The Internal Medicine Residency newsletter is posted each week to share important news, announcements and updates about the residency program. Please contact Randy Heffelfinger or Emily Strollo with corrections, contributions and suggestions.
From the Director
Hey everyone, and hope everyone remembered daylight savings, aka "drawing the short straw for those on call or night rotations Saturday night!". We have had a spectacular week, with a cool case of hsv meningitis presented by SAR
Kristen Dicks at DRH report, plus much learning regarding candiduria at Duke report from SAR
Ed Coverstone, plus too many opportunities to laugh at, I mean with, ACR
Dan Fox. Our first recruitment day exceeded all expectations, so a huge thanks to all who went to dinner, chatted with the applicants and led tours. SAR
George Cheely knocked chairs conference out of the park and our first SAR talks with
Jason Webb and
Christy Kaiser set a high bar for all.
We announced our newest program initiative, the
Stead Academic Societies of Duke Medicine, led by
Matt Crowley, Steve Crowley, Susanna Naggie, Ben Powers and Heather Whitson. I am so pleased to see that JAR
Coral Day came up with the first competition, which is to see which society can raise the most money for our annual thanksgiving food drive.
I am so proud to show off our great program to the "future Duke residents" who are interviewing. Thanks also to our Stead Attendings
Diana McNeill and
Peter Kussin. Joining us next are
Alastair Smith and
Mitch Heflin!
Pubmed from the program this week highlights DRH ACR and Med Psych PGY-5
David Karol: A case of delirium, motor disturbances, and autonomic dysfunction due to baclofen and tizanidine withdrawal: a review of the literature. Karol DE, Muzyk AJ, Preud'homme XA. Gen Hosp Psychiatry. 2011 Jan-Feb;33(1):84.e1-2. Epub 2010 Nov 13. Review.
Have a great week and don't forget to sign up for recruitment dinners, tours, and to order your Duke Med Res fleece (thanks to
Matt Chung for organizing)!
Aimee
QI Corner (from Dr. Jon Bae) - Update 11/5/2011
The medicine residency program needs to
SAQ It Up! Please continue to fill out the Duke University Health System
Safety Attitudes Questionnaire (the SAQ). Our target completion rate is 100% (including med peds and med psych) and we are only about 1/3rd of the way to goal. We
need all of you to participate in this survey which will help us better assess the culture of safety here at Duke. The importance of this survey to understand our culture and to make our work environments and patient care better cannot be understated:
you can make a difference!
The survey has been sent to you via email and should take between 10-15 minutes. It will have the subject line "DUHS Safety Culture Survey" from
Pascal Metrics (you can search for this). If you have not received it, check your junk mail folder. If you still cannot find it, please alert Jon Bae.
Here are the response rates through 11/4/2011.
QI - Safety Questionnaire Response Data
Upcoming QI Opportunities:
1) Patient Safety and Quality Improvement Noon Conference:
Wednesday,
November 30th, Noon Conference
Speaker: Catherine McCarver, Duke Heart Center
2)
Join the "Always" Event Task Force: This task force is part of the hospital "Patient Oversight Team" which looks to redesign the patient care experience. This task force will be responsible for generating a list of expectations related to things that will "Always" happen with patients and families. They are seeking interested resident participation. If interested, please contact Jon Bae.
3) Don't forget to
complete your new and improved
QI modules. All interns will be given dedicated time to complete these during geriatrics rotations. SARs/JARs will be given a dedicated half day during ambulatory blocks to complete as well. However, you are free to complete these modules at any time and instructions are included below.
Clinical Quality Improvement Modules Instructions:
Some of you may notice that you have a half day of Quality Improvement while on ambulatory or geriatrics. During this time, you are required to complete a clinical quality improvement course. This course will help improve your skills in ACGME core competencies, Practice-Based learning and improvement and Systems-Based practice. Please go to https://courses.duke.edu and log on using your net id and password. You should see “Fundamentals of Health Care Improvement" course assigned to you. The course has pretests, 8 modules (each roughly 15-20 minutes in length) followed by individual module tests and post tests. We suggest logging in and not waiting until last minute to check and see if you are able to get to the modules without any difficulty. All residents are expected to complete this course at least once. If assigned, these modules must be completed by the end of the current ambulatory block; we suggest you utilize your dedicated half day to do so. If there are any questions, please contact Jon Bae or Juliessa Pavon.
Flu Vaccination
Although a large number of our residents took advantage of getting their flu shot during the recent blitz, we are a long way from the expected rate of 100% participation (as of November 4 only 60% have been vaccinated). The vaccination rates on the following attachment are sorted by the recently announced Stead Societies, and the dates/locations when vaccinations are available are highlighted in the attached flyer.
Flu Vaccination - Nov 4, 2011
Resp Fit Testing-T-Dap-TB Skin Testing Flyer Nov 2011
Stress Management and Practice Enrichment
Duke Integrative Medicine is offering stress management and practice enrichment workshops during the month of November. You are invited to attend ANY or ALL of the sessions whenever you have time available. Check out the attached flyers, and consider taking advantage of this unique opportunity
REFUGE FAQs
Drop In Sessions, Oct. and Nov.
What Did I Read This Week (by Dr. Saumil Chudgar)
[box]“The Bedside Evaluation: Ritual and Reason”, Abraham Verghese, Erika Brady, Cari Costanzo Kapur, and Ralph Horowitz,
Ann Intern Med. 2011;155:550-553.
Bedside Evaluation. [/box]
Why did I read this? I had a very interesting discussion with Joe Doty, Dr. Klotman, and Dr. Zaas about the
Stanford 25 – a series of physical exam techniques that emphasize the return to a patient’s bedside. Dr. Verghese, who authored the
Stanford 25, recently published this editorial in
Annals discussing the importance of the bedside evaluation in the care of the patient.
The growing concern: Dr. Verghese asks what role the bedside evaluation (history and physical exam) has today in an era where diagnostic methods seem to focus on laboratory tests and imaging. He states that technological advances have led to the atrophy of bedside evaluation skills.
Why is the bedside evaluation still important? Skillful bedside evaluation allows for efficient gathering of diagnostic information. He argues that the bedside evaluation remains valued as a ritual – a connection between the doctor and patient that cannot be replaced. It is ritual learned through apprenticeship – students and residents learn the art from their attending physicians. Most importantly, it puts the patient at the center of attention. Like other rituals, there is a unique terminology used (“fremitus” and “Osler’s nodes” for example). The satisfaction generated in young physicians with the bedside evaluation is very important.
Take home message: “Patients have an expectation that their doctor will examine them in a skilled, respectful, and ritualized fashion. If the expectation is fulfilled, it brings about a positive therapeutic effect.”
How will this change my practice? On a busy clinical service, it may be perceived that “card-flip” rounds in a workroom are quicker and leave more time to “get work done.” This editorial is another reminder of the importance of the bedside evaluation as a method to gain information, improve the doctor-patient relationship, assess the skills of our learners, and teach by modeling behavior to the team.
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From the Chief Residents
Grand Rounds[hr]
| Date of Lecture: |
November 11, 2011 |
| Title of Lecture: |
“Inpatient Management of Diabetes Mellitus: Update 2011” |
| Speaker(s): |
Lillian F. Lien, MD |
Noon Conference
| Day |
Date |
Topic |
Lecturer |
Time |
Vendor |
| Monday |
11/7 |
Medicine Interview Day |
|
12:00 |
Pipers |
| Tuesday |
11/8 |
Med Peds Interview Day |
|
12:00 |
Saladelia |
| Wednesday |
11/9 |
Etoh Withdrawal - Clinical Pathways |
Sarah Rivelli |
12:00 |
Moe's |
| Thursday |
11/10 |
SAR TALK |
Zhang/Odunusi |
12:00 |
Papa John's |
| Friday |
11/11 |
Chair's Conference |
Chiefs |
11:00 |
Nosh |
Turkey Bowl Practice
Turkeybowl Practice - Sundays at 3:30pm - Forest Hills Park
Duke Medicine Fleece (from the Residency Council)
Always envious of the Duke ER fleeces? Want something to identify ourselves with? Now's your chance to buy your very own personalized (if you wish)
Duke Fleece Announcement!! Fleeces without the name are $30 each, and fleeces with your name will be $35 each. We will collect money in the medicine residency office.
Please sign up on the google spreadsheet and put in your order by next Tuesday November 8th, in order to get our fleeces by Thanksgiving and Turkey Bowl!! Google spreadsheet is here:
<https://docs.google.com/spreadsheet/viewform?formkey=dG1WMGM4bDdNUEk1QlB0Y3A5SzVOQ0E6MQ>
Brought to you by our enthusiastic JAR
Matt Chung. Email us if you have any questions!
Happy Friday, Tian and the Residency Council
Cardiovascular Research Center - Seminar Series
We have attached the schedule of the Cardiovascular Seminar Serires for those have have an interest in cardiovascular research. The conferences typically are held on Wednesdays at 4:00 in the Jones building.
Cardiovascular Research Center
[divider]
From the Residency Office
Dates to Add to Your Calendars
Nov 24 - Turkey Bowl !!
Dec 10 – DOM Holiday Party
Feb 24 – Charity Auction (Contact Tian or Ann Marie to participate)
June 13 –Resident Research Event, 5-7pm
Useful links
