Weekly Updates: June 10, 2013

By admin3

From the Director

Aimee - Research NightDUKE.RESEARCH.NIGHT.03 (1)Hi everyone! It's been a busy and eventful week, highlights of which were a spectacular resident research night (thank you to Murat for planning and to Shawna, Laura, Lauren, Erin, Jen and Randy for being an awesome set up team), screening of Mallika Dhawan's documentary, Nicole Greyshocks fantastic grand rounds, an outstanding presentation by Audrey Metz  at chairs with great attendance and audience participation, an ACLT dinner for Leah Rosenberg and Tara Weiselberg and the always fabulous SAR dinner, emceed by the incomparable Jon Menachem. Kudos also to Iris Vance from her VA JAR for outstanding work on gen med. Brian Griffith and Clay Musser are giving Maestro tips at the beginning of noon conference - be there, it's very helpful. Also be aware of the personalization labs - make every effort to go and learn the tricks of inpatient maestro! Congrats to Matt and Debra Summers on the birth of William Owen Summers! This week's pubmed from the program goes to our best poster at resident research night by Callie Coombs:  Exploring educational gaps in myelodysplastic syndromes in medical students and internal medicine residents: A dual-institution survey Have a great week!   Aimee

QI Corner:  Quality Improvement and Patient Safety Noon Conference

Please join us on Monday 6/10 at noon conference for our next Quality Improvement & Patient Safety Lecture. Who: Dr. Zubin Eapen from the Duke Heart Center will be discussing the Heart Center's approach to CHF readmissions and the same day heart failure clinic. But Wait, There's More!  George and Ryan will be giving QI Updates as well Don't Miss It! Quality Improvement at Resident Research Night QI was on display at this past week's Resident Research Night!  Some of this work originated with the amazing contributions of our Medicine Residency Patient Safety and Quality Council (PSQC).  This included: Jenn Rymer and Kim Bryan: "Transitions of Care: the Duke Outpatient Clinic Discharge Process Improvement Project" Aaron Mitchell and Kevin Shah: "A Stakeholder Driven Project to Improve the Safety of Outside Hospital Transfers" Congrats to Kevin Shah and Aaron Mitchell who took home the new award category - Best Quality Improvement Proposal Submission. And kudos to Hany Elmariah and Kathleen Broderick, both of who have been awarded Resident Research Grants for their QI projects for this upcoming year. If you want to get involved with the PSQC or in a QI project, please contact Jon Bae, Ryan Schulteis, George Cheely, and soon Joel Boggan! GME Trainee Performance Incentive Update Hot off the press - the final tally is in for this year's performance incentive program. At the end of period 10, the hospital has met target on 2 of the 4 measures: HCAHPS (Patient Satisfaction) and CMS Evidence Based Care Score. What does this mean?  For starters, it means we are beginning to move the needle on engaging trainees in improving the quality of care delivered. It also means that all GME trainees (i.e. YOU) will be seeing an additional $200/measure = $400 in your June paycheck!    Please be aware, it will be listed as supplemental pay. Congratulations and thank you for a year of hard work and success!

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What Did I Read This Week

(submitted by Saumil M. Chudgar, MD, MSEd)

Croskerry P.  “A Universal Model of Diagnostic Reasoning.” Acad Med 2009; 84:1022-1028.

A_Universal_Model_of_Diagnostic_Reasoning 14

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Why did I read this?

I went to an outstanding Medical Education Grand Rounds given by Jamie Fox, Peds EM faculty here at Duke, on “Teaching Novice Physicians to Think like Experts.”  His talk discussed how we approach patients and make diagnoses.  He cited this article during his presentation, so I looked it up for more information.   I thought understanding the concepts may help in teaching students and residents and take better care of patients. [caption id="attachment_10823" align="alignright" width="153"]Saumil M. Chudgar, MD Saumil M. Chudgar, MD[/caption] What I learned from reading this?The article discusses two major approaches to decision-making – Type 1 and Type 2.  Type 1 is heuristic and intuitive – the way that many experienced clinicians can do a brief history and physical and come up with a likely diagnosis based on patient presentation.   He cites the classic presentations of zoster or acute MI.  However, Croskerry warns of the challenges of this system – Type 1 reasoning may lead to diagnostic error when the presentation is atypical.  Physicians often shift into Type 2 with atypical presentations – a systematic, analytical approach.  It is more resource-intensive and less likely to lead to error.  However, it takes longer to do. Croskerry proposes a combined model based on these two types of reasoning.  In the setting of a patient presentation, we analyze the pattern and see if we recognize it.  If so, we proceed down System 1 processes, calibrate, and then arrive at a diagnosis.  If we do not recognize it, we move through System 2 processes that take longer and are more systematic before arriving at the presumed diagnosis. I have not read it (yet), but I hear that the Malcolm Gladwell book Blink has a similar approach, discussing our initial intuition in a situation.   Some of the important skills come with experience and the ability to build these illness scripts.  One thing to think about as we approach the start of the new academic is what impact this has on patient care.  We often think of the ability to recognize “sick vs. not sick” as a very important skill for interns to have – part of that ability is this approach. One idea that came from both this article and Jamie’s talk is how we approach teaching diagnoses to students.  Both of these systems move from Illness Presentation through several steps to the Diagnosis.  However, much of medical school training is focused the other way – you learn about a Diagnosis (MI for example) and all of its manifestations.   Should our focus and method of teaching be different?  All of this is very interesting to think about, and I look forward to applying the ideas in both teaching and patient care. [divider]

From the Chief Residents

Grand Rounds

Date                  Chief Resident Grand Rounds May 31             Jason Webb, MD

Noon Conference

Date Topic Lecturer Vendor
6/10 QI Patient   Safety Conference Jon Bae/Zubin   Eapen Picnic Basket
6/11 Protecting   the confidentiality of sensitive health diagnoses Carolyn   McAllastar Bullock's   BBQ
6/12 Schwartz   Rounds Lynn   O'Neill, Lynn Bowlby Jersey   Mike's
6/13 Global Health Gallops Cecelia Pezdek;   Tara Pemble Domino's
6/14 Chair's   Conference Chiefs Rudinos

 

Residents Present Global Health Cases

Thursday, June 13    12-1PM  Duke North 2002 Please join us for global health clinical case presentations. Our residents are returning from Global Health Elective Rotations in a variety of locations in Southeast Asia, Central America, East Africa and the US and they have brought back interesting cases to discuss.  Below is a snapshot of Ann Marie and Joel Boggan memorialize their last day on Karapitya’s medicine ward with the rest of the rounding team. Galle, Sri Lanka Global Health In collaboration with the departments of Medicine and Pediatrics, the Hubert-Yeargan Center for Global Health provides 2 to 3 month Global Health Elective Rotations for residents in Internal Medicine, Medicine/Pediatrics, Medicine/Psychiatry, and Pediatrics. Residents are competitively selected to serve a wide selection of global locations. For a list of global locations and Global Health Elective application instructions please visit www.dukeglobalhealth.org

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Maestro - How to Make it Work For You

(submited by Clay Musser, MD and Brian Griffith, MD)

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Maestro "hot topics" will be continuing this week as shown below.  We also are posting the pdfs/tips on MedHub for future reference.  Where to find them?  Look for "Maestro' on the list of resource documents on the right side of your home page. Maestro Noon Conference Presentations
  • June 10th – Medication Reconciliation
  • June 14th – Insulin Orders/Ordersets
  • June 19th – Core Notes / Smartphrases
  • June 20th – Core Ordersets
  • June 21st - Cutover/Go-LIVE
The open invitation to participate in one of 4 GenMed Specialty Labs that Clay and Brian will be doing still stands.  If you would like to know more and inquire about space for attending, please email Brian directly.  The date/time for these sessions are below.  Each will be in the Eye Center Mobile Classroom.
  • June 17th 5-6:30pm
  • June 18th 4-5:30pm
And finally, the Personalization Labs also are offer a great opportunity for you to fine tune your skills.  You can find a date/time that will work for you by using the following link? https://intranet.dm.duke.edu/sites/medicine.duke.edumedicine.duke.eduMaestroCare/SitePages/Articles/May13_Wave4_PersonalizationLabs.aspx

More Maestro Info

Residents as Authorizing Providers for Medication Orders Only in Maestro Care -  We will implement a change that will make residents authorizing providers for medication orders only. Once this change is in place, residents will be required to list an authorizing provider for all non-medication orders; these orders will be routed to the authorizing providers for signature. Residents who fail to enter authorizing providers for non-medication orders will be prompted for that information when they attempt to sign the orders. [divider]

From the Residency Office Summers Pic

Addition to Our Families

Matt Summers is off on leave - celebrating the new addition to their family. Congratulations, and please help us welcome William Owen Summers to the Residency Program

SAR Board Review Schedule

Final session - and much appreciation to all who have facilidated these sessions over the past two months!
Date Topic Faculty
11-Jun Mixed Bag (Medical ethics, Palliative Medicine, Psych) Dr. Zaas, Chiefs
 

Recruiting Residents and Fellows for Study of Sedation Training Software

Duke University's Human Simulation and Patient Safety Center is recruiting residents for an Army sponsored study of our sedation training software.  We would like to reach the broadest possible set of non-anesthesia/non-surgery residents and fellows for our 60 person study. Participants who are selected will be compensated $500. There is a long term post test that will be held at our center in Sep. It is critical that study participants commit to coming back for the long term post.    Details on the following flyer:  2.PDAATS IRB Recruitment v5 Michael Steele, ILE@D Program Manager

Where are the Water Pouches?Gnome H2O

The first batch arrived and is quickly being deployed.  It is great to see how fast these are taking hold, so rest assured - more are on order.  For now Erin is the local distributer if you are stopping by the office to pick one up. Thank you to everyone for helping us make this migration away from bottled water a success!!  

Contact Information/Opportunities

 

Upcoming Dates and Events

  • June 14:  Chief Grand Rounds - Jason Webb, MD
  • June 20:  Kerby Society Durham Bulls Outing
  • June 21:  Chief Grand Rounds - Jeffrey Clarke, MD

Useful links

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