The Internal Medicine Residency newsletter is posted each week to share important news, announcements and updates about the residency program. Please contact Randy Heffelfinger with corrections, contributions and suggestions.
From the Director
Happy Holidays! It’s hard to believe the (academic) year is nearly halfway complete….we’ve accomplished so much and there are many exciting things on the horizon. I hope I tell you guys often enough, but, just in case…I’m incredibly proud to be part of such an amazing team.
Recruitment season continues in full force as well, with
David Butterly and
Emily Strollo serving as outstanding leaders of this great effort. Thanks to all the residents who have led dinners, tours, slideshows (was that
Vaishali Patel and
Mariam Naveed, or just one person?), etc in an effort to make the prospective residents feel at home. Med Peds SAR
Ann Marie Navvar-Boggan impressed them with a great afternoon report case of an inflammatory pseudotumor on Monday, and Med Psych JAR
Krista Alexander capped the week off with a fantastic Chair’s Conference (levamisole-induced vasculitis, or “LINES” disease). Throughout the week, we had other outstanding presentations, including JAR
Carrie Horney’s presentation of radiation pneumonitis that highlighted the role of physician communication in making a diagnosis. Intern
Aaron Mitchell introduced us to omental necrosis in the differential diagnosis of abdominal pain.
Pubmed from the Program this week goes to all who presented at the 7
th Annual Duke Quality and Safety Symposium. Way to highlight our QI iniatives!
George Cheely - Improving the Frequency and Quality of Diabetic Foot Exams in a Resident Continuity Clinic
Joel Boggan and Tian Zhang -Shift Changes for the Hospital Team: Standardizing and Evaluating Transitions of Care in the Era of Duty Hour Reform
Anne Marie Navar - Rates of Hypertension Control Among Patients Followed by Cardiologists: An opportunity for Quality Improvement
In the holiday spirit (and the spirit of In Service Training Exam Scores returning this week), here is your medical trivia question. The prize may vary from something cool to a Christmas sweater…I’m not sure. What is the most useful physical finding to detect ascites? (Bonus: what is the most useful symptom to detect ascites?)
Happy holidays to you, your families and loved ones!
Aimee
What Did I Read This Week (by Amy Rosenthal, MD)
[box]"July Effect”: Impact of the Academic Year-End Changeover on Patient Outcomes, Annals of Internal Medicine Sept 6, 2011, pages 309-315.[/box]
Why did I read this article? This topic caught my eye as we were experiencing our own academic year transition. I thought it would be near and dear to readers of the Weekly Announcements too!
Overview: The purpose was to see if trainee changeovers during academic transitions affect patient outcomes. The authors looked for articles that examined 1) the turnover of physicians-in-training related to the beginning of the academic year, 2) used a control group, and 3) reported the effect on patient
mortality, morbidity, medical errors, or
efficiency of care. None of the studies examined the effects of year-end switches on ambulatory systems.
Higher quality studies reported a statistically significant difference in mortality, and adjusted odds ratio of 1.08 to 1.34. Six studies reported medical error outcomes, 3 of these suggested that changeovers were associated with worsened safety outcomes. Among the higher-quality studies showing increased length of stay, relative worsening of efficiency was between 0.3% and 7.2% compared with non-turnover months or nonteaching hospitals or both.
Some thoughts: This is a very challenging topic of study, and better data was available with regard to mortality and efficiency of care as opposed to morbidity and medical errors. The heterogeneity of studies did not permit firm conclusions about the degree of risk posed and how changeover affects morbidity and rates of medical error. It is difficult to tell how much of any effect was due to trainee experience vs trainee knowledge of the system. Authors suggest that a reduction in initial degree of trainee workload could be tried (already done in the ambulatory setting) and/or a system of staggering schedule starts for trainees, which could be logistically challenging.
"Fair Warning"
I would like to take just a few minutes to ask everyone to review the "
Fair Warning" policy that was posted in the last issue of "Updates". The policy, which is intended to help safeguard the privacy of our patients and employees, is now in effect. The policy allows for electronic monitoring of the numerous IT systems that contain personal health information and permits the Duke University Health System (DUHS) Compliance Office to conduct audits of staff’s access to DUHS clinical and billing systems. These reports permit the Compliance Office to initiate audits that include your access to patients’ records in which you do not appear to have a business need to access. Violations of the policy will be taken very seriously.
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From the Chief Residents
Grand Rounds
We will not hold Grand Rounds this week. Departmental Grand Rounds will resume on January 6, 2012.
Noon Conference
| Day |
Date |
Topic |
Lecturer |
Time |
Vendor |
| Monday |
12/19 |
Medicine Interview Day |
|
|
Saladelia |
| Tuesday |
12/20 |
Townhall |
Chiefs |
12:00 |
Domino's |
| Wednesday |
12/21 |
CXR Conference |
Goodman |
12:00 |
Papa John's |
| Thursday |
12/22 |
HOLIDAY |
|
NA |
|
|
|
|
|
|
|
| Monday |
12/26 |
HOLIDAY |
|
NA |
|
| Tuesday |
12/27 |
HOLIDAY |
|
NA |
|
| Wednesday |
12/28 |
HOLIDAY |
|
NA |
|
| Thursday |
12/29 |
HOLIDAY |
|
NA |
|
|
|
|
|
|
|
| Monday |
1/2 |
HOLIDAY |
|
NA |
|
Medicine Residents Holiday Annual Fund Drive
This is the final "push" of our
Annual Christmas Drive. We are hoping to serve the local community again this month as we collect Christmas gifts for families at the DOC and our CLC residents at the VA. The generosity of our residents, faculty and staff is overwhelming. We have all ready collected over $1,000, but we continue to need your help if we are going to make this Christmas special for the families on our list.
The deadline for turning in gifts has passed, but we will be accepting donations through the weekend via
PayPal. Keep up the great work! If you want to go shopping with the donation fund tomorrow, get in touch with either
Joel Boggan or
Newton Wiggin. We would love some company. The more the merrier. See you soon.
Take care, The Residency Council
Rising JAR and SAR Preferences - 2013 Academic Year
Rising JAR's and SAR's - by now you should have received two emails regarding preference forms.
The first came from our office and included directions regarding how to submit preferences for the next academic year. Take special note of the
"Kussin Bucks" and use them wisely.
The second email was generated directly though Survey Monkey and includes your unique link to the data collection forms. If you accidently deleted the link or need assistance, please contact
Laura Kujawski.
DOC Video Newsletter
Just in case you missed it - log in and check out the DOC Video NewsLetter. We are using this format to help keep everyone up to date on the happenings around the DOC. A special thanks to
Dale Okorodudu for the video-taping, and to all who participated!
How? Login with your DHE password at
https://news.medicine.duke.edu/wp-login.php and then go to
http://news.medicine.duke.edu/2011/12/doc-video-newsletter-for-nov-dec-2011/ Video link is located on the center of the page, scroll down to middle of the page.
From the Residency Office
Resident "FAQ's" and Who to Contact
One of the last things Rhea did for us before departing for her new position is to develop a list of FAQ's that seem to pop up every day. Please take a look, and keep these at hand for future reference. Even better, we are posting them prominently in our office should you forget where your mail is or where to go to renew your license. The title of the document - what else, but
Rhea's FAQ's.
As to whom to ask should you need assistance, here is a brief guide in addition to Rhea's FAQ's
Schedule - Laura Kujawski and Lauren Dincher work as a team to manage the complex schedules. Lauren specializes in the ambulatory schedule, and Laura is in charge of the block and clinic schedule, but if you have a question of an urgent nature, please contact either one.
Schedule Changes or Time Away - Any requests for schedule changes or time off should first be directed to your Chief Resident. The Chief will forward recommendations and approvals as appropriate to our office. Regarding time away, please remember that you schedule must reflect accurately where you are and the training activity.
Duty Hours, Evaluations, General Questions - Lauren will help address questions related to these categories.
Email Etiquette - This is also an opportunity to encourage everyone to be considerate of copying only those who need to know or can act on your requests. Copying everyone in the office actually does not speed things up, and in fact can create confusion.
Call Rooms and Security
With approaching holidays security issues are even more important, and unfortunately a theft was recently reported from one of the call rooms.
What can you do to help?
1. Call room lockers are not intended for long term use. Please remove any old items from lockers so that others who use the call rooms will have a safe place to store belongings.
2. If you see/find people in call rooms, on beds, using computers, watching TV please report ASAP to Duke Police
684-2444.
Dates to Add to Your Calendars
March 9 - Charity Auction
June 13 –Resident Research Event, 5-7pm
Useful links
