From the Director
Happy Halloween! Eileen, Tony and Juliessa kept me updated on everyone's great work this week, including guest appearances by Violet and Matilda Menachem and Tony Okorodudu at JAR night out. I guess recruitment can never start too early! Interns Armando Bedoya, Laura Caputo and Jeremy Halbe get a big thanks for planning a stellar Halloween party - look for pictures on the website soon.
The Halloween theme continued with a " raised from the dead" (sorry) awesome autopsy conference led by JARS Ryan Nipp, Denise Duan-Porter, and Zach Healy with attending discussants Chris Cox (pulmonary) and Jennifer Crowe (pathology). Thanks also to Eileen Maziarz and Murat Arcasoy.
SAR Lauren Gratian is diagnostician of the week for "uncovering" nec fasciitis. And a shout out for excellent work on CAD came to me from the heart failure team for interns Jeremy Gillespie and Scharles Konadu. Final shout out for great teamwork at the VA to JARS Sam Horr and Tara Weiselberg.
Congratulations to SAR Mariam Naveed on her wedding this past weekend!
Get ready for recruiting!
Aimee
WIRTW (Dr. Larry Greenblatt)
[box]Hansen LO, Young RS, Hinami K, Leung A, Williams MV, Interventions to Reduce 30-Day Rehospitalization: A Systematic Review. Annals of Internal Medicine. 2011;155: 520-528 [PMID: 22007045] [/box]Why this matters to me: Readmissions are costly, wasteful, demoralizing to patients and families (and residents!) and can lead to substantial financial penalties for hospitals under new Medicare rules. I work with the group at Duke providing care management services to Medicaid recipients and we have a clear mandate from the state legislature to reduce both hospitalizations and readmissions. I also serve on a hospital-wide committee looking to reduce readmissions. I’ve attended numerous meetings on this topic and presented our efforts at state and national meetings. Our readmission numbers at Duke are improving though there is potential for much more progress.
Strengths of this article: The authors from this outstanding medical school did a comprehensive search, rated the quality of each article, and sorted the interventions used. They point out the limitations of the existing body of literature.
Weaknesses: Human behavior is complex. Changing human behavior typically requires complex interventions. These authors from this very fine medical school deemphasized effective multicomponent interventions even when these are carefully described and potentially reproducible. Their conclusion that “No single intervention implemented alone was regularly associated with a reduced risk for 30-day re-hospitalization” is true but fails to capture the important work that has been done by researchers such as Jack, Coleman, and Naylor.
My take: A well-done review. Physicians looking to implement programs to reduce readmissions would find this information helpful and can readily find the references for multifactorial interventions that have proved effective in RCT’s at other institutions. We need more study to understand how to best reduce readmissions.
Interventions to Reduce 30-Day Rehospitalization
QI Corner
Thank you to Judy Milne, Patient Safety Officer for DUHS, who presented a great introduction to the "Culture of Safety" at Patient Safety and Quality Improvement Noon Conference this past week. Try to be mindful about how this applies to your own practice, particularly as it relates to concepts of "drift" and "normalization of deviance". For those of you who missed it, we will upload the conference into medhub. As she discussed, the Duke University Health System Safety Attitudes Questionnaire (the SAQ) has gone live as of Oct 24th. We need all of you to participate in this survey which will help us better assess the culture of safety here at Duke. The survey will be sent to you via email and should take between 10-15 minutes. It is completely confidential and anonymous. Be on the lookout! (The survey is generally sent out on Mondays. Here are the response rates through the first week. Our goal for medicine is 100%. You can see we have a ways to go and we are barely edging out surgery and pediatrics… SAQ Response Rate Upcoming QI Opportunities: 1) Save the Date: Patient Safety and Quality Improvement Noon Conference, Wednesday, November 30th. 2) Join the "Always" Event Task Force: This task force is part of the hospital "Patient Oversight Team" which looks to redesign the patient care experience. This task force will be responsible for generating a list of expectations related to things that will "Always" happen with patients and families. They are seeking interested resident participation. If interested, please contact Jon Bae. Lastly: Don't forget to complete your new and improved QI modules. All interns will be given dedicated time to complete these during geriatrics rotations. SARs/JARs will be given a dedicated half day during ambulatory blocks to complete as well. However, you are free to complete these modules at any time and instructions are included below. We are monitoring this Clinical Quality Improvement Modules Instructions: Some of you may notice that you have a half day of Quality Improvement while on ambulatory or geriatrics. During this time, you are required to complete a clinical quality improvement course. This course will help improve your skills in ACGME core competencies, Practice-Based learning and improvement and Systems-Based practice. Please go to https://courses.duke.edu and log on using your net id and password. You should see “Fundamentals of Health Care Improvement" course assigned to you. The course has pretests, 8 modules (each roughly 15-20 minutes in length) followed by individual module tests and post tests. We suggest logging in and not waiting until last minute to check and see if you are able to get to the modules without any difficulty. All residents are expected to complete this course at least once. If assigned, these modules must be completed by the end of the current ambulatory block; we suggest you utilize your dedicated half day to do so. If there are any questions, please contact Jon Bae or Juliessa Pavon. Blair Irwin is asking for volunteers to help review abstracts for the Duke Patient Safety and Quality Conference…time commitment is modest and would give you a chance to learn the process of appraising an abstract. Please email Blair if interested! [hr]A New Track for 2nd year Residents....
We are excited to offer the Ambulatory Care Leadership Track (ACLT) for second year residents beginning in July 2012. Applications will be accepted from current interns in the spring of 2012. Specifics of this program are being developed by the ambulatory leadership team at this time. Who should consider applying for the ACLT? Physicians interested in careers as:- Leaders of ambulatory general medicine or ambulatory subspecialty clinics
- Clinician-educators
- General medicine researchers
- Health system leaders with a focus on excellence in clinical skill
- Additional advanced communication skills training taught by faculty including James Tulsky and Kathryn Pollak.
- Outstanding physical examination skills with increased emphasis on ambulatory medicine issues.
- Broad clinical experience in a range of specialties to include geriatrics, women’s health, dermatology, musculoskeletal medicine, mental health, etc.
- Additional training in QI, practice management, team leadership, and new models of health care delivery. Includes the opportunity to participate in a number of innovative projects. Participants will likely be able to take graduate school class in Duke’s Master in Health Sciences in Clinical Leadership Program. Classes will be for learning and will not earn college credit.
- Comprehensive teaching skills training using the entire Stanford Resident Development curriculum.
From the Chief Residents
shiga toxin-producing E.coli (from Juliessa..)
Please read the attached provider memo from the North Carolina Division of Public Health containing important information regarding identification, management and reporting of patients with infections due to shiga toxin-producing E. coli. E coli Provider MemoVolunteer Opportunities for Housestaff and Faculty:
The opportunity to continue to serve the homeless of Durham is possible for all internal medicine residents and faculty who wish to volunteer at the Urban Ministries Shelter Clinic (affiliated with Lincoln Medical Clinic) in downtown Durham. Available times are currently on the third Wednesday of the month from 5:30-7:30. More dates will also be available in the near future. Residents interested in volunteering, or faculty wishing to precept, should contact Dave Karol or Shereen Katrak for more information.Grand Rounds
M & M, Dr. Peter Kussin; 2002 Conference Room, Nov 4th 8:00 AMNoon Conference
The first of our SAR talks begin this week. Kicking them off is Jason Webb and Christy Kaiser. We're looking forward to hearing some great talks over the next few months. Don't miss them! Duke North Conf Room 2002, 12:00 p.m. Note: During Recruitment, Chair's Conference will be at 11:00 (rm 2002) (lunch will be in the library following conference).| Day | Date | Topic | Presenter | Vendor |
| Monday | 10/31 | PWIM: Teambuilding | Drs.McNeill & Prewitt | The Picnic Basket |
| Tuesday | 11/1 | Townhall | Chiefs | Domino's - Pasta |
| Wednesday | 11/2 | Emerging Applications for Psychotherapeutic Agents: Chemotherapy Induced Nausea and Vomiting | Dr. Jason Webb - SAR TALK | Chick-fil-A |
| Thursday | 11/3 | SAR TALK | Dr. Christy Kaiser | Bullock's BBQ |
| Friday | 11/4 | Chair's Conference 11:00 a.m. | Dr. Klotman | Saladalia |
From the Residency Office
Recruitment
[box]Don't miss the Recruitment Kick-Off Party Tuesday, Nov 1 - 7pm - 9 pm G2B Gastropub [/box]Dinner Signups
Thank you to everyone who signed up for the November recruitment dinners. The December signups will be posted in the med res office this upcoming week. Stop by to sign up! Restaurant List:| 604 West Morgan | Piazza Italia | Six Plates |
| G2B | Parizade | Tobacco Road |
| Revolution | Piedmont | Pop's |
- November: Fri 11/4, Mon 11/7, Fri11/11, Mon 11/14, Fri 11/18, Mon 11/21
- December: Fri 12/2, Mon 12/5, Fri 12/9, Mon 12/12, Fri 12/16, Mon 12/19
- January: Fri 1/6, Mon 1/9, Fri 1/13, Fri 1/20, Mon 1/23, Fri 1/27
Lunchtime during Recruitment...
Just a reminder...Recruitment lunch time is a great time for us to showcase our great program and incredible residents that are here at Duke. Housestaff, please come and join the applicants during lunch time on recruitment days. Picture sheets will be posted the evening before on the 8th floor so make sure and take a look at them to identify applicants visiting from your med school and make an effort to connect with them.
A few housekeeping items; please allow our "guests" to go through the food line first. Clean up after yourselves. Recruitment takes a lot of effort by all and picking up your personal trash is part of your responsibilities. Please don't leave this for the office staff to do, it just reflects badly on us all. The recycling bins are coming back to the library (yeah!). Try and put all bottles and cans in the bin marked as such. Most importantly....Remember your interview days???...have fun!
Congratulations and Best Wishes...
SAR Mariam Naveed was married this past weekend. We want to wish the married couple our warmest congratulations and best wishes.
MedHub
MedHub received a face-lift. If you have any trouble navigating your pages, please contact Rhea. A list of enhancements that are relevant and hopefully helpful to you will be coming in the next week.Open Enrollment (deadline this week!)
Open enrollment for your benefits ends November 5, 2011. Don't miss it ! If you have questions about open enrollment, please contact Jill Watkins (GME Payroll and Benefits specialist) at 684-2897.Free Help with your Educational Loans:
One-on-One Consultations on Your Student Loans / Workshop on Repayment Strategies Sponsored by: Duke University School of Medicine / Duke University Hospital Provided by Paul S. Garrard, Founder and President, PGPresents, LLC Mr. Garrard, a nationally known expert in educational debt management for medical students and medical residents, will be on campus providing both private, in-person consultations (where you can discuss the particulars of your student loan portfolio), but will also provide a workshop on managing your student loans in residency and beyond. You will not want to miss this unique opportunity to get objective and timely information on everything from consolidation to Income Based Repayment to Public Service Loan Forgiveness.- One-on-One Consultations on your Student Loans
- Monday, October 31, 1:00p until 5:00p, (30 minute segments), and
- Tuesday, November 1, 8:30a until noon
- Location 0210 – Duke South Financial Aid Office
- To make an appointment: contact Paul Garrard directly paul@PGPresents.com or 877.201.6162 (first come first serve basis)
- Workshop– “The Reckoning: What to do when your student loans come due”
- Monday, October 31, 5:30 – 7:00pm
- Medical School Amphitheater (across from Duke South Food Court)
- Food will be served – please register by sending an email to dukegme@mc.duke.edu by noon on Friday October 28th
Dates to Add to Your Calendars
- Nov 1 - Recruitment Kickoff, G2B Gastropub 7-9
- Nov 2 - ACLT (Ambulatory Care Leadership Track) Information Session 5:15 pm, Med Res Library
- Nov 14-17 - BLS Blitz
- Nov 16 - Urban Ministries Shelter Clinic Volunteer (5:30-7:30 pm)
- Dec 10 – DOM Holiday Party
- Dec 15 - Duke Patient Safety and Quality Conference
- Dec 21 - Urban Ministries Shelter Clinic Volunteer (5:30-7:30 pm)
- Mar 9 – Charity Auction (Contact Tian or Ann Marie to participate) Note: change of date
- June 13 –Resident Research Event, 5-7pm
Employment Opportunities
Useful links
- Main Internal Medicine Residency website
- Main Curriculum website
- Ambulatory curriculum wiki
- Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response.
- Department of Medicine website