November 2009 E-Newsletter

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Medical Student Perspectives: Preparing for the USMLE Step 1 Exam

For medical students, preparing for Step 1 means something completely different depending upon your class level. If you are a first year medical student, preparing for Step 1 really doesn't interest you because anatomy lab is quickly taking over your life and finals are rapidly approaching. Second year students react with instant tachycardia or complete denial of the approaching storm. For those of you who are unaware, or in need of a wakeup call, the United States Medical Licensing Examination comes in three doses during your medical education. USMLE Step 1 is the test taken usually at the end of the second year of medical school after basic science education. USMLE Step 2 is administered in two parts—somehow one day of testing is too brief—and they are taken during the fourth year before you graduate. Step 2 focuses more on clinical knowledge than Step 1, which focuses on basic medical knowledge. USMLE Step 3 is taken during your residency training after internship year and tests your ability to manage diagnoses and treatment plans. Step 1 is considered by most students and residency programs as the most important exam of the three. The Step 1 score has become a large component of determining the competitiveness of residency for which you will be able to apply. This was not the original intent of the exam but nonetheless has become the reality of the process of becoming a doctor.

So where do you start tackling one of the most important exams in your life? You have to start with a plan and start early. Everyone has a different studying style and way they learn information. The most important thing to remember is to do what has been successful for you so far. If you have a routine or a study group that works for you, keep that going since it has been successful for you in the past. The Step 1 test is cumulative for both the first and second years of medical school so it will be necessary to give yourself ample time to review. Most people I know who took the test scheduled to take it after their second year in June. Students usually begin studying around three months before they take the test. Committing to studying every single day for a set block of hours is necessary to keep your mind engaged and will foster better cohesiveness of the material. Some schools give their students the opportunity to have time off to prepare for the exam. If you have this luxury, use this time to your advantage. A break from school allows you to completely focus on preparing to do well on Step 1. An increasing number of schools are providing mock exams which have helped a lot of students with their preparation. You should schedule your test at least one week after your finals and not around any huge life events to ensure the least amount of distraction.

After you have scheduled your exam and allocated ample time to prepare without life's distractions, your next priority is to decide what resources you will study. Most students agree that going through all the material you have used for classes is a waste of your time. There are many great review resources available that highlight the important information in a great format. The Step 1 exam will not be like your home institution's tests and the test makers will stress high-yield information. The phrase “high-yield” may cause strong reactions for you at the end of this process since it will be so overused by your instructors. Students who have scored well in the past agree that using some sort of question bank is one of the best options for preparing. Many students use Kaplan QBank or USMLE World question banks. These question banks are computerized and are formatted to look as similar as possible to the FRED software that Step 1 uses. This allows the student to become familiar with the format and will ease your test-day anxiety. In-depth answers are provided, allowing you to learn from your mistakes, which will compound the knowledge you are obtaining through your daily studying. These question banks are a key component to scoring well and I do not know a single student who feels that they were not worth their time.

Another popular and highly successful way to prepare for the Step 1 exam is by using a review book. There are several books available, such as First Aid for the Step 1, Step 1 Secrets, and Step Up to Step 1. Each resource uses a different format to present the material the authors feel is high-yield. There will be pictures, radiographs, electron micrographs, and also audio/video questions on the exam. Make sure you choose a resource that provides as many of these types of material as possible. I have not seen a resource that offers audio/video yet but that will surely be provided in the future. When choosing a book, I recommend talking to students you know who have already taken the exam and ask what they think was a good resource for them. After talking with many students, it seems that each school has different popular review books. Most students would agree that you should only choose one or two review books and read them at least twice each. Do not get bogged down in trying to read five books and not knowing them very well. Knowing the material cold in one book is more important than skimming five books.

Students also like to use resources they are familiar with from first and second year. Individual subject review books such as Board Review Series for Biochemistry, Pathology, etc., and Goljan Rapid Review are great resources that students used while preparing for their classes. These provide great in-depth reviews in subject areas that you may have forgotten or need to brush up on. Only choose two or three of these in which you feel you need the most complete review and use them at the beginning of your studying plan. Do not feel obligated to finish the whole series as this can be a very large and time consuming task during which you may be covering material that will not appear on the exam. Time efficient studying is more important than logging hours and hours of time reviewing material that is obscure and too detailed. If you have your set of notes or review materials that you used during your classes, these can be a great weapon in your studying arsenal. Using familiar diagrams, charts, or notes can be a quick way to review material. Be certain to follow up with review books and questions to be sure you are covering the right material.

Succeeding on Step 1 is absolutely a possibility and should be your major goal throughout your studying process. With the right plan of adequate timing and trying to minimize distractions, you will be able to prepare the best way possible. Question banks have been a key component to most students’ success and allow you to become familiar with the testing format. Remember to use review books you feel comfortable with and read them all the way through several times. Also, make sure you have a good support group to keep your spirits up when you may feel overwhelmed. Spending some time each week with people preparing in the same way will also provide motivation and encouragement to keep pressing for your goal of doing well. As you get to the end of your studying, you will probably feel somewhat burned out. Pace yourself and make sure you keep doing the things you enjoy, like exercising, eating with friends and family, and the routine things in life. As long as you maintain some normalcy in your daily studying regime, you will be on your way to the best outcome.

Many students told me to plan some sort of event or trip after my exam. This was a great idea and something I was able to look forward to after all the hard work I did. Once you have finished those pivotal nine hours of testing, surround yourself with those who make you happy. Stay focused and confident. You are on your way to becoming a doctor.

Gates Colbert, MSIV
Southwestern Representative, Council of Student Members
University of Texas Medical School at Houston, 2010
E-mail: Gates.B.Colbert@uth.tmc.edu

Check out more volunteer opportunities.

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My Kind of Medicine: Real Lives of Practicing Internists: William Cassidy, MD

William Cassidy, MD

For 16-year-old Bill Cassidy, the idea of having cancer was something he never considered, but the doctors had discovered swollen lymph nodes, so the tests were ordered. It was strange and unsettling, but the young Dr. Cassidy managed to see the good in it, an attitude that would come to shape his life. As he interacted with the doctors around him, he found that he liked them, what they did, and how they did it. He wanted to be a part of it. “I thought to myself ‘Wouldn’t this be an incredible thing to do?’” he remembers. “You always want your life to have meaning, and I realized those doctors had it.”

Chasing Truth
The tests came back negative and Dr. Cassidy was free to begin the rest of his life. Today that life reflects a noteworthy and interesting career that includes internal medicine, hepatology, teaching, and most recently, public service. Currently, he is the U.S. Representative for the Sixth Congressional District of Louisiana, a position he’s held since January of this year. The job in many ways is a culmination of the knowledge and skill he’s built over the last twenty years. He says that being a congressman is in many ways like being an internist. “As an internist, you learn to be patient because it takes a while to get a good result,” he explains. “Public service is similar, but if you keep chipping away—educating, educating, and educating, eventually you will get your outcome.”

But before there was Congressman Cassidy there was Dr. Cassidy, and the first step to that began at medical school at Louisiana State University. Later during his residency at the University of Southern California, internal medicine was an easy choice. He found it intellectually rigorous and practicing internal medicine made him feel like Sherlock Holmes, piecing clues together. He says even compared to surgery, he found internal medicine much more fascinating because of the variety. His conviction was further reinforced by his experience working with a mentor, Dr. Telfer Reynolds, who had told him that he once said to another physician in response to a request for a second opinion, “I’m just here to help you pursue the truth.” Dr. Cassidy was struck by the sentiment of the statement. “I really liked that idea—that as internists and teachers we’re pursuing the truth,” he says.

He took his first job as an internist and hepatologist for Cigna Medical Center in Los Angeles for a year before returning to his native Baton Rouge to take an assistant professor position at Louisiana State University Medical School. The role was an easy fit, which he both loved and excelled at, so much so that he stayed for 20 years. The title changed along the way from “assistant” to “associate,” and the passion never waned. “As a teacher you’re always trying to come up with the right answer,” he says, “which I love to do, and I also like being with young people. There is something about the idealism of young people that keeps your own embers of idealism stoked. Most of these young students are motivated for the right reasons.”

Even amid the excitement of his new life on The Hill, his years spent teaching remain the highlight of his career. “My best professional accomplishment is the fact that I have taught,” he says. “I feel as though the teachers I’ve had through the years gave of themselves to me to make me a better internist, and even though they never saw the end result, they understood on some level that they had made a difference. So I consider having taught to be an incredible compliment and accomplishment.”

The Rookie
Making the transition from professor to lawmaker meant learning the ropes all over again. It was a few years ago when he decided to act on his inclination to serve health care in another avenue; he knew instinctively that his experience would be valued in such an environment, however foreign it might turn out to be. He and his wife Laura, a surgeon, made the decision together. His first race was in 2006 for the District 16 seat in the Louisiana Senate. The experience was new and familiar all at once. “Running for office for the first time was a little like my internship,” he jokes. “You’re not quite sure when and where you’re supposed to be every day.” He also had to get used to taking advice instead of giving it. “As a physician, you’re used to giving counsel to other people and you’re used to them taking it.” Now, it was the other way around, and Dr. Cassidy found himself depending on people with more experience than he had. Once elected however, he soon adjusted. “I’ve found public service to be as fast-paced and intellectually stimulating as teaching,” he says.

Just two years later as a freshman congressman in Washington, Dr. Cassidy is appointed to several subcommittees of larger committees. He is crafting a reputation for himself by asking the right questions to spur more productive resolutions. For example, during an impasse in a discussion about a statistical program involving children run by The Indian Health Service, he inquires about office overhead and revenue levels for Medicare and Medicaid patients; in an H1N1 briefing, he asks about risk associated with vaccine lag time. He says being an internist has given him an edge for handling his new responsibilities. “Internal medicine is incredibly good preparation for what I’m doing now,” he explains. “A good internist is a good servant…you’re constantly walking down the hall thinking about details and implications.”

Since taking office in January as a Republican, Dr. Cassidy has experienced what it is like to be in the minority. He seems unaffected by it. “I’ve been told that it’s more fun to be in the majority,” he jokes, “but it’s fine, really. You’re always talking to people across the aisle about a number of things.” But there is one part about the new job which he does admit to not loving: the travel. It’s a typical complaint of many legislators, but one gets the sense that it is particularly challenging for Dr. Cassidy, who is as rooted in his native Baton Rouge as the deepest of Bald Cypress tree roots. He is devoted to the community—his efforts spearheading a successful vaccination effort in Baton Rouge fourteen years ago resulted in the vaccination of over 36,000 children for hepatitis B at no cost to the families or communities. He cites this as a close second to his years spent teaching as his proudest accomplishment. He is a family man as well—he says spending three nights a week away from his wife and three children, ages 15, 12 and 8, is difficult. And when it comes to down time, Dr. Cassidy finds enjoyment easily. “I know it sounds simple, but I just love walking with my wife,” he says.

Check out previous articles as physicians share what motivated them to become physicians as well as why they chose their particular type of practice.

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Internal Medicine Interest Group of the Month: Ohio University College of Osteopathic Medicine

The Ohio University College of Osteopathic Medicine (OUCOM) Internal Medicine Interest Group (IMIG) is gaining interest among the first year medical students this year. The challenges and opportunities that internal medicine provides appeal to many medical students and the officers hope to fuel that interest this year through club activities. The club leadership includes the basic four-tiered leadership found in most clubs, President Kevin McAninch, Vice-President Graham Johnson, Treasurer Jason Rapaport, and Secretary Jeremy Wachenschwanz. We also have two first-year liaisons, one for each curricular tract offered here at OUCOM, who allow us to increase communication and schedule accordingly between the first and second years.

A typical event from last year that we hope to build upon this year was a “What is an Internist?” meeting, led by our faculty advisor, educating the first years about internal medicine. This event provided the students a day in the life perspective as well as information about how residencies and fellowships work after medical school. Other events that further help educate students are skills labs, led by local internal medicine residents, using education tools to teach students basics of intubation, lumbar punctures and central line placements. These labs provide educational exposure to procedures performed by internists. Our club also sponsors lunch lectures collaboratively with Alumni Affairs or the Careers in Medicine series, which feature either alumni or other decorated physicians who come and speak to students about their particular field, specialty, or simply a topic of medicine that interests them. These events allow students to ask questions, learn about different aspects of clinical medicine, and hear actual clinical cases related to what they are learning in class.

The main fundraiser we hold every year is our Chilly Open Golf Tournament. This event includes a shotgun start, with teams of four playing a “scramble,” which allows for beginners as well as experts to participate. Students and members of the community are encouraged to participate and enjoy a friendly game. Prizes are awarded for the first place team, as well as individual prizes for the longest drive, the longest putt, and the closest to the pin on a par three. Both students and faculty look forward to this event every year.

One aspect of our IMIG that we hope to improve this year is our volunteer activities. Last year our club volunteered at Passion Works Studio, which locally collaborates between artists with and without developmental disabilities. Club members worked vigorously preparing the materials used for their unique passion flowers, which decorate many local buildings here in Athens. Giving back to the community is a truly rewarding experience for the club members.

The IMIG at OUCOM continues to improve every year. We hope to continually meet the needs of the students and provide an effective organization that highlights the field of internal medicine.

Kevin McAninch, OMS II
President OUCOM Chapter of SOIMA/IMIG
Ohio University College of Osteopathic Medicine, Class of 2012
Email: Kevin.P.McAninch.1@ohio.edu

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Winning Abstracts from the 2009 Medical Student Abstract Competition: Metastatic Renal Cell Carcinoma In A 19-Year-Old Male Treated With Interleukein-2

Authors: Ian Amber, Priyanka Handa, Michael Shiman, Paul Mendez, MD FACP

Case Presentation:
A 19-year-old Haitian male presented to the hospital after receiving a positive PPD test and an abnormal chest X-ray from immigration authorities. The patient was asymptomatic, denying shortness of breath, cough, or hemoptysis. His oxygen saturation was normal. Upon admission, a chest CT scan revealed bilateral pulmonary nodules consistent with metastatic disease. Additionally, partially visualized hypodensities with peripheral calcifications were seen appearing to originate from the right kidney. Given the patient's age, a germ cell tumor was suspected. However, beta-hCG, alpha-fetoprotein, and lactate dehydrogenase levels were within normal limits. Furthermore, an ultrasound of the scrotum indicated no evidence of disease. Additional imaging was performed. A brain CT was normal. A CT of the abdomen and pelvis confirmed a 3.8 x 3.7 cm exophytic lesion, with ring-like calcifications, in the mid portion of the right kidney. Biopsies of the lung lesions were performed using video-assisted thoracoscopic surgery (VATS). The lesions were consistent with juvenile renal cell carcinoma. Immunostaining was negative for thyroid transcription factor-1 (TTF-1), thyroglobulin, CK-7, and amylase. However, stains were positive for CD10 and strongly positive for carbonic anhydrase IX (CAIX).

Discussion:
Tumors with an over-expression of CAIX typically correlate with a poor prognosis, due to aggressive metastasis. However, CAIX positivity makes him a candidate for interleukin-2 treatment. CAIX is an important prognostic indicator of interleukin-2 treatment, because while response rates vary at approximately 15-20%, only patients who are positive for CAIX are capable of achieving a complete remission.

Because interleukin-2 therapy produces potentially fatal systemic toxicities, it is relatively contraindicated in older patients. Typically, vascular endothelial growth factor inhibitors, such as sunitinib and sorafenib, are used as a less toxic, though palliative, option. While it is rare to diagnose renal cell carcinoma in a young patient, it is important to note how age affects the treatment paradigm. Specifically, in a young patient such as this case, the opportunity to achieve complete remission with interleukin-2 therapy outweighs the risks associated with this treatment modality.

Though clinically he appeared to present with a classic case of a germ cell tumor, this case supports the need for biopsy before any treatment decisions are made. In addition, it highlights the importance of seeking immunomodulatory therapy in young patients with a potentially curable illness.

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Subspecialty Careers: Highlights about Careers in Internal Medicine: Sports Medicine

The Discipline
The discipline of sports medicine primarily concerns itself with the emergency assessment and care of acutely injured athletes, diagnosis, treatment and management of common sports injuries and illnesses, management of medical problems of the athlete, rehabilitation of ill and injured athletes, and exercise as treatment.

Training
Sports Medicine fellowship training requires 12 months of accredited training beyond general internal medicine residency.

Certification
The Sports Medicine Certification Program is jointly developed by the American Board of Internal Medicine (ABIM), the American Board of Emergency Medicine (ABEM), the American Board of Family Medicine (ABFM), and the American Board of Pediatrics (ABP).

Major Professional Societies

  • American Medical Society for Sports Medicine
    11639 Earnshaw
    Overland Park, KS 66210
    Phone: (913) 327-1415
    http://www.newamssm.org/

  • American College of Sports Medicine
    401 West Michigan Street
    Indianapolis, IN 46202-3233
    Phone: (317) 637-9200
    http://www.acsm.org

Major Publications

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Advocacy Brief: Department of Education Publishes Final Rules on Higher Education Reauthorization

The Department of Education recently published four sets of final rules for the federal student loan programs authorized under Title IV of the Higher Education Act.

With regard to medical school financial aid, the regulations:

  • Amend the calculation of monthly payments under the Income-Based Repayment (IBR) program to adjust for spouses who both elect IBR;
  • Increase graduate student annual and aggregate loan maximums in the Perkins Loan Program from $6,000 to $8,000, and from $40,000 to $60,000, respectively;
  • Describe the required content for "codes of conduct" and require institutions to develop and adopt such codes;
  • Require institutions to report on reimbursements received for certain service on lender advisory boards;
  • Require institutions to describe for prospective and enrolled students the terms and conditions of the loans students receive under the Federal Family Education Loan (FFEL), Direct Loan, and Perkins Loan programs;
  • Eliminate the requirement that borrowers make ''written'' requests to obtain a forbearance on their Perkins Loan;
  • Reduce from 12 to nine the number of consecutive on-time, monthly payments a borrower must make to rehabilitate a defaulted Perkins Loan; and,
  • Modify the entrance and exit counseling requirements.

The regulations are effective July 1, 2010.

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Did You Know That ACP’s Council of Student Members is Looking for New Representatives?

If you are active in your local chapter, get involved nationally by running for a seat on the ACP Council of Student Members (CSM). The CSM is responsible for planning programs for the annual meeting for medical students and providing a student perspective on current issues impacting the field of internal medicine. Seats are currently open in the following regions of the United States: Midwest, North Atlantic, Southeastern, Southwestern, and Osteopathic Medical Schools.

More information including time requirements for the Council and the nominations process can be found on ACP Online.

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MKSAP for Students 4 Question 1

A 78-year-old woman who has acute respiratory distress syndrome and was admitted to the medical intensive care unit for mechanical ventilation 2 days ago is evaluated for disorientation. Prior to hospitalization, she lived alone and functioned well independently. The patient is on a ventilator, has received small doses of lorazepam over the past 48 hours, and had initially appeared comfortable. The nurse indicates that the patient recently became disoriented and is not interacting as clearly with her family as she had before. Her mental status has fluctuated over the past 24 hours.

On physical examination, vital signs are normal except for slight tachycardia. She is calm and awake but cannot follow directions and cannot answer simple questions by nodding her head. There is no evidence of hallucinations. Neurologic examination shows no focal abnormalities, and cranial nerve examination is normal.

Laboratory studies show hemoglobin of 9.9 g/dL and a leukocyte count of 11,000/µL with a normal differential. Comprehensive metabolic panel is normal. Serum total T4 and thyroid-stimulating hormone levels are normal.

Which of the following is the most likely cause of her current symptoms?

A. Cerebrovascular accident
B. Delirium
C. Dementia
D. Paranoid psychosis

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MKSAP for Students 4 Question 2

A 28-year-old woman is evaluated in the office for a lump in the right side of her neck that has grown large over the past month. She has not had fever, soaking night sweats, weight loss, or recent illness. She does not smoke cigarettes and takes no medications. The remainder of the history is noncontributory.

On physical examination, a 3.5-cm right anterior cervical lymph node and a 1-cm right supraclavicular lymph node are palpable. Laboratory studies, including complete blood count, comprehensive metabolic profile, lactate dehydrogenase concentration, and heterophile antibody assay, are normal. Chest radiograph is unremarkable.

Which of the following is the most appropriate management for this patient?

A. Bone marrow aspirate and biopsy
B. Empiric antibiotic therapy and re-evaluation in 2 weeks
C. Lymph node excision
D. Observation for 3 months

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MKSAP for Students 4 Answer 1

Answer: B: Delirium

This patient has the most common type of delirium in the intensive care unit (ICU), which is hypoactive or “quiet” delirium. Delirium is a form of acute brain dysfunction that occurs in 50% to 80% of mechanically ventilated patients in the ICU. It is associated with a 3-fold higher rate of death by 6 months, much longer stays in the ICU and hospital, higher costs, and a 10-fold higher rate of chronic cognitive deficits after ICU survival. Delirium can be diagnosed quickly using the Confusion Assessment Method-ICU (CAM-ICU), which takes 20 to 30 seconds to perform in most patients. The four cardinal features of the diagnosis are: 1) acute onset or fluctuations in mental status over a 24-hour period, 2) inattention, 3) disorganization of thinking, and 4) an altered level of consciousness at the time of the evaluation. This patient has features 1, 2, and 3. She is having fluctuations in her mental status, cannot follow directions, and is inattentive, as evidenced by her inability to correctly answer simple questions that would require organization of thinking. Hallucinations may be a symptom of delirium, but they are not required for the diagnosis. She is not hyperactive or in “distress,” and this also is not required for the diagnosis of delirium. In fact, only 5% of ICU delirium is of the pure hyperactive subtype. Although most CAM-ICU monitoring is done by nurses, physicians should be familiar with these criteria so that they can detect this form of organ dysfunction and recognize the many potential causes, such as acute respiratory distress syndrome or administration of benzodiazepines, as in this patient.

She exhibits no signs of acute focal neurologic events such as a cerebrovascular accident. Since she was functioning independently prior to hospitalization and her mental status changes occurred while in the ICU, dementia is an unlikely diagnosis. The fluctuating mental status and absence of a premorbid history of mental illness make psychosis unlikely.

Bibliography
1. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286:2703-10. [PMID: 11730446] [PubMed]

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MKSAP for Students 4 Answer 2

Answer: C: Lymph node excision

The rapid onset of enlarged lymph nodes over the course of 1 month and size >2 cm are symptoms suspicious for infectious or malignant disease. Lymphadenopathy in the supraclavicular region almost always indicates an infectious or neoplastic cause and requires an immediate diagnostic procedure. This young patient, who does not smoke, most likely has Hodgkin's or non-Hodgkin's lymphoma. A complete lymph node excision is always preferred over a percutaneous needle biopsy in this setting because an adequate amount of tissue and preserved lymph node architecture can ensure a proper histologic diagnosis.

Observation for 3 months would be appropriate only in patients with smaller cervical lymph nodes (less than 2 cm). Antibiotic trials are never of value in the absence of signs, symptoms, or cultures suggesting infection. Bone marrow biopsies or aspirates are not optimal for establishing a primary diagnosis of lymphoma because of the lack of lymph node architecture present in this type of specimen; however, this test is the preferred diagnostic approach when lymphoma is suspected but no tissue from a peripheral enlarged lymph node is available for biopsy.

Bibliography
1. Huntington MK, Sewall BO. Neck mass: how would you treat? J Fam Pract. 2007;56:116-20.[PMID: 17270117] [PubMed]

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Articles for Medical Students from ACP Internist and ACP Hospitalist

    Keep in touch with Internist and Hospitalist through social networking:

  • Blog about Internist
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ACP Internist (formerly ACP Observer)

Find all of our print and online content, by going online for the following stories:

  • Experts debate pros, cons of vitamin D
    An obscure nutrient is now being hailed as a link to prevention of diseases as disparate as diabetes, schizophrenia, cancer, strokes and heart attacks. Experts square off on how much vitamin D can be associated with illnesses, the proper amount that people should get, and how they can get it.
  • Work up the whole patient when treating IBS
    With so many confounding factors to consider with irritable bowel syndrome, physicians can benefit their patients most with an important diagnostic tool—listening. Learn how to work up these patients from first steps to cognitive therapy options.
  • Uncertain diagnosis for pain leads doctor to dig further
    A 66-year-old woman presents with abdominal pain radiating to her back, and CT scans show multiple lesions worrisome for metastatic disease. But when the pain resolves and the lesions don’t change, one internist reconsiders the diagnosis.

ACP Hospitalist

The relaunched ACP Hospitalist is the place to find all of our print and online content, including ACP HospitalistWeekly, our polls, and surveys (including our cartoon caption contest). Go online for the following stories:

  • Code status discussions sometimes difficult, but necessary
    Understanding individual preferences about code status is critical to delivering the care patients want. Still, code discussions between doctors and patients don’t always happen when they should, or at all. A 2008 study in the Journal of Hospital Medicine found that only 10% of patients in six university-based hospitals had documented code discussions within 24 hours of admission.
  • A new tool developed by hospitalists helps assess mobility
    The I-MOVE sounds like a state-of-the-art electronic gadget, but it’s actually the simplest of medical tools. Developed by clinicians at Mercy Hospital of Pittsburgh and the Mayo Clinic in Minnesota, the Independent Mobility Validation Examination, or I-MOVE, is a 12-point scale that could help hospitalists assess their patients’ mobility.

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Students: Join ACP for Free

Benefits of Membership for Students: ACP's free Medical Student Membership includes benefits designed especially to meet students' needs.

Join Now: Sign-up today and begin enjoying the benefits of ACP Medical Student Membership.

MKSAP 15 Discount 10% Off

MKSAP 15 Discount 10% Off

Get ready for the New Year with the newest edition of MKSAP. Enjoy a 10% discount off MKSAP 15 for a limited time. You must order by December 11, 2009 and use priority code E9048 to get the discount.

Holiday Gift offer - 10% off

Holiday Gift offer - 10% off

A great gift for a colleague or yourself - Landmark Papers in Internal Medicine: The First 80 Years of Annals of Internal Medicine. Enjoy a 10% discount when you order by December 11, 2009 and use priority code E9049.

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