January 2007 E-Newsletter

Enjoy a Starbucks Card Compliments of ACP! IMpact Contest Question for January

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If you are among the first 30 respondents to answer the following question correctly you will receive a $5 Starbucks card. E-mail your answer to ImpactContest@acponline.org. The correct answer to January’s contest question will be included in the February issue of IMpact. You must be an ACP Medical Student Member to be eligible to win and contest winners are not eligible to win again for 4 months.

IMpact Contest Question for January

A 25-year-old man is evaluated because of a 3-month history of episodic dyspnea at rest. The episodes occur approximately three times per week and are accompanied by cough. His symptoms awaken him at night approximately three times per month. He had asthma as a child, which resolved.

His temperature is 36.5 ºC (97.7 ºF), pulse rate 85/min and regular, respiration rate 14/min, and blood pressure 125/75 mm Hg. The only abnormality noted on physical examination is bilateral wheezing without crackles. Chest radiograph is normal.

Spirometry shows a forced expiratory volume in 1 sec (FEV1) 78% of predicted, and a forced vital capacity 93% of predicted. He has a 17% (430 mL) improvement in FEV1 after using bronchodilators.

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

( A ) Albuterol
( B ) Albuterol and a long-acting β-agonist
( C ) A long-acting β-agonist
( D ) Albuterol and a low-dose inhaled corticosteroid

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Medical Student Perspectives: Why Should You Attend Internal Medicine 2007?

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Medical students are warmly welcomed each year at ACP’s national conference and 2007 will be no exception. The conference provides an opportunity to meet like-minded students and physicians, to learn more about internal medicine, and to experience the camaraderie and cutting-edge developments in the field. Read on to discover why you should attend Internal Medicine 2007 (formerly Annual Session) April 19-21 in San Diego, California!

Scientific Program Sessions

Physicians from all over the country are drawn to the meeting for its 250 educational sessions. Workshops range from general internal medicine to the many subspecialties of internal medicine and include topics as varied as Arthrocentesis and Soft Tissue Injections; Best Drug or Best Advertised Drug?; Business of Medicine 101; Disaster Preparedness; Healthcare for the Homeless; HIV Update; Mastering Cardiac Murmurs; and Grand Rounds: The Professor in Action. Students are welcome to attend all sessions.

Workshops Designed for Medical Students by Medical Students

The Council of Student Members develops content for the following sessions especially for students: Brush Up for the Boards; Ethics and Professionalism for Medical Students; Getting Through the Match; and Stump the Professor.

Medical Student Abstract Competition Winners and Poster Finalist Competitions

The top ten winners of the 2007 Medical Student Abstract Competition are invited to present oral abstracts of their research, community initiatives, and clinical cases. A second group of poster finalists are invited to display their work in the Medical Students-Associates Poster Area and compete for additional prizes.

Medical Student Mentoring Breakfast

Exclusively for medical students! The Medical Student Mentoring Breakfast is a 90 minute session where students can meet with internists in a casual setting. Invited mentors are physicians – both general internists and subspecialists – practicing or teaching in a variety of settings and of a broad range of ages, backgrounds, and interests. Bring your questions!

Third Annual Internal Medicine Residency Fair

Representatives from internal medicine residency programs across the country will be on hand to discuss the unique aspects of their programs with students.

Medical Students, Associates, and Young Physicians Recognition Reception

All medical students are invited to a wine and cheese reception on Saturday evening, where winners of the ACP Associate and Medical Student Poster Competitions and the winner of the 2007 Doctor’s Dilemma™ Championship are honored.

Medical Students, Associates, and Young Physicians Hospitality Room

Throughout each day of the meeting, the hospitality room is open for students to come together for coffee and snacks, socializing, and relaxing. Books containing the winner and finalist research abstracts will also be available in the hospitality room.

San Diego

Take some time in the evenings or in your free time to enjoy the spring weather in one of the country’s most beautiful cities!

ACP Medical Student Members attend Internal Medicine 2007 free! Nonmember medical students pay a $99 registration fee. To register for the conference, visit the Internal Medicine 2007 website. Can’t wait to see you there!

Lucy Goddard
CSM Representative, New England Region
Yale School of Medicine, 2007
E-mail: lucy.goddard@yale.edu

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My Kind of Medicine: Real Lives of Practicing Internists: Alex Foxman, MD

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Alex Foxman, MDDr. Alex Foxman is not one for sitting around waiting for things to happen. For example, he opted to attend medical school at the American University of the Caribbean instead of waiting for admittance to one of the more crowded U.S. schools because he “wanted to move ahead.” His idea of a “hobby” is launching a business. In an interview, he answers all of your questions before you have the chance to ask them, and on the subject of internal medicine—its strengths, its challenges, its future—he is equally tireless. His progressive viewpoint is energizing; while some may furrow their brows or wring their hands over the future of the profession, Dr. Foxman paints a brighter picture, one filled with promise. His view of internal medicine ten years down the road is more than optimistic—it’s exciting, and the best part about it is that you don’t need rose-colored glasses to see it.

Supply and Demand

According to U.S. Department of Labor, the need for internists and family practitioners who care for all of a patient’s needs is growing. The 2006-2007 Occupational Handbook published by the U.S. Bureau of Labor Statistics projects that the employment of physicians will grow faster than average through 2014. Dr. Foxman explains that given the trend over the last several years of medical students flooding other specialties, he feels it is inevitable for the pendulum to swing back in the other direction.

“The issue of compensation has been guiding a lot of people in their decision to not pursue internal medicine,” he says, “but what is happening is that some of these other specialties are getting saturated, and when that happens, the demand goes down, and then the pay goes down. It’s happening right now in anesthesiology.” He believes the downward trend in internal medicine is beginning to reverse, and not just for the short term, but for good. “There is a lot more attention focused now on primary care than there has been in a long time,” he explains. “We are in the front lines of the future of medicine.”

Being in the front line of medicine is one of the reasons why Dr. Foxman loves being an internist. He says being limited to one small area of medicine would bore him. “One of the benefits of internal medicine is the range of work. I’m comfortable doing everything from a biopsy to a knee injection. The work is intriguing and interesting.” Another central belief of Dr. Foxman’s is the importance of doing things yourself. This conviction goes hand-in-hand with his role as an internist. “I’m not a gatekeeper,” he says, “I rarely consult out. Because of my training I can handle 90% of patients on my own.”

For medical students searching for their special niche, he says residency is the key time for decision making. “Residencies and rotations are good because they give you the opportunity to see what something is really like. I believe you cannot make that decision until you actually work in a field. I made my decision during my residency. For me, I love being around people and I want to have long term relationships with my patients. I wouldn’t enjoy performing a procedure never seeing the patient again to see how it turned out or how the patient is doing.”

A Worldly View

For medical school, Dr. Foxman journeyed to the Caribbean for his core studies, then to England for his electives, and finally to California for his selectives. He was then accepted into the internal medicine residency program at the University of Southern California Medical Center in Los Angeles. Working in the English health care system required him to adopt a different approach to patient care, one centered more on clinical evaluation and skills and less on testing. It would become his blueprint for patient care. Dr. Foxman explains that in the U.K., where resources are fewer than in the U.S., physicians rely more heavily on evaluating and examining the patient. For him, it is the only way to practice medicine, the opposite of what he calls the “shock and approach” system currently used in the U.S.

“In England, any time they order a test they ask themselves, ‘Why am I doing this?’” he says. “One of the biggest issues in medicine right now is the cost of services. I’m willing to bet there are more CT scanners in the city of Los Angeles than there are in the entire country of Britain. As a resident, I was taught to rely on my education and training. It’s something I’ve carried with me throughout my career.”

Dr. Foxman finished his residency at the University of Southern California Medical Center, a Level 1 trauma center with a very busy ER. What he experienced there fueled his passion for prevention, a common thread of everything he stands for today. Much of his job working at the trauma center involved treating patients with advanced chronic conditions, and it was a sobering experience for the young doctor.

“I saw the worst of the worst,” he said, “the advanced diseases I treated and witnessed were mostly due to a prolonged period of either undiagnosed or poorly managed co-morbid conditions. These were people who had suffered large strokes, had advanced cancers and renal failure, who were blind … I would say 95% of these conditions could have been prevented or significantly delayed if preventive health care and screening were utilized.” It was an experience which resonates throughout his career and shapes his decisions.

When it was time to begin his professional career as a practicing internist, he decided to open a practice near the Russian housing projects in L.A. While it may have been an overly ambitious choice for some, for Dr. Foxman is made perfect sense. Of Russian Jewish decent, he spoke fluent Russian, and because of his most recent experience as a resident, he did not shy away from heavily populated urban areas with high demand.

Of course, no matter how many things you have going for you, a new practice doesn’t build itself. As he puts it, “medicine is a business too, and you can’t run a business by sitting around waiting for patients.” So the determined Dr. Foxman built his business by marketing himself within the community—giving educational presentations, running various projects and establishing a reputation for himself through word of mouth referrals. Once again his industriousness paid off. When he started out, he had three patients; today after moving the practice to Beverly Hills, adding a partner and expanding services, he has over 2,000.

Like most people who are fiercely passionate about what they do, there is not much about Dr. Foxman that can’t be traced back to his main goal: making preventive medicine a permanent part of health care. When you ask him what he does in his spare time, he talks about his involvement with several health care businesses. One business he is particularly interested in is an outpatient care facility for seniors. The program, which offers a wide range of preventive services, from nursing support to social work services to exercise programs, is centered on the goal of keeping seniors out of nursing homes for as long as possible. It encourages active patient involvement and a better quality of life for seniors. It also mirrors Dr. Foxman’s beliefs about what the health care system should look like and how it should operate, down to the last detail. “I firmly believe that aggressive preventive care can be the savior to the United States health system,” he says. For this doctor, there is little time to waste.

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Internal Medicine Interest Group of the Month: Indiana University School of Medicine

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The Indiana University School of Medicine Internal Medicine Student Interest Group (IMSIG) has been in existence for over 10 years and is a well established organization on campus. The aims of our organization are to support and advise students interested in primary care and medicine subspecialties, to expose students to career opportunities in internal medicine, and to participate in and organize philanthropic activities.

Our biggest annual event is a philanthropic health fair held in the fall. This year, in celebration of National Primary Care Week, we sponsored our 9th Annual Westside Community Health Fair in October. The fair is run and organized by students. It is held in an underserved area that neighbors the university and is completely free for those who wish to attend. We provide information in both Spanish and English and also provide Spanish interpreters. With help from other student interest groups, we were able to provide activities for both adults and children such as free health screenings and education on a variety of health problems including: diabetes, high blood pressure, colon cancer, osteoporosis, high cholesterol, vision and hearing, child safety, and breast cancer, to name a few. This year was our most successful health fair on record with more than 400 attendees and over 150 volunteers. We gave over 400 free influenza vaccines and checked blood pressure, total cholesterol, and blood sugar on over 150 fair attendees. Part of our success is due to the huge amount of support we receive from the community, without which our fair would certainly be impossible.

IMSID sponsors a lunch time lecture series geared toward first and second year students, but open to all. Kicking off this school year, Robert Lubitz, MD, FACP, Governor of the ACP Indiana Chapter, gave a lecture entitled “Top 10 Reasons to be a Big Doctor,” highlighting the often overlooked enjoyments and privileges of being an internist. Throughout the year, other lunch-time talks are offered to educate students on topics not traditionally covered in the medical school curriculum. This year we have sponsored a lecture on complementary and alternative medicinal practices. Lectures on the treatment of depression in the primary care setting, urban and third-world medical practices, the role of primary care physicians in political advocacy, and a panel of subspecialists to answer students’ questions on what life is like in their fields are being planned for the remainder of the year.

We also host evening events geared toward helping senior medical students along the path of applying to internal medicine residencies. The “post-match” meeting has been popular, in which fourth year students who have recently matched in internal medicine share their experiences of interviewing, formulating a rank-list, and accepting a residency position. Other lectures geared toward seniors include talks on choosing fourth year electives and a question and answer period with our internal medicine program director about applying and interviewing for an internal medicine residency.

Finally, our student group has been involved in activities at the national level. Several students each year have enjoyed attending the national ACP scientific meeting or ACP Leadership Day on Capitol Hill, with full financial support from the ACP Indiana Chapter. The educational benefits of these trips have been immeasurable in terms of learning about the profession of internal medicine and clearly understanding and articulating governmental policies affecting medicine today.

The IMSIG in partnership with ACP has been busy in 2006 and is looking forward to another great year in 2007. We wish your organization success in the New Year!

Laura Barnett (ltietz@iupui.edu) and Anna Burgner (aburgner@iupui.edu), Co-Chairs of the Indiana University School of Medicine IMSIG
IMSIG officers include Michael Sha MD, FACP and Palmer Mackie, MD (Faculty Advisors); Domingo Maynes MSIV (Vice Chair); A.J. Voelkel MSIII (Financial Officer); Lina Ghosh MSIV (Secretary); Scott Anderson MSIV, Mushoba Njalamimba MSIV, and John O’Malley MSIII (West Side Health Fair Co-Chairs ).

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Winning Abstracts from the 2006 National Medical Student Poster Competition: Potential Role for IFN-a Therapy in Erosive Arthritis

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Author:
Kofi A. Mensah, University of Rochester School of Medicine & Dentistry, 2011

Introduction:
Patients with systemic lupus erythematosus (SLE), an enigmatic autoimmune condition characterized by diverse clinical features and end-organ involvement, frequently develop painful joint inflammation but, on plain x-ray, rarely manifest erosive changes like those common in rheumatoid arthritis (RA). Peripheral blood mononuclear cells (PBMC) from SLE patients have an alpha-interferon (IFN-a) signature, which stimulates their differentiation into dendritic cells (DC). Interestingly, this stimulation inhibits the differentiation of PBMC into osteoclasts (OC), the cellular mediator of erosive arthritis. Here we test the hypothesis that systemic IFN-a prevents erosive arthritis by biasing myelopoiesis towards precursor DC (pDC) and away from OC precursors (OCP) in a mutually exclusive fashion that can be characterized by the expression of unique surface molecules on the plasma membrane of precursor cells.

Methods:
The RAW 264.7 monocyte (Mo) cell line was used to evaluate the effects of 500 U/mL of recombinant IFN-a on pDC, OCP and OC in-vitro before or after culture with 100 ng/mL of the OC differentiation factor RANK-ligand (RANKL). The amounts of IFN-a and RANKL were based on published data. After culture, the cells were analyzed by fluorescence-activated cell scanning (FACS) with labeled antibodies against immune cell surface markers: c-Fms, FcgRIII, CD11b and CD11c.

Results:
OC development in RAW cell cultures was observed after two days of treatment with RANKL, while untreated cells remained as Mos. OCP presence was confirmed by FACS. OCPs were defined as c-Fms (M-CSF receptor) positive since the M-CSF cytokine stimulates Mo differentiation into OCs. When expression of FcgRIII (a Mo marker down-regulated in OCs) and CD11c (a DC marker) was compared in untreated RAW 264.7 Mo, none of the cells were CD11c+/FcgRIII– or CD11c–/FcgRIII–, 30% were CD11c–/FcgRIII+ and 70% were CD11c+/FcgRIII+. Treatment with RANKL resulted in a shift to 25% CD11c+/FcgRIII–, 7% CD11c–/FcgRIII+ and 40% CD11c+/FcgRIII+. When treated with RANKL followed by IFN-a there was no change in the percentage of double-positive cells. Treatment with IFN-a before RANKL, however, resulted in 87% double-positive cells.

Conclusion:
The CD11c+/FcgRIII+ populations decrease following RANKL treatment. In contrast, pre-treatment with IFN-a before RANKL results in a marked increase in double-positive cells, even above the level seen with neither treatment. This study suggests the potential for IFN-a therapy in treatment of erosive inflammatory arthritis based on the shift in cell populations described.

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Subspecialty Careers: Highlights about Careers in Internal Medicine: Hematology

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The Discipline

From the Greek word haima, meaning blood.

The discipline of hematology relates to the care of patients with disorders of the blood, bone marrow, and lymphatic systems, including the anemias, hematological malignancies and other clonal processes, and congenital and acquired disorders of hemostasis, coagulation, and thrombosis.

Procedures

Important procedural skills include therapeutic phlebotomy, bone marrow aspiration, core bone marrow biopsy, and delivery of chemotherapeutic agents and biological products. In addition, hematologists are expert at interpreting the peripheral blood smear, bone marrow aspiration and biopsy, clotting assays, hemoglobin electrophoresis, iron studies, lymph node biopsies and lymphoid cell immunophenotyping.

Training

Hematology fellowship training requires two years of accredited training beyond general internal medicine residency. Of the two years, a minimum of 12 months must include clinical training in the diagnosis and management of a broad spectrum of medical diseases. In addition, a minimum of one half-day per week must be spent in a continuity outpatient clinic for the entire two-year curriculum. Dual certification in hematology and medical oncology requires three years of full-time combined fellowship training which must include: (a) a minimum of 18 months of full-time clinical training with patient care responsibility, (b) a minimum of 12 months in the diagnosis and management of a broad spectrum of neoplastic diseases including hematological malignancies, and (c) a minimum of six months of training in the diagnosis and management of a broad spectrum of non-neoplastic hematological disorders. During the entire three years the trainee must attend at least one outpatient clinic for a minimum of one half-day per week and have the responsibility for providing continuous care to a defined cohort of patients being managed for neoplastic and hematological disorders.

Certification

The American Board of Internal Medicine offers certification in hematology. Candidates applying for certification in hematology and oncology must complete all three years of required combined training before being admitted to an examination in either specialty. Those candidates that have completed all three years of required combined training may take the hematology and medical oncology examinations in the same year or in different years.

Training Positions

As of August 2005, there were 12 ACGME-accredited training programs with 67 active fellowship positions in hematology. 32% of the trainees were female, and 52% were U.S. graduates. During the same reporting year, there were 125 programs with 1,164 active fellowship positions in hematology and oncology. 44% of the trainees were female and 57% were U.S. graduates.

Practice

Approximately 25% of the graduates enter clinical practice in hematology in the United States and 50% enter academic medicine. Approximately 50% of the graduates from combined training programs enter clinical practice in hematology and oncology in the United States, and 42% enter academic medicine.

Professional Society

American Society of Hematology
1900 M Street, NW
Washington DC 20036
(202) 776-0544
www.hematology.org

Major Publications

American Journal of Hematology
Blood

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Advocacy Briefs: Enroll in ACP’s Key Contact Program

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ACP’s continued success on Capitol Hill greatly depends on year-round grassroots efforts from the College’s nearly 4,500 Key Contacts. Key Contacts communicate with their local members of Congress on issues of importance to internists and their patients and report the results back to ACP. To enroll as a Key Contact, ACP members are not required to have existing relationships with members of Congress. ACP provides members the tools necessary to develop and maintain these relationships. The program is open to all membership categories. Enroll now in the Key Contact Program.

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Did You Know You Have Access to Annals of Internal Medicine Online?

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The most widely cited medical specialty medical journal in the world, Annals of Internal Medicine delivers major review articles, incisive original research, topical clinical reviews, thought-provoking editorials, and a spirited exchange of medical opinion. To access your Annals Online subscription, register on the Annals web site.

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MKSAP for Students 3 Question 1

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A 46-year-old woman is evaluated because of several days of pain in her wrist and trouble writing due to the pain. Her only prescription medication is levothyroxine for hypothyroidism. She has been taking over-the-counter naproxen without relief.

Examination reveals no synovitis, intact motor strength, and a positive Finkelstein's test (the patient makes a fist by grabbing the thumb under the fingers, and pain is produced over the radial styloid when the wrist is deviated to the ulnar side). Percussion of the median nerve produces minimal discomfort, and apposition of the backs of the hands with the wrists at 90 degrees of flexion produces no symptoms. The patient's pain localizes to the lateral wrist over the distal radius. There is no pain with downward pressure on the first carpometacarpal joint.

Which of the following is the most likely diagnosis?

( A ) Carpal tunnel syndrome
( B ) De Quervain's tenosynovitis
( C ) Osteoarthritis of the first carpometacarpal joint
( D ) Rheumatoid arthritis of the first carpometacarpal joint

MKSAP for Students 3 Question 2

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A 39-year-old man is evaluated in the emergency department with a 4-hour history of gradually worsening dysuria and right flank pain that radiates into the right testicle. He does not have fever or chills.

On examination, he is restless because of pain. Blood pressure is 145/89 mm Hg, pulse rate is 92/min, and temperature is 37 °C (98.6 °F). He has right costovertebral angle tenderness. The serum creatinine concentration is 0.9 mg/dL. Urinalysis shows a specific gravity of 1.025, 3+ hematuria, and no proteinuria. Urine microscopy reveals more than 50 erythrocytes/hpf, 3 to 5 leukocytes/hpf, and occasional calcium oxalate crystals.

Which of the following has the highest accuracy in the diagnosis of this patient's condition?

( A ) Intravenous pyelography
( B ) Plain radiography of the abdomen
( C ) Noncontrast spiral computed tomography
( D ) Renal ultrasonography

MKSAP Answer 1

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Answer: B

Educational Objective: Diagnose de Quervain's tenosynovitis.

The patient has typical findings of de Quervain's tenosynovitis, that is, pain localized to the lateral wrist over the distal radius and a positive Finkelstein's test. Corticosteroid injection into the tendon sheath provides the most immediate relief. Osteoarthritis and rheumatoid arthritis of the first carpometacarpal joint cause pain over the lateral wrist, but just distal to the wrist crease, nearer the base of the thumb, compared with de Quervain's tenosynovitis. Also, the absence of synovitis makes rheumatoid arthritis unlikely. Although Tinel's sign was equivocal, the clinical scenario does not suggest carpal tunnel syndrome. Therapy with nonsteroidal anti-inflammatory agents may improve de Quervain's tenosynovitis, but local corticosteroid injection is more effective therapy.

References

Rankin ME, Rankin EA. Injection therapy for management of stenosing tenosynovitis (de Quervain's disease) of the wrist. J Natl Med Assoc. 1998;90:474-6. PMID: 9727290.

MKSAP Answer 2

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Answer: C

Educational Objective: Know the most appropriate radiologic procedure to diagnose nephrolithiasis.

Noncontrast spiral computed tomography of the abdomen yields the most information on renal stone disease because it can detect both radiolucent and radio-opaque stones in the kidneys and ureters and can detect hydronephrosis. Computed tomography provides additional information about abdominal anatomy, which may be helpful if the test does not show a renal stone as the cause for the patient's symptoms (an alternative diagnosis may be found as often as 10% of the time). Plain abdominal radiography does not show radiolucent stones. Ultrasonography can detect both types of stones and demonstrate hydronephrosis but cannot easily detect ureteral stones. Ultrasonography is often used as a first line diagnostic tool because it is readily available, inexpensive, and non-invasive. Intravenous pyelography often misses small radiolucent stones.

References

Fielding JR, Steele G, Fox LA, Heller H, Loughlin KR. Spiral computerized tomography in the evaluation of acute flank pain: a replacement for excretory urography. J Urol. 1997;157:2071-3. PMID: PMID: 9146582

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Internal Medicine Residency Program Fast Facts

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Program Name: University of Missouri, Kansas City
Location: Kansas City, Missouri
Hospital Type: University Based Hospital
Program Size: 26 First Year Positions, 56 Positions Total
First Year Salary: $41,000
Web Site: www.med.umkc.edu/education

Program Name: Geisinger Medical Center
Location: Danville, Pennsylvania
Hospital Type: University Affiliated Community Hospital
Program Size: 19 First Year Positions, 51 Positions Total
First Year Salary: $44,000
Web Site: www.geisinger.org/professionals/education/
Residencies/internal/

Program Name: Carilion Health System
Location: Roanoke, Virginia
Hospital Type: University Affiliated Community Hospital
Program Size: 18 First Year Positions, 42 Positions Total
First Year Salary: $42,000
Web Site: www.carilion.com/Community/SitePage/SitePage.asp
?App=SitePages&docid=93B7A4F4C3774F17BD019
FE5ECAA980F

Program Name: Cooper University Hospital
Location: Camden, New Jersey
Hospital Type: University Based Hospital
Program Size: 21 First Year Positions, 49 Positions Total
First Year Salary: $41,000
Web Site: www.cooperhealth.org/content/gme_internalmed.htm

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Students Needed to Work at Internal Medicine 2007

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The College needs medical students with basic to intermediate computing skills to help in our medical informatics workshops. We also need 2 male medical students to assist in the central venous line placement workshop in the Herbert S. Waxman Learning Center. Students will be paid a small honorarium ($100 per half-day, $200 for a full day). If you are attending Internal Medicine 2007 and would like to help, please contact Lisa Rockey at (800) 523-1546 ext. 2588 or lrockey@mail.acponline.org.

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Clinical Skills Review Course at Internal Medicine 2007

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Students can prepare for the USMLE Step 2 Clinical Skills Examination by participating in the Waxman Learning Center’s Clinical Skills 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:

  • Assessment orientation
  • 4 Station Clinical Skills Assessment:
    • 15 minutes per patient visit
    • 10 minutes immediate feedback for 2 stations
    • 10 minutes for 1 patient note
  • 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 Learning Center are free of charge but require onsite advance registration. To learn more, visit the Herbert S. Waxman Learning Center website.

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Announcing the New Internal Medicine Essentials for Clerkship Students 2007-2008 Textbook

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The new Internal Medicine Essentials for Clerkship Students 2007-2008 textbook is available. Created by the American College of Physicians and the Clerkship Directors in Internal Medicine, Internal Medicine Essentials is written by 68 authors who direct internal medicine clerkships around the country, who help design the internal medicine curriculum, and who are actively involved in teaching students during their internal medicine clerkships. This invaluable guide demonstrates to students how to care for patients, prepare for clinical rounds, and study for the end of rotation examination. Internal Medicine Essentials covers the common problems and disorders a student is expected to understand and likely to encounter. The printed content is enhanced with clinical photographs, tables, screening tools, and other instruments on the Internet . This is a unique resource that provides medical students with the skills they need to enhance learning during the third-year internal medicine clerkship.

List Price: $49.95
ACP Student Member Price: $39.95
Product #: 330361030
ISBN: 1-930513-82-8

Order online now.

You can also call ACP Customer Service to order at 800-523-1546, extension 2600 or 215-351-2600 (M-F, 9 a.m.-5 p.m. ET).

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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.