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.
Hey! Greetings from Chicago and the 51st Annual ICAAC (ID) meeting! Lots of great talks and abstracts, and plenty of Duke representation. More to come next week with exciting findings from the meeting. I still need to get my slides together for my talk on Monday at 3 pm and need to make sure they conform to all the things we talked about at the “How to Give A SAR Talk” sessions last week. The hospital and clinics have been busy, with Ambulatory Chief Juliessa Pavon, DOC Medical Director Lynn Bowlby and DOC Leadership Group representatives (PGY-2 Nilesh Patel and others) launching the new Dictaphone project (fortunately SAR Kyle Hornsby did NOT lose all his dictations) and the VA Gen Med teams having a successful first week of the much anticipated new system. We also had a fun night on Thursday at Piazza Italia to kick off the recruitment season with Duke Med Students who are applying for categorical or prelim years in medicine. There was great representation from the med students, faculty and chiefs, as well as current residents.
Speaking of recruitment, we have downloaded over 2500 ERAS applications, and have 160 interview invitations already extended to some fantastic applicants. Look for the suits to be arriving to the Med Res library on November 4th . Residents, we will be asking for signups for the applicant dinners, and faculty, we will be reminding you to sign up to interview!
Kudos this week go to many of our residents, including PGY-1 Scharles Konadu for her recognition of outstanding patient care on Duke Gen Med with a Gold Star, and PGY-3 Johanna “Queen of Chair’s Conference” Chan’s outstanding presentation of a case of Henoch-Schonlein Purpura. PGY-1 Bronwyn Garner got the diagnosis, seconded by PGY-3 Mike Durheim. Nice work! Johanna taught us that there are about 3 cases per million adults of HSP per year, and we have seen 2 of them since July! Report has been fun, with a nice discussion of the azithromycin for COPD article by PGY-2 Phil Lehman (with PGY-2 Hassan Dakik, and PGY-3’s Dan Fox and Leon Cannizzaro using some great EBM skills to dissect the findings), a medical fascinoma presented by PGY-3 Ryan Schulties and also a great case presentation of Buerger’s Disease by PGY-2 Eric Chu, with some unforgettable angiograms for us to see.
Also, way to go micu team (pgy-2s nicki storms, lisa vann, shereen katrak and nick wisnoski, and fellow bryan kraft) for wearing cowboy boots in honor of med peds pgy-2 scott tolan. Fashion statement AND able to run to a code!
Thanks to our Stead Attendings Peter Ubel and Chet Patel. Taking on the Stead Attending role for the next two weeks are former chief residents Ben Powers and Manesh Patel..we look forward to learning from them, and expect that Manesh’s teams will be proficient in cardiac catheterization by the end of two weeks.
Diagnostician of the Week award goes to PGY-3 Richard Wu, who correctly thought of using the procalcitonin test for estimating the likelihood that a patient on gen med had a viral versus bacterial cause of illness. We can’t yet use this in “real time”, but he chose the correct scenario for its use. See [box] Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms.. Schuetz P, Chiappa V, Briel M, Greenwald JL.[/box]
Big week ahead with the CPC on Tuesday night! We are looking forward to PGY-3 Talal Dahhan’s presentation. It has been quiet on the Turkey Bowl Trash Talk front, so we are looking for ACR’s Krish Patel and Ed Coverstone to BRING IT this week. (yes, that is a challenge).
Pub Med: This week’s Pubmed from the Program goes to recent graduate Bibhu Mohanty for his case report in the American Journal of Medicine, “ Too Many Clots for Comfort”, written with senior author Carlos DeCastro. Just accepted, look for it as an epub and print publication soon!
Have a great week,
Aimee
Final Call for Applications! Please submit your Global Health Elective Rotation application to tara.pemble@duke.edu by 5pm this Friday, September 23rd. Interviews will be scheduled for applicants with completed applications only. Application is open to residents from Departments of Medicine: Internal Medicine (PGY 2); Med-Peds (PGY 3) and Med-Psych (PGY 4). Access the application form and FAQ at http://dukeglobalhealth.org/education-and-training/global-health-elective-rotation.
International Sites: Australia, China, Haiti, Kenya, Nicaragua, Sri Lanka, Tanzania, Thailand, New Mexico
Application deadline is Friday, September 23, 2011. Interviews will be held from September 26 to October 7. For more information, contact Tara Pemble, Program Coordinator at tara.pemble@duke.edu or 668-8352.
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Leslie, Olivia, and myself are proud to announce the arrival of Beatrice Anne Roberts, born Thursday Sept 15th at 900 am at our home (!) with our midwife attending. Everything went great! Here are some pics, including posing in front of the birthday cake we made for her. I know I get some double takes when I mention home-birth, and I had to read more before I understood it better.
If you are interested, you will probably come across this metaanalysis (1) from 2010 comparing outcomes in planned home births and planned hospital births in low risk women. The analysis found no difference in perinatal mortality between the two groups, but they do report a 3-fold increase in neonatal (up to 28 days) mortality in the planned home birth group compared to hospital birth. This finding ends up in the abstract and title for the study, but buried in the results section they state that when poorer quality studies are excluded including data on home births that were NOT attended by a certified midwife, then the neonatal mortality rate was not significantly different between the two groups. 
This is all interesting and controversial and many in the field are called for a retraction of the paper (2). What I took from this was that if you are low risk (singleton, head down, no medical co-morbidities) and you prefer less medical intervention (no epidural, no episiotomy, etc) then home birth with a well-trained midwife appears to be a safe alternative to a hospital birth.
See you all soon,
John
From the Director
Hey! Greetings from Chicago and the 51st Annual ICAAC (ID) meeting! Lots of great talks and abstracts, and plenty of Duke representation. More to come next week with exciting findings from the meeting. I still need to get my slides together for my talk on Monday at 3 pm and need to make sure they conform to all the things we talked about at the “How to Give A SAR Talk” sessions last week. The hospital and clinics have been busy, with Ambulatory Chief Juliessa Pavon, DOC Medical Director Lynn Bowlby and DOC Leadership Group representatives (PGY-2 Nilesh Patel and others) launching the new Dictaphone project (fortunately SAR Kyle Hornsby did NOT lose all his dictations) and the VA Gen Med teams having a successful first week of the much anticipated new system. We also had a fun night on Thursday at Piazza Italia to kick off the recruitment season with Duke Med Students who are applying for categorical or prelim years in medicine. There was great representation from the med students, faculty and chiefs, as well as current residents.
Speaking of recruitment, we have downloaded over 2500 ERAS applications, and have 160 interview invitations already extended to some fantastic applicants. Look for the suits to be arriving to the Med Res library on November 4th . Residents, we will be asking for signups for the applicant dinners, and faculty, we will be reminding you to sign up to interview!
Kudos this week go to many of our residents, including PGY-1 Scharles Konadu for her recognition of outstanding patient care on Duke Gen Med with a Gold Star, and PGY-3 Johanna “Queen of Chair’s Conference” Chan’s outstanding presentation of a case of Henoch-Schonlein Purpura. PGY-1 Bronwyn Garner got the diagnosis, seconded by PGY-3 Mike Durheim. Nice work! Johanna taught us that there are about 3 cases per million adults of HSP per year, and we have seen 2 of them since July! Report has been fun, with a nice discussion of the azithromycin for COPD article by PGY-2 Phil Lehman (with PGY-2 Hassan Dakik, and PGY-3’s Dan Fox and Leon Cannizzaro using some great EBM skills to dissect the findings), a medical fascinoma presented by PGY-3 Ryan Schulties and also a great case presentation of Buerger’s Disease by PGY-2 Eric Chu, with some unforgettable angiograms for us to see.
Also, way to go micu team (pgy-2s nicki storms, lisa vann, shereen katrak and nick wisnoski, and fellow bryan kraft) for wearing cowboy boots in honor of med peds pgy-2 scott tolan. Fashion statement AND able to run to a code!
Thanks to our Stead Attendings Peter Ubel and Chet Patel. Taking on the Stead Attending role for the next two weeks are former chief residents Ben Powers and Manesh Patel..we look forward to learning from them, and expect that Manesh’s teams will be proficient in cardiac catheterization by the end of two weeks.
Diagnostician of the Week award goes to PGY-3 Richard Wu, who correctly thought of using the procalcitonin test for estimating the likelihood that a patient on gen med had a viral versus bacterial cause of illness. We can’t yet use this in “real time”, but he chose the correct scenario for its use. See [box] Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms.. Schuetz P, Chiappa V, Briel M, Greenwald JL.[/box]
Big week ahead with the CPC on Tuesday night! We are looking forward to PGY-3 Talal Dahhan’s presentation. It has been quiet on the Turkey Bowl Trash Talk front, so we are looking for ACR’s Krish Patel and Ed Coverstone to BRING IT this week. (yes, that is a challenge).
Pub Med: This week’s Pubmed from the Program goes to recent graduate Bibhu Mohanty for his case report in the American Journal of Medicine, “ Too Many Clots for Comfort”, written with senior author Carlos DeCastro. Just accepted, look for it as an epub and print publication soon!
Have a great week,
Aimee
Flu Vaccination
Last week we announced the Duke Medicine plan to vaccinate all health care works on September 27. However, no need to wait till then if you want to get ahead of the crowd. You can stop by Employee Health at any time to be vaccinated. The goal is to get 100% of all health care workers vaccinated in 24 hour period. This exercise will test DUHS mass vaccination/drug distribution plans which would be used during an epidemic, pandemic, or emergency event such as an explosion at Sharon Harris Nuclear Plant. 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
Global Health Residency:
Developing the next generation of globally educated, socially responsible healthcare professionals dedicated to improving the health of disadvantaged populations.
Now Accepting Applications for Global Health Elective Rotations
Final Call for Applications! Please submit your Global Health Elective Rotation application to tara.pemble@duke.edu by 5pm this Friday, September 23rd. Interviews will be scheduled for applicants with completed applications only. Application is open to residents from Departments of Medicine: Internal Medicine (PGY 2); Med-Peds (PGY 3) and Med-Psych (PGY 4). Access the application form and FAQ at http://dukeglobalhealth.org/education-and-training/global-health-elective-rotation.
International Sites: Australia, China, Haiti, Kenya, Nicaragua, Sri Lanka, Tanzania, Thailand, New Mexico
Application deadline is Friday, September 23, 2011. Interviews will be held from September 26 to October 7. For more information, contact Tara Pemble, Program Coordinator at tara.pemble@duke.edu or 668-8352.
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From the Chief Residents
Grand Rounds
Professional Women in Medicine Visiting Professor: Marie Lynn Miranda, MDNoon Conference
| Day | Date | Topic | Lecturer | Time | Vendor |
| Monday | 9/19 | Sickle Cell | Laura DeCastro | 12:00 | Bullock's BBQ |
| Tuesday | 9/20 | Jeopardy | Chiefs | 12:00 | Dominos |
| Wednesday | 9/21 | Global health gallops | Global Health | 12:00 | Jersey Mike's |
| Thursday | 9/22 | Feedback from the Program | Chiefs | 12:00 | Meelos |
Endocrinology Grand Rounds
Presenter: Dr. Cary Ward Topic: Cardiac Concerns in Turner Syndrome Patients Monday, September 19th , 2011, 5-6pm at the Alban K. Barrus Conference room 3031 in Duke South."New Addition" to the Residency Program" AND
“WIRTW” (by John Roberts 9-19-11)
Hey Everyone,
Leslie, Olivia, and myself are proud to announce the arrival of Beatrice Anne Roberts, born Thursday Sept 15th at 900 am at our home (!) with our midwife attending. Everything went great! Here are some pics, including posing in front of the birthday cake we made for her. I know I get some double takes when I mention home-birth, and I had to read more before I understood it better.
If you are interested, you will probably come across this metaanalysis (1) from 2010 comparing outcomes in planned home births and planned hospital births in low risk women. The analysis found no difference in perinatal mortality between the two groups, but they do report a 3-fold increase in neonatal (up to 28 days) mortality in the planned home birth group compared to hospital birth. This finding ends up in the abstract and title for the study, but buried in the results section they state that when poorer quality studies are excluded including data on home births that were NOT attended by a certified midwife, then the neonatal mortality rate was not significantly different between the two groups. 
This is all interesting and controversial and many in the field are called for a retraction of the paper (2). What I took from this was that if you are low risk (singleton, head down, no medical co-morbidities) and you prefer less medical intervention (no epidural, no episiotomy, etc) then home birth with a well-trained midwife appears to be a safe alternative to a hospital birth.
See you all soon,
John
Turkey Bowl Practice
Turkeybowl Practice - Sundays at 3:30pm - Forest Hills ParkUpdates From Our ICGME Rep(from Kathleen Lee Kiernan, MD, PGY-2)
*The Duke Medicine-wide influenza vaccination effort begins this week! Make sure to get your flu shot. *The Health Policy Lecture Series begins in October!! The lectures will be on a weekday evening 5:30-8:30pm and more information will be forthcoming. Law and Medicine / Employment Law (October 2011), Accountable Care Organizations (December 2011), Healthcare Reform and the Uninsured (February 2012), Quality and Performance (March 2012), and Negotiation (May 2012). *Please keep the Duke Police number in your cell phone (919-684-2444)! Call for any questions or concerns involving your safety with patients, families, or on campusFrom the Residency Office
Teaching the Teachers - Who Won the iPad?
The "Teaching the Teachers" conference series that was completed this year offered faculty a unique opportunity to learn new ways to engage learners, fine tune their skills, and interact with those considered "experts" in medical education. At the end of the program we completed a post conference assessment. The results: 92% of respondents indicated that the conferences changed the way that they teach, 85% said that they felt more comfortable in their role as teachers, and 55% felt that the TTT conference had changed their style of bedside teaching. As an added incentive, those who responded to the survey were eligible to participate in a random drawing for an iPad. The winner - shown above - is Hope Uronis, MD MHS. Dr. Uronis is one of our past Chief Residents and is an Assistant Professor in the Division of Medical Oncology.
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.
Employee Heath - September Services
Fit Testing/ T-Dap Vaccination/ TB Skin Testing will be again be available for your employees in September. We do not have many days scheduled at North due to Staffing the Flu Program. Resp Fit Testing-T-Dap-TB Skin Testing Flyer Sept 2011 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. 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 or at Employee Health at 684-3136 Option 2 or Rita Oakes 681-0513, if you have questions.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_GroupNoon Conference - Grand Rounds Recordings
Reminder noon conference and grand rounds are being recored 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. Attched please find a copy of the information distributed for future reference.ILP Requirements Directions 9-19-11
Dates to Add to Your Calendars
Looking ahead, dates to keep in mind: Sept 20 – CPC @ 604 W Morgan (RSVP to follow) Sept 27 - Leader Board @ 5:30 PM in the Faculty Lounge Sept 27 - Duke Mass Vaccination Exercise Oct 5 - Cardiology Interest Group, 5-6, in the Med Res Library Oct 7-18 - Inservice Training Exams Oct 11 - Evening Rounds at the Zaas' Oct 29 - Greenfield Celebration Dec 10 – DOM Holiday Party Feb 24 – Charity Auction (Contact Tian or Ann Marie to participate) June 13 –Resident Research Event, 5-7pmCarreer Opportunities:
CA, Hospitalist IM Opportunity Flyer (1) CA, Internist IM Opportunity Flyer (2)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