February 2008 E-Newsletter

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Medical Student Perspectives: Leadership Day and Internal Medicine 2008: A Week Not to Be Missed!

Leadership Day 2008: From Education to Legislative Action

ACP Leadership Day, an annual event held on Capitol Hill, is a tremendous opportunity for you to become involved in the legislative process. The first of the two days of programming includes a series of legislative briefings on topics central to ACP’s national advocacy agenda. You will hear from a variety of speakers and have the opportunity to split up into smaller sessions where you will synthesize and rehearse talking points on the issues you have just been educated on. The morning of May 13th will feature a briefing aimed at medical student and resident members. This briefing will highlight the important education and student-related issues covered within the ACP advocacy agenda. This briefing is also a terrific opportunity to meet your fellow ACP student members and learn more about what ACP is doing in Congress to help medical students. Students play an integral role in Leadership Day every year; although legislators are interested in the current state of practice, they are even more interested in the future of medicine and your input and viewpoint are essential in helping shape their understanding!

The 14th is the day on which you will join your state delegation and put the briefings you have just absorbed into practice. You will accompany your delegation as they meet with your state’s representatives and senators. Touch base with your state delegation ahead of time; state leaders, including your state ACP Governor, are often very enthusiastic about having medical students along. Your voice and your perspective on medical student debt, the primary care shortage, and the diminishing number of students entering primary care are invaluable in helping us lobby for legislation to remedy these crises facing medicine.

An addition to this year’s Leadership Day is a special rally to be held on the steps of the Capitol on the afternoon of May 14th—please keep your eyes and ears open—more information will follow!

Sign up today—registration for Leadership Day is FREE!

Internal Medicine 2008

Combined with Leadership Day this year, attending Internal Medicine 2008 can make for a long, albeit worthwhile, absence from school! ACP’s annual conference, also being held in DC this year, will feature three days of scientific sessions, hands-on learning activities, and programming specially geared toward medical students. Included this year are four unique sessions, back by popular demand:

  • Stump the Professor
    (Thursday, 5/15/2008, 2:15-3:45 p.m. with Dr. Faith Fitzgerald)
  • Brush Up for the Boards for Medical Students
    (Thursday, 5/15/2008, 4:30-5:30 p.m. with Drs. Barry Wu and Stephen Atlas)
  • Ethics and Professionalism for Medical Students
    (Friday, 5/16/2008, 8:15-9:15 a.m. with Dr. Neil Farber)
  • Getting Through the Match
    (Friday, 5/16/2008, 11:15 a.m.-12:45 p.m. with Drs. Michelle Cyr and Kelly McGarry)

Also on the agenda are some very special opportunities for you to interact with and learn from your fellow medical students and practicing internists. Please attend the Student Mentoring Breakfast on Saturday morning to meet internists at all stages of their careers, and have your questions about starting a practice, work-life balance, and practice options answered. On Saturday afternoon, we will be hosting our fourth annual Internal Medicine Residency Fair—join us to have your questions answered by program directors and to learn more about the residency opportunities available in internal medicine. We will also have a luncheon and evening reception on Saturday to give you an opportunity to meet and mingle with your fellow medical student members. Here are the details:

  • Medical Student Mentoring
    Breakfast (Saturday, 5/17/2008, 7:00-8:30 a.m.)
  • Medical Student Luncheon
    (Saturday, 5/17/2008, 11:00 a.m.-12:30 p.m.)
  • Fourth Annual Internal Medicine Residency Fair
    (Saturday, 5/17/2008, 2:00-5:00 p.m.)
  • Medical Student, Associate, and Young Physician Reception
    (Saturday, 5/17/2008, 6:30-7:30 p.m.)

In addition to the special sessions geared toward medical students and the opportunities for networking and mentoring, the Internal Medicine 2008 conference will also feature a hospitality area for students and associate members to relax and enjoy snacks in between the day’s events—come and socialize with your fellow ACP Medical Student Members!

Registration to Internal Medicine 2008 is FREE for ACP Medical Student Members! To learn more, please visit ACP's Web site.

Hope to see you in DC in May!

Maya Babu
Council of Student Members Representative, New England Region
Harvard Medical School, Class of 2010
E-mail: mbabu@hms.harvard.edu

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My Kind of Medicine: Real Lives of Practicing Internists: John Eisold, MC USN, FACP

The Office of the Attending Physician to Congress is a well-oiled machine. Each day, underneath the tall dome of the U.S. Capitol, a team of physicians, nurses, technicians, ambulance crews, and assistants take on the job of keeping America’s governing body in good health. On an average day, their office is like that of any other physician group—meeting with patients, scheduling consultations, recommending further treatment. But on other days, it can be quite different. It can be taking nasal swabs following an anthrax attack or providing initial treatment for an intracerebral bleed of a U.S. Senator. It is a lot of responsibility, but John Eisold, MC USN, FACP, takes it in stride. "I suppose to outsiders looking in it might seem stressful,” he says, “but what we do here is just an extension of what all physicians do."

High Stakes
It was aboard a nuclear submarine named the USS Francis Scott Key in 1971 that a 25-year-old Eisold, then a Nuclear Submarine Officer in the Navy, rewrote his life’s plans. A fellow crewman had fallen ill with meningitis, and despite the efforts of the physician on board, the man’s condition could not be reversed. Eventually the man passed away. The commanding officer then made the decision to surface to deliver the body. Even though it was a sad and unfortunate event, Dr. Eisold saw something else: what it meant to have someone’s life in your hands. "I was impressed by his composure," he says of the physician. "I saw the power of what a pair of healing hands could do. I decided then and there to resign my commission; I thought that’s what I should be doing."

John Eisold, MC USN, FACP

John Eisold, MC USN, FACP

His next step was to enroll in Dartmouth Medical School in Hanover, New Hampshire; he had already earned an undergraduate degree in physics at Dartmouth College. After graduating, he served his internship and residency at the National Naval Medical Center (NNMC) in Bethesda, Maryland. It was during this time that he says he made a clear-cut decision to pursue internal medicine. "I wasn’t one of those people who wanted to do every specialty after they finished a rotation," he explains. "I knew I wanted to be an adult doctor from the beginning, and I could tell that internal medicine would give me the challenge I was looking for, as well as the kind of relationship depth I wanted with my patients." He liked the accountability of it as well. "I like being in charge, that’s part of the fun," he says. "I actually want patients to call me after hours. I want them to know I’m accountable. When a patient calls me in the middle of the night, I find it to be a high compliment."

Dr. Eisold has been in his current position for 14 years. His office provides medical care for the U.S. Congress and U.S. Supreme Court Justices, their staffs, as well as any visiting tourists in need of medical attention. "The stakes are high," he admits. "There’s no softball." A fast hardball was delivered in 2001, when anthrax attacks were reported in the office of Senator Tom Daschle. Although the Office had a detailed contingency plan ready to go in case of such an event, the reality of it was striking. "My first reaction was 'This is exactly the scenario we’ve trained for and I can’t believe it’s here,'" he says. Dr. Eisold and his staff took nasal swabs from nearly 6,000 staff, employees, and visitors—anyone who had potentially been exposed to the bacteria. There were daily press conferences. People unraveled. Dr. Eisold says those tense three weeks were the longest of his life. "What we were really doing was managing fear," he says. "That was the most startling thing to see, the sheer panic. Looking back on it, I am glad that we were able to convey a confidence to reassure them. There is something comforting about putting someone in a line, even if they had to wait for three hours. At least they knew we were doing something about it." His staff was awarded several honors for their management of the attack; Dr. Eisold was personally awarded the Distinguished Service Medal.

The Front Desk Approach
His take on patient care is a valuable lesson in humility. "Front desks should be conduits, not barriers, to care," he says. "'The doctor’s busy’ falls short. Everyone is busy. Patients are often late for reasons not of their own doing. They may be confused and show up on the wrong day … they may be angry, but always take the high road and trust them."

He has a unique affinity for older patients, something he honed as an intern working at NNMC, where many of his patients became like good friends to him. Once again, his ability to extract and celebrate the good in an otherwise difficult situation made geriatrics a natural choice for a subspecialty. To some physicians, an elderly patient with multiple chronic conditions is just that; to Dr. Eisold, the patient represents much more. "I’ve always loved older people," he says. "Some think these patients may be more complicated, but they’ve always been my favorite," he says. "They have wonderful stories." He says medical students and physicians just starting out should not view death as a failure but rather as a natural event, and recommends attending as many patient funerals as you can. "Never underestimate what your presence means to a grieving family and friends," he says.

Prior to his current assignment, Dr. Eisold worked as Special Assistant to the Navy Surgeon General and later as the Chairman of the Department of Internal Medicine at NNMC, where he earned his current rank of Rear Admiral. He says both positions were satisfying and even "fun," but he longed to return to what he had discovered on that solemn day in 1971—the satisfaction and joy of hands-on patient care. "I could go on and on about internal medicine, why I think it’s wonderful and why I love it and love being a physician," he says, "but for me it comes down to the doctor-patient relationship. People need a relationship—and not just for a year—for five, ten, fifteen, twenty years. That’s what internists are about. The cornerstone of the practice of medicine is the doctor-patient relationship. It transcends all, including information technology, pharmacology, and the newest diagnostic studies. Its value will never be diminished."

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Internal Medicine Interest Group of the Month: University of Nevada

The Internal Medicine Student Interest Group at the University of Nevada School of Medicine in Reno attracts about half of the medical school’s first and second year students to each of its monthly lunchtime meetings. Nobody ever turns down a free lunch! Once we get them in the door, we give the students information not only about how the day is structured for a cardiologist, for example, but how that individual got turned on to cardiology, what he or she had to do to get into that residency, and how a family may or may not have factored into the equation.

Our goal is to organize monthly lunchtime discussions with general internists and subspecialists from the community. We invite a male and a female physician from specific subspecialties that students have expressed interest in, so that students will hear different perspectives and different stories relating to how physicians became involved in internal medicine.

Last fall, our first meeting was hosted by our faculty advisor, Dr. Kirk Bronander, who also heads up the third year clerkship in internal medicine. He brought with him a young woman who had just completed a year as chief resident of internal medicine in Reno. The highlight of this meeting was her capacity to engage us and relate to us as peers. She had recently taken her clinical knowledge out of the hospital and into the desert for Nevada’s most notorious festival, “Burning Man.” She spent four days serving as a physician amongst 30,000 suntanned partygoers clad in body paint and glitter (and sometimes not much else). She used her stories to sell the field to us. The way she integrated her life experiences into telling us about her career choice was very appealing, and she addressed every question we had about how family, well-being, and finances factored into her decision to be an internist.

At the end of the semester, our group gathered at a restaurant inside one of Reno’s hospitals and enjoyed a catered dinner which included a question and answer session with various internists and subspecialists. This gave us a chance to compare different fields and explore options for summer activities, clerkships, and research. All of the group’s events are planned by one or two second year medical students, with guidance and some financial support from our faculty advisor. Funding is also provided by the Student Executive Committee and the American College of Physicians. Our faculty advisor is always helpful in finding younger physicians from throughout the community with whom we will be able to relate for our lunchtime meetings.

We look forward to meeting with two gastroenterologists in February and hopefully two hematologist/oncologists in March. At the end of the spring, when I start thinking about Boards, the interest group will be handed over to two first year students so that they can plan next year’s events and explain to the Class of 2012 what internal medicine is all about!

Kristina Eaton, Class of 2010
President, Internal Medicine Student Interest Group
University of Nevada School of Medicine
E-mail: keaton04@gmail.com

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Winning Abstract from the 2007 Medical Student Abstract Competition: An Association between Cardiovascular Risk and Cognitive Status in Non-Demented, Elderly Women with a Family History of Alzheimer's Disease.

Author:
Sophia Wang, Mount Sinai School of Medicine

Introduction:
Alzheimer's disease (AD) is the commonest form of dementia in the elderly population, with an estimated prevalence in 2050 of 8.6 million cases in the US alone. Prevention or even delay of cognitive decline would significantly decrease caregiving hours and costs. Epidemiologic studies suggest that cardiovascular risk factors may be associated with cognitive impairment and AD. Therefore, better characterization of the role of preventable and/or treatable cardiovascular risk factors in milder forms of cognitive impairment would be extremely beneficial. Here, we tested the hypothesis that increased cardiovascular risk is associated with subtle cognitive deficits in non-demented older women with a family history of AD.

Methods:
We recruited 477 asymptomatic women, age 65 or over with a family history of AD, to participate in a 5-year double-blind, placebo controlled trial to study whether hormone replacement therapy can delay the onset of AD and memory loss. Subjects were included if they had normal cognition and no active heart disease, and received an annual neuropsychological battery, medical exam, and functional assessment. A baseline memory composite score, consisting of 4 measures of memory (Immediate and Delayed Recall for Selective Reminding Test and Visual Reproductive Test for Weschler Memory Scale Revised), was calculated. Coronary heart disease (CHD) risk was estimated as per the Framingham Heart Study. The algorithm included age, lipid levels, hypertension, diabetes and smoking. Relative risk was calculated as the ratio of a subject's CHD risk to that of a low risk, age-matched female. Linear regression was performed with memory composite score as the dependent variable, with relative CHD risk, age, ethnicity and education level as covariates.

Results:
376 persons were evaluated. Mean age was 72.7 years; mean education was 14.2 years; and 19.4% were non-Caucasian. Mean (SD) baseline memory composite score was significantly increased in those with relative CHD risk below the population's median compared with those at or above the median: memory composite score 111.4 (21.4) 103.0 (21.7) (P < 0.05). Differences in the individual components of the memory composite scores were not significant. Except for age, none of the other cardiovascular risk factors significantly correlated with cognitive measures.

Conclusion:
These findings suggest that even subtle elevation of cardiovascular risk plays a role in cognitive status and poorer memory. Further studies should investigate whether this also applies to the wider geriatric population, and if early, aggressive treatment of CHD risk factors can prevent or delay cognitive decline.

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Subspecialty Careers: Highlights about Careers in Internal Medicine: Allergy and Immunology

The Discipline
Allergy is derived from the Greek word allo, meaning "other or different" and ergon, meaning, "work." In this sense, allergy is something that "works differently" from normal. Immunity is derived from the Latin word immunitas, meaning "an exemption from taxes or public or military service." In the late 19th century, when knowledge of toxins and infection evolved, the meaning was extended to persons "exempt from" or protected against the onslaught of foreign substances and were said to be "immune."

Allergy and immunology involves the management of disorders related to hypersensitivity or altered reactivity caused by the release of immunologic mediators or by activation of inflammatory mechanisms.

Procedures
Important procedural skills include spirometry and spirometric response to irritant challenges and bronchodilators, rhinoscopy, drug desensitization protocols, immediate skin tests for IgE-related reactions, patch tests, and prick and intradermal skin tests.

Training
Allergy and Immunology fellowship training requires two years of accredited training beyond general internal medicine residency in an accredited Allergy and Immunology fellowship training program.

Dual certification can be obtained in the specialties of Rheumatology and Allergy and Immunology after a minimum of three years of training following the general internal medicine residency program. At least one year must be devoted to full- time clinical Rheumatology training in an accredited program. At least 18 months must be devoted to full-time allergy/immunology training in an accredited Allergy and Immunology fellowship-training program. Weekly attendance for 18 consecutive months in an ambulatory care program supervised by Rheumatology faculty must be included in the program.

Certification
The American Board of Allergy and Immunology offers certification in this specialty.

Training Positions
There are 71 ACGME-accredited training programs in Allergy and Immunology.

Major Professional Societies
American College of Allergy, Asthma & Immunology
85 West Algonquin Road, Suite 550
Arlington Heights, IL 60005
http://www.acaai.org/

American Academy of Allergy Asthma & Immunology
555 East Wells Street
Suite 1100
Milwaukee, WI 53202-3823
http://www.aaaai.org/

Major Publications

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Advocacy Brief: Update on Reauthorization of the Higher Education Act

On February 7, the House of Representatives passed "The College Opportunity and Affordability Act of 2007" (H.R. 4137) to reauthorize the Higher Education Act (HEA) through 2012. H.R. 4137 contains several changes, new programs, and studies of importance to medical education.

In the area of student financial aid and loan forgiveness, the House bill provides:

  • An increase in the annual Perkins loan limit for graduate/professional students from $6,000 to $8,000 and a corresponding increase in the aggregate Perkins loan limit for graduate/professional students from $40,000 to $60,000;
  • A new $10,000 loan forgiveness program for "medical specialists" who have been accepted to, or currently participate in, an ACGME-accredited graduate medical education training program or fellowship that requires more than 5 years of total graduate medical training and has fewer U.S. medical school graduate applicants than the total number of positions available under these programs;
  • A 6-month grace period for repayment of GradPLUS loans;
  • Direction for the Department of Education to work with the Department of the Treasury to enhance the financial literacy of students at institutions of higher education through the development of initiatives, programs, and curricula;
  • A requirement that institutions to certify private educational loans and to provide information on available federal alternatives; and
  • The "student loan sunshine" language that addresses financial aid administrator-lender relationships.

The House bill also includes a Government Accountability Office study on education related indebtedness of medical school graduates. The Senate passed their version of the reauthorization bill in July 2007.

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Did You Know there are Special Events for Medical Students at Internal Medicine 2008?

ACP's annual meeting, Internal Medicine 2008, held May 15-17 in Washington D.C., contains a variety of events and courses geared toward Medical Student Members. Please visit ACP's Web site for a complete listing of these events.

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Learn about residency programs at the Residency Fair.

The Fourth Annual Internal Medicine Residency Fair will be held during ACP’s national scientific meeting, Internal Medicine 2008 on Saturday, May 17th from 2:00 to 5:00 p.m.

At the Residency Fair, you will learn about internal medicine residency programs throughout the United States, while you gather essential information about the residency application process and the Match. You will also have the opportunity to practice your networking skills while introducing yourself to internal medicine residency program staff and meeting fellow medical students.

Register now for Internal Medicine 2008. If you have questions about the Residency Fair please e-mail Membership Development.

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Attend the Clinical Skills Review Course.

Students can prepare for the USMLE Step 2 Clinical Skills Examination by participating in the Waxman Clinical Skills Center Step 2 Practice Session. This workshop consists of four stations that simulate the experience of the USMLE Step 2 Clinical Skills Exam. Professional teaching patients (standardized patients) will present you with common problems and provide expert feedback on your history and physical examination skills, communication skills, and written note. A checklist score will be generated and shared with you in addition to other verbal feedback on your global performance. You will be provided with a written note summarizing the feedback, highlighting areas of strengths and weaknesses. Two students will be paired for the four station workshop, allowing each student two "hands-on" experiences and two observation experiences.

Features include:

I. Assessment orientation

II. 4 Station Clinical Skills Assessment

  • 15 minutes per patient visit

  • 10 minutes immediate feedback for 2 stations

  • 10 minutes for 1 patient note

III. Detailed performance profiles of scores for each of the areas of a Clinical Skills Examination:

  • conducting a relevant patient history

  • performing a focused physical examination

  • providing diagnosis

  • communication and interpersonal skills

  • 1 graded patient note for accuracy and completeness

  • English proficiency

Here are representative comments from previous medical student participants in this highly rated workshop:

  • These teachers are excellent! Want more time with them!

  • The training was desperately needed. I've really gained insight on my strengths and weaknesses in the clinical setting.

  • Best activity so far in the conference.

  • Feedback was key!

Activities in the Herbert S. Waxman Clinical Skills Center are free of charge but require onsite advance registration. Please visit our Web site to learn more.

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Volunteer to work during the meeting.

The College needs medical students with basic to intermediate computing skills to help in our medical informatics workshops. Students will be paid a small honorarium ($100 per half-day, $200 for a full day).

If you are attending Internal Medicine 2008 and would like to help, please contact Lisa Rockey at (800) 523-1546 ext. 2588 or lrockey@mail.acponline.org.

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MKSAP for Students 3 Question 1

A 30-year-old woman is evaluated for symptoms of depression that she has been experiencing for the past several months. She has been treated successfully for depression in the past, but gained 9 kg (20 lb) on antidepressant therapy, and is reluctant to take medications again because of her fear of weight gain.

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

A. Amitriptyline
B. Bupropion
C. Mirtazapine
D. Sertraline

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MKSAP for Students 3 Question 2

A 25-year-old, asymptomatic woman in the second trimester of pregnancy is evaluated for a heart murmur. She has no history of cardiovascular disease, and the murmur was not heard during previous medical evaluations. Examination shows a displaced apical impulse, normal S1 and S2, and an S3 at the apex. A grade 2/6 early-peaking systolic murmur is audible in the second left interspace. The remainder of the examination is normal.

Which of the following is the most likely cause of the murmur?

A. Bicuspid aortic valve with regurgitation
B. Bicuspid aortic valve with stenosis
C. Congenital pulmonary stenosis
D. Mitral valve prolapse with regurgitation
E. Physiologic murmur related to pregnancy

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MKSAP for Students 3 Answer 1

Answer: B, Bupropion

Antidepressants can have variable effects on weight, but can cause weight gain. Adherence to therapy is hindered by this side effect. Tricyclic antidepressant use can lead to substantial weight gain, up to 0.9 kg (2 lb)/month for patients receiving this therapy. Mirtazapine is associated with significant weight gain, occurring in up to 50% of patients treated with this medication. Selective serotonin reuptake inhibitors have a variable effect on weight, and can cause weight gain. Fluoxetine appears to cause less weight gain than others in the class. Bupropion does not cause weight gain, and may actually cause slight weight loss, which may be due to its lack of serotonin receptors.

Bibliography
Croft H, Houser TL, Jamerson BD, Leadbetter R, Bolden-Watson C, Donahue R, et al. Effect on body weight of bupropion sustained-release in patients with major depression treated for 52 weeks. Clin Ther. 2002;24:662-72. PMID: 12017410

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MKSAP for Students 3 Answer 2

Answer: E, Physiologic murmur related to pregnancy

During normal pregnancy, the physical findings may mimic those of heart disease. An early-peaking ejection systolic murmur and an S3 are audible in more that 80% to 90% of normal pregnant women and are caused by a pulmonary outflow murmur. Left ventricular apical displacement and an S3 are common because of the increase in blood volume that occurs during pregnancy. Later in pregnancy, apical displacement is accentuated as a result of cardiac displacement cause by increasing abdominal distention. The report of normal findings on previous cardiac examinations supports the diagnosis of a physiologic murmur related to pregnancy.

In a patient in this age group, aortic valve stenosis would most likely be caused by a bicuspid aortic valve, and an ejection sound may be noted with this murmur. An aortic outflow murmur is usually best heard over the second right intercostals space. Pulmonary valve stenosis is also commonly associated with a pulmonary ejection sound that decreases in intensity with inspiration. In addition, the right ventricle may be palpable in a patient who has pulmonary valve stenosis. The murmur associated with mitral valve regurgitation is usually best heard at the apex. When associated with mitral valve prolapse, it often causes one or more systolic clicks. Aortic valve regurgitation is a diastolic murmur that does not correlate with the findings described in this patient.

Bibliography
McAnulty JH, Morton MJ, Ueland K. The heart and pregnancy. Curr Probl Cardiol. 1988;13:589-665. PMID: 3063438

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Student Members Receive a 30% Discount When Ordering MKSAP for Students 3

MKSAP for Students 3 includes over 400 patient-centered self-assessment questions and their answers in print and on CD-ROM. Designed for medical students participating in their clerkship rotation, the questions help define and assess a student’s mastery of the core knowledge base requisite to internal medicine education in medical school. The questions reflect the daily management dilemmas faced by internal medicine physicians and when coupled with the answer critiques, provide a focused, concise review of important content.

New in MKSAP for Students 3:

  • All new questions and critiques

  • More topics and chapters

  • 12 electrocardiogram questions

  • 24 color figure dermatology questions

List Price: $44.50; Student Member Price: $30.00

To order MKSAP for Students 3 please visit the ACP catalog.

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Articles for Medical Students from ACP Internist and ACP Hospitalist

ACP Internist (formerly ACP Observer)

ACP Hospitalist

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Congratulations to the Internal Medicine Interest Groups that Exceeded 25% ACP Participation in the IMIG Sponsorship Program!

A big thank you to the following 64 interest groups that reached 25% or more ACP Medical Student Membership by December 31, 2007. These groups will receive additional funding of $2 per student member. Visit the IMIG Web site for more information on the sponsorship program.

University of Hawaii (82%)
University of Mississippi (58%)
University of Cincinnati (57%)
Touro University (56%)
University of Utah (55%)
UMDNJ New Jersey Medical School (53%)
Wright State University (52%)
Texas A&M University (52%)
University of Nevada (51%)
Mercer University (49%)
University of North Dakota (46%)
Lake Erie College of Osteopathic Medicine (46%)
University of Nebraska (44%)
Louisiana State University New Orleans (44%)
Drexel University (40%)
Virginia Commonwealth University (39%)
University of Miami (39%)
Medical College of Wisconsin (39%)
Florida State University (38%)
University of Virginia (36%)
University of Vermont (35%)
University of South Carolina (35%)
University of Maryland (35%)
Wake Forest University (34%)
University of South Alabama (34%)
University of Iowa (34%)
University of California Davis (34%)
UMDNJ College of Osteopathic Medicine (34%)
Penn State University (34%)
University of Texas San Antonio (33%)
State University of New York Syracuse (33%)
Southern Illinois University (33%)
University of Kentucky College of Medicine (32%)
Uniformed Services University (32%)
Michigan State University (32%)
Indiana University (30%)
University of Washington (29%)
University of Texas Houston (29%)
University of Pennsylvania (29%)
University of Colorado (29%)
Tufts University (29%)
Saint Louis University (29%)
Rush Medical College (29%)
Oregon Health Sciences University (29%)
Howard University (29%)
Wayne State University (28%)
University of South Dakota (28%)
University of Missouri Columbia (28%)
University of Massachusetts (28%)
Philadelphia College of Osteopathic Medicine (28%)
Johns Hopkins University (28%)
Albany Medical College (28%)
University of Texas Galveston (27%)
Michigan State University College of Osteopathic Medicine (27%)
Chicago Medical School (27%)
Baylor College of Medicine (27%)
University of Puerto Rico (26%)
University of California San Diego (26%)
New York Medical College (26%)
Medical College of Georgia (26%)
University of Southern California (25%)
University of South Florida (25%)
Kirksville College of Osteopathic Medicine (25%)
Dartmouth Medical School (25%)

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The ACP Internal Medicine Report: Team-Based Approach Improves Diabetes Care; Diabetes Initiative Extended for Two More Years

Due to the success of the first three years of the ACP and ACPF Diabetes Initiative, the program has received an additional unrestricted educational grant from Novo Nordisk to continue for an additional two years through December 2009. Launched in 2005, practices and patients are seeing significant improvements in such areas as immunizations and eye and kidney disease screenings.

Don't miss ACP's Vincenza Snow, MD, FACP, Director of Clinical Programs and Quality of Care, in the latest Internal Medicine Report broadcast news story.

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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

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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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