Changes to Duke Curriculum

[nasdr]

I read one of tommy’s comments on a prior thread, but didn’t want to highjack that thread about family-friendly programs into one about Duke.

Essentially, Duke seems to be making a fair number of changes to the curriculum which will affect the incoming intern class in 2009. I was hoping a current resident could comment on what exactly these changes include.

Thus far, here is what I have gathered:

1. Duke is eliminating overnight call on the 4-5 subspecialty rotations (I assume this includes cards, heme/onc, renal, and the pulmonary months?). Just curious what the new system would be for interns. Also, does this mean that an intern will not be taking overnight call “alone” since gen med overnight call is with a JAR/SAR?

2. The 3 months of overnight gen med call will be q5 instead of q4, and will be 24 hours as opposed to 30 hrs

3. Addition of a 1 month elective opportunity for incoming interns

4. The total number of overnight call months is 4 (3 for gen med and 1 month of CCU which is q4)

5. Also, no short white coats for interns, which doesn’t matter to me, but some people care about

6. More hospitalist help for cross-cover issues

Interns get night-time one-on-one signouts with a chief resident while on gen med. I didn’t add this above, since I believe this has been going on for some time already.

Tommy, I didn’t understand the details of the 70hr/wk maximum type of schedule Duke is trying to implement. Is this something which Duke expects will happen naturally with addition of more hospitalists?

Thanks for any input!

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[MGKatz036]

Hello, I'm a current JAR at Duke. I'm attaching a document that will hopefully answer many of your questions.

By the way, one-on-one Intern signouts with the Chiefs -will- be a new addition next year that does not currently occur. (Sign-out are actually pretty awesome... right now, whenever you are on call, some-time around 9 or 10 pm the JAR or SAR will "sign-out" all the admissions they have for the day to that point with the Chief and/or the Assistant Chief Resident [a SAR]. As you can imagine, in the first few hours of admitting the pt, you spend that time stabilizing them and getting the initial labs to work them up. By the time signout rolls around, you can spend about 5 or so mins per pt reviewing their labs and discussing the finer points of management which may come up over the next day or so. When you're finished, the Chiefs/ACRs will usually send you 2 or 3 papers related to your patients.)

Hope this stuff helps answer your questions. I'm a big advocate of the program. Friendly colleagues/teachers, southern living, cheap cost of living, early/safe clinical autonomy, and (probably most importantly), you'll be able to achieve almost anything you want with your career when you are finished.

 

[TommyGunn04]

I'd echo what the above 2nd year resident said about the program. The overwhelming majority of us are very happy here, and love the many unique features of our system. Perhaps the most important thing to recognize about these changes though is that they've all been incredibly well thought-out. I can't emphasize that enough, as I'm sure there's anxiety about possibly matching into a program that's "going to change." I can't even begin to convey the amount of time spent and number of people involved in this process of change, from students, to residents, to administrators, nurses, chiefs, faculty, etc. The program even went so far as to send residents so several other peer programs to see what other places were doing, and gather data on what works well and what doesn't (not sure that's ever been done elsewhere). So many of us rallied for things we felt were too important to change, and helped to work on instituting quality changes that will improve daily life as a resident while also maximizing education and not affecting quality of care. For this reason, we chose not to move to a purely night-float system, because of the common problems we observed with these models, and have taken great care to preserve certain aspects of our tradition that we deem incredibly valuable and unique, such as night-time signouts.

It's also important to recognize that the VA call structure will not change, which would comprise 1-2 months per year of a typical intern or 2nd year schedule. The VA will still have 1 resident with 1 intern on q4 call overnight, together, and the resident will go to night-time sighouts with the chief. It's the Duke gen med system that is going to 24hr call, q5, with interns doing signout and residents going home at night. This should help further diversify our training, exposing residents to several different models of care and ways of thinking, all within a single program. And by hiring a few extra hospitalists, cross-cover on gen med at Duke Hospital will effectively be eliminated! An on-call intern will cover only his/her patients plus the patients of the other intern on their team, whose patients are presented on rounds each day, so they're not totally unknown to the overnight intern. The other patients will be covered by a hospitalist, who will be in-house overnight to do gen med consults and help out if anyone gets into trouble. There will also be an overnight resident who will help the intern with admissions as needed.

Regarding the 70hr/wk thing, it's something they've actually calculated based on the new gen med schedule. If I remember correctly, the q5 overnight schedule with 24hr call instead of 30 ends up coming out to 65hrs/wk, with 5 to spare, in case you get caught up and stay later on a few non-call days. I mentioned this just to give you an example of how these changes affect the number of hours worked per week, and thereby should improve quality of life.

The program is already awesome, with several features that set it apart from most, but these changes will serve to take things even a step further. We're pretty psyched about it!