Weekly Updates - October 3, 2011 - Week 15

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

Hello!  A few sunny fall days in a row, and it does a lot for everyone’s mood!  The week was busy and fun, with some great happenings to note…Diagnostician of the Week is JAR Blake Cameron, for his overall work as a night JAR on Duke Gen Med, including supervising a sub-I’s admissions and using his physical exam findings to change the plan of care for a patient.  Nice work, Blake.  Another compliment to SAR Lauren Gratian, who was spotted giving feedback to night hospital medicine attending David Gallagher on a patient they worked up.  We heard a fantastic presentation of fatigue and somnolence by JAR Jason Rose, with an ultimate diagnosis of severe hypercalcemia related to multiple myeloma.  Teaching points included the various CNS manifestations of myeloma, and how to use the Cl:PO4  (or Cl-90:PO4) to help you figure out the etiology of hypercalcemia.  Interns Kimberly Bryan and Nancy Lentz and SAR Ike ILonchonwu should be complemented for their active participation in the discussion! The VA Gen Med teams are adapting to the new system on Gen Med as well and I look forward to hearing more from the VA at report next week.   Thanks also to a STRONG group of MS II’s who leave us to get ready for exams and move on to other rotations.  It’s been fun having you on the wards, and we’ll be ready to welcome your colleagues in a week! The residents and chiefs had a Town Meeting on Tuesday to discuss programmatic issues and ways to improve.  For starters, read all the way through Updates this week to see what the office has done to respond to the concern about how far in advance the monthly schedules are released.  Efforts  from the chiefs, Randy, Rhea, Laura, and Lauren to make this happen are much appreciated! Thanks again to Dr. Victor Dzau for an absolutely fantastic kickoff to our Leader’s Board series.  It was a good reminder that mentorship is key to career success, as is recognizing that opportunity finds you when you are willing to work hard at the things you enjoy doing.  Much thanks to Emily Strollo for helping organize, and to SARs Daniel Ong, George Cheeley and Krish Patel for raising some outstanding questions, as well as interns Bobby Aertker and Aaron Mitchell, Med Peds JAR Joel Boggan and the chiefs for good discussion.  Keep reading the updates for the timing of the next event. SARs/SAR significant others – don’t forget to mark your calendars for Evening Rounds with Anne Lore on Oct 11 at our house! If the weather stays great, we are looking forward to putting the fire pit to good use (wine and s’mores? Hmmmm) Question time! In honor of medicine research conference week, prizes to whoever is the first to tell me what GLCCI1 is and why it is newsworthy this week.  Thanks to those who answered about Weil’s disease (leptospirosis), treated with doxycycline, and is the possible reason why the Native Americans were weakened in Plymouth, MA, allowing the Pilgrims to be successful colonizers.  Prizes last week went to Interns Jim Gentry, Hany Elmariah and Chris Hostler. Pubmed from the program this week goes to JAR Zach Healy for his article “Inactivation of tautomerase activity of macrophage migration inhibitory factor by sulforaphane: a potential biomarker for anti-inflammatory intervention”.   Cancer Epidemiol Biomarkers Prev 2011 Jul;20(7):1516-23. Epub 2011 May 20, published with senior author Paul Talalay from Johns Hopkins (Zach’s alma mater).  Way to go Zach! Thanks to Jon Bae and Bimal Shah for kicking off the comprehensive Quality Improvement curriculum this week.  Special thanks to Paul Lee for a fantastic first lecture in our lecture series.  Want to know what is happening in QI? Check out the QI corner of the updates! Have a great week,  Aimee

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

WIRTW (Dr. Lynn Bowlby)

[box]The Schwartz Center Rounds: Evaluation of an Interdisciplinary Approach to Enhancing Patient-Centered Communication, Teamwork, and Provider Support Beth A. Lown, MD, and Colleen F. Manning, MA Academic Medicine Vol 85 no 6 June 2010 p 1073-1081[/box] I was excited to see the NYT article on Sept 15 about the Schwartz Center Rounds, and more excited to see that the effect of the Rounds had been studied and published in Academic Medicine in 2010. What are the Schwartz Center Rounds? They are the legacy of Kenneth Schwartz, a 40 yr old health care attorney who died in 1995 of lung cancer at MGH. Offered at over 200 hospitals in the US they “offer healthcare providers a regularly scheduled time during their fast-paced work lives to openly and honestly discuss social and emotional issues that arise in caring for patients. In contrast to traditional medical rounds, the focus is on the human dimension of medicine. Caregivers have an opportunity to share their experiences, thoughts and feelings on thought-provoking topics drawn from actual patient cases " (from the web site).  These topics might include: management of team conflict, stories of  hope and miracles, instances when providers become patients, the impaired professional, the impact of patient violence toward providers, or instances when cultural or religious beliefs impair providers’ ability to communicate. How to study a topic, so important, but not lending itself to quantitative research? A combined approach was used, looking both at retrospective surveys at institutions doing the Rounds for years, and prospective surveys at newer institutions. Semi-structured interviews were done at the experienced institutions. The surveys examined 3 areas: insights into psychosocial aspects of clinical care, teamwork and support for providers. A 6 point rating scale was used for the surveys, and Jefferson Scale of Physician Empathy. A patient interaction score and teamwork score was calculated and regression analysis used. The results? A positive effect was seen in patient interactions, for example attending to non verbal cues and compassion. The importance of empathy was scored highly. Frequency of attendance to rounds mattered, the more attended, the more change noted. For caregivers, a statistically significant reduction in stress and increased ability to cope with the psychosocial demands of work were noted. Importantly 40% noted institutional shift in culture, policy and procedure may not have changed, but the culture had. The interdisciplinary nature of the rounds led to improved sense of support and less isolation. Participant had a sense of connection and shared purpose. Enhanced teamwork enhances work. Some data did not show significant change from pre to post survey such as empathy and teamwork. Length that rounds had existed and incoming skill set likely contributes to this result. So how do we take care of ourselves so we can care for patients and families? How do we provide the highest quality patient-centered care possible? This is one way to help with these goals. Do we do Schwartz Rounds at Duke? Not yet, but I hope to bring them here. Schwartz Center Rounds Evaluation Study Acad Med 2010 (2)  

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) Presented by: Barak Richman JD, MA, PhD (Duke University School of Law  and Fuqua School of Business) and Paul Derrick JD (Cranfill Sumner & Hartzog, LLP) See the attached document to view more detailed information about all sessions. 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. If you have questions, please contact Dr. Alisa Nagler (alisa.nagler@duke.edu or 919-681-6601) or Joanne Schlueter (joanne.schlueter@duke.edu or 919-684-0147). 2011.2012 Health PolicyAnnouncement & Participant Agreement

From the Chief Residents

Holiday Schedule Posted

For those who may have missed noon conference this week, please note that the holiday schedule (the weeks of Christmas and New Years),  has been posted on amion.com  Should you have questions or concerns, please address them to  your Chief Resident no later than Wednesday, October 5, at 5 PM, for consideration. The holiday schedule is always a challenge, and please be assured that all efforts have been make to consider personal preferences, while also balancing patient care responsibilities.

In-Training Exams - it's that time again..

All ITE’s will 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
7-Oct	Friday	DN 2003
8-Oct	Saturday	DN 2003
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 2^nd 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

Morbidity and Mortality Conference;  2002 Conference Room, Oct 7th 8:00 AM

Noon Conference

Duke North Conf Room 2002, 12:00 p.m.

Day	Date	Topic	Presenter	Vendor
Monday	3-Oct	CML Leukemias	Joesph Moore	Simply Delicious
Tuesday	4-Oct	Pleural Effusions	Momen Wahidi	Domino's
Wednesday	5-Oct	Med Peds Conference:                                                         Transitions of Care in CF patients	Kussin/Roggli	Moe's
Thursday	6-Oct	CXR conference	Phil Goodman	Jersey Mike's
Friday	7-Oct	Chair's conference:	David Simel	Chick-fil-A

 

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

Trainee Time Out (from Tian Zhang)

It’s that time of year again!! Join housestaff from across the hospital at our annual Duke Football tailgating tent - Trainee Time Out! In what's become a housestaff ritual, over a hundred residents and fellows spent Saturday afternoons last year restoring their Vitamin D levels before every Duke home game. There are 7 home games this year, so ditch your white coat, dust off your (royal) blue face paint, and enjoy some quality outside-the-hospital time with your colleagues as the Duke Football team battles on Saturdays this fall! If you are interested in hosting and/or tickets, please e-mail Leslie Johnson @ leslie.johnson@duke.edu  The next home game is October 15 vs Florida State.

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)

Thank you to all who attended our first Quality Improvement and Patient Safety Noon Conference!  A special thanks to Dr. Paul Lee for his insightful talk on how to define and measure quality and the forces that are driving the quality movement in healthcare.  For anyone who did not get a chance to attend, the conference will be posted shortly in medhub. This will be a repeating conference, occurring 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.  Abstracts for poster presentation are due Oct 7th. (see attached flyer). Pt Safety & QI conference info

Looking for Biostatistical Advice?

The Biostatistics Core of the DTMI was organized as a mechanism to link basic, clinical, and translational scientists with appropriate biostatistical collaborators to contribute to design, conduct, and analysis of studies. Activities include assistance in conceptualizing and developing research projects, collaboration with investigators in developing new grant applications, protocol development, statistical analyses and reports, preparation of abstracts and manuscripts for publication. Information about the Biostatistics Core and a link to request a meeting are available at https://www.dtmi.duke.edu/for-researchers/quantitative-resources/biostatistics-core . As a first step, investigators are encouraged to make contact with the Core to discuss proposed projects and possible collaborative solutions. To facilitate this contact, two members of the Biostatistics Core are holding “office hours” at the Faculty Center, located in the Seeley G. Mudd Building near the medical center library, every Thursday between noon and 2 p.m. Additionally, in the near future the Biostatistics Core will be offering seminars to cover some of the statistical issues that arise in the conduct of research. Input regarding topics of interest should be sent to Diana.abbott@duke, Yuliya.lokhnygina@duke.edu or YiJu.Li@dm.duke.edu.

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From the Residency Office

BLS Blitz – Do Not Miss This Opportunity

The November 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

Where’s my Schedule?

Have you ever been scheduled to start CAD on Monday, and have NO idea if you’re starting on PAC or DHP…. Please remember that the schedule assignments for many of our services are posted on MedHub’s home page under “Resource Documents”.    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

Our target is to post detail schedules no less than 1 week before the start of each block.  

Posting Schedules on MedHub

A request was made at the town hall meeting this week for detail schedules to be posted on MedHub further in advance of the date when they go into effect.   We appreciate the value of posting schedules sooner, and would like to “give it a go”, particularly now that schedules and templates have settled out, and we have adjusted to the many changes implemented at the start of this year. The schedules for block 5 will be posted to the resource document section in MedHub before the end of the week.  Moving forward our goal will be to post the schedules one block ahead. The critical element in posting schedules this far in advance is the limiting factor of late change requests.  All 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.  Of particular concern are changes that impact clinic schedules, which can be difficult to accommodate at best, and negatively impact patient care.  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. Thanks for the recommendation, and we will evaluate how this works over the remainder of this calendar year.

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 form 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.  Your password on the website is good for one year from application and will need to be renewed annually. 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

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.

Cardiology Interest Group

The Cardiology program would like to offer the opportunity to meet with representatives to learn more about the fellowship program and address any questions that you may have.  The meeting will be held on Wednesday, October 5, from 5-6 in the Med Res Library. https://www.surveymonkey.com/s/Cardiology_Interest_Group

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

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 eveyone regarding Individual Learning Plans.  Attached please find a copy of the information distributed for future reference. ILP Requirements Directions 9-19-11

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.  

Dates to Add to Your Calendars

Oct 5 - Cardiology Interest Group 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 Bookclub Oct 28 - Medicine Research Conference, 12 noon in DN2002 Nov 1 - Recruitment Kickoff, G2B Gastropub 7-9 Dec 10 – DOM Holiday Party Feb 24 – Charity Auction (Contact Tian or Ann Marie to participate) June 13 –Resident Research Event, 5-7pm

Career Opportunities:

Medical Career Path Opportunities

Useful links

• Main Internal Medicine Residency website
• Main Curriculum website
• Ambulatory curriculum wiki
• Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response.
• Department of Medicine website