1. Autonomy – We strive to ensure graduated levels of responsibility throughout our program, both on inpatient and ambulatory services. Our general medicine and subspecialty inpatient medicine services allow interns to serve as the primary physician for their patients daily care, while the JARs and SARs have opportunities to hone team management and teaching skills.  We envision an end of year intern as a "competent and confident" physician who is able to formulate a working plan for inpatient admissions. JARs and SARs strive to become team managers, bedside teachers and facile users of evidence-based medical information to guide patient care decisions. Interns will have an opportunity to "sign out" cases with the Duke Chief Resident during overnight call, which provides a time for one-on-one discussion with one of our top clinicians. JARs and SARs have this opportunity at the VA, DRH and during  Morning Report. Our night float system also gives JARs and SARs an opportunity for autonomy during inpatient workups on the subspecialty and oncology services. On our ambulatory rotations, the number of patients seen per clinic sessin increases from intern to JAR/SAR year, and the opportunity to see patients in our subspecialty clinics begins primarily in the JAR year.

 

2. Overnight call – Duke residents have continued to support and recognize the value of overnight call experiences on general medicine and ICU services in enriching their educational experiences and clinical competence  and as a  a necessary and invaluable component of our educational system, that it helps preserve continuity, minimize dangerous handoffs, and promote learning during the most critical first 12 hours of patient care after admission. In order to maximize learning experiences and continuity of care on our subspecialty medicine services (pulmonary, transplant, oncology), a night float system will be in place. This system will allow interns on these services to be present during daytime hours for patient care and teaching and have junior or senior residents responsible for coverage at night.

3. Team structure – Team structure is varied based on location, allowing for exploration of differing management styles as well as graduated levels of responsibility for interns, JARs and SARs.  On the VA General Medicine service, teams are led by JARs, with one JAR supervising one intern. An attending supervises each JAR/intern team. This allows the JAR to begin to develop team management skills, as well as a close collaborative relationship between interns and JARs on the team.  The team structure is similar at Durham Regional Hospital, although teams are led by SARs at DRH. At Duke Medical Center, teams are led by a senior resident, who supervises two interns. An attend supervises the SAR/2 intern team. This structure allows for expanding team management skills to be gained by the SAR as well as an opportunity for interns to develop independent assessment skills. We see the Duke Hospital General  Medicine experience as a pinnacle experience for SARs, with the opportunity to develop and hone management and teaching skills in preparation for working at an attending or fellow level.

 

4. Evidence based focus – although EBM is emphasized in most programs, Duke emphasizes the practice of EBM in realtime, through night-time signouts with the chief resident.  Since the JAR/SAR does not have to supervise two interns and a large team of 20-24 patients as is true at many programs, there is more time to think about evidence-based practice in the context of real patients.  During these sessions, each new admission is presented briefly, and key articles are pulled from the literature, with discussion about how to apply these principles to the care of the patient.

 

5. Subspecialty services – interns learn cardiology from top-notch cardiologists on the subspecialty service, not through consultants on a general medicine service.  Each intern round for about a month each on the pulmonary, renal, oncology, cardiology services, instead of doing 6-8 months of “gen med.”  This ensures that subspecialty teaching occurs in a more intensive block format, in addition to the more customary teaching through consultants on general medicine rotations throughout the year.

 

6. Patient population – Duke is rather unique in that it is a private, tertiary hospital which also serves an extremely diverse population, regardless of patients’ ability to pay.  Residents thus gain exposure to a wide variety of diseases and cultures without worries about reimbursement issues, or chasing down multiple private attendings per day for “private patients.” 

 

7. Resident run hospital – nearly every inpatient is cared for by residents, regardless of insurance status or ability to pay.  In the context of Duke’s world class ancillary services, this helps to ensure resident autonomy and countless educational opportunities, while minimizing non-educational “scut-work.”

 

8. Fellowship opportunities – Duke residents enjoy opportunities to stay on as fellows in world-class programs like cardiology, gastroenterology, hematology/oncology, etc.  Many residents choose this option each year, but as our match lists show, Duke residents match extremely well in all specialties and geographical areas.

 

9. Quality of life –Durham is an often overlooked feature of the Duke program.  Our cost of living is impressively low, and most house staff buy homes or townhomes within a very short drive from campus.  The median home price in Durham is below $200,000, easily within the budget of a starting intern, and local commutes are very relaxing, with little traffic.  The surrounding area is rich in cultural, artistic, industrial, culinary, and educational opportunities, with multiple world-class universities, eateries, the capital city of Raleigh, and Research Triangle Park all within a 10-20 minute drive. 

 

10. Research opportunities – during the second year, residents have the opportunity to take a month-long course in clinical epidemiology and research design, culminating in the creation of a research plan.  Many residents also have a month-long block of time set aside during the third year for dedicated research.  Opportunities abound, with the world-renowned Duke Clinical Research Institute (DCRI), Institute for Genome Sciences and Policy (IGSP), and university research labs located here on campus, facilitating resident research for those who are interested.