Weekly Updates - October 10, 2011 - Week 16

By rf21@dhe.duke.edu
The Internal Medicine Residency newsletter is posted each week to share important news, announcements and updates about the residency program. Please contact Rhea Fortune with corrections, contributions and suggestions.

From the Director

It's been another busy week in the program - I am feeling empathy for our residents taking the inservice training exam as I (and several other Duke faculty) got to do my ABIM recertification exam this week. Not to show how old I actually am, but last time I took it, it was a scan-tron. I did miss an awesome chest xray review noon conference to take my boards, but thanks Krish Patel and Dr. Goodman for leading the conference. As I was walking out on Friday, I heard from hospital medicine faculty Cecily Peterson that patients have continually commented on having "the best hospital experience they have ever had" from her gen med team, led by SAR Jennifer McCarty Gutierrez, interns Jeremy Halbe and Tapsi Dayanand (psych) and MSIV Christine McMahon.  Way to go guys!  Lynn Bowlby also sends a DRH-shout out to SARs Emily Ruden, Richard Wu and Mariam Naveed for providing fantastic care (as team leaders and dayfloats) to complex gen med patients!  For those of you at the DOC, get ready for JAR Dale Okorodudu’s (with cameo appearances by JAR Jason Watts, and Interns Aaron Mitchell and Lindsay Anderson) video newsletter.  It’s certainly in competition for an Emmy. Despite a "leak" in last weeks updates, JAR Jake Harris rocked chair's conference, with a great discussion led by David Simel. Both psychiatrists and internists learned to respect the thyroid! We also learned that Jake won the clinical vignette competition at the annual med psych meeting in Chicago and that Sarah Rivelli is chair elect for next years meeting. Some excellent presentations at report included SAR Sahar Koubar reminding us about the acid-base disturbances in salicylate toxicity and SAR Daniel Ong taking us to the bedside with a twist on the classic presentation of critical aortic stenosis.  Intern report was covered by former Duke Chief Brian Griffith but I hear that intern Bobby Aertker did an outstanding presentation of hepatorenal syndrome AND the differential diagnosis on the whiteboard in the med res library was phenomenal! Thanks to David Zaas, our Stead Attending for the week.  Next week, Joel Morgenlander (Neuro) joins David on the wards! Pubmed from the Program goes to two of our residents: JAR Hassan Dakik….The use of GTX as second-line and later chemotherapy for metastatic pancreatic cancer: a retrospective analysis. Dakik HK, Moskovic DJ, Carlson PJ, Tamm EP, Qiao W, Wolff RA, Abbruzzese JL, Fogelman DR.  Cancer Chemother Pharmacol. 2011 Aug 18. [Epub ahead of print] PMID: 21850466 SAR John Roberts for his article published with nephrology attending Uptal Patel: Roberts JK, Patel UD.  Management of Coronary Artery Disease in End-Stage Renal Disease Seminars in Dialysis 2011. Sep 9 Also, if you missed John’s meeting on teaching at the Durham City of Medicine HS, please email him for info. Looking forward to seeing the SARs and their significant others at our house on Tuesday night for Evening Rounds with Anna Lore.  Interns and JARs, there is a journal club at Manesh Patel’s house, organized by Manesh and Diana McNeill to discuss careers in cardiology and the ROCKET trial. And, for this week’s question…….what is the Gallaverdin phenomenon?  There is clearly a hint in this week’s updates. Have a great week,  Aimee

WIRTW (from Dr. Bill Hargett)

[box]Reference:  “Personal Best” by Atul Gawande, The New Yorker, October 3, 2011. (see attachment or this link:  http://www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande) [/box] Scenario:  No situational catalyst--it looked like an interesting article. Intellectual Plot Line:  Many top performers have coaches—why not doctors? Context for Residency:  Residency training can be stressful, particularly during the development of independent decision-making skills and learning to be comfortable with uncertainty.  As apprenticeship time decreases in internal medicine training, “deliberate practice” becomes increasingly important. “Smart” people are used to doing well and continuous testing and scrutiny doesn’t feel good.  Ignore this feeling.  You came to Duke to learn from the best (attendings, residents, nurses, therapists, coordinators, etc.) and everyone knows that training and patient care are team sports.  Take advantage of your opportunities by actively seeking observation and feedback. When you become an attending, you will miss the feedback.  Don’t believe me?  Ask any attending.  In Pulmonary & Critical Care, one of the reasons that several of us enjoy staffing the DRH ICU is for the opportunity to work closely with another attending in alternating 12 hour shifts. Key Quote:  “Expertise is thought to be not a static condition but one that doctors must build and sustain for themselves.” Take Home Point:  Use every opportunity (with your peers, patients, attendings, etc.) to engage in “deliberate practice” and get real-time feedback on your performance. Additional Info:  If you have any interest in instructional coaching (discussed in the article), check out Jim Knight's Blog:  http://jimknightoncoaching.squarespace.com/ Coaching a Surgeon What Makes Top Performers Better  

Health Policy: Just in Time

Duke GME Program Directors, Residents and Fellows are invited to participate in a Health Policy Lecture Series, presented by Fuqua faculty and national experts. This opportunity was made possible by the Duke GME Innovation Fund. First Topic:   Law & Medicine and Employment Law/Contracts (Tuesday, October 18, 2011 5:30pm-8:30pm) If you are interested, please complete and return the participant agreement (attached) to Joanne Schlueter (via email joanne.schlueter@duke.edu or fax 919-684-8565) by Monday, October 10, 2011. 2011.2012 Health PolicyAnnouncement & Participant Agreement

Duke Internal Medicine Book Club

When was the last time you reflected on how a patient’s illness and death affected you? If you would like to explore this and other related questions, please consider joining your fellow housestaff on October 26 at 6:30 in the MedRes library to review "Final Exam: A Surgeon's Reflections on Mortality" by Pauline Chen. Dr. Chen is a transplant surgeon who trained across the country, and you may have seen her column for the New York Times. In “Final Exam,” she looks at modern medicine and how medical training/the medical community deals with death and dying. The book will be reviewed and discussed as a group over approximately one hour, with specific topics to touch on coping and self-care. There will also be a format to survey housestaff interest in future topics. October 26 at 6:30pm Med Res Library.  All are invited to share in this great discussion! Look for more book club/self care events throughout the year! Please contact: Ashlei Lowery, M.D. or Juliessa Pavon, MD for details  

From the Chief Residents

In-Training Exams are underway...

All ITE’s begin promptly at 7:30 a.m. All examinees should arrive by 7:15 to allow for check in and the distribution of materials.  Each day consists of two 4-hour sessions with a short lunch break in between. The total testing time is 8 hours.  Lunch will be provided for you.  Pencils will also be available for your use. The testing rooms are historically kept cold, so please dress appropriately and/or bring a sweatshirt or sweater. There is no dress code for test days, however, please wear your id badge.  The day will end no earlier than 4:00 pm please refer to your email from Dr. Maziarz  for additional information THE SCHEDULE IS ATTACHED - please make note of the room assignments below:
Date
Day
Location
 14-Oct  Friday  DN 2003
 15-Oct  Saturday  DN 2003
 17-Oct  Monday  DS M224
 18-Oct  Tuesday  HH 131
DS M224 is in Duke South, Green Zone. Take the elevator on left just before you walk out into the Quad (near Dr. Dzau’s Office). Exit onto the 2nd Floor, turn R, room is on your left. Hanes House (HH131) is on the corner of Erwin and Trent (map attached). Testing room is on first floor ITE Schedule Hanes House 

Grand Rounds

Drs. Andrew Wang & Robert Harrison, Division of Cardiology, Title: TBA;  2002 Conference Room, Oct 14th 8:00 AM

Noon Conference

Duke North Conf Room 2002, 12:00 p.m.
Day Date Topic Presenter Vendor
Mon 10-Oct columbus day-no lecture lunch in library Papa John's
Tues 11-Oct Business of Medicine - Hospital Payment Shelby Reed Domino's
Wed 12-Oct Sexuality Bruce Peyser Souper Salad
Thurs 13-Oct Headaches Tim Collins Rudino's
Fri 14-Oct Chair's Conference M Diehl, R. Corey Bullock's BBQ

DOC video newsletter

Chief Resident Juliessa Pavon, MD, and her colleagues have a new video newsletter for news and updates from the residents and staff at the Duke Outpatient Clinic.

Project Homeless Connect (from Dave Karol)

Project Homeless Connect (PHC) is scheduled for Thursday, October 13, 2011 at the Durham Bulls Athletic Park. PHC is a one-day, one-stop, on-site center designed to link homeless people with needed services and to reduce major barriers that prevent people from becoming stably housed. Medical screening and care is a part of this, and Dr. Larry Greenblatt has worked with residents on this day in the past in a mini Health Care for the Homeless Clinic. He is looking for interested resident volunteers who would be willing to spend a day or half-day working with him. Interested residents, particularly those on ambulatory rotations, should contact the chief residents to discuss the feasibility of being excused from regular clinical services that day. Residents can also contact Dave Karol, med/psych PGY-5, or Shereen Katrak, PGY-2, for more information regarding opportunities to volunteer on 10/13 as well as other days at the homeless shelter clinic in downtown Durham. Project Homeless Connect flyer  

Save the Date  (from Tian Zhang and Leon Cannizzaro) 

Save the date and start planning your Halloween costumes! The annual Halloween party, organized by the intern reps of the residency council, will be on Saturday, October 29th, at The Tavern. 1900 W. Markham Ave., Durham. Watch out for SPOOKY details to follow!  

Recruiting Season Kickoff

Make note on your calendar for the kickoff of our next major event  - the kickoff to "RECRUITING" season! November 1, at G2B Gastropub from 7 - 9. Who's playing?  The best team of residents and faculty in the country.  Don't miss it!

 

Turkey Bowl Practice

Turkeybowl Practice - Sundays at 3:30pm - Forest Hills Park

   

QI Corner (from Dr. Jon Bae)

Quality Improvement and Patient Safety Noon Conference conference will  occur the last Wednesday of each month.  Be sure to Save the Date for our next conference -- Wednesday, October 26th --  when Judy Milne from Patient Safety will present an introduction to "The Culture of Safety". And if anyone is interested in getting involved now, or has an idea for a quality improvement project, please come talk to Jon Bae or Aimee Zaas. A Reminder.... the 7th Annual Duke Patient Safety and Quality Conference is Thurs Dec 15.   (see attached flyer). Pt Safety & QI conference info

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From the Residency Office

Required Procedures for Program Completion:

The med res office has  received questions regarding which  procedures must be logged and the number for completion of your training in Internal Medicine.  I hope you find the information provided below answers these questions.  If you need further information, you may contact Rhea or Dr. Zaas.  Please don’t forget that all procedures must be logged into medhub and must be approved by an attending physician (fellows and senior housestaff are NOT permitted to sign off on intern/resident procedures).  Also note that you are encouraged to continue to log procedures even after you have met the threshold.  Many facilities require you to provide a log of procedures performed when you are credentialed  for employment. As stated by ABIM…. ABIM procedure requirements ". ….to assure adequate knowledge and understanding of the common procedures in internal medicine, each resident should be an active participant for each procedure five or more times." Required procedures include:
Abdominal paracentesis Incision and drainage of an abscess
ACLS  (continued certification) Lumbar puncture
Arterial line placement Nasogastric intubation
Arthrocentesis Pap smear and endocervical culture
Central venous line placement Placing a peripheral venous line
Drawing venous blood Pulmonary artery catheter placement
Drawing arterial blood Thoracentesis
Electrocardiogram

Fit Testing/ T-Dap Vaccination/ TB Skin Testing

Fit Testing/ T-Dap Vaccination/ TB Skin Testingwill be available on a limited basis at Duke North for employees in October.  Persons that need Fit Testing on other days can come to EOHW at Duke South. Normal schedule will resume in November. Also available:            Color Vision   Flu Shots   TB Skin Testing   (T-Dap) vaccine (Diphtheria, Tetanus, Pertussis) Required for all employees working with Children 18   months of age or younger. Location - 4th floor room 4000C. Mark Urbano, David Triplett, or Amy Weaver will be your fit testers. They will alternate fit testing in room 4000C (This Room is beside the private patient elevator behind the main circle elevators on the 4th floor) Feel free to call us in room 4000C-  at 681-7185 (No Voice Mail), or at Employee Health at 684-3136 Option 2 or Rita Oakes 681-0513,  if you have questions.  See  Flyer:      Fit Test Flyer

BLS Blitz – Do Not Miss This Opportunity

If your BLS expires between Nov 14, 2011  and March 30, 2012,  THIS IS FOR YOU. (no other BLS classes will be available until April, 2012) The  BLS Blitz will be held at Hock Plaza from November 14 through 17, 2011. Sessions will be held as follows: 8:00 a.m. – 10:00 a.m.             3:00 p.m. – 5:00 p.m. 10:00 a.m. – 12:00 p.m.           5:00 p.m. – 7:00 p.m. 1:00 p.m. – 3:00 p.m. Additional sessions on November 14 and 16, 2011 will be held at 7:00 p.m. – 9:00 p.m. Location: Hock Plaza, Suite G07 Based on feedback from participants and leadership, we have identified a new process for participants to register for their preferred session via Swank. We are able to accommodate 96 participants per session and hope it will be a customer satisfier to have a registration option in place. Attached please find the directions for staff to register in Swank and an Informational Blitz Flyer. Once registration has been completed in Swank, a confirmation will be e-mailed to the address provided by the registrant. Participants must bring confirmation e-mail and present it at the registration desk. Walk-ins will be accommodated only as space allows.  Staff are expected to have a copy of the AHA BLS Provider Manual and their Duke ID Badge for the Blitz. Blitz registration 2011 Fall Blitz

Posting Schedules on MedHub

Please remember that the schedule assignments for many of our services are posted on MedHub’s home page under “Resource Documents”.    Our target is to post detail schedules no less than 1 week before the start of each block. The posted services include:
Duke Gen Med DRH MICU
DRH Gen Med CCU Duke
VA Gen Med Call and Clinics CCU VA
Duke Night Float SS VA MICU
CAD Duke MICU
Pulm 9100 Intern
Neuro
Block 5 Schedules are  posted.   Remember, all time off requests must be submitted to the Chiefs no later than one month ahead of the start of a block – unless they are of an urgent nature.  Any requests to change schedules on short notice will be expected to be presented with a coverage proposal and who/how coverage will be accommodated.  No changes can be made without approval by the Chiefs, and all time off must be reported.

Noon Conference - Grand Rounds Recordings

Reminder noon conference and grand rounds are being recorded each day.  If you missed conference and would like to "catch up", simply open MedHub, go to your personal calendar, click on the conference you would like to view, and then click on the link provided.  Let us know how this is working and whether you find this option helpful.

ILP - Directions

Dr. Woods recently sent out a reminder to everyone regarding Individual Learning Plans.  Attached please find a copy of the information distributed for future reference. ILP-Requirements-Directions-9-19-11

North Carolina Controlled Substance Reporting System

Many of you have applied to use the NCCSRS.  Thank you!  If you haven't, keep reading.  We are trying to get all the residents to sign up and use this valuable resource routinely.  Please note that the VA may have rules about using this resource.  Please check with your faculty there before using for your veteran patients*. This website will allow you to see your patients' prescriptions of controlled substances that were filled in North Carolina.  Information provided includes the medication, number dispensed, pharmacy, and prescriber.  This information can be very useful in preventing unintended medication overdose as well as abuse and diversion of controlled substances.  The application is attached below and is brief and straightforward.   Your password needs to be renewed every 12 months from the time you first signed up.  You'll need to have your application notarized.  Locations of notaries include: -Duke Outpatient Clinic, Gloria Manley -Medical Residents Office, Rhea Fortune -VA Federal Credit Union, First Floor.  You will be charged a small fee. *Note that the VA requires physicians to obtain written, informed consent before accessing a veteran's data on this site. We have arranged to have submitted to the state all resident DEA numbers and verification that you are in training at Duke. Instructions for using the website are available after you have registered.  It is easy to use.  Please take a moment and read the Do's and Don'ts file about using this important resource. North Carolina Controlled Substance Reporting System csrs-applicationform Do's & Don'ts for Prescribers Using NC Reporting System Larry Greenblatt, MD ;  Associate Program Director for Ambulatory

Internal Medicine Topics and Career

Interns and PGY2’s :   You are invited to Dessert and Discussion of  Internal Medicine Topics and Careers Tuesday, October 11, 2011, 6:30-8:00PM, specialty topic will be Cardiology. Home of:    Drs. Manesh and Sallie Patel, 35 Wilhelm Drive, Durham, 27705 Come and meet faculty, fellows, and residents for casual discussion on their careers and an article in their field: Dessert & Discussion please RSVP to Dr. Diana McNeill at  mcnei006@mc.duke.edu

Flu Vaccination

Residents/fellows can receive at Duke Hospital, DRH and Duke South clinics (as they're working in clinical areas) Residents, at VA can come to cafeteria or Employee Occupational Health and Wellness Duke South Clinics.

The Learners' Perceptions Survey is Open

The VA Learners' Perceptions Survey is a valuable tool that is used to help improve training opportunities.  Please take the time this week to log in and provide your feedback using the following link:     http://www.va.gov/oaa/surveys/

Your responses will be kept confidential.  If you have trouble logging in, call 1- 888-877-9869 or e-mail    OAA Help Desk.

Dates to Add to Your Calendars

Oct 7-18  -  Inservice Training Exams Oct 11 - Evening Rounds at the Zaas' Oct 18 - Fuqua Health Policy Lecture 5:30-8:30 pm Oct 22 - Greenfield Celebration Oct 26 - Duke Internal Medicine Book club, 6:30 pm, Med Res Library Oct 28 - Medicine Research Conference, 12 noon in DN2002 Oct 29- Resident Halloween Party, The Tavern, details TBA Nov 1 - Recruitment Kickoff, G2B Gastropub 7-9 Nov 14-17 - BLS Blitz Dec 10 – DOM Holiday Party Dec 15 - Duke Patient Safety and Quality Conference Feb 24 – Charity Auction (Contact Tian or Ann Marie to participate) June 13 –Resident Research Event, 5-7pm

Career Opportunities:

Medical Career Path Opportunities Traditional IM Opportunity (Northeast NV)

Useful links

   

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