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ACOI American College of Osteopathic Internists
Resident News June 2011
JUNE 2011
TABLE OF CONTENTS



2011 RESEARCH CONTEST PROVIDES CASH PRIZES

The ACOI is pleased to announce the 2011 awards for Research Abstract posters prepared by residents and fellows in internal medicine and its subspecialties.

Cash awards of $1,500, $1,000, and $500 will be made for the 1st, 2nd, and 3rd place posters as judged at the 2011 Convention, October 12-16, 2011 in San Antonio, TX. In addition, the top three finishers will present their work at a plenary session of the Convention and receive reimbursement of their travel costs (1-2 nights at hotel and coach air travel), if not paid by your program.

A second category for competition will include an interesting case or several cases analyzed with a review of the literature and supporting or refuting contemporary attitudes in literature. There will be separate cash awards of $500, $250 and $100 for the top three case presentations. Unfortunately, funding constraints do not allow reimbursement for travel for winners of this competition.
  • To download application form and submission instructions, click here.
  • Please clearly specify in which category (Research abstracts or Case presentations) your entry is submitted.
  • The deadline for submission is July 26, 2011.
The contest is open to DO residents and fellows in osteopathic and allopathic internal medicine and subspecialty programs. I would strongly encourage you to enter. In addition to the research contest, a first-rate convention is planned. The $100 resident convention registration fee is waived for all whose entries are accepted in the research competition.

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.




A DAY IN THE LIFE OF A COMMUNITY HOSPITAL HOSPITALIST

I have read a few articles in various journals in the past, describing a day in the life of a physician. I feel that a common theme to most of these articles is frustration, and even anger in some instances. I find a workday to be very gratifying and stimulating, if sometimes a little hectic. All this being said, I thought I would write about a day in the life of a small town, community-hospital hospitalist, to give some insight into the workday of someone who enjoys being an internist.

4 or 5 am: I have always been an early riser, day shift does not start until 7am, but since we work 12 hour shifts, if I want to get some exercise in, this is the time. Breakfast, coffee, gym.

7 am: Showered and ready for the day. Sign out from the overnight shift. I had signed out to the overnight physician one sick elderly woman who was in respiratory failure and needed ICU care. She did well last night. In addition to yesterday’s patients, there are two new patients. An elderly woman with chest pain and middle aged man with exacerbation of his COPD. After about 30 minutes of discussing plan of care and overnight issues, it is off to work.

8 am: Time to get to work. We typically have 10 or 12 patients to see each day, in addition to three or four new patients we will get throughout the day. This can be the best part of being a doctor. Seeing people in the morning, seeing that they are getting better, talking with them, and getting people back home and back to their lives. This morning I am able to get Ms. Jones home after three days of treatment for pneumonia, Mr. Adams is returning to the nursing home after treatment for heart failure, and the day continues with each patient.

10 am: Time to call some of the primary care doctors of the discharged patients. I am sometimes jealous of their shorter workdays. But after thinking about it for a few minutes, I would not trade the pace of the hospital or the patient population for any other job. I want to see sick patients and have the time to see them as many times a day as needed and make changes to their care, hourly if needed. Three calls made, 30 minutes used up. Back to seeing people.

11 am: First admission of the day. After a short discussion with the ER doc, I admit a 56-year-old man with hypertension and history of smoking with chest pain. Examine and talk to the nice man and set him up for rule-out lab work and a stress test. Not too difficult.

Noon: 15 minutes for lunch and a quick check of the email. Send out two important emails and eat a sandwich. Still have five more patients to see; have to keep moving.

2 pm: Everyone is seen, and doing ok. The confused elderly woman from the nursing home has worsening hyponatremia. I call the Nephrologist who helps guide me and tells me that he will see her in just a little while. The ER has now started to heat up.

2:30 pm: Time for the afternoon admissions. A frequent visitor to our hospital, a 23 year old woman with type 1 diabetes and frequent hospitalizations for DKA, returns to the ER with a blood sugar of 650 and severe acidosis. A candidate for the ICU. Treating patients is the reason why I became a doctor, but this young lady is going to require a lot of work, lab checks and time.

4 pm: Still getting the young lady squared away in the ICU and it is time to do a consult for orthopedics. An 82-year-old woman tripped on a rug and has a broken hip. She will need to be seen, have a cardiac risk assessment done and have her medicines reviewed and ordered prior to her going to surgery the next day.

6 pm: Labs rolling in, time to recheck the “sick” patients, call families and answer the regular floor calls. The floor calls can make you feel like you are a resident again, but I take it in stride. The nurses don’t want to bother you; they are just trying to make sure the patients have what they need. After the four pages in 10 minutes, I need to remind myself of this.

Time for some last minute paperwork. There are always a few forms to fill out. I tell myself to do them as they come in. Let them back up and they become an hour-long project.

7 pm: Time for sign out. Have to tell the night doc about the labs that will be resulted for the lady with DKA and what the plan of care is. Twelve hours has rushed by.

8 pm: Home for dinner with the family. Bedtime comes early due to the 4 am wake up call. A little TV and a little reading before bed. A fulfilling day.

This is an example of one Hospitalist’s day. Seven days of 12 hours each can really take it out of you. It is a lot of work to be a Hospitalist. You fill 12-hour days without problem, but you get to care for people who need your help. Block schedules mean that next week I will have seven days to myself with my family. Between that and the slightly better salary than my clinic counterparts, the workweek does not seem so bad.

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.



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JULY APPROACHES

As spring is in full swing, many of us are already thinking about the upcoming summer months and the general excitement that surrounds this time of year. Some of you will be finishing residency or fellowship and embarking on a career path. Others will transition into the next post-graduate year with new responsibilities and tasks. No matter what stage of residency or fellowship training you are in, July will always be synonymous with change. That shift each summer is often associated with excitement and some degree of apprehension; however, no July will ever be as distressing as the intern one.

Dr. Sandeep Jauhar (now a cardiologist) wrote a memoir in 2008 entitled Intern: A Doctor’s Initiation, where he chronicled his intern year and the trials and tribulations associated with it. As you can imagine, most of what he discusses are issues that all interns face. Jauhar writes, “This introduction [internship] to the profession is a legendarily brutal year, for many doctors the most trying of their professional lives. Working eighty or more hours per week and staying up every fourth night or so on call, most spend it in a state of perpetual exhaustion, as near ascetics with regard to family, friends, food, sex and other pleasures… I still remember it the way soldiers remember war.”

While not everyone remembers internship as surviving a battle, it certainly is a stressful year complete with a steep learning curve, new coworkers, intense responsibility and emotion-provoking situations. With that in mind I am urging you to take a moment over the next few weeks and think about your internship year. What was your favorite moment? Most treasured patient experience? The time you felt most proud of something you accomplished? What was your biggest regret? Worst mistake? What did you wish someone else had told you? Then, compile all those thoughts and share them as you meet the incoming interns this July. Communicating your experiences with an intern and being his/her ally is one of the most effective ways to help ease the transition. We cannot change the work hour regulations, move family closer, improve the cafeteria food or hand-hold all day, but we can provide a support structure so that interns know where to turn with questions. Jauhar quotes, “The only mistake you can make is not asking for help.” Make sure the interns where you are training know they can turn to you for aid and those before them have shared the same experiences. July may just seem a little less scary for those starting this year.

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.

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THE PHYSICIAN BURNOUT SYNDROME, PART II: SIGNS AND SYMPTOMS

Burnout is a syndrome that can be described as a triad of emotional exhaustion, depersonalization and diminished feelings of personal accomplishment. Although similar to Major Depressive Disorder (a condition which affects all aspects of a person’s life), burnout is primarily a work-related syndrome. The incidence of burnout is the highest in careers that require extensive care of other people.

According to the Center of Professional Wellbeing, the characteristics of burnout often include somatic (exhaustion, insomnia, GI symptoms), emotional (sadness and depressed mood, negativism, decreased creativity and increased cynicism), and interpersonal manifestations (quickness to anger, defensiveness, readiness to blame others, and a negative world-view). It is often correlated with the process of grief, as a work-related dream is lost. Depersonalization of patients and distancing develop in patient/staff relations and disorganization and ineffectiveness increase. In fact, studies have shown that burned-out residents were significantly more likely to indicate that they had been responsible for at least one suboptimal patient care practice at least monthly compared with their counterparts.

Unfortunately the signs and symptoms can go unrecognized, and if prolonged can precipitate patient care and personal consequences (medical mismanagement, career loss, lost relationships, addictions, and even suicide). It is our responsibility, as physicians, to recognize and address these signs and symptoms in ourselves and our colleagues, before they lead to detrimental consequences.

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.

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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.


A 57 year old female presents with bilateral shoulder aching for the past couple of months. She relates difficulty brushing her hair. Further questioning reveals that she has morning stiffness lasting 30-40 minutes and generalized fatigue. Her hips ache but not as bad as her shoulders. She denies headache, fever, vision changes or jaw claudication. Physical exam is essentially normal. There is full range of motion of the shoulders and hips, no muscle weakness and no temperal artery tenderness. No distal joint synovitis is noted. Labs reveal a negative RA and ANA. She has a mild normocytic anemia and a sedimentation rate of 82 mm/hr. Diagnosis can be established by:

  1. Measurement of cyclic citrullinated peptide antibodies
  2. Measurement of C-reactive protein
  3. Temporal artery biopsy
  4. Shoulder MRI
  5. Trial of low dose (15-20 mg/day) oral prednisone
The correct answer is 5. This patient has polymyalgia rheumatica and will have dramatic improvement within a few days of starting low dose prenisone. Although patients with PMR are at fairly high risk of temporal arteritis this patient has no features (such as headache, fever, jaw claudication or temporal artery tenderness) that would suggest this diagnosis. MRI would show inflammation but this would not be specific for PMR. C-reactive protein would be elevated and not diagnostic. Anti-CCP antibodies may be positive in a patient with RA but this scenario is not a typical RA patient (proximal as opposed to distal joint involvement as an initial presentation).




INTERESTING CASE OF THE MONTH

Presented by Amanda Valvano, a second year medicine resident at UMDNJ-Kennedy Health System in Stratford, NJ.
Click the case title to view the report.





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AFFORDABLE CARE ACT CONTINUES ITS WAY THROUGH THE COURT SYSTEM

The U.S. Supreme Court rejected a request by the Commonwealth of Virginia for expedited consideration of Commonwealth of VA v. Kathleen Sebelius on April 25. The U.S. District Court for the Eastern District of Virginia upheld the ACA but invalidated the requirement that individuals carry health insurance coverage. As a result, the U.S. Court of Appeals for the Fourth Circuit will now proceed to oral arguments.

The Supreme Court’s decision to deny an expedited review was not unexpected. The path to the Supreme Court for a challenge to the ACA continues to take shape. To date, both the Eastern District of Virginia and the U.S. District Court for the Northern District of Florida have found the individual mandate created by the ACA to be unconstitutional. Three other courts have upheld the constitutionality of the ACA. Appeals are currently pending in the U.S. Courts of Appeals for the 6th, 11th and the District of Columbia Circuits.

ACOI JOINS PARTNERSHIP FOR PATIENTS

The ACOI has joined the Partnership for Patients, which brings together hospitals, employers, physicians, nurses and patient advocates in a shared effort to improve patient safety and healthcare efficiency. The goals of the Partnership are to keep patients from getting injured or sick and to help patients heal without complication. The Partnership aims to decrease hospital-acquired conditions by 40% by the end of 2013. In addition, the Partnership intends to reduce hospital readmissions by 20% over the same time period. It has been estimated that achieving these goals will reduce healthcare costs by approximately $35 billion with a $10 billion savings to the Medicare program and additional savings over the next 10 years. You can learn more about the Partnership by visiting www.healthcare.gov.

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

Joplin Residents Perform Heroically

A pickup truck with what looked like two rescue workers and two injured people weaves in and out of traffic to get to Freeman Hospital West in Joplin, Mo. after the town was hit by a tornado on Sunday, May 22, 2011. (AP Photo/The Wichita Eagle, Jaime Green)

The devastating tornado that struck Joplin, Missouri last month wreaked havoc on the community and placed major stresses on the ability of the healthcare infrastructure to respond. Freeman Health System, which is an osteopathic postgraduate education site, was the only local hospital able to function. The seven osteopathic internal medicine residents there performed heroically, despite personal loss and trauma.

Program Director Leslie Hamlett, DO, provided a firsthand account: "I have never seen such a horrifying event. Our internal medicine residents went above and beyond the call of duty. Many worked for hours on end, exhausted, saving lives. They were intubating, putting in chest tubes, bagging patients because we ran out of ventilators, suturing, easing pain, cleaning wounds and so much more. I did not have to ask one single resident to come into the hospital. They all showed up and helped. Their expertise was amazing in a situation that none of us had ever encountered before. People were lined up in hallways, lying on gurneys on the floor, multiple people per room. It was a war zone.

"I truly have the best internal medicine residents in the nation. They deserve to be recognized nationally," Dr. Hamlett said.

One of the residents, David Dawson, DO, was seriously injured and lost his apartment and all possessions in the storm. Third-year resident Scott Hamilton, DO, was in a local Wal-Mart with his family when it was destroyed. They had to dig themselves out amid many dead and wounded customers.

A fund has been established to assist Dr. Dawson. Anyone interested in contributing may send a check made out to: David Dawson Tornado Relief Fund, c/o Leslie Hamlett, DO, 3827 Spring Hill Rd, Joplin, MO, 64804. The ACOI Legacy Fund has contributed $1000 to this cause.

The ACOI Board of Directors and staff commend the Freeman Health System internal medicine residents. In addition to Drs. Dawson and Hamilton, the other residents are Gretchen Cole, DO, Alison Galloway, DO, Geoffrey Graham, DO, Adam Fahrenholtz, DO and Carla Renaldo, DO.



Nominations Sought for ACOI Resident Teaching, Humanism Award
The 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.



2011 CERTIFICATION EXAMINATION DATES/APPLICATION DEADLINES
Internal Medicine Certifying Examination
Computerized Examination 200 Sites Nationwide
September 15, 2011
Application Deadline: Expired
Late Registration Deadline: Expired

Subspecialty & Certification of Added Qualifications Examinations
August 27, 2011
Lombard, IL
Application Deadline: Expired
Late Registration Deadline: Expired

  • Allergy/Immunology
  • Cardiology
  • Clinical Cardiac Electrophysiology
  • Endocrinology
  • Gastroenterology
  • Geriatric Medicine
  • Hematology
  • Infectious Disease
  • Nephrology
  • Oncology
  • Pulmonary Diseases
  • Rheumatology
  • Sleep Medicine

Hospice & Palliative Medicine
Certification of Added Qualifications Examination
October 30, 2011 in Orlando FL
Application deadline: July 1, 2011
Application packet available here



2012 CERTIFICATION EXAMINATION DATES/APPLICATION DEADLINES
Internal Medicine Certifying Examination Computerized Examination 200 Sites Nationwide
September 13, 2012
Application Deadline: February 1, 2012
Late Registration Deadline: April 1, 2012

Sports Medicine Conjoint Examination For Certification of Added Qualifications
Tuesday, April 17, 2012
During AOASM 27th Annual Clinical Conference, April 18-22, 2012
Held at the Marriott Louisville Downtown Hotel, Louisville, Kentucky
Application Deadline: Tuesday, January 17, 2012 (no penalty)
Final Application Deadline: February 17, 2012 ($100.00 penalty)
Application packet available here

Contact Information:
AOA – Certifying Board Services
Phone: (312) 202-8195
ekraynak@osteopathic.org

Visit www.acoi.org/CertGen.html for additional information.




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ACOI Contacts
Thomas F. Morley, DO, FACOI
President
tmorley@comcast.net
Jack D. Bragg, DO, FACOI
President-Elect
braggj@health.missouri.edu
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



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Council on Education and Evaulation
John B. Bulger, DO, Chairman
jbulger@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
Frederick A. Schaller, DO
frederick.schaller@touro.edu
John M. Kauffman, Jr., DO
jkauffman@vcom.vt.edu
Maryanne Samuel, DO
Council Resident Representative
maryanne@nova.edu