Weekly Updates: July 8, 2013

By admin3

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Happy 4th of July and happy and successful first week of the 2013-14 academic year! Interns are settling in very well, Maestro is becoming the new normal and it's great to see the JARs and SARs in their new roles. Special thanks to our first week conference presenters, including Adva Eisenberg with the first intern report and Christine Bestvina with the first chairs conference.  Attendance and participation have been stellar for week one! Be on the lookout for the milestone based self-evaluation coming in MedHub, including an instructional video made by our very own tech genius, Bill Hargett.  In maestro - please use pagingweb to contact a consult service if you don't hear back in a timely manner using the maestro page - a fix is on the way, but some pages aren't going thru. We will keep you posted when the fix happens. This week's pubmed from the program goes to Matt Summers. Congrats Matt and mentor Manesh Patel. …  Curr Cardiol Rep. 2013 Jul;15(7):379. doi: 10.1007/s11886-013-0379-x.  Appropriateness of percutaneous coronary intervention: a review. Summers MR, Patel MR. Enjoy some 4th of July photos. It's not going to surpass seersucker but it's pretty awesome. Have a great week Aimee JARQOutfit - HatPants                   [box]

"Best Care at Lower Cost"…an IOM Report; chaired by Mark D. Smith, MD, MBA

Aimee Zaas, MD

[/box] No, no…don't fall asleep already.  This is good stuff, and we are going to be hearing, talking and learning more about it over the course of this year, and years to come.  One of the best things about the whole concept of high value cost conscious care and learning health systems (aside from providing great care to our patients and not bankrupting them and the country in the process) is that these concepts are relatively new to all of us.  During much of our training, no one talked about cost of care very much, and often the "best" workup was the most comprehensive, ordering the most tests, etc.  Clearly, this is no longer the case and as responsible physicians, we must consider (and involve our patients in the decisions) the relative costs and values of the care we provide.  Best quality is really doing the right test or right medicine for the right person at the right time. And the idea of a learning health system simply didn't exist, or wasn't on the minds of practicing clinicians or learners.  But, things are changing… This year, we will be bringing you the ACP's High Value Cost Conscious Care Curriculum through the noon conference lecture series.  We are also developing opportunities for you to get involved in learning health care, and how to look at data from your own practice.  Stay tuned for more information in the coming weeks/months! So, what does the IOM have to say? They want to develop a continuously learning health care system and have formed a committee charged with outlining the key elements of learning health care.  The committee has the following mission.. Effectiveness. The Committee will define the foundational elements of a learning system for health care that is effective and continuously improving Efficiency. The Committee will define the foundational characteristics of a healthcare system that is efficient, delivers increased value, and is continuously innovating and improving in its ability to deliver high value to patients Why is this important?  Medical care is becoming increasingly complex (obvious point to those of you who are taking care of patients with medication lists of 20+ meds for 4+ chronic and 2 acute problems, or when you have to arrange follow up with one PCP, 3 specialists and home PT).  This complexity results in FRAGMENTED CARE, WASTE, LOST OPPORTUNITY TO IMPROVE HEALTH and POSSIBLE HARM What is Learning Health Care?  A health system that captures real time data, aggregates the data, and provides feedback to providers and patients based on this data so that providers can then ACT on the data to modify practice. (a simple example:  You admitting a patient with a fever.  They are stable, have no cough, no central lines, and have no urinary symptoms.  You are told that they have a UA that "looks like a UTI" and they have already received one dose of antibiotics.  You wonder how many UA's that look like UTIs really turn out to be UTIs…and how many even have a urine culture paired with them so that you can get the "gold standard" answer.  IN A LEARNING HEALTH SYSTEM, you could query (quickly, easily, and in the future, automatically) how many UA's were ordered for indication "evaluate for UTI", how many had a paired culture with them, how many had pyuria, and how many had a + culture.  Even better, a learning health system could then help change your practice.  You might find that the ordering practice should change to force a paired urine culture to go with any UA ordered for "evaluate for UTI".  Or you might find that the system should cancel urine culture orders for clean UA.  Or you might be pleasantly surprised to note that your team ALWAYS matches the reason for sending a UA with the need for a culture.  But the information you gain could allow a change in practice across the system.) What is happening in society that makes Learning Health Care possible?  EHRs that reliably capture and aggregate data, better computing power, empowered patients, value based incentives, transparency, and an involved leadership are all part of what will make this possible. Where can you go if you want to learn more about these concepts? 
  1. Read the attached article by Friedman, et al "Achieving a Nationwide Learning Health System" Science Translational Medicine Nov 2010; 2; 57-59
  2. Read the attached article by Ginsburg, et al "Academic Medical Centers: Ripe for Rapid Learning Personalized Health Care" Science Translational Medicine  2011; 3:101cm27
academicmedcentersANDrapidlearning Best care at lower cost[1]     BestCareReportBrief[1] fundamentalsofRLHS [divider]

From the Chief Residents

Grand Rounds

Date:  July 12, 2013
Drs.   Anderson/Moehring Infection Control
 

Noon Conference

Date Topic Lecturer Vendor
7/8 Rheumatologic Emergencies Lisa Criscione Pita Pit
7/9 Acute Renal Failure John Middleton Moe's- casadilla
7/10 Schwartz Rounds Lynn Bowlby, Lynn   O'Neill Jersey Mike's
7/11 Antibiotic   Stewardship Dev Anderson Domino's pizza
7/12 Chair's Conference Chiefs Chick-Fil-A

Residency Council

Please help congratulate the following members of the Residency Council for FY 14. Note that although not yet selected, the Intern class will soon have the oppotunikty to select representatives to the Council. Co Chairs:  Armando Bedoya and Chris Hostler Bedoya   Hostler SAR Class:   Laura Caputo, Jeremy Halbe, Brian Miller, Kevin Shah JAR Class:  Katie Broderick-Forsgren, Ryan Huey, Erin Boehm, and Nicholas Rohrhoff. Interns:  tbd Med-Peds:  Timothy Mercer Med-Psych:  Amy Newhouse [divider]

From the Residency Office

To Order New Lab Coats

Answers to the questions that have come in from our JAR's and SAR's - All residents MUST place order ONLINE first.  If you want the same exact sizes that you already have, email Rebecca.dincher@duke.edu directly with the information that your want embroidered. Your email address will be your  signature so in case there are any discrepancies. If you want something different, please go to the store to get fitted and then fill out the embroidery in the store. Rising JARs and SARs have to put their order in BEFORE they go to the store. https://shopgmeuniforms.dukestores.duke.edu

Rheumatology Fellowship info session

LIVE ONLINE INFORMATION SESSION: Thursday, July 18th,  7:00pm-8:00pm (Eastern Time) Please join us for a live online information session with faculty, chief fellow, and the Program Director from Duke's Rheumatology & Immunology Fellowship Program. This is an excellent opportunity to learn more about the fellowship training program and to have any questions answered in real time. If you are interested in participating, please send an email to Amy  Coppedge:  amy.coppedge@duke.edu so that she can get you registered and send you the necessary information for joining the online session. Please RSVP by Tuesday, July 16th.

How to Prepare for Professional Job Interview

What questions interviewee should ask and get answered?   What questions should interviewee be prepared to answer? InterviewSponsor: American College of Physicians North Carolina chapter
  • When: Friday August 2, 2013
  • Where: Duke Medicine Resident Library 8th floor
  • Time: 7pm (Dinner provided)
This is a great opportunity to find out first hand what works - and what doesn't.  The panelists include:
  • Dr. David Gallagher Hospitalist Medicine Duke
  • Dr. Lalit Verma Hospitalist Duke Regional Hospital
  • Dr. Saumil Chadgar Hospitalist Medicine/Academics
  • Dr. Jonathan Bae Hospitalist Medicine/Academics/Quality Improvement
  • Dr. Amy Rosenthal (Federal government/VA/Private Practice)
  • Dr. Sharon Rubin Primary Care/Outpatient
Please RSVP to Dr. Sharon Rubin sharon.rubin@dm.duke.edu  by Friday July 26, 2013 The following attachement provides a list of some of the discussion topics:  Thinks to know about a job and questions to ask

Poster Competition, SoM Clinical Science Day

October 18,2013

The third Clinical Science Day will take place during Medical Alumni Weekend with the goal of bringing together alumni, faculty, and trainees to celebrate clinical research and the vast and diverse array of activities taking place across our campus, showcase these activities, and encourage collaborations. Registration is required. Visit the website to register and for poster rules and instructions. The abstracts will be emailed to Dr Arcasoy at arcas001@mc.duke.edu by July 14, 2013. Any questions can be directed to his attention. Poster criteria for submission:
  1. Must be original Duke research
  2. Research must have been completed during the last 18 months
  3. Research must have a pre-specified data/statistical analysis plan
  4. Resident/fellow must be the primary author
  5. An abstract must be submitted with the nomination
Abstract format (500 words):  Background, Hypothesis, Methods, Results, Conclusion Posters will be judged by reviewers on the following criteria:
  1. Is there a defined hypothesis
  2. Is the study designed to answer a specific question
  3. Are there sufficient observations for statistical evaluation
  4. Have the data been appropriately analyzed
  5. Are the conclusions appropriately derived from the data
  6. Is the work novel

Contact Information/Opportunities

Idaho Hospitalist      Idaho Internal Medicine Pennsylvania Internal Medicine Cornerstone Internal Medicine at Premier, Outpatient Only  

Upcoming Dates and Events

  • July 18th        Intern Welcome Party at Dr. Klotman's
  • August 16th  Program Wide "Summerfest Party" at the Zaas's

Useful links

Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response.

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