From the Director
Hi Everyone! Food trucks, fire trucks, and a great turnout! Thanks everyone for showing up at the most eventful Liver Rounds in history! A 30% chance of thunderstorms was perhaps an understatement, but it was definitely fun to have you all over to the house. Next time, I'll be sure to negotiate for clear skies. And a special thanks to
Randy Heffelfinger and
Erin Payne for extra hard work orchestrating the set up and helping the entire night run smoothly. We collected 126 pounds of food for the FoodBank of NC…thanks also for helping our community.
Kudos also to
Murat Arcasoy for organizing the second annual
Physical Exam Week! Lots to be learned, and we look forward to the summary information prepared by JAR
Laura Caputo and SAR
Mandy George. Also thanks to SARS
Kevin Parrott, Newton Wiggins, Kevin Riggs and Scott Tolan and JAR
Aaron Mitchell for serving as our, um, spokesmodels (?) for the physical exam course. Don't forget the Rational Physical Exam page on jamaevidence, and the neuro and musculoskeletal exam DVDs are in the residency office.
Other kudos this week go to JAR
Audrey Metz, who received a gold star for her care of a family at Duke. Nice work Audrey! Congratulations to our new residency council reps. Looking forward to working with you this year.
The interns are now done with their first month…thanks everyone for an incredibly well run July. And continued special thanks to our
Maestro champs at the DOC and Pickett. Be on the lookout for tips and tricks, as well as times you can go to the personalization lab and update your account. Maestro is a marathon, and by all reports, we are doing amazingly well.
PLEASE HELP US…we are working to update the website in time for recruiting (see, the interns have just finished July, so we can officially think about recruiting). Erin has emailed you a survey monkey so we can profile you on the website…we want to know what you like about the program, Durham, etc. We will resend this on Monday, so be on the lookout and take 5 minutes to answer the questions. And, as a reminder, if you PUBLISH or have an ABSTRACT ACCEPTED for presentation at a national meeting….be sure to let us know — email the info to Erin Payne. We want to be able to recognize your accomplishments.
PubMed: This week's Pubmed from the program goes to JAR
Aaron Mitchell for his article on cost-effectiveness and the use of statins..Nice work, Aaron. Mitchell AP, Simpson RJ Jr.; Statin cost effectiveness in primary prevention: a systematic review of the recent cost-effectiveness literature in the United States.
BMC Res Notes. 2012 Jul 24;5(1):373
Have a great week! Aimee
What Did I Read This Week (Saumil Chudgar, MD)
[box] Alexander EK , et al. “Variation and Imprecision of Clerkship Grading in US Medical Schools” Acad Med 2012; 87:1070- 1076 Variation_and_Imprecision_of_Clerkship_Grading_in.19[1] [/box]
Why did I read this?
The article caught my attention given my interest in medical student and resident education. It is relevant to all residents and faculty as we all grade medical students on the Medicine clerkship/subinternship. Also, some of their discussion ties into competency vs. outcomes-based education and milestones, a hot topic in GME today that will impact residency training for everyone.
What I learned from reading this?
There is significant variation in grading scales for clinical rotations at all medical schools. The majority (63/119) have a 4-tier grading system (like Duke) with Honors/High Pass/Pass/Fail, but they range from a 2-tier to 11-tier grading. Even within the 4-tier system, there are variations in the names (A/B/C/F, High Honors/Honors/Pass/Fail, Honors/Satisfactory/Low Satisfactory/Fail, etc).
Also interesting is significant variation in the numbers of students who get the highest grade (honors for example) – on the Internal Medicine clerkship across schools (interschool), the range was only 10% Honors at one school while another had 77% Honors. Nationwide, in a 4-tier system, about 30% of students got Honors in Internal Medicine. Also, there is a significant variation within a school (intraschool) in the number of students who get the highest grade. For example, one school had 82% of students get Honors in Neurology but only 20% in Psychiatry.
Anything controversial?
This study raises some interesting questions regarding significant heterogeneity in clerkship grades both across school and within a school. It doesn’t seem that adding more grade tiers helps, as 97% of all students receive one of the top three grades regardless of how many tiers there are. Because grades are one component used by residency programs to rank candidates, it is important to consider what the meaning of this level of variation means, as Honors from one school may be very different than Honors at another.
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From the Chief Residents
Grand Rounds
| Date |
Division |
Speaker |
Title |
| 3-Aug-12 |
Infectious Disease |
Dr. Chuck Hicks |
Syphilis |
Noon Conference
| Date |
Topic |
Lecturer |
Time |
Vendor |
Room |
| 7/30 |
Cross Cover Emergencies |
The Chiefs |
12:00 |
Saladelia |
2002 |
| 7/31 |
Rheumatological Emergencies |
Lisa Criscione |
12:00 |
Jersey Mike's |
2002 |
| 8/1 |
IM-ED Combined Conference |
|
12:00 |
Moe's |
2002 |
| 8/2 |
DMS overview/Insulin |
Lillian Lien |
12:00 |
Papa John's |
2002 |
| 8/3 |
Chair's Conference |
Chiefs |
12:00 |
The Picnic Basket |
2002 |
Residency Council (from Coral Day and Newton Wiggins - 2013 co-chairs)
Hi everyone. The election results are in, and we would like to announce the 2012-2013 Internal Medicine Residency Council Representatives:
JAR Class: Armando Bedoya, Laura Caputo, Jeremy Halbe, Christopher Hostler
SAR Class Reps: Megan Diehl, Shereen Katrak, Nilesh Patel, Scott Westphal
Med/Peds: Joel Boggan
Med/Psych: Nora Dennis
Selection of the representatives for the intern class will be announced next month. Congratulations and we look forward to working with you this year!
[divider]
From the Residency Office
Maestro Tips (submitted by Jen Chen, MD)
I skimmed through some of the Tips on the Maestro website, and I personally found these three attachments helpful.
# "SmartPhrases and Smartlinks":
Dr. Spratt had sent a helpful list of dot phrases (aka abbreviations), but there's a way to
SEARCH in EPIC to see if a phrase/link exists, and what its abbreviation is.After reading this, they actually taught this in our training session, but I completely forgot.
SmartPhrases and Smart Links
# "Flowsheets":
Particularly helpful (to me) for trending vital signs / weights. Maybe everyone else figured this out on Wednesday, but I couldn't for the life of me figure out how to look up the previous BP. Can also trend labs, but this can be done from the Labs tab too.
Flowsheets for Viewing and Documenting
# "Facility administered medications":
Quick reminder on how to order medications to be given in clinic, and where to view the order (so the nurses know what to administer). I know that our side ran into this problem this week.
Ordering Facility-administered Medications
Hope this helps! ~ Jen
FY 13 Schedule
Crafting a schedule for a program of this size is quite a task, and our "hat's are off" to Laura Kujawski and Lauren Dincher who spend countless hours putting the pieces into place. Block schedules, clinic schedules, ambulatory rotations, QI/Admin schdules, and a myriad of preferences are only a few of the variables that need to be considered. Our goal is to have schedules published no less than 3 months ahead of the start of each block, however the start of the academic year often makes this impractical. So, for those who are wondering where things stand, here is a brief update:
- Clinic schedules for block 4 were distributed on Friday
- Work has all ready started on block 5 clinics
- Schedules for the annual in-training service exams have been completed and will be released this week
- We are very close to finishing the holiday schedule, which will be announcned under a separate email
This work required many hours of effort - and our thanks to all who contributed.
Announcement: Chief Resident - Singapore
Title: Chief Resident (Duke Faculty); Location: Duke-NUS Graduate Medical School Singapore – Singapore
Dates: 7/1/13 – 6/30/14 Housing: Provided by SingHealth
Position Summary:
The chief resident will be responsible for enhancing the structure and design of clinical training of residents and medical students, including advising on the development and implementation of administrative tools and structures required for residency operations. The purpose of this position will be to enhance and support integration of the inquisitive culture of Duke into the SingHealth Environment. The resident will select a focus of activities which may include participation in educational/clinical teaching, including bedside and seminar-based teaching, organizing and conducting seminars, assisting in curriculum development, creation of new educational tools, engaging in co-mentorship with Singapore faculty, and assisting in developing and/or enhancing clinical guidelines. The chief resident will work with Singapore counterparts to identify and develop opportunities for collaborative research. The chief resident will identify a focus for his/her individual program in collaboration with Duke, Duke-NUS and SingHealth education leaders.
Importantly, applicants should be innovative and flexible. Since this is a new position/opportunity there will be significant opportunities to demonstrate creativity while working with the educational leadership at NUS.
For those interested please contact Dr. Ralph Corey (919 668-7174).
Deadline: September 1
st, 2012
Provider Orders for Outpatient Clinical Services Policy Approved by EMC
The following policy has been developed and approved for implementation related to “Provider Orders for Outpatient Clinical Services”. The policy can be found though the following link and is located in the DUHS Policy and Procedure Manual.
Provider Orders for Outpatient Clinical Services
The policy outlines:
- Requirements for orders Types of Orders
- Who may write or receive orders
- Describes expectations for medication orders
- Describes when e-mail can be used for orders
- Provides examples for writing orders and for utilization of electronic signature
An FAQ on Outpatient Orders has also been provided.
4 3 12 Outpatient Orders FAQs - final
Thomas A. Owens, MD
Chief Medical Officer, Duke University Health System
Dates to Add to Your Calendars /Contact Information
Useful links
