Internal Medicine Residency News - July 7, 2014

By residency1

From the Director

DUKE.RESEARCH.NIGHT.03 (1) Week one is in the books! Great job by our new interns, JARs and SARs (and chiefs and office team and attendings) - it is nice to have orientation done, and everyone settling in on the wards and in the clinics. It has been fun seeing the teams around the hospital, and many new interns, including Logan Eberly, were overheard teaching their MSII's!  I hope you all could enjoy part of the holiday weekend outside of the hospital as well.  There was fun to be had at the VA on July 4th (See the photo proof!) VAphoto Kudos this week go to our fantastic SARs who set the bar very high for the new SAR talk/intern emergency lecture series…thank you to Angela Lowenstern, Kevin Trulock and Carli Lehr for fantastic talks! We are looking forward to more great teaching from our SARs.  Also kudos from George Cheely to Jesse Tucker for help on Gen Med and to Dave Kopin and med student Arthika Chandramohan from Adva Eisenberg for an awesome start on VA Gen Med, and as well to GI fellow Matt Kappus for his great email to the outgoing interns and JARS.  Kudos from (cardiology fellow!) Phil Lehman to Bhavana Singh and Adam Banks for great JAR/SAR level work in the CCU.  Also welcome to our ACRs – Alyson McGhan (Duke), Tim Mercer (VA) and Aparna Swaminathan (DRH/amb).  Thank you as well to Katie Broderick-Fosgren and Brittany Dixon for representing the residency council at our annual "Program Evaluation Committee" meeting last week.  We will be bringing you highlights from the meeting, as well as reporting our efforts to improve the program in a variety of venues, including before noon conference, in MedHub, at town halls and via the Med Res News.  Feel free to stop by the chiefs offices, my office, your advisors or APDs offices anytime to chat as well. Congratulations also to Lynsey Michnowicz! She is officially the new program coordinator for Med-Psych. Lucky for us, she will still be in the office on the 8th floor, so stop by and say congratulations! Coral and I had the opportunity to visit the new Simulation Center at the VA.  Dr. Park Chan and his team are excited to work with us to bring airway, line, and other simulation training to the medicine residents.  We will be planning times for you to go to the sim center as part of the ICU, procedures, VA gen med and ambulatory rotations. I hope that you all like your new copy of "The Evidence",  written by Cardiology Fellow Rob McGarrah. We are excited to bring you this great resource…and now you can get it on your phone! The iOS app is now available on the Apple app store for iPhone and iPad (easily found by searching "The Evidence: classic studies").  It will be $0.99 during the first two weeks of July, priced for those of you who have the book. This weeks pubmed from the program goes to John Wagener for his publication with Dr. Sunil Rao…. “Strategies to Avoid Bleeding in the Management of ACS.” Medscape Online. Released July 30, 2013. Have a great week! Aimee [divider] [box]

210_RubinSharonWhat Did I Read This Week?

submitted by: Sharon Rubin, MD

Bloomfield, Olson, Greer et al. “Screening Pelvic Examinations in Asymptomatic, Average Age Risk Adult Women: An Evidence Report for a Clinical Practice from the American College of Physicians.” Annals of Internal Medicine 2014; 161 (1):46-53.

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    When I was a medical student I could not believe a British patient who told me in England they do pelvic/pap smears every 5 years. Fast forward 10 years there is no supporting evidence to perform pelvic exam and due to improvements with technology and detection of HPV, pap smears interval can be increased to 5 years for women > 30 -65 with normal pap smear and negative HPV testing. This was a systematic review article via Medline and Cochrane to evaluate the benefits and harms of routine screening pelvic exam and that focused the positive predictive value of pelvic exam to detect nonce rvical cancer, PID, other GYN conditions. They wanted to answer; does a pelvic exam reduce mortality and morbidity from any condition? What are the harms and benefits of a routine pelvic exam? Results: Diagnostic Accuracy of Screening Pelvic exam: (only from 3 studies) only for ovarian cancer PPV was 1.2 to 3.6%. There were no studies that looked at morbidity or mortality benefits for detection of cancer or nonmalignant conditions. Harms: limited evidence suggested that women associate pelvic exam with pain, discomfort, fear, anxiety, embarrassment and 1 study showed indirect harm: screening pelvic exam led to unnecessary surgery in 1.5% of women. Importantly victims of sexual violence are more likely to avoid pelvic and Pap smear and would experience harm from a routine pelvic screening exam. Split in recommendation: ACOG recommends annual routing pelvic exams but this is based on expert opinion. USPTSF recommend against pelvic exam for screen for ovarian cancer (Grade D recommendation). Many providers still perform pelvic exam: for screen for ovarian cancer, before prescribing hormonal contraception, to dx STDs or part of well woman visit. High value care: Balancing clinical benefit with cost and harms with the goal of improving patient outcomes. From Medicare 2013 Pelvic exam #38.11 and pap $45.93. The estimated cost of preventative GYN exams + lab + radiology $2.6 billion. 1/3 = $850 billion spent on unnecessary cervical cancer screening in women < 21 years old; indeterminate % on other pelvic exams. Conclusions: continue the Cervical cancer screening, there is evidence but consider stopping pelvic exam in asymptomatic women not at increased risk of gynecological cancer. [divider]

Clinic Corner

zipkin

Hi guys! Welcome to the new year at the Duke Outpatient Clinic! We are excited to meet all of our new interns and welcome back our JARs and SARs in their new roles. The DOC is organized into three Firms, or Steads - Stead A is led by Lynn Bowlby, Stead B by Dani Zipkin, and Stead C by Larry Greenblatt. Each stead also has a nurse, one or more CNAs, and a front desk staff person linked to the group. Check out the posted, color-coded grid in clinic to see your group - it is also attached here. And, when you're in clinic, ask us how to manage in-basket messages to be efficient and leverage the help of your Stead staff in connecting with patients and getting things done.

We will share information with you in emails, in the DOC Newsletter 2014 July (see attached here!!), and even on the Duke Outpatient Clinic Facebook page - which you can join without sharing your personal info. Contact Matt Atkins to get hooked up, or check it out on FB. For Maestro Tips for the clinic, Dani Zipkin has created lots of helpful videos - check them out here: http://news.medicine.duke.edu/2014/02/maestro-care-tips-from-your-colleague-zipkin-screensharing/ See you all soon! Dani [divider]

From the Chief Residents

Grand Rounds

Friday, July 11th - Duke University Health System - Kevin Sowers/Dr. Tom Owens

Noon Conference

Date Topic Lecturer Time Vendor
7/7/14 SAR Emergency Series: Radiology Essentials Mike Malinzak 12:15 Subway
7/8/2014 SAR Emergency Series: Acute/Decompensated Heart Failure Sneha Vakamudi 12:15 Pita Pit
7/9/2014 SAR Emergency Series: EPIC/Maestro Care Brian Griffith 12:15 Cosmic-Quesadillas
7/10/2014 SAR Emergency Series: GIB Alyson McGhan 12:15 Sushi
7/11/2014 Chair's Conference  Chiefs  12:00 Dominos
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From the Residency Office

Survival Guides and End of Year Gifts

The 2014 Survival Guides are in and they are awesome.  If you are a continuing Internal Medicine resident, please come by the MedRes office and pick up your copy during normal business hours.  We can only provide one copy per resident.  If you are interested in purchasing a copy, please contact Jen Averitt.  An electronic version of the guide is currently in development and we should have more information on when that will be available soon! For all continuing Internal Medicine residents, please also pick up your copy of “The Evidence – Classic and Influential Studies Every Medicine Resident Should Know” with the compliments of the program for a great year! Change in Parking Location (continuing trainees) Trainees who entered Duke in 2013-14 and are currently parking in the Research Drive lot, are being relocated to PG2 (across from Duke North),  effective July 1.  Continuing trainees currently in PG2 will remain in the PG2 Garage.  Parking Decals are in the mail and, per the parking office, should arrive at your home soon (to the address listed in duke at work).  Your current decal will remain active until July 11th  which will allow plenty of time for you to receive the new decal.  Exceptions to this are the departments of Dermatology (assigned to and remain in PG1)  and the departments of Ophthalmology and Nephrology (all trainees are assigned to and remain in Research Drive).

Stead Resident Research Grants- Request for Proposals

For All Internal Medicine, Med-Peds, and Med-Psych Residents We are pleased to announce the Request for Proposals for the inaugural “Stead Resident Research Grant” applications. We are grateful to the leadership of the Stead Scholarship Society for their generosity to support resident research and our Stead Leaders for their mentorship and for promoting your scholarly activities ! The applications due on September 1, 2014 for a funding start date on October 1, 2014. Please find attached the Stead Resident Research Grant Instructions-2014, Stead Resident Research Grant Application Forms-2014, Human Subjects example,  and NIHSAMPLE Biosketch Form.   Please include your mentor’s NIH Biosketch and support letter with your application. Please see  link below for Biostatistical Support resources available to you for your projects and discuss with your mentor. http://residency.medicine.duke.edu/duke-program/resident-research/biostatistics-and-data-management-support Each proposal must have a Human subjects section that describes the protections of the patients and patient data, describe the consent procedure if applicable, status of IRB protocol (to be submitted, already submitted or already approved, as appropriate) etc. This section is required whether to not your project is a retrospective or prospective study, whether patient identifiers are exposed (or not) during data collection/analysis, whether consent is to be obtained or there is a waiver for consent. Please see attached example language that you can adapt to your own protocol after discussing with your research mentor who has already thought about the Human subjects issues. Wishing you continued success with your research projects ! Murat Arcasoy and Aimee Zaas

Information/Opportunities

www.summitsps.com

Upcoming Dates and Events

July 25th- Summer Celebration at Dr. Klotman’s House August 17th- Kerby Society Hosting Durham Bulls Game Gathering

Useful links

 

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