Spring Cleaning

Hi everyone,

To honor Spring, I spent yesterday cleaning my home office, though I also honored the warm weather with a bike ride. Today, I’m cleaning up my “things I want to tell you list,” so here we go:

1. Chick-fil-A: I got a heartfelt letter last week from Todd Langston, the owner of the Wallingford Chick-fil-A, thanking me for discussing the boycott question with him. He hopes to continue working with us and shared his thoughts about the company and his business philosophy. I’ve attached his letter, which includes an inspiring video describing their college scholarship fund. I still plan to write to the CEO, Dan Cathy, to discuss the company’s contributions to groups with anti-LGBTQ policies. If you’d like to join me, let me know.
2. 28-hour-call: We had a productive meeting on Thursday night and the Chiefs will be sending out a survey soon so we can plan for next year. Here’s a quick summary:
   1. In the MICU, we could eliminate most 28-hour calls for interns and PGY2s by moving one of the PGY3s to a night rotation. There would still be occasional calls to relieve the night resident as well as some longer days in the admission cycle. We’d also have to work out logistics with MICU leadership. The alternative would be to continue the current system, eliminating new admissions after 2A to make overnight call more manageable.
   2. At the VA, we have no immediate changes planned, though we will continue to explore whether the MICU senior can relieve the on-call residents for part of the night. Going forward, we could explore creating night teams, but we don’t have the staffing to do it yet, and the consensus is that of all the calls, the VA call was generally most tolerable.
   3. For Oncology, we are working to see if we can 1) significantly decrease the number of admissions that go to the call resident or 2) assign interns to take call twice a week so the resident isn’t on alone. Spread over the entire intern class, the latter system would require that each intern do a small number of calls over the course of a year, for example when they are on elective.
   4. For Fitkin, several people have suggested that we try switching day residents to the night team. This approach would solve the 28-hour call issue but it would lead to understaffing during the day, which would be particularly stressful when we have sub-interns on Fitkin, because we’d have fewer residents to supervise them. The two leading contenders to address call on Fitkin are to 1) continue with the current system, which caps admissions at 3A or 2) to add a 5th resident to Fitkin to create a night team, which would require a modest decrease in resident elective time.
   5. If we choose to continue call, we could try to limit the duration to 2-weeks at a time. While this is technically possible, it does introduce logistic challenges to the schedule, which would likely come up against other scheduling objectives like giving residents the chance to experience as many specialty rotations as possible over the course of training, because the number of scheduling options available for each block would be more limited.
   6. A couple of final comments on this issue: First, we recognize that creating the optimal staffing model is extremely challenging and our discussions will likely continue to evolve in the years ahead. Eliminating call requires more staffing at night, which necessarily forces us to pull residents from other rotations. Whether we want to take this approach will require ongoing discussion. Second, we recognize that resident viewpoints diverge widely on this issue, ranging from those who would push to eliminate 28-hour call, even if it means sacrificing other opportunities like electives, to those who tolerate or even prefer overnight call and don’t want to make those sacrifices. Whatever we decide as a residency, we will take everyone’s input into account, recognizing that because opinions vary so much, we won’t please everyone. We will remain focused on our key objectives- to promote patient safety, resident wellness, and effective education.
   7. Please respond to the Chief’s survey when it goes out.
3. Graduation awards: Believe it or not, graduation is coming and it’s time to bestow awards on residents, faculty, and staff. Please complete the linked survey! The deadline is April 30^th, 11:59P.
4. APD: We have begun recruiting for a new ambulatory APD to replace Dr. Gielissen. The candidate would work with and mentor our new PCC Chief and would lead ambulatory education. Please feel free to suggest candidates!
5. PCC Chief: We are looking for PCC Chiefs for both the 2019-20 and the 2020-21 academic years. The Chief will be responsible for precepting and teaching in the PCC (and then the NHPCC). If any graduating seniors are interested in the position for this coming year, or any PGY2s are interested in exploring the position for next year, let me know.
6. Retreats: We’ve rented a house in Niantic for this year’s retreats and exciting plans are in the works. Tell the Chiefs if you have ideas.
7. ACGME Survey: Thank you, thank you, thank you for completing the survey. 100% of you participated, and we will share the results when we have them.
8. Transitions: As we approach the end of the year, it’s time for PGY1s to start transitioning into the resident role to prepare to lead their own teams. Try running rounds, doing admissions start to finish on your own before seeking advice (emergencies aside), writing discharge summaries, and leading teaching rounds. It’s also time for committee heads to start turning leadership over to juniors so you can overlap for a few weeks. Go for it!
9. Fellowship applications: The time to apply is coming fast! For those of you applying to fellowship this year, please send me your personal statements and CVs to review. It’s also time to contact potential letter writers and, if you like, reach out to the Yale fellowship directors and section chiefs to discuss your plans. My door is always open if you’d like advice.
10. Out of town: As I write, I’m on Amtrak, traveling to Philadelphia for the Spring Program Director’s Meeting. The rising Chiefs and APDs will be there too. It’s a great opportunity to see old friends and share ideas. I also hope to catch up with former residents and meet my daughter, a senior at Haverford, for dinner. I’ll be back on Thursday.

With that, I’ll settle back and enjoy the ride (especially so because I’m sitting beside the wonderful Manisha Juthani).

Talk to you soon,

Mark

For your reading pleasure:

How to improve your memory: https://www.nytimes.com/2019/04/12/smarter-living/how-to-improve-your-memory-even-if-you-cant-find-your-car-keys.html?smid=nytcore-ios-share