November 2008 E-Newsletter

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Medical Student Perspectives: The Match: What You Need to Know

In a few months the time will come for all students applying for residency to come up with a list of programs they like. These will be entered into a national database, which will then undergo a seemingly complicated algorithm in order to produce a list of applicants whose preferences are matched as faithfully as possible with those of the programs. This process is called the match, and here we will demystify its various elements in order to give students a better idea of how to get the most out of the system.

Rank Order Lists
All applicants interested in matching submit an ordered list of programs on the National Residency Match Program (NRMP) website. Because it is extremely unlikely for applicants to match to programs at which they have not interviewed, they should only rank those programs where they have interviewed. A rank order list should represent an applicant’s true preferences, not taking into account the applicant’s perceived likelihood of matching at various programs. This is encouraged because there is no disadvantage to ranking preferred programs highly, even if it is unlikely that an applicant will be highly ranked by those programs. Ranking a large number of programs is also to an applicant’s advantage, especially if the applicant has ranked very competitive programs. In fact, applicants should rank every program at which they feel they would be happy enough to accept a position.

The Algorithm
Let us say there is a residency applicant named John, and another named Sue. The national computer system first goes through John’s preferences, starting with his highest ranked program. If it cannot match him to that program, it will then evaluate John’s second program, and so on. When it comes to his third choice, US Residency Program (USRP), which has also ranked John, the system will tentatively match him to that program. It will then move on to Sue.

Sue’s top choice for residency is USRP. When the computer system comes to this program, it finds that USRP has ranked Sue higher than John. Therefore, it will bump John off the match list for USRP and replace him with Sue. This will be a tentative match for Sue. Next, the system will return to John and evaluate his entire rank list again in an attempt to make another tentative match for him. And so on.

If the system cannot find a single program with which to make a tentative match for an applicant, that applicant will remain unmatched.

The Scramble
Match day, when the match results are released to all applicants, occurs on a Thursday. On noon of the Tuesday before match day, all unmatched applicants are given a chance to contact programs with open positions that they did not originally rank in the hopes that they may be offered a position. This process is known as the scramble. Such applicants are sent a list of programs that have unfilled positions, and each applicant must contact programs independently. Those who procure positions this way are then considered matched on match day.

Couples Matching
Couples undergoing couples matching must register independently with NRMP and indicate the desire to be matched as a couple. The couple then ranks pairs of programs (one program for each individual), and these pairs are considered in the match process. Pairs of programs can consist of the same program for each individual, different programs in the same city, or different programs in different cities. The NRMP then matches couples using the same algorithm as it uses for individuals. Couples are encouraged to rank programs in the true order of their preferences and include all programs that would be acceptable to both parties.

Important Dates
This year, the NRMP registration deadline is November 30. Rank order list entry begins January 15 and ends February 25. The match runs on March 16, followed by the scramble on March 17. Match day is March 19!

More information on matching can be found on the NRMP website. Good luck!

Aliza Monroe-Wise, MSc
Council of Student Members Representative, Pacific Region
Stanford University School of Medicine, 2009
Email: aliza1@stanford.edu

Check out more volunteer opportunities.

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My Kind of Medicine: Real Lives of Practicing Internists: Esther Nash, MD

If you had to choose the one person of the roughly 6,000 people working in the Independence Blue Cross building in downtown Philadelphia who believed in their job the most, there is a good chance it would be Esther Nash, MD. Every day from her office on the 32nd floor she thinks about how she—the company’s Senior Medical Director of Population Health and Wellness and Co-Director of the Office of Consumerism—can improve the health of over three million health plan members. Although she is not their personal physician, she approaches her job as if she were. “The way I look at it is that even though I don’t influence them as much as I would in a single patient visit, I get to impact many more of them in little ways,” she says. “That keeps me going.”

Finding Her Way
Dr. Nash was drawn to medicine by personal circumstance. When she was in high school, her mother, a clinical psychologist, suffered several retinal detachments, eventually going legally blind. The effect it had on the family and on Dr. Nash in particular was substantial. “It put a lot of responsibility on me as the oldest,” she recalls. “I had to take over the errands, drive my sister to and from places. It was also hard to watch her go through it, because my mother had always been a professional role model for me. After she became affected by the condition, she was no longer able to work.”

Dr. Nash spent a good deal of time in the hospital with her mother. “I remember having a good feeling about the environment there,” she recalls. The experience inspired her to become a doctor, as she explains. “Watching my mother go through all of this made me want to help her, and watching the doctors made me want to be really good at something. So that’s when I realized I wanted to be a physician.”

At medical school at Brown University in Providence, Rhode Island, Dr. Nash decided to join the American Medical Student Association (AMSA), for which she was appointed as a delegate for her school. At a meeting one year, she happened to meet David Nash, a delegate from the University of Rochester School of Medicine. A year later they were engaged. While it was difficult living 800 miles apart in medical school, when it came time for internship, they moved together to The Graduate Hospital at the University of Pennsylvania.

Having pursued ophthalmology with passion and determination, Dr. Nash was selected for the residency program at the Scheie Eye Institute of the University of Pennsylvania, at the time one of the most competitive programs. But in the middle of her medical internship, she began to have a change of heart. “I realized that my determination to become an ophthalmologist was influenced by the experience with my mother,” she says. “And I thought to myself, ‘I can’t give up the whole body just for the eyeball!’” She chose internal medicine instead. “It truly fascinated me,” she says. “I liked the ultimate problem solving, the talking to the patients and forming relationships with them. I liked the idea of having that much knowledge. There’s just nothing that compares to internal medicine in terms of the broad range of what it touches.” She contacted the director of the ophthalmology residency and told him that she wanted to relinquish her spot.

A Growing Passion
As a resident, her love for internal medicine was fostered by one of her attending physicians in infectious diseases. “One of the best teachers I’ve had—the late Dr. Russ Stumacher—was a walking encyclopedia!” she says. “He was also the only one who taught us how to do the most basic thing: walk into a patient’s room, listen, and determine whether or not the patient was actually 'sick.'

During their medical residency, Dr. Nash and her husband started a non-profit organization, Dual Doctor Families, to address the career issues of two-physician couples. Together they grew the organization to the point where they needed a board and had to incorporate. Dr. Nash says the experience gave her an idea of what she was good at. “It gave me some exposure in managing something, of running an organization. I found out that I like to run things.”

However, as they continued their work with the non-profit and Dr. Nash’s husband pursued a fellowship at the University of Pennsylvania, they soon found reality knocking on their door. “Someone had to earn a living!” she says. She took her first job as a practicing general internist at an HMO in Philadelphia, and it was not long before she was trying to change things. “I had been there for only a year before I was saying to myself ‘I could do it better,’” she says. “I wanted to change the scheduling system, the record keeping system … I wanted to revamp the processes.”

The urge to improve things for the better was one she knew would last. “These early formative experiences are really what led me down the road to where I am today,” she says. “The decisions I took in my career are reflective of that.” She began taking steps towards this goal, taking positions over the next several years that would gradually pull her closer towards health care management on an executive level. The first of these positions was as an Associate Chair of Medicine at the Albert Einstein Medical Center, Southern Division, which she took at the age of 29. The job had its pressures. “There was a lot of turmoil that area hospitals were going through at the time,” she says, “with utilization management pressures, early quality improvement efforts, and hospital labor issues.” She was also going through her own life changes, as she had become pregnant with twins. “I spent half of the time on bed rest and in the hospital,” she says. Four years later, Dr. Nash and her husband welcomed their third child into the world, a boy. Dr. Nash cites the work-life balance as the toughest test of her career. “I can’t imagine my life without my family or my career, but balancing both together has been a challenge,” she admits. “It’s been hard all the way through.”

The True Populist
A few years later as Director of Quality Improvement and Medical Education at Bryn Mawr Hospital, and then as a medical director at Prudential Health Care, Dr. Nash honed her skills in administrative management. By the time she took a job as a medical director at Prudential in 1994, her work consisted almost entirely of management responsibilities and she was considered a physician executive. Although she was further removed from direct patient contact, she recognized how the path related to her experience as a clinician and teacher. “A lot of the emphasis on health improvement, prevention and managing chronic conditions is focused on or around the major role of the primary care physician,” she says. “GI conditions, hypertension … it’s all the world of the internist. Internal medicine gives you so many directions to go in. Being an internist has made all of the work I’ve done possible.”

Developing health care plans may not seem exciting to some, but for Dr. Nash it could not be a more gratifying job. For example, one of her proudest achievements she says has been developing and shaping Independence Blue Cross’ Connections (sm) program, an award-winning chronic condition support program. “We’ve been a leader in this area and we’re very proud of it. We did the clinical research on the program and we’re seeing a return on investment, which means for every dollar that’s being invested in the program, several more dollars are being saved by avoiding relapses and complications, resulting in less suffering for our members. It means patients are able to manage their conditions better and follow their physicians’ treatment plans.”

She describes her job in simple terms. “We design health programs, figure out how to reach the population, and measure the results,” she says. She explains how much of the work she and her staff do on a daily basis varies. “It runs the gamut,” she says. “It’s chronic conditions, reminders for necessary prevention services, reviewing clinical guidelines; it’s running community collaborations and wellness programs, some of which we deliver at the work site or at public venues, or now increasingly through the internet.”

For Dr. Nash specifically, a lot of her work involves getting feedback from physicians on health plan programs. “I’ll meet with doctors in the community and ask them ‘Do you agree with this? Are you comfortable with this? Is the content ok with you?’” she explains. She describes how the profession, and in particular the medical insurance industry, is moving towards the overall theme of consumer empowerment in health care. “The role of health care plans is to be there for the patient so the patient can make the right decision,” she says, “I like that I am able to use my knowledge to improve health. I work for a very ethical and committed company. What I do can help a lot of people.” She adds how excited she is about a program she’s working on now. “One that is coming out I’m really excited about it,” she says. “It’s based on incentives—it’s similar to a points system for healthy behavior. I think it will work, because incentives are based on realistic behaviors—it’s human nature.”

Dr. Nash is proud of what she does and has a tangible passion for and commitment to the issues affecting health care today. But rather than just talking about it, Dr. Nash is an agent of action. A priority now is health care consumerism through information technology. “I think our system is so disconnected now,” she says. “I want to develop an advanced personal health record system for my community. Health care information belongs with the consumer so they can be partners with their doctors in their own health. If I had to pick one thing to put on my tombstone it would be ‘Bring the power to the people.’”

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: Medical College of Wisconsin

The Medical College of Wisconsin (MCW) has been fortunate to have an ACP student chapter since 1994. Kurt Pfeifer, MD, FACP serves as our chapter’s faculty advisor and ensures continuity in leadership in a chapter that changes student officers from outgoing to incoming second-year students every academic year. Dr. Pfeifer joined the MCW faculty in 2002 and is currently an Associate Professor of Medicine and Associate Program Director of the Internal Medicine Residency Program at the Medical College of Wisconsin Affiliated Hospitals. We receive some funding from MCW via our student assembly, and the rest from the Wisconsin ACP Chapter, to which all student members pay a four-year membership fee of $15. My new set of officers and I look forward to continuing the successful activities that have offered first- and second-year medical students the opportunity to learn more about the field of internal medicine and develop contacts in the MCW community.

We’ve already had an introductory lunch talk with MCW faculty; next, we will sponsor a clinical skills workshop where internal medicine residents demonstrate and let first- and second-year students practice some fundamental clinical skills. In addition to listening to chest sounds and performing auscultation, students ask residents about their residencies and medical journeys. Later in the spring, we will cater a meal in our cafeteria (meals always attract hungry students!) and invite subspecialists and medical students to our most popular event, the subspecialty networking reception. Students will have the chance to informally talk to subspecialists and develop connections that may lead to shadowing opportunities and contacts for career advice. I used this opportunity last year to meet a cardiologist and find shadow rounds in the Coronary Intensive Care Unit. Many students wait until the reception to develop relationships with faculty members, but we also offer the opportunity for students to request a faculty mentor at any time during the school year. Young students can gain an early appreciation for internal medicine in action with our Saturday Rounds program, which lets first- and second-year students tag along on rounds and observe the roles of upper-level medical students, nurses, residents, and attending physicians in an academic hospital. For our last activity, Dr. Pfeifer returns with his chief resident and engages an audience of first- and second-year students in differential diagnoses of a few recent cases. First-year students principally observe while the second-year students play a more interactive role as they sharpen their skills before taking the boards and moving on to the wards.

Toward the end of the spring semester, we work with the Wisconsin ACP Chapter to give interested first-year students the opportunity to apply for paid ($300) one-week summer externships in internal medicine fields ranging from primary care to intensive care. Former participants report that these experiences helped them ease into their clinical years and better understand the roles and responsibilities of junior and senior medical students.

I am excited to announce our chapter’s new community service partnership with Community Partners in Health (CPH) and our American Medical Student Association (AMSA) chapter. Last year, a group of MCW students authored a short presentation on hypertension (reviewed by physicians) and delivered it at a church meeting on Milwaukee’s north side. Church and community members discussed their knowledge of hypertension and their personal experiences with the disease. Our student volunteers listened, answered questions as best as they could, and offered free blood pressure screening. Students reported that the meeting was a success for both participants, who claimed to have learned more about hypertension than they did at their doctor visits, and for students, who gained perspective on patient compliance and how low-income families view disease and the health care system. This year, our volunteers have strengthened connections with community leaders and discussed appropriate health topics they would like us to cover. We are currently authoring new presentations on these health topics and recruiting physicians to attend our presentations. We hope that a strong AMSA-ACP partnership will make this a lasting and meaningful program for both MCW students as well as Milwaukee community members.

My officers?Kellen Gregori, Amy Pearson, Solange Eloundou, and Timothy Trichler, all graduates of the class of 2011?and I are thankful for the help from Dr. Pfeifer and the work of previous generations that has made our student chapter a perennial success. Last year we recruited approximately 80 students from a class of 204, and this year we already have 50 new members from the first-year class.

John S. Symanski
ACP Student Chapter President
Medical College of Wisconsin, 2011
Email: jsymansk@mcw.edu

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Deadline quickly approaching: The CDC Experience Applied Epidemiology Fellowship - Call for Applications

Are you a medical student looking for something different to do next year?

• Are you curious about how public health and the CDC work?

• Do you want to work with state, local and international public health partners?

• Would you be interested in investigating outbreaks of tuberculosis among the homeless, or in a prison population?

• Or traveling to Southeast Asia to help set up a surveillance program for avian influenza?

• What about assessing risk factors for birth defects using national data bases?

• Or perhaps you would like to be at the forefront of injury prevention research?

Do you want an experience that offers an opportunity to enhance your research skills, build leadership potential, and improve your clinical acumen via a population health perspective, all by working on real-life problems?

Then consider applying to The CDC Experience!
The CDC Experience Applied Epidemiology Fellowship is a one-year fellowship tailored for rising 3 rd and 4th year medical students, designed to increase the pool of physicians with a population health perspective. Eight competitively selected fellows spend 10-12 months at the Centers for Disease Control and Prevention (CDC) offices in Atlanta, GA where they carry out epidemiologic analyses in various areas of public health. Examples of previous and current areas of concentration include viral diseases, cardiovascular health, birth defects, STDs, food borne diseases, injury prevention, and air pollution and respiratory health.

To learn more about the CDC Experience visit us online at CDC Experience. Applications for next year’s fellowship class must be postmarked by Friday December 5, 2008. Questions? Ask us at cdcexperience@cdcfoundation.org.

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Winning Abstracts from the 2008 Medical Student Abstract Competition: Targeting The HSP90 Co-chaperone CDC37 Causes Growth Arrest And Sensitizes Prostate Cancer Cells To Chemotherapy And Radiation

Authors: Phillip J. Gray, Jr.; Stuart K. Calderwood.Johns Hopkins University School of Medicine, Baltimore, Maryland and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Introduction
Prostate cancer affects over 200,000 men each year and nearly 30,000 will die of their disease. While early-stage prostate cancer is highly treatable, there are very few options for men who present with metastatic disease. The development of novel therapies will require a better understanding of the inner workings of the cancer cell. The HSP90 (heat shock protein 90) chaperone system is a ubiquitous intracellular protein control system which we hope to exploit to aid in the development of these novel treatments for this devastating disease.

Methods
We utilized lentivirally delivered short hairpin RNA plasmids targeted at Cdc37, a known HSP90 co-chaperone in order to study its function in the cell. By utilizing a combination of clonogenic survival assays, Western blot, quantitative PCR, flow cytometry and luciferase reporter assays we analyzed the downstream effects of Cdc37 knockdown on a wide variety of prostate cancer cell types. We also compared the effects of combining Cdc37 knockdown with cytotoxic drugs and ionizing radiation.

Results
Knockdown of Cdc37 induced an irreversible total growth arrest in all of the tested prostate cancer cell lines. This effect was mediated by an inhibition of multiple signaling pathways within the cell including the Akt, Erk, mTOR and androgen receptor pathways. Combining Cdc37 knockdown with the chemotherapeutic drug Paclitaxel showed supra-additive cytotoxic effects on cell survival (IC50 2.68 vs. 5.82 nM) mediated by accelerated apoptosis induction. Cdc37 knockdown also combined well with ionizing radiation (DER25: 1.59)and led to inappropriate advancement through cellular checkpoints resulting in cell death. We also demonstrate that Cdc37 inhibition sensitizes cancer cells to the HSP90-inhibiting drug 17AAG by nearly a full log (IC50 13 vs 125nM). Cdc37 inhibition greatly enhances the protein destabilizing effects of 17AAG and inhibits the upregulation of HSP70, thought to be the major cause of acquired resistance to HSP90-targeted drugs.

Conclusion
Cdc37 is a novel and promising molecular target for the treatment of prostate and other cancers. Its strength as a potential therapeutic tool lies in its ability to simultaneously inhibit numerous kinase signaling pathways commonly dysregulated in cancer. Furthermore, its synergistic interactions with other accepted agents would lead to reduced toxicity and reduced development of resistance when targeted clinically.

This could be your winning abstract. Deadline to submit for the 2009 competition is December 8, 2008. For more information and the link to submit, please click here.

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Subspecialty Careers: Highlights about Careers in Internal Medicine: Interventional Cardiology

The Discipline
From the Latin word intervenire, "to come between" Interventional Cardiology is the branch of Cardiology responsible for catheter-based interventions in the management of ischemic heart disease, congenital heart disease, and acquired valvular disease.

Procedures
Important procedural skills include coronary artery catheterization, angioplasty, intra-coronary thombolysis, valvuloplasty, coronary artery stent placement, and intra-aortic balloon counterpulsation.

Training
Interventional Cardiology fellowship training requires 12 months of accredited training beyond three years of general cardiology training.

Certification
The American Board of Internal Medicine, ABIM, offers certification in Interventional Cardiology.

Major Publications

Major Professional Societies

  • The Society for Cardiovascular Angiography and Interventions

    • 2400 N. Street, NW

    Washington, DC 20037-1153

    1-800-992-7224

    scai.org

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Advocacy Brief: Enroll in ACP’s Key Contact Program

ACP’s continued success on Capitol Hill greatly depends on year-round grassroots efforts from the College’s more than 5,600 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 the ACP Council of Student Members Nominations are Due Soon?

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

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

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MKSAP for Students 3 Question 1

A 33-year-old pregnant woman (G1, P0, Ab0) is evaluated because of hypertension. She has a family history of hypertension, but has never previously had hypertension. Her pregnancy has been uneventful, and she has gained 3.6 kg (8 lb). At the end of her first trimester, her blood pressure was 158/94 mm Hg, and she had trace edema. Other than findings compatible with a second-trimester pregnancy, the remainder of her physical examination is normal.

  • Laboratory values:

    • Hematocrit 33.4%

    Blood urea nitrogen mg/dL

    Serum creatinine 0.4 mg/dL

    Serum uric acid 3.1 mg/dL

    24-hour urinary protein 100 mg

    Creatinine clearance (estimated) 150 mL/min

    Urinalysis Trace proteinuria by dipstick

The patient is seen 1 week later. Her blood pressure is 162/92 mm Hg. She has trace proteinuria, and laboratory values have not changed.

Which of the following should be done next?

A. Start atenolol
B. Start methyldopa
C. Start ramipril
D. Advise termination of pregnancy

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MKSAP for Students 3 Question 2

A 48-year-old woman comes to the office as a new patient. She weighs 82 kg (180 lb) and has an abdominal girth of 91.5 cm (36 in). Her body mass index is 30 kg/m2. She has a family history of diabetes and premature coronary artery disease. She smokes one pack of cigarettes a day. Her blood pressure is 135/86 mm Hg. The remainder of her physical examination is normal.

Which of the following should be done next to evaluate this patient’s vascular risk?

A. C-reactive protein test
B. Exercise electrocardiographic stress test
C. Exercise echocardiographic stress test
D. Fasting lipid profile and blood glucose
E. Postprandial triglyceride level

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MKSAP for Students 3 Answer 1

Answer: B, Start methyldopa

This patient has gestational hypertension. Treatment must be individualized, because there are few studies to guide therapy. Treatment of patients with gestational hypertension will not decrease their risk of preeclampsia or maternal or fetal mortality. In addition, treatment does not affect perinatal or neonatal outcomes. However, treatment improves blood pressure and decreases the incidence of hospitalization and of proteinuria at delivery. Methyldopa is the recommended oral therapy with the longest track record of safety and efficacy.

Angiotensin-converting enzyme agents (for example, ramipril) are contraindicated after the second trimester because of fetal complications, such as oligohydramnios, renal and maturational failure, and death. Atenolol has been associated with adverse fetal outcomes, such as intrauterine growth retardation and low placental weight in the second trimester. There is no indication for termination of pregnancy.

Bibliography
1. Garovic VD. Hypertension in pregnancy: diagnosis and treatment. Mayo Clin Proc. 2000;75:1071-6. PMID: 11040855[PubMed]

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MKSAP for Students 3 Answer 2

Answer: D, Fasting lipid profile and blood glucose

A standard fasting lipid profile and blood glucose testing should be done in this patient. This patient may have metabolic syndrome, which is a risk factor for coronary artery disease. The NCEP-ATP III criteria for metabolic syndrome include the presence of three or more specific risk factors, which include abdominal obesity, as assessed by waist circumference; triglyceride level greater than 150 mg/dL; high-density lipoprotein (HDL) cholesterol level less than 50 mg/dL in women; blood pressure greater than 130/85 mm Hg; and fasting glucose level greater than 110 mg/dL. This patient has abdominal obesity and high blood pressure. If she also has elevated serum triglycerides, low serum HDL, or fasting plasma glucose greater than 110 mg/dL, she would meet the criteria for metabolic syndrome.

If she does meet these criteria, an aggressive lifestyle approach is indicated, including adherence to the NCEP-ATP III lifestyle diet, weight loss, and regular physical activity. Lipid-modifying therapy also might be appropriate, depending on the levels of various lipoproteins.

An elevated postprandial triglyceride level is associated with increased vascular risk, but this test is not recommended as part of the routine screening for risk of coronary artery disease. Exercise testing (electrocardiographic or echocardiographic) is not recommended as a screening tool for primary prevention of coronary artery disease. C-reactive protein can be a useful adjunctive test in patients who are in an intermediate category of cardiovascular risk (that is, 10%–20% over 10 years) by the Framingham risk score, but not in this patient.

Bibliography
1. Abbasi F, Brown BW Jr, Lamendola C, McLaughlin T, Reaven GM. Relationship between obesity, insulin resistance, and coronary heart disease risk. J Am Coll Cardiol. 2002;40:937-43. PMID: 12225719[PubMed]

2. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO, Criqui M, et al. Markers of inflammation and cardiovascular disease. Application to clinical and public health practice. AHA/CDC Scientific Statement. Circulation. 2003;107:499-511. PMID: 12551878[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)

  • Anchoring errors ensue when diagnoses get lost in translation
    A patient's use of key words led to anchoring errors in diagnosing an abdominal aortic aneurism and a classic case of intermittent claudication.
  • Podcast engages medical bloggers in a virtual talk show
    An internist/blogger creates a talk-show format for his podcasts to link internists with one another.
  • On the blog: AHA, CHEST 2008
    ACP Internist's writers have crossed the country in recent weeks, reporting from conferences at the American Heart Association Scientific Sessions, the American College of Chest Physicians and American College of Rheumatology. They've covered the breaking news as it happens and some hilarious minutiae when it doesn't. Read their coverage plus check out the latest Medical News of the Obvious, new every Monday.

ACP Hospitalist

  • Hospitals tackle ‘failure to rescue’ errors
    Failure to rescue, the failure to identify patients with critical abnormalities and provide the resources necessary to prevent harm, was one of the top three preventable errors found in hospitals in 2004-2006, accounting for 17% of total errors. Experts offer their solutions.
  • Finding an algorithm for heart failure
    The OPTIMIZE-HF study showed which symptoms predicted likelihood of in-hospital mortality from decompensated congestive heart failure and what were the most important predictive factors. Now, there's an algorithm for stratifying patients.
  • Top Docs: Meet our 2008 top hospitalists
    The doctors recognized in ACP Hospitalist's first annual Top Hospitalists issue include teachers, quality improvement gurus, researchers and bloggers.

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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