Weekly Updates: May 27, 2013

By admin3

From the Director

Get ready! Before you know it (as in Tuesday), we have the return of Seersucker Tuesday! While Phil may have been more pre-occupied with the birth of his beautiful daughter, time has been flying along and we are rapidly approaching the first Tuesday after Memorial Day.  Hope to see you all representing in your striped finest. Kudos this week go to Scott Westphal for an absolutely phenomenal CPC.  The explanation of the metabolic defect leading to the patient's diagnosis was outstanding, and all around just a great discussion.  Thanks Scott and to all who attended.  Also kudos to Leah Rosenberg on a gold star as well as a comment from a patient at DRH to hospital leadership on her wonderful care. Additional kudos to Hany Elmariah on his ASCO award and Jason Rose on his ATS Abstract Award.  Looking forward to seeing both of them (and many others) present at resident research night next week. Ryan Schulties kicked off the Chief's Grand Rounds series in awesome fashion, as anticipated! Great job Ryan.  We look forward to hearing from George Cheely next Friday. Please don't forget to fill out your Learner's Perception Survey…this helps us know what is going well with the continuity clinics and where we need to improve.  Thanks to all who have filled this out already! This week's pubmed from the program goes to Saumil Chudgar and Bill McManigle for their presentation at the SHM meeting in DC…“Teaching Essential Skills: Training Medical Students in Quality Improvement, Procedures, and Transitions of Care.” Have a great week! Aimee [box]

What Did I Read This Week

(submitted by Alex Cho, MD, MBA)

Jenkins, L. “How ‘bout them apples.” Sports Illustrated. April 29, 2013. Available at: http://sportsillustrated.cnn.com/vault/article/magazine/MAG1207447/index.htm.

Gawande, A. “Personal Best: Top athletes and singers have coaches. Should you?” New Yorker. October 3, 2011. Available at: http://www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande.

[/box] ChoLooking back, I’ve sometimes – almost wistfully – thought that I was at the peak of my (admittedly limited) powers as an all-around clinician (from primary care to hospital medicine and critical care, from central lines to communicating bad news; you get the drift) as I neared the end of residency. And then it’s done – the mix of ICU and primary care and back again is over, and slowly but surely, skills fade.  Perhaps more importantly, no one really ever directly observes (or asks to) any more how one practices medicine.  And, until Jon Bae succeeds in beating Epic (nicely) into giving up its secrets, even the performance data we might get (admittedly not as easily reduced as shooting efficiency) has its limits as well. So, to the graduating SARs, I salute you. And in your honor, submit two articles for your consideration in this week’s WDIRTW. Let’s start with the fun one first.  This profile of Kevin Durant, whom many would consider the second-best player in the NBA today (behind Lebron James), talks about how he is trying to overcome that label – and win a championship in the bargain – by consulting a statistician who tells him like it is, and watching things like his shooting efficiency from different points on the floor, his impact on scoring by others, and of course, video.  The result?  The OKT had a better season statistically than they did last year, which makes no sense, because they traded key third man James Harden (not to be confused with our own Ivan Harnden), the fifth-highest scorer in the NBA, days before the season began.  And Durant himself took the fewest shots of his career.  But his efficiency was the highest it had ever been, and he increased his average APG (assists per game) by nearly two, versus a couple of years ago.  That is, he was making his team better, and in the words of his coach Scott Brookes, scoring “smarter.” (Now, the OKT were knocked out in the second round by the Memphis Grizzlies, so maybe there’s a bit of reverse-Hawthorne effect going on here, otherwise know as the SI cover curse.  Or maybe in the playoffs it really does take at least three marquee players.) So what does this have to do with anything?  (Besides medicine also being a team sport.) Atul Gawande opens his piece by speaking to the fact that he feels like his performance in the OR has plateaued.  On the one hand, he says he’d like to think this is a good thing, that he’s arrived at his professional peak.  But on the other, he confesses it also seems to him that he’s just stopped getting better. To continue with the sports metaphor, he recounts how, during some downtime during a medical meeting, he goes to a local tennis club looking to get some whacks in.  He ends up hitting with the club pro, who after playing some points, begins coaching Gawande, pointing out that he could get more power from his serve.  Gawande reports being dubious, having been a fair player himself in high school, playing in national tournaments, and that his serve had always been the best part of his game. But then with some tinkering at the direction of this impromptu coach, Gawande soon began serving harder than he ever had.  Not long afterwards, he was watching Rafael Nadal play, and the camera panned to his coach – and what he admits as being completely obvious struck him: even Nadal had a coach; almost every elite athlete does. “But doctors don’t.” Gawande then describes how he enlists one of his former attendings, Robert Osteen, with whom he had done his first splenectomy, and who let him discover for himself during that operation – without prompting or anger – that he had made his initial incision too small to fully expose the spleen.  Gawande asks Osteen now to observe him doing a thyroidectomy, a procedure Gawande had done about a thousand times before – secretly wondering if he would have anything to tell him that he didn’t already know. Osteen comes up with a whole list of observations, from the fact that the patient was draped in a way that perfectly accommodated Gawande, but made it difficult for the surgical assistant to assist, that Gawande’s elbows were up in the air at times – suggesting that he was not in the right position or needed different instruments, etc.  The piece then goes on to describe how, through the use of a mix of video and in-person observation, Gawande continues the coaching relationship with Osteen. Gawande also doesn’t mince words when it comes to discussing the uncomfortable implications.  When patients – and we, too – would rather think of physicians as fully trained, completely knowledgeable, and incapable of mistakes, it can be hard to advance the parallel idea that doctors might also benefit from continued coaching.  And so to a large extent it is left up to each and every one of us as individuals to self-assess, note our flaws, and take advantage of opportunities and talented colleagues – particularly here at Duke, at both a resident and attending level – to get even better at what we do. [divider]

From the Chief Residents

Grand Rounds

Date                  Chief Resident Grand Rounds May 31             George Cheely, MD

Noon Conference

Date Topic Lecturer Vendor
5/27 Memorial Day- no noon conference
5/28 MGUS/Myeloma Dr. Arcasoy The Picnic Basket
5/29 Gallops ACRs Saladelia
5/30 Extended Infusion Vancomycin Rebekah Moehring Domino's
5/31 Chair's Conference Chiefs Chick-fil-A

Thank You !!

Sometimes, when you are so relieved to be finished with something, you forget to thank some of those people that helped you the most.  I made that mistake this ff4morning, rushing through my thank-Us and forgetting the real Chief Residents that make this program great everyday.  They deserve my formal acknowledgement.  But instead, they will get strange Photoshop Gratitude!  I present to you, the real fantastic four! Thank you Jeff, Jason, Nicole, and George.  I could never ask for a better group of Chiefs to work alongside.

Maestro - Short and Sweet

OK - so maybe not sweet, but we are adding brief - focused Maestro sessions (15 minutes) to a numnber of our upcoming noon conferences. Why?  To help get everyone to the same skill level, and also to take advantage of lessons learned. Please make every effort to put the following dates on your schedules:  June 6, 7, 10, 14, 19, 20, 21.  More to come as details unfold. [divider]

From the Residency Office

Additions to Our Family (submitted by Phillip Lehman, MD  )

"Emily and I are super proud, excited, and a bit exhausted to introduce our daughter, Anna Giles Lehman, to Duke Medicine!Lehman 1 She weighed in at 6 lbs, 10 oz and 19.25 inches.  We're at home and Emily and Anna are doing so well! Lehman 2Here are our two favorite pictures!  Please share.  And next week, we have a double whammy pink shirt extravaganza to share!!!

SAR Board Review Schedule

Board Review Sessions will be held in the MedRes Library, Duke North, 8th Floor. Please contact Megan Diehl or Jeff Clarke if you would like to attend.  The schedule is as follows:  
Date Topic Faculty
22-May Renal Dr. Butterly
28-May Neurology Dr. Skeen
5-Jun Dermatology/Rheumatology Dr. Criscione
11-Jun Mixed Bag (Medical ethics, Palliative Medicine, Psych) Dr. Zaas, Chiefs

CRQS Community

108412_schulteis001-300The VA Chief Resident Quality and Patient Safety year is fast coming to an end.  If you would like to get a snapshot of the accomplishments over the past year, here is your chance.  The Chief Residents from across the country will be presenting their work on June 4th and 5th. Ryan Schuleits (Improving Care for Veterans Presenting with Chest Pain) will be presenting on June 4th @ 15:20. Sessions will be held in the 8th floor conference room of the VA Medical Center.  The sessions have been designed to be interactive and should offer opportunities for spirited discussion regarding the important work that will be presented. The following link provides the full schedule of presentations: CRQS- 2013 Schedule of end of year presentations  

Contact Information/Opportunities

 

Upcoming Dates and Events

  • May 31:  Chief Grand Rounds - George Cheely, MD
  • June 4:  Resident Research Conference, Searle Center
  • June 7:  Chief Grand Rounds - Nicole Greyshock, MD
  • June 8:  SAR Dinner, Hope Valley Country Club
  • June 14:  Chief Grand Rounds - Jason Webb, MD
  • June 21:  Chief Grand Rounds - Jeffrey Clarke, MD

Useful links

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