Weekly Updates - January 9, 2012

By heffe004@dhe.duke.edu
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

“It’s good to be back! Happy 2012 to everyone – in the New Year, we have found the hospitals to be at peak capacity, but a lot of excitement and energy from all.  I received some wonderful compliments from several residents this week about their peers, which is the highest praise you can get! Way to go Jim Gentry, Marcus Ruopp and Mike Durheim for your exceptional work that was recognized by your teammates. We have a great deal of exciting events coming up, including more recruiting days (thanks to our dinner hosts, tour guides and slideshow leaders!), an opportunity to get involved in EPIC validation, Team STEPPS training for JARs, fellowship interest group meetings, and a chance to participate in the medical student journal club focused on GI/ID (featuring the NEJM article on fidaxomicin for c. dificile colitis).  We’ll end the month with our Stead Society faculty draft party…stay tuned for details! Now that it is the second half of the year, your attention can start to focus on maturing into your upcoming roles…interns, think about what you would do in a clinical situation if you were the team leader at the VA; JARs, consider what it will be like to be an ACR or other type of leader in the program;  SARs, it’s time to think like an attending or fellow – I was most impressed as our group of gen med SARs put themselves in the role of ICU fellows when considering the management decisions in a complex case presented by Dan Fox.  We know you guys are ready…..keep up the great work and the lifelong learning. Aimee

What Did I Read This Week (by Jon Bae, MD)

[box]“Improving the Discharge Process by Embedding a Discharge Facilitator in a Resident Team”; Finn, Kathleen, et al, Journal of Hospital Medicine, 2011, 6 (9); 494-500[/box]  Discharge Facilitator JHM Why Did I Read This?   This little article caught my eye as I was perusing some of the hospital medicine ‘rags’.  Given my love for all things readmissions, I thought I should take it out for a spin.  The basic construct here is that readmissions are bad and hospitals everywhere are struggling to find ways to curb them.  There is much interest in the discharge process as one potential area at risk for mishap as our very sick patients make the transition from hospital to home.  In the world of ACGME duty hours, there is even more perilous as residents have limited time to complete a seemingly endless list of tasks, let alone do them well.  A well-coordinated discharge takes as long, and in my experience, longer then an admission, yet current educational models focus very little on this type of interdisciplinary practice.   As such, this group at Mass Gen embedded a “discharge facilitator” within a general medicine resident team to focus discharge  -- i.e. medication reconciliation, follow-up appointments, discharge summaries and PCP communication, patient education, and the like -- hypothesizing that in doing so, they would increase team efficiency and improve ER returns and readmission rates. What Did I Learn?  Well, it didn’t really work.  At least not to decrease ER returns or readmission rates.  But focusing on that misses the forest for the trees.  Readmissions are but a murky reflection of the quality of care we deliver.  There are many things that we should be doing for ALL of our patients (not just the ones that are readmitted) that are what I would consider “best practice”.  And in most cases, failure to do these things actually DOES NOT result in readmission.  For example, all patients should have an accurate medication list when they leave the hospital.  And doesn’t it make sense that all PCPs should receive some form - any form - of communication about their patient’s recent hospital stay?  I think you see where I am going here.  Viewed in this light, this study was a success.  The team with the discharge facilitator had better PCP communication, medication reconciliation, follow-up, etc.  It just didn’t move the needle on readmissions.  But in my humble opinion, that is beside the point.  This is more evidence to the fact that readmissions are complicated and there is no “silver bullet” to reduce them including excellent discharge coordination.  But, should that mean our patient’s should expect anything but the best care coordination at the time of discharge?  I leave that to you to decide for yourself, loyal reader… [hr] [divider]

From the Chief Residents

Grand Rounds

Grand Rounds 1.13.2012: Novel Therapies for Sepsis Medicine Grand Rounds on Fri., Jan. 13 at 8am in Duke Hospital room 2002 will feature Peter Kussin, MD, associate professor of medicine (Pulmonary, Allergy & Critical Care Medicine) and vice chair for CME. His topic will be The Failure of Novel Therapies for Sepsis: When you don’t know where you’re going, any road will get you there.

Noon Conference

Day Date Topic Lecturer Time Vendor
Monday 1/9 Medicine Interview   12:00 Nosh
Tuesday 1/10 Med Peds Interview   12:00 Saladelia
Wednesday 1/11 VA feedback session Chiefs 12:00 Bullock's
Thursday 1/12 SAR TALK Carly Kelley 12:00 Chick-fil-A
Friday 1/13 Chair's Conference Chiefs/Ed Coverstone 11:00 Panera
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From the Residency Office

Fellowship Programs

If you are planning to apply for fellowship program, you are in luck.  We are coordinating a series of events that will help you on your way. First the Residency Council will be hosting a general informational session about how to apply for a fellowship on Tuesday, Jan 17th from 5:30-6:30pm in the Med Res Library. They will also be hosting subspecialty specific advice sessions in the near future which will be led by senior residents who applied for the respective subspecialties. More information about these to come. Next, if you would like to learn more about the fellowship programs that are available in the Department of Medicine, please complete the following survey by January 22, 2012.   The information will be shared confidentially with Program Directors (example - Endocrinology will only know which residents have expressed an interest in their program).  For programs where there is sufficient interest we will facilliate group meetings with Directors and other  program representatives. https://www.surveymonkey.com/s/Fellowship_Program_Interest_Groups

W2s for Housestaff

Effective January 2012, Corporate Payroll Services will implement electronic W-2 Forms for all active Duke University and Health System employees.  Both paper and electronic forms will be available for calendar year 2011.  Active Employees will access the new forms using their Duke@Work account, the same method used for the pay statements. We are happy to highlight some of the benefits and efficiencies of the new online tool:
  • Earlier Distribution Date for Electronic W-2 Forms.
  • Email notification when the online form is available.
  • Electronic W-2 Forms are available online 24 hours per day, 7 days per week.
  • Online messages will be generated for employees who did not have earnings for the calendar year or who are not eligible for a W-2 form.
  • Enhanced security since the online form is accessed using the net ID and password in the Duke@Work Portal
The process for obtaining duplicate W-2 forms will be handled by directly accessing your Duke@Work account.  All active employees can take advantage of this feature and print duplicate copies at their discretion.
The 2011 W-2 form will be available online for multiple years.  Copies of tax documents for calendar years prior to 2011 will not be available online; however, they may be requested by contacting Jill Watkins j.watkins@duke.edu  in the GME Office.

Fit Test - TB Test Schedule

The January schedule for testing and vaccinations is attached for reference.

Resp Fit Testing-T-Dap-TB Skin Testing Flyer Jan 2012

Dates to Add to Your Calendars

March 23 - Charity Auction - UPDATED  (previously posted as March 9) June 2 - Annual SAR Dinner June 13 –Resident Research Event, 5-7pm Recruiting Days - January, 2012
9-Jan Medicine Recruitment Monday
10-Jan Med-Peds Recruitment Tuesday
13-Jan Medicine Recruitment Friday
13-Jan Med-Psych Recruitment Friday
17-Jan MD PhD Recruitment PM Thursday
20-Jan Medicine Recruitment Friday
23-Jan Medicine Recruitment Monday
27-Jan Medicine Recruitment Friday

Financial Planning Webinar

The following financial planning webinar (January 24) is being made available to residents and fellows.

January 24th - Financial Planning Webinar for Residents _ Fellows

Dessert and Discussion of IM Topics and Careers - CIMGro Series

January Topic - Gastroenterology

Tuesday, January 24, 2011, 6:30-8pm

Home of Dr. Spanarkel, 3505 Medford Road, Durham, 27705

Come and meet attendings, fellows, and residents for casual discussion on their careers and an article in their field:

 Fidaxomicin vs Vanc in CDAD   NEJM, 364:5, feb3, 2011

Please RSVP by submitting your name on this          google form

Opportunities

Charlotte - Outpt IM Opportunities Flyer

Useful links

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