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ACOI American College of Osteopathic Internists
Resident News November 2011
NOVEMBER 2011
TABLE OF CONTENTS



INTERNAL MEDICINE, SUBSPECIALTY TRAINING GROWTH CONTINUES

The Annual ACOI Survey of Internal Medicine Residency Programs was completed this Fall by DMEs and Program Directors of all osteopathic internal medicine programs. Information from all programs has been received. There are now 102 approved internal medicine programs, with 92 training residents. That is six more programs approved and eight more with trainees than last year. Approved and filled positions both increased significantly again this year. The total number of residents in internal medicine, including combined programs, is 1,257, a 15% increase over last year.

The number of funded internal medicine positions also increased dramatically. More than 1450 of the 1667 approved positions are funded. This is up from 1125 last year.

DUAL PROGRAMS – The survey captured data on whether the responding programs are also approved by the ACGME. Twenty-seven programs reported dual approval. They are training192 residents (including combined EM/IM and IM/PEDS). That is the same number of programs and 18 more residents than last year.

SUBSPECIALTY TRAINING – The demand for internal medicine subspecialty training is growing and the profession continues to meet it. Thirty-four institutions offer one or more subspecialties, four more than last year.

The number of available subspecialty programs has increased to 104 (five more than 2010-11). There are now 227 fellows training in 13 specialty areas. This is up from 201 fellows last year. There are no approved trainees reported in allergy/immunology, palliative medicine, sleep medicine or electrophysiology. Training is occurring in all other specialties.

LAST YEAR’S GRADUATES
The online Resident Annual Reports completed by all residents require graduating residents to report their future plans. For June 30, 2011 graduates, here are the results:

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.




THE ROLE OF THE MENTOR

“Better than a thousand days of diligent study is one day with a great teacher.” – Japanese Proverb

I believe the best thing that I did in my years as a student and as a Resident is finding two physicians that I could rely on for career advice and that could also help me progress from student to resident and staff. I would call them “Mentors.” We all meet people during our education whom we look up to and would like to emulate. This is how we shape our practice, our bedside skills and even our daily habits. These people you may meet briefly, or work with on occasion on rotations. But, in addition to these role models and teachers, the Mentor provides something more.

The Mentor is a Physician you can trust to give you good advice about any subject (patient care, directed reading, job interviews and even career guidance). The Mentor has been in your place and wants to help you develop as a person and physician; they will have the experience to offer you the needed advice.

In addition to being a sounding board and giving advice, mentors often help you in ways above and beyond. They may suggest you for projects that they know you are interested in to those in charge, or speak well of you at meetings, even ask you to head committees or task forces. I was lucky enough to have two people like this in my Residency. I was placed on committees or projects that, at the time, I did not think I had time for, or the skills to complete. Pushing me closer to my limits helped me grow as a person, while also developing valuable skills and great achievements for my CV. These projects also allowed me to meet people of influence at my institution. It will not be long until you are applying for something (residency, fellowship, or job) and having a well-rounded CV, as well as the backing of important people, is the name of the game.

It is never too early to try to identify a Mentor. You will probably know when you found the right person, but some good qualities included being influential and respected in their current position and willing to take the time to talk with you. They also have to like you. A true mentor may be the most valuable thing that you obtain from your education and residency. We all need to learn the art of medicine, but this is not the only thing we should learn in the seven years of medical training. Let a Mentor help you with the things outside of the standard medical curriculum.

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, and now serves as a member of the ACOI Board of Directors. He may be reached at slgirard@geisinger.edu.



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OBESITY: ARE THE PHYSICIANS OF TOMORROW PREPARED?

A few weeks ago, osteopathic internists from across the country gathered in the quiet hill country of San Antonio. There was sunny weather, golfing, dinner with friends and plenty of relaxation, but most importantly, there was a theme. The ACOI Convention does not always have a central topic, but recognizing that all physicians encounter obesity in their scope of practice, the ACOI program committee decided to make it this year’s focus. To that end, the majority of sessions at the 2011 ACOI convention were centered on obesity.

The 2011 ACOI convention syllabus is available online, with complete presentations in PDF format (www.acoi.org/CMEConSyl2011.html). There are overviews on obesity trends, presentations regarding overweight patients in critical care settings, thoughts on causes and treatments, slides on how obesity relates to nearly every subspecialty, and more. Could a virus predispose someone to weight gain? (See Dr. Taormina’s lecture at www.acoi.org/2011Convention/Taorminal.pdf). Why does obesity increase one’s risk of certain gastroenterologic cancers? (See Dr. Lepane’s lecture at www.acoi.org/2011Convention/LePane2.pdf). A quick skim of the posted presentations reveals no area of medicine is exempt from the complications associated with obesity. Therefore, physicians of the future must be armed with sufficient knowledge of this national crisis.

Of course as residents, fellows and students, you encounter obesity everyday in the hospital and office. But how often do you pause to think about how that patient’s body mass index (BMI) is affecting every aspect of his health? (How often do you even calculate BMI?) Studies by both Dr. Nichola Davis1 and Dr. Christopher Ruser 2 suggest that we under-recognize, lack comfort discussing and have negative attitudes towards obesity as medical residents. Do you feel comfortable discussing a patient’s weight with him? Do you skirt around the obvious, address diabetes and obstructive sleep apnea, but never mention the core topic of weight loss? Information from the National Health and Nutrition Examination Survey3 shows most physicians are not discussing weight with patients and patients are less likely to identify themselves as obese if their doctor has not mentioned it.

Many medical schools and residency training programs are adding obesity education to their curriculum. If you have not been exposed to formal training, there are some simple measures you can take to incorporate weight into discussions with patients. The National Institutes of Health propose the following4:

  • Talk – Open a dialogue with patients regarding their weight, struggles, well-being and goals. Do not be embarrassed to start a discussion, but gauge each patient’s willingness to explore the topic.
  • Use Non-offensive Terms – Most patients prefer “excessive weight” or “over-weight,” as opposed to “fat” or “obese.” If unsure, ask patients what terms they are comfortable with. At the end of the day, it is about communicating effectively.
  • Advice – Be able to provide information on nutrition, exercise and setting goals. Be available for follow-up.
Whether or not we are prepared as clinicians, patients are gaining weight. The CDC estimates 33.8% of the US population is obese and there is no state where obesity rates are less than 20%. Take time now to become more comfortable with studies regarding obesity, global trends and ways to communicate with patients about their weight; it will serve you in the future.

As always, please feel free to send comments, questions and ideas to acoiresidentrep@gmail.com.

1 Med Educ Online (serial online) 2007;13:5 doi:10.3885/meo.2008.res00257
2 Gen Intern Med. 2005 Dec; 20(12):1139-1142
3 NHANES information available at http://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm
4 NIH NIDDK (Talking with Patients about Weight Loss: Tips for Primary Care Professionals) available at http://win.niddk.nih.gov/publications/talking.htm

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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NEW ADDITION TO THE DOCTOR'S TOOL BAG: THE SMARTPHONE

In this age of texting, emailing and instant messaging, we are living in a world where information and communication are just a click away. Naturally, these advances in technology have seeped into the medical field and have been enticing the technophiles as well as the technology-naive in our profession.

As a resident, it was common to see our pockets brimming over with bound books, papers, and notebooks: books for pharmacological agents, various reference books on guidelines and disease pathology, and “pocket brains” a.k.a. mini-notebooks we would use to record high yield information. With the trend toward using handheld devices such as smartphones, however, our pockets have gotten lighter and the culture of practicing medicine has changed.

The versatility of this upcoming technology ranges from providing the ability to obtain unlimited information to being a major tool in physician documentation for patient encounters. Can’t remember medical equations, drug- drug interactions, or minute details about disease processes? The answers are found in seconds using a device that is no bigger than a deck of cards. Smartphone applications are dynamic enough that they also can be used to find appropriate billing codes, drug formularies, medical news, up to date medical guidelines, medical procedures, and they can even be used for language translation. Physicians are also using the smartphone’s bigger cousins, the netbook and tablet personal computers for electronic medical records in addition to the aforementioned features.

In the year 2011, most doctors’ tool bags not only include a stethoscope, reflex hammer, penlight, otoscope and ophthalmoscope, but also a smartphone. Though it is controversial that physicians are becoming more reliant on technology, especially during our years of training, technology is never a replacement for a physician’s diagnostic skills. The smartphone, however, is an enhancement to the way we currently practice medicine.

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 65 year old male presents to your office complaining of the rash shown.
Which historical fact would suggest the diagnosis?

  1. Recent travel to Haiti
  2. Recent hunting trip to Pennsylvania
  3. Extensive dental work one month prior
  4. History of chronic hepatitis C
  5. Recent travel to Chesapeake Bay and the consumption of raw oysters
The correct answer is 2. The rash shown is erythema migrans and it occurs frequently in patients with Lyme disease. The infection, caused by Borrelia borgdorferi is transmitted by ticks in endemic areas. Travel to Haiti might suggest malarial or hepatitis A infections which are not associated with this rash. Recent dental work might cause endocarditis but the typical skin lesions of endocarditis are generally petechial in nature. Chronic hepatitis C can cause cryoglobulinemia which may cause palpable purpura. Consumption of raw or undercooked oysters may cause vibrio vulnificans which can lead to severe bullous hemorrhagic skin lesions and septicemia.




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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US DEPARTMENT OF LABOR DENIES PETITION TO REGULATE DUTY HOURS
The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) announced that it declined a petition by Public Citizen Health Research Group (Public Citizen) and others to promulgate a federal workplace standard to regulate and enforce limits on the number of duty hours of resident physicians and subspecialty resident physicians. In a letter dated September 14, the U.S. Department of Labor noted that employees in many other professions also experience fatigue caused by working long hours and rotating shift schedules. As a result, all professions would have to be reviewed. The letter went on to state, “At this time, OSHA has determined that resident duty hour standards are best addressed within the context of resident training and education.” It was also noted that OSHA is currently working on guidance which will provide advice on coping with the effects of fatigue and sleep deprivation related to working extended hours.

SUPREME COURT AGREES TO HEAR ACA CHALLENGE
The U.S. Supreme Court announced that it will hear legal challenges to the Patient Protection and Affordable Care Act (ACA, Pub. L. 111-148). The Court agreed to hear legal questions presented in the case of Florida v. Department of Health and Human Services. The case was brought by the State of Florida and joined by 25 other states, the National Federation of Independent Business and two individuals. The U.S. Court of Appeals for the Eleventh Circuit in a 2-1 decision found the “individual mandate” to be unconstitutional on August 12. The majority found that the commerce clause of the Constitution does not allow the Federal government to “mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time that they are born until the time that they die.”

Oral arguments are expected to take place in March with a decision being handed down in June 2012. Recognizing the gravity and complexity of the issues presented, the Supreme Court has allotted five and a half hours for oral arguments. Generally, the Court allows just one hour for oral arguments per case. While cameras are not generally permitted in the Supreme Court during proceedings, several requests have been made asking the Court to allow television coverage of oral arguments. The Court has not provided an indication as to how it will respond to the request.

CALL ON CONGRESS TO REPEAL THE MEDICARE SGR FORMULA
A bipartisan group of U.S. senators and representatives was named in August to serve on the Joint Select Committee on Deficit Reduction. These 12 members of Congress have a unique opportunity to permanently repeal the Medicare Sustainable Growth Rate (SGR) formula, which has threatened to impose draconian Medicare physician payment reductions nearly every year since its inception. The Committee is intended to avoid the historical policy and political challenges that have impeded the attainment of permanent solutions in the past.

To reach the goal of SGR repeal, the ACOI in conjunction with the AOA and others, launched a campaign entitled EveryPatientCounts. The campaign features a petition that calls on Congress to enact a permanent solution to the SGR formula. Through this petition, physicians, medical students, patients, healthcare administrators and concerned citizens can collectively express their support for a permanent solution to this ongoing problem.

While correcting the SGR formula is not easy, the next three months hold great potential to secure a permanent solution to this ongoing problem. We urge you to join in this campaign by signing the petition. Once you sign, urge your colleagues, family and friends to do the same. It is as easy as clicking visiting www.everypatientcounts.org.

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

RESEARCH CONTEST WINNERS RECOGNIZED
Congratulations to the more than 45 residents and fellows who participated in the annual research abstract poster contest. The winning entrants, as judged at the 2011 ACOI Convention and Scientific Sessions in San Antonio, are pictured below.


Poster winners from left: First place, Lisa Caltabiano, DO, Summa Western Reserve Hospital, Cuyahoga Falls, OH. Third place winner, T.J. Trad, DO, OSU Medical Center, Tulsa, OK, and second place winner, Katrina Plat, DO, Arrowhead Regional Medical Center, Colton, CA.



Case Presentation winners from left: First place winner, Mahdi Taha, DO, OSU Medical Center, Tulsa, OK. Second place winner, Todd James, DO, LewisGale Hospital at Montgomery, Blacksburg, VA, and third place winner, Benjamin Hudson, DO, Good Samaritan Regional Medical Center, Corvallis, OR.

AOBIM HAS NEW WEBSITE
The American Osteopathic Board of Internal Medicine (AOBIM) has developed a new website. All information regarding certification examinations in internal medicine and the subspecialties can be found on the website www.aobim.org. Applicants for all certification examinations must register on line on the website. After registering, the application materials can be downloaded and printed from the website.
The application materials must be mailed to the AOBIM with the examination fee. Deadline dates, policies and procedures and all pertinent information, including contact information, is on the website.
As a reminder, the deadline date for registration and receipt of the application materials and examination fee in the AOBIM office is February 1 for the Internal Medicine exam and April 1 for the subspecialty and added qualifications examinations.


RESIDENTS WIN RAFFLE PRIZES AT CONVENTION
More than 200 osteopathic internal medicine residents and subspecialty fellows attended the 2011 ACOI Annual Convention in October. In addition to attending the general Convention lectures and several sessions designed specificially for residents, those attending were eligible for daily prize drawings at the sessions. The prize winners are:
   Local Winery Tour Tickets (2): David Cullen, DO, Metro Health Hospital, Wyoming, MI
   Six Flags Fiesta Tickets (2): Amanda Valviano, DO, Kennedy Memorial Hospital, Stratford, NJ
   $100 American Express Gift Card: Joshua June, DO, Metro Health Hospital, Wyoming, MI
   ACOI Logo Gear: Ramin Rashidan, DO, Botsford General Hospital, Farmington Hills, MI
   iPad: Emilia Arden, DO, Oakwood/Southshore Medical Center, Trenton, MI
   iPad: Thomas Drames, DO, Mercy Catholic Medical Center, Darby, PA
All residents and students attending the Convention also received a $75 voucher towards the purchase of a text book courtesy of the ACOI Legacy Fund and members of the College.


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.







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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

Subspecialty & Certification of Added Qualifications Examinations
August 25, 2012
Westin Lombard Yorktown Center, Lombard, IL
Application Deadline: April 1, 2012
Late Registration Deadline: May 1, 2012

  • Allergy/Immunology
  • Cardiology
  • Critical Care Medicine
  • Endocrinology
  • Gastroenterology
  • Hematology
  • Infectious Disease
  • Interventional Cardiology
  • Nephrology
  • Oncology
  • Pulmonary Diseases
  • Rheumatology

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



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ACOI Contacts
Jack D. Bragg, DO, FACOI
President
braggj@health.missouri.edu
Robert G. Good, DO, FACOI
President-Elect
Robert.Good@carle.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



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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)
gary.slick@okstate.edu
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
Contact by Email
Jo Ann Mitchell, DO
Contact by Email
Maryanne Samuel, DO
Council Resident Representative
maryanne@nova.edu