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
It’s hard to go anywhere without someone mentioning how hot it has been this week. For our new interns who are not from the Southeast … trust us, this cannot last forever!
We have had another busy week in the medicine program. Highlights include a great noon conference by Dev Anderson on antibiotic stewardship, the first Duke intern report (thanks,
Josh Thaden, for the excellent kick-off presentation, a case of piperacillin-tazobactam induced DRESS), and a
tour de force Grand Rounds of bench-to-bedside-to-education management of gout by
John Sundy, which included the trifecta of Duke’s gout luminaries (
Hal Silberman,
Mike Hershfeld and John Sundy).
We also had breakfast at Nosh to thank our JARs and SARs who were leading teams at the VA, and noted some strong teamwork by Durham Regional ACR
Mike Durheim, DRH Chief
Juliessa Pavon and the hospital medicine team at DRH (
Lalit Verma and
David Boyte) as they began multidisciplinary team rounds on DRH general medicine.
Finally, we had our Annual Program Review on Friday with the GME team and representatives of the Residency Council (
Tian Zhang,
Newton Wiggins, and
Nancy Lentz). In our action plans for next year, we will focus on our quality improvement education and implementation program, developing milestone-based evaluations of residents and expanding our opportunities to train residents in ambulatory care.
We are excited about having “Weekly Updates” featured in the MedicineNews blog. Thanks to Anton Zuiker and Randy Heffelfinger for making this happen. We’re told that perhaps you won’t need VPN soon to get to the Updates from home, so stay tuned for that upgrade.
Have a great week!
Aimee
What I Read This Week “WIRTW” (submitted by Aimee Zaas)
[box] “July Effect”: Impact of the Academic Year-End Changeover on Patient Outcomes. A Systematic Review; John Q. Young, MD, MPP; Sumant R. Ranji, MD; Robert M. Wachter, MD; Connie M. Lee, MD; Brian Niehaus, MD; and Andrew D. Auerbach, MD, MPH; Annals of Internal Medicine; 2011; 155 (2) [/box]
Why did I read this? It is timely and certainly the cause of much interesting debate.
What did the study do? This study was a meta-analysis evaluating whether or not patient outcomes are adversely affected by the changeover of trainees in July. Authors looked at studies that met the following criteria:
- examined the turnover of physicians-in-training (interns, residents, fellows, or their equivalent) related to the beginning of the academic year;
- used a control group or time period as a comparator; and
- reported the effect of the changeover on patient mortality, morbidity, medical errors, or efficiency of care.
Studies included medical and surgical services. Of studies of reasonable quality, 45% showed an association between changeover and mortality with an effect size ranging from a relative risk increase of 4.3% to 12.0% or an adjusted odds ratio of 1.08 to 1.34. Efficiency was also likely to decrease during July.
Conclusions? Possibly, overturning your workforce in a short period of time can have adverse effects on patient outcome. However, authors were not able to discern much about supervisory structures present in any of the studies reviewed, nor were they able to ascertain the involvement of trainees in the adverse events.
Controversies? Definitely! There is a large amount of discussion regarding this article online, and it is frequently quoted in the blogosphere and mainstream media.
What should we do? This is a “food for thought” article and should get us all thinking about ways we can design systems that minimize the opportunities for error related to workforce turnover.
Physical Exam Week
If you have not all ready done so, please
complete the online survey to help us prepare for the upcoming seires on physical examination - to be held the week of August 8, 2011. This survey will be strictly confidential.
[divider]
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 |
7/25 |
Stroke |
Larry Goldstein |
12:00 |
Jersey Mike's |
2002 |
| Tuesday |
7/26 |
DVT/PE |
Victor Tapson |
12:00 |
Dominos |
2002 |
| Wednesday |
7/27 |
Rheumatologic Emergencies |
Lisa Criscione |
12:00 |
Moe's |
2002 |
| Thursday |
7/28 |
DMS/Insulin Overview Talk |
Lillian Lien |
12:00 |
Bullock's BBQ |
2002 |
Residency Council Minutes (from Nora Dennis)
Attached please find the minutes from this week's meeting of the Medicine Residency Council. One major highlight will be upcoming elections for the intern class during the first week of August. There are also multiple service efforts under the Council -- the first will be a school supply drive for the Lakeview Alternative School, now through August 15th. Please bring notepaper, pencils, pens, and 1-subject spiral notebooks to an ACR office near you! Finally, the council reps discussed feedback from various rotations, as we make a smooth transition to the new duty hour requirements.
(link to the Council minutes:
Residency Council Meeting minutes 7-18-2011 )
Quality and Patient Safety (from Tian Zhang)
"The GME Patient Safety and Quality Council met at 7am on July 19th. New council co-chairs Michael Barfield and Kristy Rialon, with the help of faculty advisors Drs. Karen Frush and Tom Owens, will be focusing efforts on grassroots improvement of patient safety, initiated by house staff members. Medicine residents were represented by Adia Ross, Priyesh Patel, and Rebecca Sadun. Current task forces are in place to make improvements in handoffs/transitions of responsibility, as well as in monitoring duty hours and resident supervision under the new ACGME regulations. Last year's education task force also developed an innovative education discussion module on patient safety that will be rolling out to house staff around the institution.
Have an idea on improving the quality of care for our patients on an institutional level? Reach out to Mike Barfield and Kristy Rialon, and come join our meetings! Mark your calendar - the next meeting of the GME PSQC will be at 7am on Tuesday, August 16th, in Duke South Rm 1170, with the resident supervision task force meeting at 4pm on the same day (8/16/2011) in the GME conference room. If interested in the resident supervision task force, please email
tian.zhang2@duke.edu."
Cardiology Grand Rounds
Cardiology Grand Rounds is on a summer hiatus and will resume in September. However, on August 1st, Dr. Robert Temple from the FDA will be visiting Duke, and we would like to take advantage of his visit to provide a Special Cardiology Grand Rounds.
Dr. Temple is the Center Director for Clinical Science of FDA’s Center for Drug Evaluation and Research and is also Acting Director of the Office of Drug Evaluation. He has had a long history of overseeing the regulation of cardiovascular drug products at the FDA, and has contributed to the design and conduct of several pivotal clinical rials.
The topic of his Grand Rounds will be "Reflections on cardiovascular drug development and approval." We hope this will be an interactive session and our very own Rob Califf will moderate the discussion.Grand Rounds will occur on August 1 (Monday) at 5pm in Duke North 2002. Pizza and soft drinks will be served.
Please put this on your calendars as a not-to-miss event!
Thanks, Tracy Y. Wang, MD, MHS, MSc
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 12 - Liver Rounds at the Zaas' home (change of date)
[divider]
From the Residency Office
Office Support
Notary: We are happy to share that we have identified another notary in Duke North who will help cover during the time that Rhea is out of the office. Joy Williams in the Chairs office, suite 1102, has offered to be of assistance.
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.
Useful links
It’s hard to go anywhere without someone mentioning how hot it has been this week. For our new interns who are not from the Southeast … trust us, this cannot last forever!
We have had another busy week in the medicine program. Highlights include a great noon conference by Dev Anderson on antibiotic stewardship, the first Duke intern report (thanks, Josh Thaden, for the excellent kick-off presentation, a case of piperacillin-tazobactam induced DRESS), and a tour de force Grand Rounds of bench-to-bedside-to-education management of gout by John Sundy, which included the trifecta of Duke’s gout luminaries (Hal Silberman, Mike Hershfeld and John Sundy).
We also had breakfast at Nosh to thank our JARs and SARs who were leading teams at the VA, and noted some strong teamwork by Durham Regional ACR Mike Durheim, DRH Chief Juliessa Pavon and the hospital medicine team at DRH (Lalit Verma and David Boyte) as they began multidisciplinary team rounds on DRH general medicine.
Finally, we had our Annual Program Review on Friday with the GME team and representatives of the Residency Council (Tian Zhang, Newton Wiggins, and Nancy Lentz). In our action plans for next year, we will focus on our quality improvement education and implementation program, developing milestone-based evaluations of residents and expanding our opportunities to train residents in ambulatory care.
We are excited about having “Weekly Updates” featured in the MedicineNews blog. Thanks to Anton Zuiker and Randy Heffelfinger for making this happen. We’re told that perhaps you won’t need VPN soon to get to the Updates from home, so stay tuned for that upgrade.
Have a great week!
Aimee
What I Read This Week “WIRTW” (submitted by Aimee Zaas)
[box] “July Effect”: Impact of the Academic Year-End Changeover on Patient Outcomes. A Systematic Review; John Q. Young, MD, MPP; Sumant R. Ranji, MD; Robert M. Wachter, MD; Connie M. Lee, MD; Brian Niehaus, MD; and Andrew D. Auerbach, MD, MPH; Annals of Internal Medicine; 2011; 155 (2) [/box]
Why did I read this? It is timely and certainly the cause of much interesting debate.
What did the study do? This study was a meta-analysis evaluating whether or not patient outcomes are adversely affected by the changeover of trainees in July. Authors looked at studies that met the following criteria: