From the Director
The last seersucker Tuesday of 2013 has come and gone…what next now that it is not appropriate to wear seersucker? Get ready to order your Duke Medicine Residency Fleece! Be on the look out … we plan to have the order set up in a couple weeks. And don't worry, it's still cool to wear a Duke tie on Fridays, and to bring your seersucker clothes back out after Memorial Day. And, for some JARs, it is apparently ok to wear red, purple, yellow, etc pants to work.
First kudos go to our awesome ACRs – Carling "Coffee at Report" Ursem, Jenn "Let Me Help you With that CAT" Rymer, and Brian "Have A Cookie, Don't Starve on Gen Med" Miller. You've been amazing! And welcome to Lauren Porras, Alex Fanaroff and Matt Summers. Big shoes to fill, and we know you will do that very well! Also kudos this week from Sajal Tanna to Hal Boutte for his outstanding work on GI consults at the VA, to Armando Bedoya for his willingness to pitch in when VA Gen Med got really busy really fast, to Brittany Dixon for taking on the first intern report of block 3 (great presentation as well), to the DRH Gen Med SARs for coming to morning report (See earlier reference to coffee!) and to Rachel Titerance for her extraordinary work making a diagnosis on Duke Night JAR. Brice, Mike, Claire, Adrienne and I had a great time at JAR dinner night – dates for September to be posted soon.
Kudos for Aaron Mitchell and Eric Yoder for receiving our first GOLD STARs for the year. Gold stars are given by Duke Hospital when a patient mentions you by name in a patient satisfaction survey or sends a letter on your behalf! WAY TO GO! Also kudos to Adva Eisenberg for helping Dr. Peyser figure out a complicated clinic patient!
September is going to be a great month…Turkey Bowl practices should begin soon, paintball is on the horizon, the SARs are interviewing all over the country, and we are kicking off some other residency program initiatives. Again thanks to our hand hygiene champions Emily Ray, Jessie Seidelman and Steph Giattino for leading this charge, with help from Joel Boggan and Jon Bae. Please remember to pick up your photo business cards from the med res office (since they have photos on them, its pretty easy for us to tell who hasn't picked them up yet) and GIVE THEM TO YOUR PATIENTS (inpatients and outpatients). This is a project being led by Katie Broderick, and we are hoping to increase awareness among patients of who their doctor is.
Coming up soon is also the 2013 FLU VACCINE BLITZ! As you may know, we have led the way at Duke for the past 2 years in getting 100% of our house staff vaccinated (last year we FINISHED vaccination by 10/23!). The race to immunization is a Stead Society competition, with Kerby Society winning for the past 2 years. Kempner is challenging them big time this year, so that they can try to boast TRIVIA and VACCINE championships. We will be having a flu shot station outside noon conference on 9/18, and many other opportunities to get your (mandatory!) vaccine.
CONGRATULATIONS TO THE NEWEST MEMBER OF THE MED RES FAMILY….Carter and Katie Davis are now proud parents of Charles "Charlie" Hughes Davis.
Pubmed from the program this week goes to Jon Bae for the paper he co-authored with Mamata Yanamadala and Mitch Heflin for the Journal of Graduate Medical Education "Can graduate medical education trainees learn clinical quality improvement principles through online modules?"
Have a great week!
Aimee
QI Corner (submitted by Joel Boggan, MD)
New Patient-Centered Business Cards
The new patient-centered business cards have arrived. Please pick them up if you haven't had a chance to help the good Dr. Broderick-Forsgren improve patient awareness of providers. On the cards, there are places where you can help fill out information to tell patients who you are, what your role is, and who else might be taking care of them in the hospital . . .
Morbidity and Mortality Conference
Thank you to Peter Kussin and Jason Stout for leading our first M&M of the year and to Laura Caputo for presenting our case. If you'd like to view some of the articles that were discussed in the conference, please check out http://news.medicine.duke.edu/2013/08/grand-rounds-83013-mm-conference/.
Flu Vaccination Campaign
Our flu blitz kicks off 9/18 at our next High Value, Cost-Conscious Care noon conference led by the very engaging and very awesome Dan Ariely. As part of the conference, flu shots will be given both before and after outside DN 2002. We had 100% compliance last year within 35 days of the kickoff, and we're planning on doing even better this year. IF YOU NEED AN EXEMPTION, THAT IS DUE BY 9/13. IF YOU HAVE QUESTIONS ABOUT EXEMPTIONS, PLEASE EMAIL US!!! As per last year, the Stead Societies will be competing to see who can reach 100% first . . .
[box]
What Did I Read This Week
Submitted by Carling Ursem, MD
Freedman, Neal D., et al. "Association of coffee drinking with total and cause-specific mortality." New England Journal of Medicine 366.20 (2012): 1891-1904.
[/box]
Why I read this: During my tenure as ACR at DRH I made it my personal goal to get coffee provided at morning report. I thought that if I as ACR would rather stay in bed (okay I won’t lie, go to a morning spin class) than go to morning report, I know other people must feel the same way. I thought that a warm caffeinated beverage might serve as a token of appreciation for our early morning efforts, and also help to jazz up the 7:15am conversation. I wondered if there was any data to support the seemingly miraculous powers of coffee and came across this article.
Background: Multiple prior studies have tried to look for an association between coffee consumption and health outcomes. Most of them have been small and retrospective, with varied results ranging from associations with increases in LDL and blood pressure to decreases in the incidence of stroke and diabetes. Prior studies looking at the relationship between coffee drinking and mortality have shown either no association, or a small decrease in mortality.
Results: The NIH-AARP Diet and Health study sent extensive health related questionnaires to 617,119 AARP members ages 50-71 in 8 states, one of which was NC. Coffee consumption was just one element of the questionnaire. The study excluded people with cancer, heart disease and prior stroke, leaving 402,260 participants. They were followed from 1995-2008, during which time 52,515 died. In the raw analysis there was an increased risk of death among coffee drinkers, however this was confounded by the strong correlation between smoking status and drinking coffee. After controlling for smoking, alcohol and other potential confounders they found a decreased risk of death among coffee drinkers, with an approximate dose relationship. For men the hazard ratios for death among those who drank coffee compared with those who did not were: 0.94 (95% CI 0.90-0.99) for 1 cup/day, 0.90 (95% CI 0.85-0.96) for 2-3 cups/day, 0.88 (95% CI 0.84-0.93) for 4-5 cups and 0.90 (95% CI 0.78-0.93) for 6 or more cups. For women the hazard ratios were: 0.95 (95% CI 0.9-1.01), 0.87 (95% CI 0.83-0.92), 0.84 (95% CI 0.79-0.90) and 0.85 (95% CI 0.78-0.93). Additionally, there was a correlation between coffee consumption and decreased incidence of diabetes, similar to in previous studies.
What does this mean: Unfortunately, nothing. Although the dose response relationship is encouraging that some sort of causation could be present, at the end of the day this is still just an observational study. Despite what the authors state in their discussion, we can’t even conclude that coffee doesn’t increase mortality. Without an RCT I will have to continue enjoying coffee for no other reason than just that it makes me happy.
Addendum: The following video demonstrates the postive effects that have been document at DRH morning report: http://youtu.be/EWbwfXaq-xE
[divider]
From the Chief Residents
Grand Rounds
Date: September 6, 2013 Topic: ARDS Presenters: Dr. Neil MacIntyreNoon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 9/2 | Labor Day- No Noon Conference | 12:00 | ||
| 9/3 | CXR Interpretation | Phil Goodman | 12:00 | Saladelia |
| 9/4 | IM-ED Combined Conference: U/S guided resuscitation | 12:00 | Saladelia | |
| 9/5 | Gallops | ACRs | 12:00 | Dominos |
| 9/6 | Chair's Conference | Chiefs | 12:00 | Chik-Fil-a |
From the Residency Office
Annual Flu Vaccination
This is week 3 of our campaign, and the first critical date is fast approaching. If you are planning to request an exemption you only have 2 weeks left to do so. To review options and/or download the forms, please log into the Duke intranet using the following link. https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx The Blitz is also only a few weeks away – September 18/19to be exact. Watch for the flyers and more announcements in the coming weeks.More Dates to Put on Your Calendar
The annual "Recruitment Kick-off" will be held on Monday, October 28th, 7:00 to 9:00pm at Alivia’s. We are very excited for another recruitment season and want to thank you for all the help you will provide! Voices in Medicine: Wednesday, December 4th. Details to come but please mark your calendar! Last year was a hit and we hope to make this one even larger! This is an amazing opportunity to connect and see each other in a different light!Mini CEX - Program Requirements
In an effort to clarify the process by which Mini CEXs are tracked and reported on, we have decided it is best to no longer list them as required procedures. The program will continue to require three (3) inpatient Mini CEXs per trainee each year, and the evaluation will not change. As a reminder, all Interns should have at least one (1) completed by August 30th. In addition to this change, the currently entitled “Mini CEX-Ambulatory Evaluation” has been re-named “Ambulatory Evaluation.” We will continue to require that at least three (3) ambulatory evaluations be completed on each trainee each academic year and we are working with the lead attendings at the continuity clinics to determine the best plan of action as to how these evaluations will be assigned and completed prior to each of the three Clinical Competency Meetings.Changes to the Step 3 Examination in 2014
Reminder that residents are required to take and pass Step 3 prior to the start of their SAR year. Please take note of the following changes that will happen in 2014 The current Step 3 examination is administered in two 8-hour test sessions, which must be taken on consecutive days. The restructured examination will also be two test days; however, examinees will be able to schedule the two test days on non-consecutive days. The examination days will consist of the following: Step 3 Foundations of Independent Practice (FIP)this test day will focus on assessment of knowledge of foundational medicine and science essential for effective health care. Content areas covered will include applying foundational sciences; biostatistics, epidemiology/population health, and interpretation of the medical literature; and social sciences, including communication and interpersonal skills, medical ethics, and systems-based practice/patient safety. The test day will also include some content assessing knowledge of diagnosis and management. This test day will consist solely of multiple-choice questions and will include some of the newer item formats, such as those based on scientific abstracts and pharmaceutical advertisements. Step 3 Advanced Clinical Medicine (ACM): this test day will focus on assessment of applying comprehensive knowledge of health and disease in the context of patient management. Content areas covered will include assessment of knowledge of history and physical examination, diagnosis and use of diagnostic studies, prognosis/outcome, health maintenance/screening, therapeutics, and medical decision-making. This test day will include multiple-choice questions and computer-based case simulations. A single score (with graphical performance profile information) and a single pass/fail outcome will be reported following completion of both examination days. The restructured Step 3 examination will be administered beginning November, 2014. During an approximately one-month period (October, 2014), it is likely that no Step 3 examinations will be administered. Practice materials for the restructured examinations will be posted to the USMLE website in mid-2014. Examinees should anticipate a score delay following the introduction of the restructured examinations. Additional information will be posted as soon as it is available.Duke GME Health Policy Lecture Series
OPEN TO ALL DUKE GME TRAINEES & PROGRAM DIRECTORS
Registration Link: https://www.surveymonkey.com/s/2013HealthPolicyRegistration
2013.2014 HEALTH POLICY: JUST IN TIME LECTURE SERIES
Supported in part by the Chancellor's GME Innovation Fund
The Fuqua School of Business and the Duke University Hospital Office of Graduate Medical Education have joined together for the 5th year to offer a Health Policy lecture series for Duke GME programs. Program Directors, residents and fellows are invited to participate. Physicians will benefit from an understanding of health care delivery systems, payment structures, incentives, and policy. Increasingly, the role of the physician will be less of a clinical technician and more of a team-leader as our health care system evolves, using a more multidisciplinary & team-based model. To this end, we are offering a program which covers topics that will allow residents and fellows to acquire a baseline understanding of our health care system. Participation addresses the ACGME competency of Systems Based Practice and provides critical knowledge to graduate physician leaders.
HEALTH POLICY LECTURE SERIES OBJECTIVES:
Objective 1: Provide health policy content for residents and fellows, to better prepare them for practice following GME training.
Objective 2: Offer content using a hybrid approach with live lectures and online material, to attempt to meet individual schedule needs and learning styles.
Objective 3: Enhance GME training with topics that address the ACGME Core Competencies, specifically, systems-based practice.
Objective 4: Enhance interaction and collaboration across Duke GME departments and programs by enrolling together GME Program Directors, resident and fellows from a variety of programs.
Objective 5: Evaluate the usefulness of content and delivery method using confidential written evaluations as well as qualitative verbal feedback.
TOPICS INCLUDE:
- Health Care Policy (September 19th, 2013)
- Comparative Health Systems (October 10th, 2013)
- MedPac Annual Report Overview: Medicare/Medicaid (November 14th, 2013)
- Health Informatics (December 12th, 2013)
- Quality & Pay for Performance (January 9th, 2014)
- Healthcare Reform (February 13th, 2014)
- Health Care Disparities (March 13th, 2014)
- Accountable Care Organizations (April 10th, 2014)
- Conflicts of Interest (May 8th, 2014)
The series will kick-off with the "Health Care Reform Panel: Obama-care versus Canada Single-Payer Care"; Thursday, September 12th
5pm – 7pm, Duke South Amphitheatre
Light refreshments will be served
For more information and to register for the panel please use the following link - https://www.surveymonkey.com/s/HealthCareReformPanel2013
PROGRAM FORMAT: Sessions will be held the second Thursday of each month (6:00pm-7:30pm) in the Medical Center Board Room from September 2013 to May 2014.
PARTICIPATION OPTIONS
1. Residents/fellows can earn a Health Policy Series Certificate of Completion (with letter presented to their Program Director) by completing these requirements:
-
- Attend all sessions
-
- Complete a self-assessment at the beginning and end of the series
-
- Evaluate all sessions and provide feedback on the program overall (via on-line surveys)
-
- Please use the link below to register
2. Residents/fellows (and their Program Directors) are welcome to attend as few or many sessions as they would like and their schedules will permit. Register for individual sessions via the link below.
Registration Link: https://www.surveymonkey.com/s/2013HealthPolicyRegistration
Contact Information/Opportunities
I-M Outpatient Feb2012Upcoming Dates and Events
- September 17: Application deadline for Global Health Electives
- September 18/19: Flu Shot Blitz
- October 1: Duke’s Global Health-Internal Medicine Residency deadline to submitt applications
- October 18: SoM Clinical Science Day
- October 28: Annual Recruitment Kickoff
- December 4: "Voices in Medicine"
Useful links
- https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
- August 2013 Resp Fit Testing-T-Dap-TB Skin Testing Flyer
- http://duke.exitcareoncall.com/.
- Main Internal Medicine Residency website
- Main Curriculum website
- Ambulatory curriculum wiki
- Department of Medicine
- Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response.