Residency Update

March 2018 

The Residency Update was on a brief hiatus while I settled into the new position and got my feet under me.  But I think we’re ready to roll once again. 

Big News

**New** Resident PEC: PEC stands for Program Evaluation Committee. A PEC is a group, mandated by the ACGME, which every residency has in place (including ours). It is designed to be composed of residency leadership, core faculty, clinic faculty and to have resident representation.  Its charge is to review all aspects of the residency that affect your education once per year.  It is a good idea but in practice probably does not meet often enough to be as nimble as I would like and does not capture the resident voice as effective as it should. 

Next month, we will be piloting a new leadership group, to run alongside the PEC, flipping the traditional model on its head – the Resident PEC (RPEC).  This will be a group of residents from all training levels encompassing all our tracks and pathways, on which there will be faculty representation.  Instead of reviewing the whole year in one meeting, I will ask this group to take a deep dive into our program, rotation by rotation, on a monthly basis.  In this way, we can come up with tailored plans of attack for our most challenging rotations, review areas of the residency most in need of change first and circle back on rotations that need work as often as we like. 

Residents, keep an eye on your inboxes this week for a call to participate and for more details. I’m looking for resident leaders from each of the classes to take charge of this process though the entire residency is invited to each meeting (or to share their thoughts if they cannot make the meeting). Since not everyone will be available each month, we will need several leaders per class so that the work can be shared. Faculty, I will be reaching out to you this week as well. I’m interested in identifying 1-2 faculty members per hospital or clinic location. The role of these faculty is to help facilitate the discussion and to bring institutional knowledge to the resident-leaders on the RPEC.

ACGME Annual Survey:  The annual ACGME survey comes out this week, March 12th to be exact.  To stay accredited, we need 70% of you to return it on time (and 60% of our core faculty).  That said, my real goal is 100% compliance because I want your feedback, so please fill this out when you get it.  The survey will come from donotreplyacgme.com.  Based on that name, I imagine it could end up in your Clutter so please look there if you do not have a survey by March 13th. 

I said this in person to some folks but I want everyone to hear the same message.  Please be honest on the survey.  Answer all questions as you see fit. There are a few tricky ones but that is why we have been going to all the noon conferences this week to help walk people through the survey. Maybe as important as how you answer the questions is that you understand how I see the results.  Everything I will get back from the ACGME will be an aggregate response – no identifying data, no site data, and no individual responses.  This is good for anonymity but bad for affecting change.  If you want to affect change, this survey will alert me to the need but will not tell me how, where or why.  For this, I encourage your participation in the RPEC (see above), just pop in and see me or shoot me an email. I want this residency to work for you.

CMS Rule Change: Medical Student Notes Count for Billing: Some of you may have seen that the Centers for Medicare and Medicaid are now allowing attending physicians to use medical students’ notes for billing purposes.  See here if you haven’t heard here’s the ruling https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10412.pdf as well as the AAIM statement with some supporting documentation as to why this rule change occurred from the ACP http://www.im.org/page/medical-student-documentation.  This change took place on Monday (March 5th, 2018) and so is just now going live.   How this will affect non-Medicare patients is not yet clear though the expectation is that private insurers will follow suit.  This leads to the most pressing question for residents, “do I still have to write a note if my student does?”  Short answer, yes. There is no change to the expectation (by hospital) regarding intern and resident documentation.  We will take this issue up at our year-end review looking forward to 2018-2019 but for now, please keep documenting as you have been. 

Upcoming Events

CAM night is back!  Careers in Academic Medicine will occur this month on Tuesday March 20th from 6:30 – 8:00PM.  The topic this month is Challenge #2: Women and Underrepresented Minorities in Medicine.  Our guest discussants will include Professor of Endocrinology Dr. Maggie Wierman as well as Professor of Renal Diseases Dr. Sarah Faubel.  As always, Dr. David Schwartz and his wife Dr. Louise Sparks will open their home to our residents and a wonderful, home-cooked dinner is provided (and is always delicious).

If you have not been to a CAM night before, I encourage you to attend.  The curriculum has been recently redesigned to run over two years and to answer the questions most residents have about starting a career in academic medicine, how to address the challenges one will face and how to be successful. 

Match Day: Interns, as of Friday March16th I will be able to offer tangible proof that you don’t have to do this forever.  Thank you all for the work you did to make our interview season such a success.  Each of you is the best part of this program, I was proud to show you off. 

Accolades and Accomplishments

Congratulations to the University of Colorado ACP Doctor’s Dilemma team for winning the Colorado Chapter Title!  Erin Armenia, Will Mckleroy, Dan Varela and Denise Hasson kept the plaque in our hands for the third straight year.  When I moved into this office, Mel left me two gifts with very strict instructions:  a bottle of very old red wine (never ever, under any circumstances, should you drink this) and the ACP Winner’s Plaque (do not let this leave the campus). Great job, team. Enjoy the Big Easy.

Congratulations to Diana Mar and Spencer Hansen as well as the whole ACE unit team.  They were recognized by a patient’s family for excellence in patient care with a letter to CEO Will Cook as well as a wonderful plaque, designed and presented by the family.  

Congratulations to Deepa Ramadurai and her mentorship team who’s vignette, “What Should Target Blood Pressure Be?” was chosen as a winner of this year’s Lown Institute Right Care Competition.  Deepa receives a scholarship to the 2018 Lown Institute Conference in Washington, D.C., which includes airfare, lodging, time at the hotel spa and unlimited drinks by the pool in order to see if the answer to her question is, ‘90/50 with a heart rate of 45’.

Congratulations to our very own Dr. Suzanne Brandenburg who has been awarded the 2018 Distinguished Medical Educator Award from the Alliance for Academy of Internal Medicine (AAIM), the national society that represents internal medicine educators.  This award represents the highest recognition available to an educator in the field of Academic Internal Medicine and has only been awarded 10 times in the history of the organization.  Suzanne joined the AAIM in 1997 when she was the very first Associate Program Director in Internal Medicine at the University of Colorado, a position she held before leading this program as Program Director for 10 years from 2006-2016.  Congratulations Suzanne!

What I’m Reading

The past few years have seen a number of great Pulmonary/Critical Care articles in the NEJM.  This past week features several articles on ICU fluid management as well as steroids in sepsis.  Classic discussions, not likely to be declared finished by these pieces.

Balanced crystalloid versus saline in the critically ill:

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1711584

Balanced crystalloid versus saline in the non-critically ill:

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1711586

Continuous steroid infusion in the treatment of severe septic shock:

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1705835

Intermittent dosing of steroids in the treatment of septic shock; this one features a shocking (pun very much intended) return of drotrecogin alpha! Residents, if you don’t know what this is, that’s good - ask someone who trained 10 years ahead of you:

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1705716 

What I’m Reading When I’m not Reading Medicine

A wonderful, short story on the meaning of the parent/child relationship, growing old and becoming (or choosing not to become) a doctor.  From the author of one of my favorite books of all time, “The Amazing Adventures of Kavalier and Clay”, Michael Chabon.

https://www.newyorker.com/magazine/2018/02/05/on-not-becoming-my-father

A very interesting article on what it means to be “brain dead”, how we as a society reached that conclusion and what it means for physicians and our patients.  Equal parts enlightening and frustrating, sad and hopeful.

https://www.newyorker.com/magazine/2018/02/05/what-does-it-mean-to-die

 

Birthdays!

Here are all our March birthdays – please wish these folks a happy birthday when you see them. 

 
Rebecca Kamins3/2
Andy Berry3/4
Alexandra Grieb3/4
Frank Hall3/4
Trey Sertich3/4
Tiana Jespersen Nizamic3/5
Tomio Tran3/7
Francis Del Rosario3/13
Jeffrey Graham3/14
Elizabeth Somes3/14
Corwin McGee3/16
Deepa Ramadurai3/19
Joseph Raycroft3/20
Jeffrey Babcock3/21
Jonathan Schultz3/23
Peter Kaminski3/30
Benjamin Trefilek3/30
David Cristin3/31

 Geoff

 

OCTOBER UPDATE
 
 
Hello everyone— 
The November 8th election has been troubling for many of you I’ve spoken with. Dr. Schwartz expressed his support on the UC DOM Facebook page (CU Anschutz Department of Medicine: please sign up), which I would like to re-state for all of you. It reflects what I think and feel as well.
 
“Dear Friends and Colleagues.
At this time of uncertainty, I want you to remember that we value everyone's opinion and strive to foster a diverse department because it makes us stronger, more nimble, and more innovative. As your chair, I want you to know that I'll do everything possible to support an inclusive environment that promotes equity, diversity, multiculturalism, and justice for all members of our department. We will continue to embrace an individual’s right to be heard regardless of culture, color, social class, status, gender, ethnicity, sexual orientation, physical ability or religious belief. By respecting our differences and working together toward our collective vision, our department, our faculty, and our staff will become stronger and even more accomplished. Diverse voices encourage a broad palette of questions and solutions for the complexity of scientific and health challenges that we are facing. We are so privileged to be part of the medical and scientific professions, to be working in an incredible medical center, and to have each other as friends and colleagues. Let’s support each other, build on our strengths, and strive to make our department reflective of the community we serve. I welcome your thoughts.
David Schwartz”
 
Good news items:
  1. 1.   Interview Season in Full Swing: We’re in the midst of our 4th out of 15 interview days this morning (Monday Nov 14th) – you all play a pivotal role in the process by participating in the evening dinners, morning breakfast sessions, interacting with applicants at noon reports, and guiding tours especially at UCH.  THANK YOU for your time and willingness to talk with them about who you all are and what your experiences have been.
  2. 2.  GEOGRAPHIC TEAMS AT UCH! – I am thrilled to announce that within a scant few months, all inpatient ward teams at UCH will be geographically cohorted.  Three teams will share the 36 bed 7th floor of AIP2 and admit and follow only patients on that floor. The fourth team will follow its 12 patients on one of two potential floors (6th or 9th), that final detail in progress.  Please thank Read Pierce and your APDs for their ongoing support in this endeavor, and a special thank you to our UCH hospital leadership for listening to our educational justification with open ears.
  3. 3.  The Great Save Award this month goes to R3 Preet Kaur. Congratulations and great work, Preet!
  4. 4.  Your Housestaff Association representatives continue to be Charlie Tharp and Alejandro Mora.  With their assistance, the HSA has negotiated an increase in your stipend which will incorporate a Denver cost of living component. Final details are pending, which we will share once public. If you see any of the HSA reps, give them a “thank you!”
Our ACGME CLER visit went well.  Thank you for your participation – the final report is pending, but I’d like to remind everyone at all sites that any and all bedside procedures must be accompanied by a checklist-guided timeout to ensure right patient, right site, right procedure.  One can never be too safe.
 
Get it right: ACGME defines “service” as activities outside the usual MD scope, such as drawing blood, transporting patients, scheduling appointments. If responding to an ACGME survey of some sort, remember that this is their understanding. We understand that clinical care can reach a point past which the educational value can diminish – and continually work to maintain the right balance of education versus ‘service’ in this much broader construct. For those in the know.
 
Your voice matters:
1.   Please give us feedback around visiting sub-I’s on your services – very helpful to have your longitudinal perspectives on how they may or may not best fit into our program.
  
Showtime is airing a documentary about pioneering internet security leader John McAfee, called Gringo: The Dangerous Life of John McAfee. It premiered at the 2016 Toronto Film Festival. It’s a fascinating and disturbing film, insofar as Mr. McAfee came in a close second to Gary Johnson for the Libertarian Party’s U.S. Presidential nomination.  On a very different note, Arrival (in movie theaters now), offers a Slaughterhouse 5-esque story of extraterrestrial visitation, time, and loss that is poignantly beautiful and unexpectedly affirming.
 
That’s the update for October and the first 8 days of November. Thanks for all that you do --  
Mel  
 
SEPTEMBER UPDATE
 
 
Good afternoon all – 
This late monthly missive comes in the midst of your residency leadership screening and scoring over 2300 categorical applications for next year’s internship class and inviting the over 500 of them to interview!  Prelim screening is next…
 
Good news items:
1.   Your classmates around the world: Pritish Iyer and Eitan Bornstein are completing an international rotation in Harare at the University of Zimbabwe College of Medicine. Dale Shamburger is in Guatemala providing medical care through the plantation we assist there.  We look forward to their safe return and learning from their experiences there.
2.   The Great Save Award this month goes to R3 Sarah McCary, whose careful attention to detail in medication reconciliation determined the cause for her patient’s metabolic collapse.  Thank you and great work Sarah!
3.   R3’s, Chiefs, and a few former graduates are on the Fellowship Interview trail around the country, amassing frequent flier miles and hours on futons to find their best match for subspecialty training. We are all pulling for you and are excited to see where you land!
4.   Sub-Interns from medical schools across the country are here these last couple of months and likely for the next few to follow. Thank you for teaching them, mentoring them, and letting them see the UC way – you all are our most powerful and genuine recruitment tools.
 
Please Register to Vote in the next several days.  October 17th is the deadline to register through a voting drive. If you have a Colorado Driver’s License, you can go to https://www.sos.state.co.us/voter-classic/pages/pub/olvr/verifyNewVoter.xhtml and do so online. Otherwise consult the Oracle, I mean the Google, for locations near you.
 
ACGME “CLER” visit November 1st and 2nd. Our accrediting body, the ACGME, will be here to conduct a Clinical Learning Environment Review (CLER) in three weeks. They will be reviewing the University of Colorado Hospital as it pertains to GME across all programs. They focus on quality and patient safety: how we conduct handoffs, quality and patient safety goals (you all know how we are highlighting hand hygiene and improving patient safety reporting), and the like.  There are three other areas they may ask about – I’d like to prepare you to talk knowingly and factually to the site visitors (they meet with residents):
A.     Service vs. Education Balance: As most of you likely know, we have undertaken multiple steps to improve the educational balance at UCH, focusing on the inpatient wards, MICU, and Cardiology.  While there are still further improvements we hope to realize, I am receiving consistent reports that things are dramatically improved overall.  Keep your chiefs, APDs and myself up to date at all our sites if you have additional feedback.
B.     Professionalism: We now have an Office of Professionalism in the Dean’s office (https://www.ucdenver.edu/academics/colleges/medicalschool/facultyAffairs/Professionalism/Pages/default.aspx) to support students, residents / fellows, and faculty in reporting unprofessional conduct – across all departments in the school of medicine.  I want you to tell us about any unprofessional conduct – start with your Chief Resident, your APD, or myself.  Or if you want to access a Confidential Advisor or your Coach, those are further options.  Ultimately we have the responsibility to develop our culture so we see, identify, and ultimately address unprofessional behavior.  In many instances we need to help our colleagues. https://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/intmed/imrp/RESOURCES/residentsupport/Pages/ConfidentialAdvisors.aspx
C.     Fatigue: Despite duty hour and patient limits, we are all susceptible to the effects of fatigue – and from time to time will need help. We have multiple resources: attendings, chiefs, other residents, changes to work flow, jeopardy, and more.  We will reimburse you for a taxi or Uber if needed (round trip, no less).  Call your Chief Resident if fatigue is threatening to impair your work or that of a colleague.  This is another aspect of our professional lives: monitoring ourselves and our colleagues to safeguard patient welfare and that of ourselves.
 
Opportunity Knocks: The Rockefeller Clinical Scholars Program is recruiting for their July 2017 class of Clinical Scholars, an educational experience for physician-scientists interested in careers in patient-oriented translational research.  The application deadline is November 1st, 2016.  Most applicants have completed fellowship training, but some select individuals are considered directly after residency. It’s a 3-year Master’s degree program funded by their CTSA and the Rockefeller University endowment.  Check it out.
 
Your voice matters:
1.     Thank you for the input around our recruitment process.  Themes that emerged included greater resident visibility (thank you in advance for your participation…) and keeping the small dinners the night before.  Duly noted.
2.     Thank you for the input around next year’s scheduling regarding reducing the number of consecutive inpatient months from 4 to 3. Fifty-four percent of you voted to decrease from 4 to 3, 27% voted to keep as it is, and 19% indicated they had no preference.  Dr. Suddarth and team are working further to implement this proposed change and to mitigate adverse impact on your availability for fellowship interviews.
  
In the “I’d like to say these things again” department – two items from last month that merit reiteration:
 
Enhanced diversity broadens our view of one another and strengthens our community in multiple ways. Consider discovering what your implicit associations might be at: https://implicit.harvard.edu/implicit/education.html (“Take a Test” tab at the top). It might be eye-opening. 
 
Check into mentorship options: 
1                 Mentors who can assist with your journey into fellowship are listed at the bottom of this webpage on our Heartbeat-IM Residency Training Program website.  Lots of other good things about the process of fellowship application. https://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/intmed/imrp/RESOURCES/fellowship/Pages/FellowshipApplicationGuide.aspx 
2                 DOM research mentors for residents and students are listed by Division / Specialty and by the type of activity, e.g. basic or clinical research, QI, Educational Research, etc. https://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/Pages/Research-Projects-with-Residents-and-Students.aspx 
3                 Your APD team (including me) is always happy to help connect you with career and/or project mentorship. Just ask. 
 
Lastly, I’d like to introduce a new, periodic, segment titled:
On the Nightstand – current readings.
Yes, these are the things that yours truly is reading in an admittedly less than linear fashion.  Much of your reading is focused on your development as physicians.  But in talking with several of you recently, you are also reading outside Medicine, ultimately an important aspect of becoming your future selves, fully realized. Here’s what’s on my nightstand, in no particular order:
 
“When Breath Becomes Air,” by Paul Kalanithi.  Quick read – about a Neurosurgical resident who develops metastatic lung cancer. Beautifully written. Perhaps ventures a bit far into metaphysics but succeeds in hitting close to home.
 
“The Righteous Mind: Why Good People are Divided by Politics and Religion,” by Jonathan Haidt.  Not a quick read, but an important one in these times in particular. I think it dovetails with the work of Nobel Prize winning economist Daniel Kahneman (“Thinking, Fast and Slow,” also recently on the nightstand) and provides a framework for better understanding our differences and an approach to dialogue.  A light summer read, say.
 
“The Meaning of Human Existence,” by Edward O. Wilson.  Very quick but thought-provoking and (spoiler alert) ultimately secular read by a noted Harvard biologist and decades long insect researcher.  Fascinating, funny, and very thought-provoking.
 
“I Contain Multitudes,” by Ed Yong, an epic journey of the microbiome in and around us and much of the worlds biosphere.  I haven’t started it yet but hear from a reliable source that it is jaw-dropping.  Eat more prebiotics, i.e. fiber!
 
MKSAP 17 Rheumatology.  Need I say more?
 
That’s the update for September.
Thanks for all that you do --  
Mel