ACOI Resident Newsletter April 2011
APRIL 2011
TABLE OF CONTENTS
- Understanding the Annual In-Service Examination
- Maximize Your Reading Time
- Through the Eyes of a Generation X Physician
- The Physician Burnout Syndrome
- Board Question of the Month
- Advocacy
- Supreme Court Rules Residents’ Salaries are Subject to FICA Tax
- Federal Courts Continue to Consider the Constitutionality of the Health Care Reform Act
- News of Note
- Nominations Sought for ACOI Resident Teaching, Humanism Award
- ACOI Staff Resources for Residents and Fellows
- Resident/Fellow Check List of Responsibilities
- ACOI Contacts
- Council on Education and Evaluation
UNDERSTANDING THE ANNUAL IN-SERVICE EXAMINATION
The annual ACOI Resident In-Service Examination was administered on Friday, March 4 at all osteopathic internal medicine training sites. The following information is provided to help explain the examination and why it should be viewed as a useful experience for residents and their programs.
The In-Service Examination consists of 200 items in 11 subtest areas which comprise 10 subspecialties and general internal medicine. About 70 to 75% of the exam questions are ambulatory-based in accordance with current health delivery and medical practice. The remaining 25% of questions focus on inpatient and critical care areas. Over 50% of the questions are case-based. The content of the exam is based on the ACOI Model Curriculum for Internal Medicine Residency Training (available at www.acoi.org), as is the content for the Internal Medicine Certifying Examination administered by the American Osteopathic Board of Internal Medicine (AOBIM). It should be noted that the item writers for the In-Service Examination are a different group of individuals than the AOBIM members who write the Certifying Exam. The certifying board has no information regarding what items appear on the In-Service Examination and vice versa for the In-Service Exam question writers. Residents should also be aware that there is a high correlation between performance on the In-Service Examination when taken during the last year of residency and performance on the Certifying Examination. The purposes of the In-Service Examination are: 1) to evaluate each resident's knowledge base in comparison to the expectation at that level of training and relative to the national average at the same level of training; 2) to determine progress of the resident from one training year to another; 3) to assist the resident in identifying personal areas of strength and weakness; and 4) to assist the ACOI Council on Education and Evaluation in evaluating individual training programs, and in identifying programs that may need assistance from the Council. It is not the purpose of the examination to grade residents or determine promotion in residency. Program directors are required to review scores individually with each resident and assist the resident in identifying strengths and weaknesses. This must occur at the end of each academic year, in late June or early in the new year in July. Residents and program directors are cautioned regarding placing significant emphasis on the scores in the individual specialty areas unless they are markedly above or below the average. This is due to the impact that occurs by changing only one or two correct or incorrect answers. It is recommended that the "total score" and overall average, in comparison to others at the same training level, be utilized to evaluate performance. Individual specialty scores should be used to direct study needs. For the first time this year, the In-Service Examination was administered electronically. This is due to the rapid growth in the number of internal medicine residents. There undoubtedly were some glitches and inconvenience experienced at some program sites. These are an unfortunate side effect of the change from a pencil and paper process. I hope that you were able to overcome these challenges and I am sure than things will be smoother next year.Brian J. Donadio, FACOI
Brian J. Donadio, FACOI, is the Executive Director of the American College of Osteopathic Internists. He may be reached via email at bjd@acoi.org.
MAXIMIZE YOUR READING TIME
It is hard to keep everything together as a resident. You have many things pulling you in a hundred directions. Patients are sick, your family misses you, clinic has scripts for you to sign, and you would like five minutes to yourself.
So when do you find time to keep current with medical the literature? You are likely getting lectures throughout the week, or maybe looking up something on a patient you have been seeing, but is that enough? I sometimes found it difficult to really absorb a lecture by a subspecialist on a specific topic, which may not have been relevant to me at the time of the lecture. You can only retain so much from a PowerPoint slideshow given at lunchtime. The best physicians stay current, and it is never too early to start the habit of following the literature. You will look intelligent if you can quote or discuss a recent study. As busy residents (and eventually busy staff physicians) you will need to be mindful of your time and make the most of your reading. Here are some hints for effective reading:Read what you are interested in. If you plan to enter a fellowship, you should be excited about the specialty and should be reading the journals/literature in that specialty area. You need to be able to speak intelligently about recent trends with Fellowship directors and staff. Read everyday. It doesn’t have to be for a long time, but it is good to be in the habit. Keep a journal at your bedside, or any other place you may be sitting for a few minutes and have a chance to read. It doesn’t take long to keep current. Once you see that a study is important, you can make a note and put it aside for more in-depth review at a later time. Have a high yield reading list. You can’t read for hours a day, so know where the best information can be found. As internists, we need to look at every issue of The New England Journal of Medicine (many landmark studies will be published here), The Annals of Internal Medicine, CHEST, and maybe JACC. In addition to these, I find that JounalWatch is a good way to keep up with the important studies in many smaller journals. This does not provide all the data, but does let you see the highlights, and provides a good starting point for important articles. Your days are full, but you will feel better about the care you provide to your patients and you will know where your teaching staff is getting their treatment plans if you keep on top of the information that makes up the medical literature. Please email me with questions or comments. Scott Girard, DO Scott Girard, DO, is a hospitalist in Danville, PA. He completed his internal medicine training at Geisinger Medical Center in Danville in July, 2008. During his training, Scott served for two years as the resident representative to the ACOI Board of Directors. He now serves as liaison and advisor for residents and the College. He may be reached at slgirard@geisinger.edu.
THROUGH THE EYES OF A GENERATION X PHYSICIAN
As the winter weather finally starts to break and the days grow longer with the arrival of spring, like most of you, I find I have a bit of extra energy. This commonly results in a cleaner house, regular trips to the gym and more time spent outdoors. At the same time, we must be sure to devote some of that additional motivation to the necessary off-duty “maintenance” that comes with working in medicine. With spring-cleaning in mind, here are a few projects that would benefit from a portion of your enthusiasm surplus.
Curriculum VitaeYour curriculum vitae (CV) is an ongoing project that should continually evolve. Everyone from medical students through attendings needs to keep a CV accessible and updated, and it is especially important to stay current with your CV during residency. Although you are working long hours in your training and have little time for much else, try to devote a few hours this spring to updating your CV so that you do not forget items along the way. Be sure to include your internship, residency and any fellowship training; certification/licensure; honors/awards; research/publications and professional affiliations. Board Exam Prep
Practicing medicine requires a continuous growth of knowledge and the ability to stay current in one’s field. To that end, there will always be another board exam in your future. Whether you are about to take COMLEX, certification boards, subspecialty exams or recertification tests, it is important to plan a preparation strategy. It can be difficult to find adequate time to study, but there truly is a difference between learning and cramming. A NY Times article from September of last year discussed the ideas of cognitive scientists regarding study strategies. For grade school students through adult learners – “hurriedly jam-packing a brain is akin to speed-packing a cheap suitcase, as most students quickly learn — it holds its new load for a while, then most everything falls out.” Even if you do not have a board exam looming immediately in front of you, it is still vital to read and learn on a daily basis as part of continuing education. With spring and summer come plenty of distractions so put study time into your routine now. Logs, Evaluations, Paperwork, etc.
Be sure to “spring-clean” your ongoing supply of paperwork. With the end of this training year around the corner, try to stay current with your logs and evaluations. It is always easier to tackle these a bit at a time, and much less stressful than attempting to catch up at the end of June. Also make sure any certifications that you need for your particular program are current, such as BLS or ACLS. And last, but certainly not least, set aside some free time for a “non-work” related undertaking. Completing personal-life tasks are just as important and rewarding. As always, please feel free to send comments, questions and ideas to acoiresidentrep@gmail.com. Kelly Schiers, DO ACOI Board of Directors Resident Representative Kelly Schiers, DO, is a first year pulmonary fellow at the University of Medicine and Dentistry of New Jersey. She may be reached via email at acoiresidentrep@gmail.com..
THE PHYSICIAN BURNOUT SYNDROME
It is without a doubt that we are in one of the most physically, mentally, and emotionally demanding career paths. We are always expected to be performing with the utmost professionalism and proficiency, for anything less may have dire consequences. For instance, after a long day of rounding, being paged throughout the night for a spectrum of issues as simple as a Tylenol order or as critical as a crashing patient is an all-too-common occurrence. We are often asked to physically, emotionally and mentally defy what our bodies are designed to handle, and that only pertains to the career aspect of our lives; whereas most of us are also juggling families, finances, and even our own health issues, as well. As osteopathic physicians, we are trained in addressing the “whole” person, and at times, we fail at applying that in our own lives. The need for rest, relaxation, reflection, and most importantly balance, does not discriminate among the professions. Ultimately, if we keep expending ourselves without taking time to replenish and reflect, it can lead to physician burnout. According to Psychology Today, “Burnout is not a simple result of long hours. The cynicism, depression, and lethargy of burnout can occur when you're not in control of how you carry out your job, when you're working toward goals that don't resonate with you, and when you lack social support. If you don't tailor your responsibilities to match your true calling, or at least take a break once in a while, you could face a mountain of mental and physical health problems.” The way we practice as residents, sets the precedent for the way we will be practicing as future attendings. It is our responsibility to recognize burnout in ourselves and in our colleagues. The ultimate price of physician burnout includes our own wellbeing and patient safety, which are all too high of a price to pay. The next few articles will be used to outline signs, symptoms and solutions to physician burnout in hopes to educate, and most importantly, hold our profession accountable for recognizing a preventable syndrome. Reference: Burnout. (2011). retrieved April 4,2011, from Psych Basics Web Site: www.psychologytoday.com/basics/burnout Maryanne Samuel, DO ACOI Council on Education and Evaluation Representative Maryanne Samuel, DO, is a first-year internal medicine resident at Palmetto (FL) General Hospital. She may be reached via email at maryanne@nova.edu..
BOARD QUESTION OF THE MONTH
This series of questions is to help residents understand how board questions are written and what kind of infomation these questions are testing. In order for residents to better understand the process, the ACOI has asked several former certifying board members to write this feature. This month's question is by Vicky Leo, DO, a general internist and past chairwoman of the American Osteopathic Board of Internal Medicine. Dr. Leo practices in Leechburg, PA.According to ATP III guidelines for treatment of high cholesterol. Which of the following is a CHD (coronary heart disease) equivalent?
- Hypertension
- Asymptomatic carotid artery disease
- Cigarette smoking
- Diabetes mellitus
- Family history of CHD
SUPREME COURT RULES RESIDENTS' SALARIES ARE SUBJECT TO FICA TAX
The U.S. Supreme Court recently issued a unanimous decision upholding the U.S. Treasury Department’s regulation providing that medical residents who work more than 40 hours per week do not qualify for the student exception to the Federal Insurance Contributions Act (FICA). The decision in Mayo Foundation for Medical Education and Research v. United States affirms the Eight Circuit Court’s earlier decision and brings a long-standing legal dispute to a conclusion.
Federal Courts Continue to Consider the Constitutionality of the Health Care Reform Act The U.S. government has appealed the U.S. District Court for the Northern District of Florida’s ruling in the case of State of Florida v. US Department of Health and Human Services. As previously reported, the court held the “Patient Protection and Affordable Care Act” (ACA, Pub. L. 111-148) is unconstitutional in its entirety. The appeal moves this case one step closer to the Supreme Court. In a separate decision, the U.S. District Court for the District of Columbia dismissed a lawsuit brought by individual plaintiffs who claimed the ACA individual mandate violated the Constitution. In the case of Mead v. Holder, the court ruled that the ACA was constitutional under the commerce clause of the Constitution. The judge found that the ACA regulates an activity that substantially affects interstate commerce. As such, the court ruled that the ACA does not violate the Constitution and Congress acted within its powers. The ACOI will continue to monitor these and other cases reviewing the constitutionality of the ACA. Tim McNichol, JD Timothy McNichol, JD, is the Deputy Executive Director of the ACOI and is responsible for the College's advocacy efforts. He may be reached via email at tmcnichol@acoi.org
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NEWS OF NOTE
Nominations Sought for ACOI Resident Teaching, Humanism AwardThe Board of Directors is seeking nomations for the award recognizing residents and fellows for excellence in teaching and humanistic qualities. The award honors outstanding compassion in the delivery of care, respect for patients, their families and healthcare colleagues, as well as demonstrated excellence in clinical teaching. The Board has approved funding for four awards this year, which will be made at the Convention in October. Each awardee will receive a $500 prize, plus up to $1000 in expenses to attend the Convention. For additional information, visit www.acoi.org/ResAward.html or contact Susan Stacy of the ACOI, susan@acoi.org, or call 1 800 327-5183. The deadline for submission is July 31.
ACOI Staff Resources for Residents and Fellows
The ACOI staff and the Council on Education and Evaluation are important sources of information and assistance for osteopathic internal medicine residents and fellows. Two staff members are available on a daily basis to address questions and concerns. Christy Smith serves as postdoctoral administrative coordinator and can answer questions about general training requirements and specific individual training issues. Keisha Oglesby is the ACOI certification liaison. Residents and other certification candidates are urged to contact her to clarify questions about completion of certification requirements. ACOI policy is that all phone calls and e-mails are acknowledged and returned within 24 hours of receipt. Please take advantage of these resources available to you.
ACOI Contacts
Thomas F. Morley, DO, FACOIPresident
tmorley@comcast.net
Jack D. Bragg, DO, FACOI
President-Elect
jackbragg@hotmail.com
Kelly Schiers, DO
Board of Directors Resident Representative
schierka@umdnj.edu
Brian J. Donadio, FACOI
Executive Director
bjd@acoi.org
Timothy W. McNichol, JD
Deputy Executive Director
tmcnichol@acoi.org
Susan B. Stacy, FACOI
Director of Administration and Finance
susan@acoi.org
Christina A. Smith
Post-Doctoral Training Coordinator
christy@acoi.org
Keisha L. Oglesby
Membership Coordinator/
Certification Liaison
keisha@acoi.org
Council on Education and Evaulation
John B. Bulger, DO, Chairmanjbulger@geisinger.edu
Robert A. Cain, DO, Vice Chair
racain@sbcglobal.net
Gary L. Slick, DO (AOBIM)
aobim@mail.com
Susan M. Enright, DO
senright@genesys.org
Joanne Kaiser-Smith, DO
jksdoc@aol.com
Robert T. Hasty, DO
hasty@nova.edu
Joanna R. Pease, DO
strixvaria@sbcglobal.net
Frederick A. Schaller, DO
frederick.schaller@touro.edu
John M. Kauffman, Jr., DO
jkauffman@vcom.vt.edu
Maryanne Samuel, DO
maryanne@nova.edu