Weekly Updates: February 10, 2013

By admin3

From the Director

Hi Everyone! It's been a busy week, and we've got some great events coming up this week as well….Wed Nov 13 is the Duke v UNC game, so come watch at Motorco! And Friday night is one of the best events of the year….the Charity Auction! We hope to see residents, faculty, staff, families out to have a great time and raise money for two great causes…Senior PharmAssist and the DOC Patient Fund. Tremendous kudos this week….we announced our chief residents for 2014-15…Nilesh Patel (Duke), Coral Day (DVAMC), and Bonike Oloruntoba (DRH-Amb).  Congratulations to this amazing group.  Also kudos to Liz Campbell for her presentation at the EM-IM conference, to Sundhar Ramalingam and Scott Westphal for outstanding SAR talks, and to Claire Kappa for being the inaugural intern to present at Chair's conference. Duke represented in an outstanding fashion at the NC-ACP meeting on Friday and Saturday.  Terrific posters were seen on Friday night, with Jim Gentry winning best overall poster (and a trip to the national meeting!) and Matt Chung winning second place in the clinical vignette category.  On Saturday, we watched Jason Webb do a fantastic chief's presentation, and then our "all-star" jeopardy team (Nick Turner, Katie Broderick-Fosgren and John Stanifer) took FIRST PLACE in the resident Jeopardy competition!  It was particularly awesome to watch Nick run the "ECG" category versus several PGY-3 future cardiology fellows from other programs, for Katie to answer question after question, and for John to need to correct the judges that "Sipple's syndrome" and MEN 2a are the same thing.  And they won an iPad Mini for the program! February is GME Month, and many of us got the opportunity to spend time with Bill Iobst, the visiting professor from the ABIM.  We reviewed the upcoming "Next Accreditation System" (how programs will be judged yearly by the ACGME) and also the reporting milestones (how we will report to the ACGME and ABIM about individual resident progress).  He was very impressed with the draft of our new evaluation (tremendous work by Bill Hargett and Murat Arcasoy) as well. The several days spent with Dr. Iobst highlight the importance of "direct observation" in understanding a resident's progress…what does this mean to you?  Look forward to more "on-the-fly" miniCex's, and an opportunity very soon to view our new gen med evaluation form.  You can view the ACGME reporting milestones (I.e. How you should progress during the years of training) through the following link:  http://www.acgme-nas.org/assets/pdf/Milestones/InternalMedicineMilestones.pdf Also, belated engagement congratulations to the following residents and their fiancés:  Armando Bedoya and Kevin Parrott. Want a chance to tell your story?  Anton Zuiker has an opportunity for you!  Through a storytelling program called The Monti, you can get professional coaching AND a chance to tell your story in front of an audience.  Follow this link for more information  http://news.medicine.duke.edu/2012/11/call-for-storytellers-voices-of-medicine/ This week's Pubmed from the Program goes to Lauren Prats for her abstract accepted to the American Medical Society for Sports Medicine meeting, with mentor Dr. Mark Bytomski.  Her poster is titled "Economic Analysis of Image-Guided Intra-articular Hip Injections" Have a great week! Aimee   [box]What I Read This Week: Nick Rohrhoff , MD Momentary Interruptions Can Derail the Train of Thought; Journal of Experimental Psychology: General, first quarter.[/box] Why did I read this article: Two words: hammer paged.  One night as a CAD intern, I got absolutely crushed on cross-cover.  Oh wait, that was every night.  Fielding so many pages while trying to admit patients with sick hearts certainly wasn’t good for me but what impact did it have on the people whose lives I was responsible for during that time? Summary:  Researchers assigned 300 volunteers a complicated computer task where they had to follow a number of steps which depended on them remembering exactly where they were in the sequence (i.e putting in admission orders or doing a med-rec for a SNF resident) in order to succeed.  When their attention was shifted from the task at hand for just 2.8 seconds (i.e. silencing a page), they became twice as likely to mess up the sequence. The error rate tripled when the interruptions averaged 4.4 seconds (i.e. reading and triaging the page quickly…7300 HUC again?).  The authors conclude, "When someone is momentarily interrupted or distracted and then returns to their task, they may do so without obvious hesitation, but with an increased chance of resuming at a different point in their train of thought than they might have otherwise."  They even gave it a cool name: contextual jitter. Deeper into the data: Non-sequence errors showed no interruption effects regardless of the interruption duration.  So it isn’t the ability to complete the task that is affected (you will enter the sliding scale correctly every single time) but it is the place in the sequence where you resume after the interruption that is the source of the error (you may have skipped ordering accuchecks.)  The work of other researchers suggests that executive functioning for sequential tasks focuses on the current element in the operation and moves on to the next step only when it becomes relevant.  In light of the results, these authors postulate that in sequential tasks, the next step is relevant as soon as you begin working on the current step. Conclusion: “Even momentary interruptions can seem jarring when they occur during a cognitively engaging activity.” Take home points:
  • Getting hammer paged is annoying but it may also be dangerous.
  • Maybe the GME Patient Safety and Quality Council can collaborate with Duke nursing leaders and develop a list of guidelines for appropriate paging according to acuity of illness, issue urgency and patient safety to triage housestaff notifications to text message, direct # or HUC.  Maybe a document like this already exists and could be revised and re-implemented in light of this new information.
  • Improving the quality of care for our patients in the 20th century depended almost entirely on what we learned about them.  In the 21st, it will depend much more on what we learn about ourselves.

QI Corner (submitted by Jon Bae, MD)

Quality Improvement and Patient Safety Conference A belated thank you to Dr. E. Phillip Lehman IV for his fantastic presentation on the "Duke Fiscal Cliff" at our most recent QI/PS Noon Conference. Be sure to join us for our next conference, 2/27/2013, with Dr. Mamata Yanamadala discussing Patient Safety and Errors. GME Patient Safety Quality Council Representatives The GME Patient Safety and Quality Council is a centralized, resident run committee with a mission to help coordinate quality and safety efforts for GME trainees across the health system. We are proud to announce our two identified representatives for the coming year will be Jenn Rymer and Nick Rohrhoff!  Thank you to Jenn and Nick for representing the program! Duke Quality Champions Each month, we hope to recognize resident quality champions.  These are residents who have gone above and beyond to attend to the patient safety and quality needs of our program, health system, and patients. For January 2013, our Quality Champions were:
  1. Phil Lehman: for providing an insightful look at the changing landscape of healthcare in the country and at Duke
  2. Jenn Rymer: for her participation on the GME PSQC
  3. Nick Rohrhoff: for his participation on the GME PSQC
Congrats to our Quality Champs!  If there is someone you would like to recognize as a Quality Champion, please let George Cheely, Ryan Schulteis, or Jon Bae know. Med Res Patient Safety and Quality Council The Med Res PSQC is up and running.  We have 2 efforts moving forward from this group
  1. Duke Gen Med Outside Hospital Transfer Improvement
  2. Duke Outpatient Clinic Discharge Follow-up Clinic
Our next meeting is Wednesday 2/13 at 5PM in the med res library. We will be following up on our discussion of OSH Transfers.  All welcome and we hope to see you there. Sharepoint Diabetic Foot Exam Updates As we showed at our last QI/PS Noon Conference, we have had phenomenal success with our Sharepoint DM Foot Exam Modules.   PastedGraphic-2 From July 2012-Dec 2012, we have had 79 residents (JARs/SARs) review 1471 charts.  Our performance through this period by clinic, stead society, and as a program is available for review in the attached powerpoint.    Sharepoint Phase 1 Update July-Dec 2012 We are currently in Phase 2 (Jan 2013-June 2013) where we will review our performance again after the implementation of the individualized performance improvement plans. There are plenty of opportunities here to coordinate interventions at the clinic level so if you would like to get involved, get in touch w/George, Ryan, or Jon today. ALSO, the Ambulatory Care Leadership Track residents are helping to select a Sharepoint Measure for year 2.  If you have any ideas, please let us know! Med Res Balanced Scorecard and GME Incentive Program Updates Please take a look at our most recent Med Res Balanced Scorecard: Resident_BSC FP6 2012-13 Also, here is the latest from the GME Incentive Training Program through FP5 (November).  We are still on pace for all trainees to receive $400 at year's end!    GME Incentive Plan Duke 8th Annual Patient Safety Conference Take a look at the following invitation to the 8th Annual Duke Medicine Patient Safety and Quality Conference.  It's a great forum to see some of the awesome QI work happening around the health system.  We have several posters featured here and hope to have even more next year with all the excellent quality work of the residents.  Also, it's free and local! We invite you to register for the 8th Annual Duke Medicine Patient Safety and Quality Conference.  The conference will be held Thursday, March 14, 2013 at the Duke University Fuqua School of Business, adjacent to the Thomas Center.  Registration will start at 7am with conference activities from 8am until 4:30pm.   Two plenary lectures will be presented:  “Balancing Systems and Individual Accountability in Pursuit of a Culture of Safety” by Gerald Hickson, MD; Vanderbilt University Medical Center; Center for Professional and Patient Advocacy and “Bedside to Battlefield: Exploring Evidence of Team Effectiveness in a High-Stress Environment”, by Peter Napolitano, MD; Colonel, MC, USA; Director, Maternal-Fetal Medicine Fellowship, Madigan Healthcare System One of the conference highlights is the poster session.  Come learn from the poster presentations and speaking with the abstract writers.  In the afternoon, join one of the breakout sessions including:
  • Does Your Team Need a Team Effectiveness Boot Camp?  Implementing team effectiveness strategies in your work area
  • Just Culture, Accountability, and Safety:  Case studies and what we’ve learned.
  • Patient and Family Centered Rounding: Duke Children’s Experience
  • Thriving vs. "Surviving" during Times of Change at DUHS: The Duke Resilience Mini-Course
  • Safety in the News: Answering Your Patient’s Concerns!
  • Culture Data:  The roadmap to success
  • Patient Centered Communication = Communicating Safely, Communicating Safety
This is an excellent opportunity for patient safety and quality education while networking with like-minded professionals.  If you need additional information, contact the DUHS Patient Safety Office at 919-668-3749 or visit our website at http://intranet.dukemedicine.org/duhs_pt_safety/default.aspx Register online today: http://cmetracker.net/DUKE/login?FormName=RegLoginLive&Eventid=48117 [divider]

From the Chief Residents

Grand Rounds

Date Division Speaker Title
15-Feb-13 Endocrine-2 Dr. Lien/Newgard Insulin Resistance/Bariatric

Noon Conference

Date Topic Lecturer Time Vendor
2/11 Ambulatory TownHall - 2002, 8253, 1700B(hallway to south) 12:00 Jersey Mike's
2/12 MED PEDS SAR TALK Avery, Shaw 12:00 Moe's
2/13 Schwartz Rounds Lynn O'Neill, Lynn Bowlby 12:00 Saladelia
2/14 Asthma Monica Kraft 12:00 Chick-fil-A
2/15 Medical Implications of Homelessness Jessie Gaeta 12:00 Bullock's BBQ

Duke/UNC BB Game!!

If you live in Durham, North Carolina you should know that next Wednesday is a holiday…… IT’S THE DUKE VS UNC BASKETBALL GAME!!!!!!! To celebrate, we will be going toMotorco to watch the game!!

Date: Wednesday, February 13th @ 9:00pm

Address: 723 Rigsbee Ave, Durham, NC 27701

Annual Charity Auction - Tickets on Sale NOW!!!

2013 Charity Auction benefiting Durham Senior PharmAssist & The DOC Clinic Fund Friday – February 15, 2013 Durham Arts Council Building 120 Morris Street, Durham, NC This is our program's charity event of the year, where we get to enjoy a great night together while supporting a wonderful cause. This year we've got some awesome items including:
  • Dr. Dzau and Dr. Klotman's basketball tickets
  • Gen Med and clinic shift coverage
  • Golf and spa packages
  • Restaurant certificates, massages, gym memberships, house cleanings, wine tastings and much more!
  • Class vs. class bidding wars, so come represent!
Who: You, friends, spouses, family, all are welcome When: Friday February 15th at 7pm Where: Durham Arts Council Building, downtown at 120 Morris St Tickets: $20. Available at the Med Res office, at grand rounds, from any of the charity auction chairs (Carling, Marianna, Jenn Chung, Laura Caputo, Meredith), and at the door Online Pre-Bidding for the 2013 Duke Medicine Charity Auction is now officially LIVE! Head to http://tinyurl.com/bcx6w59 and see just a sample of some of the awesome items to be won at the silent auction next Friday! Your online buying power will close at 11:59 pm on 2/14 so get started now!  Winners must be present on Friday as items will be distributed at the end of the evening.  

Trivia Night (Submitted by the Rankin Stead Society)

The Rankin Stead Society invites all Medicine residents, regardless of Stead group, to a special Trivia Night to be held on Wed, Feb 20, at the Carolina Ale House (3911 Durham-Chapel Hill Blvd).  The event will benefit a charity chosen by the Stead society that musters the highest trivia score.  The Stead groups will begin forming tables at 7pm and will cover your food and drink for the evening.  Trivia starts at 8pm.  To the highest scoring Stead team, we will provide $200 to donate to their local charity of choice.  Please come out and have fun for a good cause!

Informational session on Fellowship Programs

Dr. Aimee Zaas and Dr. Bill Hargett will be leading an informational session on Fellowship Programs and the application process.  Important information and insights will be shared and it is a great opportunity for anyone who is interested in applying for Fellowship! Tuesday, Feb. 19th 5:30 – 6:30 p.m. Tuesday, Feb. 26th 5:30 - 6:30 p.m. Both sessions will be held in the MedRes Library and they are the same, so you should only plan on attending one. [divider]

From the Residency Office

MKSAP

February 18 is the deadline for submitting orders for MKSAP during this academic year. Details and order form can be accessed with the following link: https://www.surveymonkey.com/s/MKSAP_16_Request_Form

Contact Information/Opportunities

Idaho Internal Medicine North Dakota Internal Medicine  

Upcoming Dates and Events

  • February 13:  Duke/ UNC Game at Motorco (game starts at 9 PM)
  • February 15:  Annual Charity Auction, 7 PM at the Durham Arts Center
  • February 15:  GME Housestaff Survey Closes
  • February 19 and 26:  Informational session on Fellowship Programs
  • March 15:  MATCH DAY CELEBRATION at Dr.  Klotman’s!
  • March 25-28:  BLS Bliz  (registration:  blsblitz )
  • March 29:  Faculty Resident Research Grant Application Deadline
  • April 19:  Residency Program Pictures (rain date April 26)
  • April 28:  2nd Annual Stead Tread
  • June 4:  Resident Research Conference, Searle Center
  • June 8:  SAR Dinner, Hope Valley Country Club

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