December 2008 E-Newsletter

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Medical Student Perspectives: Fourth Year Survival Guide

The fourth year of medical school is a unique time in a young physician's life. Instead of learning what you are told to learn, you can finally choose what you are interested in and focus your studies. You will be going on job interviews and working toward becoming a full-time employee instead of a full-time student. This is an important period in your life, and while the amount of free time and lack of responsibility you have during this period certainly make for a fun time, there are also important decisions to be made and vital resume-enhancing opportunities to take advantage of.

For this article, I have decided to forego the timeline format that many resources use and instead have created an ordered list of a fourth-year medical student's top 10 priorities.

#1: Figure Out What You Want to Be When You Grow Up
It is okay to not know what type of doctor you want to be by the end of third year. You have only had one year of clinical medicine and there are several areas of medicine that you have not even seen. Even in the fields to which you have had exposure (such as surgery, internal medicine, and obstetrics/gynecology), you have probably only seen the hospital version of those fields and not how those fields translate to the outpatient setting. The fourth year of medical school is the perfect time to take electives and figure out what type of residency you are going to apply for. Try to take electives in all the fields you may be interested in as soon as possible. Ideally, by August you should be fairly certain as to what type of residency programs you will apply.

I think too often students develop tunnel vision early in their medical school education and do not give all areas of medicine a fair shake. The importance of this decision should not be overlooked. This is your chance to see if radiation, oncology, ophthalmology, or hepatology might be for you. Even if you need to spend some of your free time rotating on services you are interested in, do it! Twenty years from now you will appreciate it.

#2: Get Your Letters of Recommendation Lined Up
If you are lucky and had a great experience with an attending on one of your clerkship rotations, and you are interested in that field, that is great! Most residency programs only require two letters of recommendation other than the departmental letter and the dean’s letter, so you are halfway there! If not, do not fret! Letters do not need to be in until the end of September and even after that is fine, as long as the rest of your application is done. If you took my advice and took the time to figure out what residency to apply for, then starting in August you should be actively seeking the two letters you need for your application. It is best if one of these letters comes from your acting internship rotation, so try to schedule that during July or August, although September would probably be fine too. Does it matter how well-known your letter writer is? I imagine for highly competitive programs with limited spots this could make a difference. I think as long as you have a strong letter from a faculty member at your institution, however, it does not matter so much who that faculty member is.

#3: Honor Your Acting Internship
This is your chance to show your stuff. The ideal month to schedule your acting internship (AI), in my humble opinion, is August. This gives you time to achieve priority #1 (see above) and brush up your medical knowledge, while giving your to-be letter writer enough time to get the letter in by September. Plus, with newbie interns on the floor, you may even end up looking sharper than them! Getting honors in your AI will be mentioned in your dean's letter and will look good on your application.

#4: Have Fun
This concept is usually ranked last on these types of lists, after stressing you out with all the stuff you need to do. This is expressed as kind of an afterthought, “Oh yeah, don’t forget to have fun!” Well, having fun during fourth year should be near the top of your list. While fourth year brings with it a lot of firsts, it also provides many lasts: the last time you will be around all of your medical school buddies and the last time you will have gobs of free time with little responsibility. So make sure you have fun. Do not schedule hard rotations throughout your fourth year. You will be on exhaustive rotations for the next three or more years, so give yourself a break. Take a trip, go out with friends, go see a movie, and watch the Rocky Marathon on AMC. If you ever feel guilty about not “getting things done,” think back to that scene in Billy Madison when he comes back from high school and tells one of his elementary school buddies, “You have to cherish it … you do …”.

#5: Try to Do Some Research
Research can be fun and fourth year is a great time to do some. Talk to physicians in some of the fields in which you may be interested and see what they have available. Even if you start after applications are due, you can talk about your research experience during interviews and it may help boost your fellowship application.

#6: Teach
Teaching is a large part of being a physician, and with your free time as a fourth year student, why not get some valuable practice at teaching? Most schools have an elective where you can be a teaching assistant for a basic science course. During my fourth year, I have been able to tutor first-, second-, and third-year students. It has been fun and it is also a great way to touch up on some pharmacology or pathology.

#7: Decide When to Take Step 2 Clinical Knowledge and Clinical Skills
This item should be placed higher on your list if you did not do well on Step 1. Step 2 Clinical Knowledge is considered to be easier than Step 1 and offers a good opportunity to make up for a poor showing on Step 1. However, if you are comfortable with your Step 1 score, there really is no need to take Step 2 until after your ERAS application has been submitted. Residency programs do not require Step 2 with your residency application and if you take it after you submit your ERAS application, you do not need to release your scores until after the match. I feel that the early months of fourth year are better spent on priorities #1 through 3 above. That being said, most people seem to do better on Step 2 than on Step 1, and you are probably best prepared to take it right after your third year is complete. So, it really is a personal decision as to when to take the test. Schedule two weeks off to study and you should be fine. As far as Clinical Skills goes, this test is really not that bad. If you have not slept through all of your third year of medical school you really only need a couple days with a review book and you should pass easily.

#8: Figure Out Where You Want to Live
This is a key part in the residency application process and will help you significantly narrow down your schools. A few key questions to ask yourself are:
• How close to family do you want to be?
• Big city? Medium-sized city? Rural?
• Cold or warm climate?
• Can you afford to live here?

#9: Discuss Features of Residency Programs with Your Mentor, Residents, Program Director, and Anyone Else Whose Opinion You Value
I have found that both residents and attendings are eager to talk about what they looked for in programs and what they think is important when applying for residency. Talk to them about different call schedules, patient populations, fellowship opportunities, program reputations, community hospitals vs. university hospitals, and whatever else you want to know. A good idea is to go to the AMA FREIDA Web site and print out a list of all the programs in the areas in which you are interested in living and review this list with someone whom you feel comfortable speaking with at your university.

#10: Enjoy the Interview Season
Traveling and answering the same questions over and over again is tiring for anybody. The key to being successful at each of your interviews is to have fun. Explore the area around the hospital, go to the pre-interview dinners, and talk to the other applicants as well as the residents. Do not worry about whether you are going to get in, or all of the money you are spending, or any of the many other aspects that could be stressing you out during this time. This is a fun time in your life and you should try to make the most of it.

Good luck! Feel free to e-mail me with any questions.

Joseph Sivak
Central Atlantic Region Representative, Council of Student Members
University of Virginia School of Medicine, 2009
Email: jasivak@virginia.edu

Check out more volunteer opportunities.

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My Kind of Medicine: Real Lives of Practicing Internists: Ebony Boulware, MD, FACP

Ebony Boulware, MD, FACP

In her 39 years, Ebony Boulware has been many things: an All-American field hockey player, a chemistry tutor, a flute player, an English major, a record-setting college basketball player, a piano player, a wife, a mother, a physician, and a researcher. For all of the things that have held her attention, it is her work on kidney disease that has been among her proudest accomplishments. It says a lot about the physician from Baltimore, Maryland, the most striking of which perhaps is the fact that she is in her heart very much a team player. “I like doing work that can help a lot of people at once,” she says. “When we do research and it finally reaches fruition, it can impact millions of people at a time. That’s why my job is so fulfilling.”

Creative Thinking
As an Associate Professor of Medicine and Epidemiology at the Welch Center at Johns Hopkins University Hospital, Dr. Boulware works primarily as a clinical epidemiologist, applying research methods to clinical health problems. The Welch Center is a multidisciplinary research center focused on diseases and conditions that impose a substantial burden on the health and resources of the public. Specifically, the center evaluates the application of lab discoveries and the adoption of best practices in clinical settings and populations through patient-oriented research.

Dr. Boulware spends her time reviewing literature, collecting data from patients and the general public, analyzing it, writing papers, and teaching students and trainees. “I’d say I spend 65 percent of my time doing research, about 20 percent teaching and writing grants, and the rest of the time seeing patients,” she explains, adding how being an internist has given her the background she needs for the job. “Being an internist, I’m very comfortable dealing with a broad range of topics,” she says. “It has given me a broader view of what goes into the care of a patient. Being an internist keeps things interesting.”

Life as a researcher is not boring, either. Dr. Boulware finds it to be the opposite. “I like the feeling of contributing to cutting-edge ideas that eventually may get incorporated into policy,” she says. “It’s kind of cool coming up with new ideas.” She says one non-negotiable aspect of the job is creativity. “Research feeds off of creativity. You have to bring your own ideas to it. You also have to know how to interpret your results.” She cites one of her career highlights as her involvement researching the cost-effectiveness of urine screening for kidney disease—a health issue which has historically taken the back seat to more prominent diseases such as diabetes. But now, with interest in kidney disease on the rise in recent years, Dr. Boulware has found herself at the forefront of it and is thrilled. “One reason I’m so glad to have worked on it is because it’s timely. No one ever really had looked into screening for kidney disease, but it’s now being shown that the disease is increasing rapidly and policy makers all over are trying to find out what the best method is for detecting it. So the work we did is now being used internationally.”

She is also passionate about her work on racial disparities in health care; in particular, concerning trust issues that she says continue to plague African American patients. African Americans have been shown to be less trusting of their physicians, and hospitals, and this impacts their health care. “There are stark differences in how people feel,” she says. “I’m proud of my involvement with it because it’s a complex issue.”

The Rebounder
While all researchers may yearn to work on projects of their choice, as Dr. Boulware explains, intriguing and timely projects do not exactly fall in one’s lap. “When I came out as a Fellow I thought I could get a paper done in five months!” she laughs, recalling her naiveté. Getting her research funded proved to be a learning experience for the level-headed Dr. Boulware, and interestingly, it is her background as a well-rounded student and athlete that helped her navigate the waters. “Having a research career teaches you patience and perseverance,” she says. “For example, you might have a paper that you think is great and then it gets shredded by your peers! But having participated in sports helped prepare me for it in a way, because I gained skills that are critical to my job. Sports taught me about the importance of practice and perseverance, time management, team playing, working with other people, and leadership. My recommendation to students is to keep yourself as well-rounded as you can because you can bring all of your experiences into your medical career.”

She drew on this experience when faced with a difficult period a few years ago, when she was having trouble getting funded. She feared for her future. “I thought my career was in jeopardy,” she admits. But at her lowest point when she feared the worst, instinct kicked in and she began to use the skills she had learned on the basketball court to turn things around. She had to work hard resubmitting grants and working with colleagues to figure out ways to keep her projects funded, but her efforts paid off, and within a year, she found herself back on top. “I almost had too much to do!” she laughs.

Diverse Doctoring
Her passion for diversity runs deep. Originally a Cleveland, Ohio native, Dr. Boulware now prefers the east coast for its variety. “There is diversity in this area,” she says, “you get a little bit of flavor!” Similarly, having grown up with parents both of whom were physicians, she chose to go in a different direction in college, choosing English as her major. While many physicians have spouses or partners that they met either on the job or at school, her husband works in corporate sales. “It’s very different from what I do and I like the fact that it is,” she says.

And while sports have proved to be of great benefit to Dr. Boulware, she is quick to point out how the pursuit of any activity, no matter what it is, can help aspiring physicians-to-be. “Medical school can be a very one- or two-dimensional experience,” she says. “The things you need to get into medical school are not necessarily the things that will make you a good doctor. Because of this, schools are looking for a different kind of student these days,” she says. “It has a lot to do with your ability to integrate. It’s all about the patient now—what their preferences are, that they trust you, etc. Being a physician is really an integrated field. I think that’s why I was drawn to it.”

Although pressed for time as a researcher, clinical epidemiologist, and mother to a two-year-old and three-year-old, Dr. Boulware still tries to incorporate her interests into her daily routine—playing the piano every now and then or picking up her flute. While it may be hard to imagine anything that Dr. Boulware cannot do or has not at least tried, it is easy to see how she craves stimulation, variety, and challenge in the environment around her. Luckily for her, internal medicine has all of it.

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: University of Miami

The Internal Medicine Interest Group (IMIG) at the University of Miami Miller School of Medicine has been an active and prominent organization on campus. Currently, our organization is composed of two Co-Presidents, a Vice President, a Secretary and a Treasurer. In addition, we have committees for each event that we host during the school year. Any member of the IMIG may run for leadership positions, regardless of their class year.

In the beginning of the year we host lunchtime meetings to attract first and second year medical students to the field of internal medicine. We usually have an internist who specializes in primary care speak about why he or she entered the field of internal medicine. We encourage the guest internist to tell us about both the positive and negative aspects of entering his or her field. We also invite hospitalists to discuss their daily lives and the benefits of providing care in an inpatient versus an outpatient setting.

The IMIG has participated in National Primary Care Week for several years and provides a lecture series as well as community events for students, faculty, and staff of the University of Miami. This year, the IMIG had a blood pressure screening booth outside of the medical school for adults visiting Jackson Memorial Hospital. Those who were found to be hypertensive were given pamphlets about high blood pressure and urged to visit their primary care physician. We also hosted a lunchtime event where an internist spoke about his work with underserved populations in South Florida and highlighted how students can pursue such careers.

Our large event is the annual Big Ten Dinner held in the spring. This activity is an informal session held in the evening that allows students to learn about the many careers internal medicine has to offer. The evening begins with dinner and a panel discussion with physicians representing each subspecialty in internal medicine. After dinner is served, each panel member makes introductions and speaks about various aspects of their fields. Students are then encouraged to ask questions pertaining to that specialty such as lifestyle factors. This event is a huge success each year because students are interested in learning about the many careers that are available after completing a residency in internal medicine. In order to organize the event, we begin contacting physicians early, as it is difficult to find an evening that all physicians can attend. In addition, food is usually ordered from a local restaurant.

Paul Mendez, MD, FACP, our faculty advisor, is heavily involved in our group and we appreciate his guidance and dedication. He attends all meetings and plays an active role during events hosted by the IMIG. In addition, he is always available to help any student applying for internal medicine. Dr. Mendez is an active member of the ACP and is a past contributor to MKSAP (Medical Knowledge Self-Assessment Programs).

Edward Mezerhane and Eric Karlin
Co-Presidents, Internal Medicine Interest Group
University of Miami Miller School of Medicine, Class of 2009
Email: emezerhane@med.miami.edu, ekarlin@med.miami.edu

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Winning Abstracts from the 2008 Medical Student Abstract Competition: Shocking Toxicity: Invasive Streptococcal Infection In A 29 Year-old Male

Authors: Robert E Burke and Shelley R Salpeter, MD, FACP

Case Presentation
A 29-year-old healthy male student presented to a local hospital with altered mental status. He had developed sudden onset of headache, epigastric pain, myalgias and leg cramping while working in a chemistry lab. His symptoms progressed while driving home, necessitating him to stop at a nearby university; a janitor found him unconscious in a bathroom two hours later. He was taken to a nearby ER, where he was found to be hypertensive, tachycardic (HR 130), disoriented and lethargic. Laboratory analysis revealed marked leukocytosis (WBC 38.4, 20% bands) and multi-organ dysfunction (creatinine 1.5,total bilirubin 11.6, and troponin 11.1). Other tests were negative, including urine toxicology, lumbar puncture, blood and urine cultures, EKG, chest X-ray, abdominal CT scan, and RUQ ultrasound. His neurologic symptoms improved with IV fluids and he was transferred to the county hospital for further workup and treatment. On transfer, he complained only of a recurrent sore throat over the past two months and generalized fatigue. An ASO titer was markedly positive, indicating a strep infection. On exam he was tachycardic, alert and oriented but agitated, with jaundice and a palatal ulcer. He subsequently developed high fever (T 102F), hypotension, anuric renal failure and fulminant hepatic failure, requiring intubation, pressor support and hemodialysis. He remained markedly febrile despite broad spectrum antibiotics. An EGD revealed severe gastritis with exudates, and a transjugular liver biopsy showed massive hepatic necrosis and inflammation. All cultures were negative, as was a complete viral, autoimmune, and toxic hepatitis workup. On his eighth day of hospitalization, the patient underwent liver transplantation but had two intraoperative cardiac arrests and expired despite aggressive resuscitation attempts. No autopsy was performed.

Discussion
The incidence of Streptococcal Toxic Shock Syndrome (STSS)is increasing worldwide since its description in 1987. The CDC defines STSS as an acute illness associated with evidence of Group A Streptococcal infection accompanied by hypotension and multi-organ involvement including at least two of the following: renal impairment, coagulopathy, hepatic dysfunction, ARDS, macular rash, and soft tissue necrosis. This case meets those criteria and has other features characteristic of STSS, including high fever, rapidly resolving confusion and gastrointestinal symptoms in a healthy young adult, and normal physical exam despite striking multi-organ dysfunction. Cultures are often negative; serologic testing combined with high clinical suspicion may provide the only clues to the diagnosis. This disease is rapidly fatal, with case mortality rates of 34-71%. There is no known treatment, but prompt surgical treatment if indicated, supportive care in the ICU, and avoidance of unnecessary high-risk procedures may improve survival. STSS should be suspected in any patient with a history of sore throat or skin trauma who presents with characteristic symptoms and rapidly progressive multi-organ disease.

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

The Discipline
Adolescent medicine focuses on the physical, psychological, social, and sexual development of adolescents and young adults. Multidisciplinary and comprehensive in approach, this specialty encompasses the full spectrum of acute, chronic, and preventive health care. Adolescent medicine evaluates medical and behavioral problems within the context of puberty and tailors management to the individual's developmental needs. Problems typically encountered include abnormalities in growth and development, vision and hearing disorders, learning disabilities, musculoskeletal problems (often sports related), allergies, acne, eating disorders, substance abuse, psychosocial adjustment problems, sexually transmitted diseases, contraception and pregnancy, and sexual identity concerns. In addition, adolescent medicine emphasizes the management of chronic diseases that begin in childhood and continue into adulthood, such as diabetes, asthma, cystic fibrosis, congenital heart disease, and inflammatory bowel diseases.

Opportunities for physicians to practice exclusively in this discipline are relatively few but growing in the private sector and are generally found within academic medical centers or in the public health sector. Adolescent medicine is an important part of general internal medicine, pediatrics, and family medicine.

Training
While most fellowship programs in adolescent medicine are clinically oriented, most fellowships do provide significant background in research, prevention, and education. Adolescent Medicine fellowships vary from one to three years in length. Candidates for fellowship programs must have completed an approved residency in internal medicine, pediatrics, family practice, or combined medicine-pediatrics.

Certification
The American Board of Internal Medicine, ABIM and the American Board of Pediatrics have agreed to award certification in adolescent medicine on the basis of performance on an examination developed jointly by both Boards. The admission requirements are similar and the standard for certification by the two Boards is identical. The examination is offered in the fall of odd numbered years.

Training Positions
As of 2007, there were 26 training programs in Adolescent Medicine. Sixty-six percent of the trainees were female and 77% were US medical graduates. The Society of Adolescent Medicine annually publishes a list of available fellowships in the Journal of Adolescent Health.

Practice
The practice and procedures performed in this specialty are very similar to those of a general internist; however, additional gynecological procedures such as colposcopy and IUD implantation may be performed.

Major Publications

Major Professional Societies

  • The Society for Adolescent Medicine

    • 1916 NW Copper Oaks Circle
    Blue Springs, MO 64015
    Phone: (816) 224-8010

    adolescenthealth.org/

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Advocacy Brief: IOM Issues Report on Resident Duty Hours

The Institute of Medicine (IOM) released a report on December 2nd that recommended more sleep and more supervision of resident physicians training in teaching hospitals. The report, "Resident Duty Hours: Enhancing Sleep, Supervision, and Safety," recognizes that residents need to gain experience in order to practice safely and competently, and recommends steps to create safer conditions within the existing duty hour limits established by the Accreditation Council for Graduate Medical Education (ACGME). Specifically, the report calls for: increased opportunities for sleep; improved resident supervision; limits on resident workloads; enhanced patient handovers with more overlapping time as residents go off and come on duty; and stronger enforcement of duty hour restrictions by the ACGME. The full report can be found here.

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Did You Know ACP Develops Policy and Advocates for a Better Practice Environment for its Members?

ACP works directly with government entities and managed care organizations to influence their internal policies and procedures and ensure that the standards for professionalism and quality are upheld. ACP has been a leader in advocating for changes to improve the practice environment for its membership. For information about the current advocacy and policy development efforts of the College please visit: advocacy.

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MKSAP for Students 3 Question 1

A 25-year-old female injection drug user comes to the emergency department because of a 10-day history of progressive malaise and fatigue, anorexia, and abdominal discomfort. The patient uses intravenous heroin on a daily basis and drinks approximately two to three cans of beer daily.

Physical examination discloses jaundice and a tender, enlarged liver. There are no other stigmata of chronic liver disease.

Laboratory studies:

Complete blood count: Normal
Serum alkaline phosphatase: 120 U/L
Serum aspartate aminotransferase: 1250 U/L
Serum alanine aminotransferase: 2120 U/L
Serum total bilirubin: 3.5 mg/dL
Serum albumin: 3.6 g/dL
Hepatitis B surface antigen: Negative
IgM antibody to hepatitis A virus: Negative
IgM antibody to hepatitis B core antigen: Negative

Which of the following is the most likely diagnosis?

A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Primary biliary cirrhosis

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MKSAP for Students 3 Question 2

A 25-year-old man is evaluated in the emergency department because of fever and a cough of 2 weeks' duration. Human immunodeficiency virus infection was diagnosed when he was incarcerated 4 years ago.

On physical examination, he is thin, his temperature is 38.3 °C (100.9 °F), and his respiration rate is 22/min. Breath sounds are decreased in the right mid-lung field. A chest radiograph shows a right middle-lobe infiltrate. His purified protein derivative is positive, with 12 mm of induration.

Which of the following should be done to facilitate infection control?

A. Airborne isolation (negative pressure)
B. Contact isolation
C. Droplet isolation
D. Standard precautions only
E. N/A

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MKSAP for Students 3 Answer 1

Answer: C, Hepatitis C

This patient has clinical and biochemical features of acute hepatitis. The key element in her history is the use of injection drugs, which suggests that she has developed acute hepatitis C virus (HCV) infection. Determination of HCV RNA is the most appropriate test for diagnosing the acute infection because up to 40% of patients may not have developed antibody to HCV at the time of clinical illness.

The presence of IgG antibody to hepatitis A virus (HAV) indicates prior exposure and immunity to HAV. The presence of IgM antibody to hepatitis B core antigen suggests acute exposure to hepatitis B virus (HBV). Similarly, the appearance of hepatitis B surface antigen suggests acute exposure to HBV. Therefore, neither HAV nor HBV is a likely source of this patient's infection. A positive antimitochondrial antibody titer supports the diagnosis of primary biliary cirrhosis, which is a chronic cholestatic disorder that does not have the clinical and biochemical features present in this patient.

Bibliography
1. Ryder SD, Beckingham IJ. ABC of diseases of liver, pancreas, and biliary system: Acute hepatitis. BMJ 2001;322:151–3. PMID: 11159575[PubMed]

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MKSAP for Students 3 Answer 2

Answer: A, Airborne isolation (negative pressure)

This patient is at high risk for Mycobacterium tuberculosis infection because of his immunocompromised state, recent incarceration, and positive purified protein derivative. He therefore requires empiric airborne isolation (negative pressure). Airborne isolation is needed because M. tuberculosis is spread by droplet nuclei, which are aerosolized when patients with pulmonary infection speak, cough, or sneeze. The door to the patient's room must remain closed, and health care workers must wear a mask.

Patients with suspected M. tuberculosis infection do not require contact or droplet isolation. Contact precautions are designed to prevent transmission of microorganisms that can be acquired by direct contact with the patient, the patient environment, and patient care items. Health care workers must use nonsterile gloves and gowns if there is direct contact with the patient or any infective material. Patients who require contact isolation are kept in a private room or with patients who have the same active infection. Droplet precautions are designed to prevent the transmission of infections due to Neisseria meningitidis, Haemophilus influenzae, Bordetella pertussis, influenza, and other pathogens spread by this route. Patients are kept in private rooms, and health care workers must wear a face mask when they are within 3 feet of the patient; however, the door to the room may remain open.

Standard precautions are recommended in the care of all hospitalized patients. Standard precautions combine body substance isolation (blood, all body fluids, and secretions) and universal precautions to reduce the risk of transmission of infectious agents between patient and health care worker. For this patient, standard precautions are necessary, but not sufficient.

Bibliography
1. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1994;43(RR-13):1-132. PMID: 8602125[PubMed]

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ACP Internal Medicine Residency Database

Interested in obtaining more information about residency programs? ACP offers the Internal Medicine Residency Database which contains information about all internal medicine residency programs in the United States. The Internal Medicine Residency Database provides a description of each program as provided by its internal medicine department or links directly into the program’s Web site.

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Succeed on your IM Clerkship Rotation!

ACP continues to help students prepare for clinical rounds and the end-of-rotation examination with the fully revised and updated Internal Medicine Essentials for Clerkship Students 2 and MKSAP for Students 4! Available individually or as a set, these fully integrated new editions ensure success on the IM Clerkship rotation! Check it out.

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Articles for Medical Students from ACP Internist and ACP Hospitalist

ACP Internist (formerly ACP Observer)

  • Mindful Medicine
    By Jerome Groopman, FACP and Pamela Hartzband, FACP
    In two cases, a patient's use of key words led to anchoring errors in diagnosing an abdominal aortic aneurism and a classic case of intermittent claudication.
  • Cancer, cardiovascular risks assessed at rheumatology meeting
    By Stacey Butterfield
    New research at the American College of rheumatology examines do TNF-antagonists increase cancer risk, diastolic dysfunction in rheumatoid patients, and the importance of good oral health care.
  • Podcast engages medical bloggers in a virtual talk show
    By Jessica Berthold
    An internist/blogger creates a talk-show format for his podcasts to link internists with one another.

ACP Hospitalist

  • Physicians of the night
    The who, what and why of nocturnists
    Disparities between day and night care, as well as new guidelines and public pressure, are pushing hospital administrators and hospitalist practices to offer 24/7 care. Quite a few hospitalists are willing to work at night under the right circumstances. December '08
  • 'Futile to whom' challenges views on reasonable recovery
    By Lachlan Forrow, FACP
    A reader debates how health care providers handle life-saving medical treatment despite no hope for recovery.
  • Test yourself: Sleep disorders
    • The following cases and commentary, which address sleep disorders, are excerpted from ACP’s Medical Knowledge Self-Assessment Program (MKSAP14).

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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