to Randy’s attention during her absence.
Who to Contact:
Scheduling questions – Laura Kujawski 681-4090,
laura.kujawski@duke.edu
Ambulatory Schedule, mail, faxes, lunch, general office – Lauren Dincher 681-2383,
lauren.dincher@duke.edu
Appointments with Dr. Zaas, training verifications, recruitment activities – Emily Strollo, 681-1464,
Emily.strollo@duke.edu
GME compliance (duty hrs, evaluations, life support), LOA’s, MedHub support, time away options/regulations – Rhea Fortune, 681-4510,
rhea.fortune@duke.edu
General Office, Research Grant support, “Weekly Updates” submissions, policy, budget and finance – Randy Heffelfinger, 668-6577,
Randy.Heffelfinger@duke.edu
Survival Guides
If you have not all ready done so – please pick up your new Survival Guide this week. Also note that we have received the following update. The pager # use for Geriatric Consults is: 970-0370
Cycling Around Durham
We had a great ride on Saturday – and although we were not out to compete with the “Tour de France”, we did enjoy a few sprints. The group this week included (from left to right) Brian Miller, Scott Evan, Bruce Peyser, Carling Ursem, Larry Greenblatt, and Randy Heffelfinger. This is a fun group – that can adjust to many levels. If you would like to join us, we are planning a repeat for next week – same time and place (below). If you want find out more about riding in Chapel Hill/Durham, or NC, we have included 2 links to get you heading in the right direction.
Next ride: 8:30a Saturday at 1955 W Cornwallis, Maureen Joy charter school
Links:
www.tarwheels.org;
www.ncbikeclub.org
Useful links
Another great week! It seems that everyone is settled in. It is great to see the teams rounding at the bedside, to overhear the CCU teaching residents talking with the CCU intern about common patient issues in the ICU, to hear about what is happening in the ambulatory clinics, and to see the gen med patients identifying with the interns as “their doctor” on rounds. There is still reasonable participation in “Seersucker Tuesday”, but let’s see if we can do a little better this week! Once we get Randy Heffelfinger to wear seersucker pants, we will know that we have truly arrived.
Stead Attendings started on Duke Gen Med (thank you to Andrew Muir and Chet Patel), the interns and chiefs enjoyed a fun evening out at Full Steam, and the “emergency lecture series” continued at Noon Conference with a particularly entertaining and informative talk by Tony Galanos regarding hazards of hospitalization. He reminded us that you are only as old as your “functional age”, and that some of the best research around comes from our own Duke trainees and attendings (One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study.
[box]Unroe M, Kahn JM, Carson SS, Govert JA, Martinu T, Sathy SJ, Clay AS, Chia J, Gray A, Tulsky JA, Cox CE. Ann Intern Med. 2010 Aug 3;153(3):167-75..[/box]
Fantastic leadership skills were shown by the VA Chief Resident Tony Gutierrez, Assistant Chief Resident, Leon Cannizzaro, and the VA Gen Med teams as they evaluated the new VA GEN MED structure and offered thoughtful suggestions for improvement. Direct observation began of interns in the clinics and on the wards, as well as team leadership assessments and observation of transitions of responsibility (aka “handoffs”) between interns and the night JARs on Duke Gen Med. Congratulations to Dale Okorodudu (PGY-2) on the birth of his son, Tony. Mom, Dad and baby are doing well.
What to look for in the week ahead…
We had a great ride on Saturday – and although we were not out to compete with the “Tour de France”, we did enjoy a few sprints. The group this week included (from left to right) Brian Miller, Scott Evan, Bruce Peyser, Carling Ursem, Larry Greenblatt, and Randy Heffelfinger. This is a fun group – that can adjust to many levels. If you would like to join us, we are planning a repeat for next week – same time and place (below). If you want find out more about riding in Chapel Hill/Durham, or NC, we have included 2 links to get you heading in the right direction.
Next ride: 8:30a Saturday at 1955 W Cornwallis, Maureen Joy charter school
Links: www.tarwheels.org; www.ncbikeclub.org