From the Director
Go DUKE! Now that was some basketball! The days are getting longer now, and we just had what is traditionally known as the best night to be on night float, but a tough day to get to work in the morning — daylight savings! What a great way to head into MATCH WEEK! We are looking forward to announcing what will be a spectacular class of interns. Please RSVP to the Match Party at Dr. Klotman's if you haven't done so already.
It's week 2 of MiniCex Madness! Congratulations to our winner,
Ryan Huey!
I'm pleased to note SAR participation in the MiniCex Madness, including
Leah Rosenberg, Kevin Riggs, and Sahar Koubar! Keep logging those MiniCex's and get yourself entered into this week's drawing.
Kudos this week to
Josh Briscoe for a compliment sent in by a patient's family from CAD for his excellent care; also from
Vaishali Patel to Nilesh Patel for great work at the VA. Welcome to our new ACR's -
Carrie Horney, Megan Diehl and Bonike Oloruntoba, and thanks for getting the annual board review started. We also heard two outstanding SAR talks from
Carrie Horney and Leah Rosenberg, both covering topics in palliative care and end of life issues. Please also see the perspectives piece in this week's NEJM by
Amy Abernethy on palliative care competencies.
Speaking of the NEJM, this week's Pubmed from the Program goes to
Phil Lehman for his article in the NEJM "The Step 2 CS Exam – A Poor Value Proposition" !
http://www.nejm.org/doi/full/10.1056/NEJMp1213760….Phil wrote this article with fellow MLPR resident Jason Ross Guercio.
Also congratulations to JAR
Lauren Prats on her wedding! Looking forward to seeing pictures.
We would also like to announce the
ACRs for 2013-14.
- Duke: Lindsay Boole, Hany Elmariah, Brian Miller, Jim Gentry, Marcus Ruopp, and Matt Summers
- DVAMC: Mandar Aras, Tyler Black, Alex Fanaroff, Chris Hostler, Ashley Lane, and Jenn Rymer
- DRH: Kim Bryan, Meredith Edwards Clement, Carter Davis, Bronwen Garner, Lauren Prats, and Carling Ursem
Have a great week!
Aimee
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What Did I Read This Week (submitted by Jeffrey Clarke, MD)
Generalist plus Specialist Palliative Care — Creating a More Sustainable Model; Timothy E. Quill, M.D., and Amy P. Abernethy, M.D.
N Engl J Med. 2013 Mar 6
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While the usual convention for WDIRTW is to discuss some latest and greatest RCT, I was inspired this week by the strong representation of Duke in the NEJM on Wednesday (by Philip Lehman and Amy Abernathy) and by the fantastic SAR talks on Thursday (by Carrie Horney and Leah Rosenberg) on advanced care planning. As a result, I decided to highlight this important perspective article by Quill and Abernethy. This article resonated with me for multiple reasons-- As a relatively inexperienced oncology fellow last year, I found balancing the palliative care needs of my patients with standard cancer treatments and preservation of hope to be a constant struggle. Additionally, I find myself this year thinking frequently about the (potentially insufficient) formal training on basic palliative medicine that we receive as Duke IM house staff.
As general internists, future subspecialists, and faculty, a nontrival portion of our training and time is spent focused on relieving symptoms and caring for patients nearing the end of life. Further optimizing palliative care for our patients is an imperative, not only to reduce suffering for those in our care, but also because clinical demand will soon outgrow the
supply of palliative specialists. Quill and Abernethy, point to this reason, in the context of ever-dwindling healthcare resources and pressure for cost-conscious practice, as primary motivators for reframing the delivery of palliative care in this country. They also highlight the opportunity to preserve clinical relationships between patient and primary physician, and prevent the further fragmentation of care.
The care model of palliative medicine proposed by Quill and Abernethy relies on delineating an expected, fundamental skill/knowledge set that all physicians should be able to implement (generalists, subspecialist, etc) versus specific roles for palliative care specialists (described in table). The clinical need for this approach transcends many disease states (and is in no way limited to just oncology or critical care) including advanced heart failure, renal disease, lung disease, dementia, stroke, etc. The authors call for an expansion of education and training to build and improve this skill set in our healthcare providers, including students, residents/fellows, and physician extenders. Indeed, curricula like Oncotalk, for instance, has already been widely successful in providing such education. The arching goal of this realignment is to achieve a ‘coordinated palliative care model,’ in which the palliative care specialist is working in concert with (not in place of) the primary physicians in appropriate situations to provide optimal patient care. The end-result is a system, which not only maximizes resources, but also preserves established patient/family-physician relationships, and minimizes redundant care.
Like countless others, I tremendously value the relationships with my patients and families in clinic. As usually the primary physician for their cancer care in a complex, multidisciplinary setting, I strive to communicate effectively and provide appropriate primary palliative care to all of my patients. The model of ‘-and with-‘ (Thanks Dr. G…) is appealing to me, in that it acknowledges and preserves my established relationship, but also recognizes specific clinical situations exist in which my (our) skill set may be inadequate. The model of coordinated palliative care proposed Quill and Abernethy seems to be a necessary shift in the approach to palliative medicine, which would ultimately benefit our health care system, but more importantly, improve care for our patients.
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From the Chief Residents
Grand Rounds
| Date |
Division |
Speaker |
| 3/15 |
Cardiology |
Dr. Rich Becker |
Noon Conference
| Date |
Topic |
Lecturer |
Time |
|
| 3/11 |
Gout & crystal-induced arthropathy |
Rob Keenan |
12:00 |
|
| 3/12 |
SAR talks |
Coral Day |
12:00 |
|
| 3/13 |
Schwartz Rounds |
Lynn O'Neill, Lynn Bowlby |
12:00 |
|
| 3/14 |
SAR talks |
Brett Goodwin, Kevin Riggs |
12:00 |
|
| 3/15 |
Chair's Conference |
Chiefs |
12:00 |
|
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From the Residency Office
Geriatrics Joins NRMP in Independent Match for 2014
Please review the following announcement if you are interested in applying for fellowship in Geriatrics.
-
Appointment Year 2014: Match Opens August 28, 2013
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Match Day January 8, 2014
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Fellowship Begins July 1, 2014
geriatrics match
Webinar Announcement: A Survivor's Journey: Understanding the Health Impact of Abuse and Paths to Promote Wellness
Date & Time: March 25, 2013; 10:00 AM - 11:30 AM PDT (11:00 AM MDT/ 12:00 PM CDT/ 1:00 PM EDT)
Description: This webinar will explore the health impact of abuse from the experience of one survivor of violence, and discover how she learned to become proactive in her healthcare. This webinar is targeted to domestic violence (DV) and sexual assault (SA) advocates and healthcare providers. For more information, please visit our
website.
This webinar is presented by the
National Health Resource Center on Domestic Violence with support from the
Family Violence Prevention & Services Program, Family & Youth Services Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.
Speaker: Olga Trujillo, JD, is an independent consultant, nationally renowned speaker, survivor, and attorney dedicated to enhancing understanding of - and building effective responses to - violence against women and children.
Participants will learn about:
1) The impact that psychological trauma can have on a survivor’s ability to actively care for her health and wellness.
2) The role of advocates and other survivor-focused programs, such as free dental and reconstructive surgery programs, to help improve the healing and wellness of survivors of violence.
Operation Medicine Drop March 17 - 23
Operation Medicine Drop is a partnership of Safe Kids North Carolina, the Riverkeepers of North Carolina, NC State Bureau of Investigation, Community Anti-Drug Coalitions of North Carolina and local law enforcement agencies working together to encourage the public to safely dispose of unused and unwanted medication. By providing safe and secure ways for people to get rid of unwanted prescription and over-the-counter medications, Operation Medicine Drop helps prevent accidental poisonings and drug abuse while protecting our waters. Since 2010, Operation Medicine Drop has collected more than 30 million at almost 1000 events. To arrange or find a drop off event:
http://www.ncdoi.com/osfm/SafeKids/sk_OperationMedicineDrop.asp
Hot Topics in UME, GME & CME
Come explore the innovations and challenges across the medical education spectrum!
Please register using the following link -
https://www.surveymonkey.com/s/MedEdGrandRoundsReg2012
- Monday, March 11 4pm (DN 2001)
-
Tuesday, March 12 12noon (DN 2001)
-
Wednesday, March 13 7am (DN 2003)
Presented by:
Colleen Grochowski, PhD, Associate Dean for Curricular Affairs, School of Medicine
Alisa Nagler, JD, MA, EdD, Assistant Dean, Graduate Medical Education
Katherine Grichnik, MD, MS, FASE, Associate Dean, Continuing Medical Education
Contact Information/Opportunities
Hospitalist Flyer
Physician Zoo Day Flyer
Huron description
Upcoming Dates and Events
- March 12 & 19: Duke Medical Oncology fellowship discussions, 4:00, Med Res Library
- March 15: MATCH DAY CELEBRATION at Dr. Klotman’s!
- March 25-28: BLS Blitz (registration: blsblitz )
- March 29: Faculty Resident Research Grant Application Deadline
- April 19: Residency Program Pictures (rain date May 10)
- April 28: 2nd Annual Stead Tread
- June 4: Resident Research Conference, Searle Center
- June 8: SAR Dinner, Hope Valley Country Club
Useful links
