July 2015

Discounted Internal Medicine 2016 Registration Rates for International Attendees

ACP members in low income/low middle income countries and upper middle income countries, as defined by the World Bank Economic Indicators, will be offered special discount registration rates for ACP Internal Medicine 2016 in Washington D.C. These discounts will apply to individual registrations as well as group delegations. The discounted individual and group delegation rates will be as follows:

ACP Internal Medicine 2016
International Individual Rates

Country Early Bird Member Rates by January 31, 2016 Member Regular Rates on/after February 1, 2016 Non-Member
High Income Countries* $659 $739 $999
Upper-middle Income Countries** $527 $607 $999
Low/Low-middle Income Countries*** $428 $508 $999

Click here to register!

ACP Internal Medicine 2016 International Delegation Rates
For Groups of 10 or More Physicians

Country Member Non-Member
High Income Countries* $527 $799
Upper-middle Income Countries** $448 $649
Low/Low-middle Income Countries*** $342 $470

*Members in high income countries pay ACP dues of $220.
**Members in upper-middle income countries pay ACP dues of $160.
***Members in low and low-middle income countries pay ACP dues of $110.

For more information, as well as a group delegation registration form, visit im2016.acponline.org/delegations.

If you have questions, please contact internationaloffice@acponline.org.


Internal Medicine: Global Perspectives

Jane Dacre, MD, FACP (Hon)
President, Royal College of Physicians

England is one of four countries that make up the United Kingdom (UK). The capital of both England and the UK is London. Bordering England is Scotland to the north and Wales to the west. England is approximately 50,000 square miles, and has an estimated population of 53 million. The UK has a publicly-funded healthcare system that is provided by the National Health Service. The National Health Service is responsible for providing the majority of healthcare in England, and it provides most services free at the point of use.
The Royal College of Physicians (RCP) is a member organization based in the UK with over 30,000 members worldwide. Members of the RCP work across 30 medical specialties in hospitals and communities. The RCP aims to improve patient care and reduce illness in the UK and around the world.

*source: Wikipedia

What inspired you to become a physician?

I was always interested in biology at school, and wanted to develop that by studying ecology. My father, who was an anesthetist, suggested I became a doctor instead because it was a proper job. So, at the age of twelve, I decided I would be a doctor, and I haven't looked back.

What do you enjoy about being a rheumatology subspecialist, with a major interest in medical education?

I love the variety of being both a physician and an educator. I am frequently inspired by the way my patients cope with their lives, often with daily pain and disability. I am equally passionate about supporting the next generation of doctors to be able to help our patients more than my own generation was able to.

Can you describe the role of the Royal College of Physicians? What are the mission and goals of the organization?

The Royal College of Physicians of London was founded in 1518 by Thomas Linacre, a physician to King Henry VIII. Linacre persuaded Henry to give the RCP a charter to grant licenses to educated physicians and protect the public from unqualified practitioners. So although we have a very long history in English medicine, and will be 500 years old in 2018, we are still true to our roots in protecting patients and maintaining standards of practice. We are now a membership organisation with 30,000 members in 29 specialties, influential in UK health policy development, and the National Health Service (NHS). Our aims are to improve patient care, develop physicians throughout their careers, lead and support our members, and shape the future of health and healthcare.

What motivated you to become involved in the RCP and to take on the role of President?

I first became involved through my interest in medical education. I began in the examinations department, contributing to the modernisation of the Member of the Royal College of Physicians (MRCP) United Kingdom examination. I found that working with physicians outside the traditional hospital environment was extremely rewarding. I made several friends, as we share so many values. I felt that I could offer a fresh approach to the presidency, as only the third women in the College's 500 year history, and as a working doctor and educator.

What would you like to accomplish as RCP President?

This is a tall order, but I want to change the culture. I want to give all physicians a voice, to make them feel empowered, included and influential in the health system. We are a bunch of able, intelligent and articulate people who deserve to be listened to.

Can you tell us a little about the upcoming 500th anniversary of the RCP?

We are very excited about the anniversary, and we have begun to plan our celebrations for the year, engaging our fellows and members for their ideas to not only celebrate our past, but create a real legacy for the future. We will have a programme of exhibitions and events to show the significance of physicians through the years, and activities looking forward to the future of healthcare.

What is the role of the internist in the United Kingdom? What are the education and training requirements needed to practice internal medicine or one of the subspecialties of internal medicine?

Internal medicine is vital to UK medicine, with the majority of patients coming in as emergencies having multiple morbidity and being over age 65. We are trying hard to support internal medicine, but have several challenges in doing this while continuing to value our 29 medical specialties. In a NHS, which is universal and free at the point of delivery, there is an exponentially increasing demand for care, and it is difficult to continue to provide the care and quality of service that our patients deserve.

To do this well, we are planning on transforming training, so that all of our specialists can achieve greater competence in internal medicine AND their specialty. At the moment, trainees come out of medical school into two years of a foundation programme, two years of core medical training, and then at least four years in specialty, picking up the MRCP examination along the way. As our patients need better general internal medicine skills in their doctors, we are negotiating a change that allows more exposure to internal medicine with no extra time or money, which is a big challenge.

What are some of the most significant challenges that physicians in your country (England) face? What are your thoughts on the best way to meet those challenges?

We have an increasing burden of long term conditions, and are reaching the breaking point. We published a document highlighting this in 2012 - Hospitals on the Edge. Following this we set up the Future Hospital Commission to address these issues. Its report, Future hospital: caring for medical patients, published in 2013, and recommended a radical redesign of services to bring care to the patient, wherever they are - in hospital, in the community, or at home. This includes better integration with social care and out-of-hospital care; co-locating emergency and acute services within hospitals; new roles for UK doctors such as the chief registrar (resident) role for a trainee physician to combine experience of leadership with medical training; and outreach services so that hospital doctors work in the community to identify and manage patients better to avoid hospital admission. Although written in the UK, its conclusions and recommendations will strike a chord in any health service under pressure.

What can other countries learn from your health system?

We are fiercely proud of providing universal health care that is free at the point of delivery. We think others could learn from that principle. We are also proud of the clinical skills of our physicians, who still maintain the ability to combine the art and science of medicine. We think this is something others should emulate, as without our clinical and problem solving skills, we become health technicians, not doctors.

What have you found to be the most rewarding part of leadership? The most challenging?

I am a collaborative leader, and so enjoy the collegiality and support from colleagues to help me to influence those in power, for the benefit of patients. The challenge is that sometimes they don't hear the message.


Order MKSAP 17 by July 31 and save up to 15%

The newest edition of Medical Knowledge Self-Assessment Program® (MKSAP 17) is coming July 31, 2015. And for the first time ever, MKSAP Digital will launch 1 month after the print version.

  • Part A Print: July 31, 2015
  • Part A Digital: August 31, 2015
  • Part B Print: December 31, 2015
  • Part B Digital: January 31, 2016

Setting the definitive standard for self-assessment since 1967, MKSAP continues to honor its legacy by helping internists gain knowledge in the core of internal medicine and its subspecialties. Every 3 years, our program is updated and presented as an original body of scholarly work. The newest edition, MKSAP 17, will give you unparalleled content in a state of-the-art format. Learn from evidence-based clinical scenarios and answering 1,200 entirely new questions

Take advantage of special discounted pricing on MKSAP 17 by placing your pre-order today. For more information, visit www.acponline.org/products_services/mksap/17/index.html.


ACP Clinical Practice Guidelines

ACP Clinical Practice Guidelines cover many areas of internal medicine, ranging from screening to diagnosis and treatment of disease. The evidence-based guidelines provide recommendations to help clinicians deliver the best health care possible.

Access ACP Guidelines from your smart phone or tablet. Download the ACP Clinical Guidelines app at itunes.com and android.com.

Recent Guidelines:

Cervical Cancer Screening in Average-Risk Women: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians

16 June 2015 | Ann Intern Med. 2015;162(12):851-859. doi:10.7326/M14-2426


Best Practice Advice 1: Clinicians should not screen average-risk women younger than 21 years for cervical cancer.

Best Practice Advice 2: Clinicians should start screening average-risk women for cervical cancer at age 21 years once every 3 years with cytology (cytologic tests without human papillomavirus [HPV] tests).

Best Practice Advice 3: Clinicians should not screen average-risk women for cervical cancer with cytology more often than once every 3 years.

Best Practice Advice 4: Clinicians may use a combination of cytology and HPV testing once every 5 years in average-risk women aged 30 years or older who prefer screening less often than every 3 years.

Best Practice Advice 5: Clinicians should not perform HPV testing in average-risk women younger than 30 years.

Best Practice Advice 6: Clinicians should stop screening average-risk women older than 65 years for cervical cancer if they have had 3 consecutive negative cytology results or 2 consecutive negative cytology plus HPV test results within 10 years, with the most recent test performed within 5 years.

Best Practice Advice 7: Clinicians should not screen average-risk women of any age for cervical cancer if they have had a hysterectomy with removal of the cervix.

Risk Assessment and Prevention of Pressure Ulcers: A Clinical Practice Guideline From the American College of Physicians

3 March 2015 | Ann Intern Med. 2015;162(5):359-369. doi:10.7326/M14-15676


Recommendation 1:ACP recommends that clinicians should perform a risk assessment to identify patients who are at risk of developing pressure ulcers. (Grade: weak recommendation, low-quality evidence)

Recommendation 2:Recommendation 2: ACP recommends that clinicians should choose advanced static mattresses or advanced static overlays in patients who are at an increased risk of developing pressure ulcers. (Grade: strong recommendation, moderate-quality evidence)

Recommendation 3: Recommendation 3: ACP recommends against using alternating-air mattresses or alternating-air overlays in patients who are at an increased risk of developing pressure ulcers. (Grade: weak recommendation, moderate-quality evidence)

Treatment of Pressure Ulcers: A Clinical Practice Guideline From the American College of Physicians

3 March 2015 | Ann Intern Med. 2015;162(5):370-379. doi:10.7326/M14-1568


Recommendation 1:ACP recommends that clinicians use protein or amino acid supplementation in patients with pressure ulcers to reduce wound size. (Grade: weak recommendation, low-quality evidence)

Recommendation 2:Recommendation 2:ACP recommends that clinicians use hydrocolloid or foam dressings in patients with pressure ulcers to reduce wound size. (Grade: weak recommendation, low-quality evidence)

Recommendation 3: Recommendation 3: ACP recommends that clinicians use electrical stimulation as adjunctive therapy in patients with pressure ulcers to accelerate wound healing. (Grade: weak recommendation, moderate-quality evidence)

Click here for more ACP guidelines.


ACP In The Clinic

Chronic Kidney Disease

In the Clinic is a monthly feature in Annals of Internal Medicine introduced in January 2007 that focuses on practical management of patients with common clinical conditions. It offers evidence-based answers to frequently asked questions about screening, prevention, diagnosis, therapy, and patient education and provides physicians with tools to improve the quality of care.

This issue provides a clinical overview of chronic kidney disease, focusing on prevention, diagnosis, treatment, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult smartmedicine.acponline.org, mksap.acponline.org, and other resources referenced in each issue of In the Clinic.

To read this issue of In The Clinic, please click here. All ACP members have full access to this content.


International Fellowship Exchange Program (IFEP) 2015-2016 Deadline Approaching

ACP's International Fellowship Exchange Program (IFEP) provides opportunities for early to mid-career physicians from outside the United States and Canada to gain expertise in a focused area relating to the prevention, diagnosis, and/or management of a clinical problem in internal medicine and the subspecialties. Through observation, mentorship, and study of the work of senior faculty physicians, fellows will acquire knowledge, experience, and skills that they can apply, utilize, and disseminate to colleagues upon return to their home country. Faculty mentors will engage fellows in individual and group clinical and educational experiences and discussions, and facilitate the design of an independent project to be implemented in each fellow's own country upon his or her return. Fellowships are observational and expected to last four weeks. Candidates must be internists or subspecialists of internal medicine and must be ACP Members or Fellows. Residents in training will be considered if they reside in an ACP Chapter.

Three scholarships will be awarded for the 2015-2016 program year. The deadline for submitting an application is August 1, 2015. Information about the program may be found on ACP's website at www.acponline.org/IFEP. If you have any questions please contact Emily Seeling, Program Coordinator, International Programs at eseeling@acponline.org.


ACP Leaders on the Road

David A. Fleming, MD, MACP, ACP Immediate Past President
Australia, Japan, Philippines

For the month of May 2015 my wife, Karen, and I had the amazing opportunity and honor of representing the American College of Physicians at several venues throughout the Pacific. These included the Philippine College of Physicians in Manila; the Royal Australasian College of Physicians in Cairns, Queensland, Australia; and the Japan Chapter of the American College of Physicians in Kyoto. It was an amazing trip that further enhanced my growing perception that ACP is a strong and contributing member of the world health care community, where our voice is heard and influence felt.

Our first stop was Manila for the Philippine College of Physicians 45th Annual Convention May 10-13, 2015. Each day was packed with informative and well attended scientific sessions including timely updates and clinical reviews. The theme this year was "Lead with Integrity, Heal with Compassion" and was underscored by one of the more intriguing sessions, a presentation of the Mexico City Principles that offer a voluntary code of business ethics in guiding physicians' relationships with the biopharmaceutical industry. These principles were adopted by the PCP at their business meeting.








From left to right: Members of the Philippine College of Physicians Board of Regents Dr. Maria Gina Nazareth, Dr. Romulo T. Uy, Dr. Anthony C. Leachon, ACP President Dr. David Fleming, Dr. Mariano B. Lopez, and Dr. Rodolfo S. Pagcatipunan

Of a total PCP membership of about 9,000 there were 7,500 attendees for the Congress. The PCP has a very engaged membership. Our hosts, Dr. Anthony (Tony) Leachon, PCP President; Dr. Mariano Lopez, PCP Vice-President and overall chair of the convention; and Dr. Oscar Cabahug, Immediate Past President of PCP and Governor of the ACP Southeast Asian Chapter; treated us royally. Luckily, we were able to carve out some personal time to visit Corregidor, while also enjoying some wonderful historic sights and cultural experiences in and around Manila. This was a great meeting and reflects well on the strong collaborative relationship enjoyed by PCP and ACP. Tony, Oscar, and Mariano encouraged ACP to return again next year.

Following a fabulous personal week "tramping" about the South Island of New Zealand, our next ACP stop was for the Royal Australasian College of Physicians Congress in Cairns, Australia May 24-27, 2015. It was a beautiful venue in tropical north Queensland and we had a delightful time. Dr. Nick Talley, President of RACP, was our host and he greeted us warmly, as did all members of the Royal College whom we met. Nick demonstrated a clear presence as a strong leader, hosting multiple international dignitaries and offering multiple presentations and speeches. There were about 700 attendees, of which 70 were trainees. Total membership is around 22,000.

I joined Nick at the podium during "Trainees Day" at the beginning of the conference, where we talked about the logistics and joys of publishing. The theme of this year's Congress was "Breaking Boundaries, Creating Connections" and focused on access issues and unique concerns, such as end of life care, the ageing physician, gender identity, and indigenous and refugee health. There were some fascinating discussions.

The highlight of both the PCP and RACP meetings was their "Ceremony" or convocation, where in full regalia, past and present leadership are recognized, awards are given, and young physicians are brought to the stage to be conferred as Fellows with great celebration from the audience. These were very special times and I was honored to be at center stage for each ceremony.

Karen and I were able to steal away some time to swim and snorkel at the Barrier Reef and the College also arranged a trip on the Skyway Rainforest Cableway for some of the dignitaries, which was fantastic! The trip home on the historic Kuranda Scenic Railway was breathtaking.

Next and final stop was the Japan Chapter of ACP May 30-31, 2015 in Kyoto. This was also an opportunity to reunite with old friends. The new Governor for the Japan ACP Chapter is Dr. Fumiaki Ueno, our host. I have known Fumiaki for many years, both of us being members of the ACP Governor Class of 2011. Although not officially Governor at that time, Fumiaki represented Japan admirably. He is a kind and generous man and the 2011 governor class embraced him warmly.

Dr. Bob Centor, Immediate Past Chair of the Board of Regents, was also in Kyoto for the meeting and it was good to see him and his lovely wife Freda again. While in Kyoto we were also hosted by Dr. Yugo Shirataki, chair of the annual meeting; and Dr. Shunichi Fukuhara, vice governor of the Japan Chapter. Sunichi's wife, Naoko, honored Karen and I with a traditional tea ceremony in an amazing 17th Century Japanese home with beautiful surrounding garden. Our trip to Japan was very special. It was experiences like this that allowed Karen and me to fully experience both the modern and the traditionally old in this fair country, while also enjoying the full depth of everything Japan ACP had to offer in professional learning and collegiality.










From left: Dr. Nobuhito Hirawa, Chair, Japan Chapter Local Nominations Committee; Dr. Fumiaki Ueno, Governor, Japan Chapter; Dr. Robert Centor, Immediate Past Chair, ACP Board of Regents; Dr. Shotai Kobayashi, Immediate Past Governor, ACP Japan Chapter; Dr. David Fleming; and Dr. Sunichi Fukuhara, Vice Governor, ACP Japan Chapter.

The meeting itself was a full two days of learning and professional development. A highlight was being able to listen in on the resident "Doctor's Dilemma" session and I was honored to moderate the presentation session of the poster contest winners. There were 78 posters and they were all great! The writing and presentation skills of our young learners and colleagues never cease to amaze me. I have found in my world travels that our learners are incredibly bright, eager to learn, and good thinkers. They are the future of our organization and interacting with them is always the best part of any visit! The Japan Chapter was established in 2002; it is the oldest ACP chapter in the Pacific and one of the most active in the world. Japan was a very special visit for many reasons, not the least of which is that we were there to join with colleagues in ACP with which we share a rich tradition and history.

ACP is now a century old-100 years of growth and development for a professional organization that has increasingly influenced health care and health policy in the U.S.A. and that now has a substantive international presence. My experiences have shown me that we, as an organization, are indeed a citizen of the world. This past year the challenges have been similar with every chapter and professional organization I have visited. But each is finding a way to sustain their integrity by maintaining the professional glue that holds them together: commitment to service, service to members, collegiality among members, consistently strong leadership, and sustained engagement with learners and trainees. It has been an honor for me to serve and represent the College in so many wonderful places around the world, as well as our own country. I truly look forward to continuing the deep friendships and professional relationships that have been forged along the way.


Future Worldwide Internal Medicine Meetings

Upcoming meetings will be held in Bolivia, Singapore, Costa Rica, and Colombia.

A complete list of other Future Worldwide Internal Medicine Meetings is available here.

Save the date! The 14th European Congress of Internal Medicine will be held in Moscow, Russia from October 14-16, 2015. ECIM 2015 is a scientific Congress during which new research is being presented and discussed among scientists and practitioners from Europe and the rest of the world.


New International Fellows

ACP is pleased to announce the following newly elected International Fellows, who were recommended by the Credentials Committee and approved for election by the Board of Regents as of July 1, 2015. They are listed by current location and may have been credentialed through a different Chapter.


  • Rohit Joshi, MD, FACP - Adelaide


  • Kazi Manzur Kader, MD, FACP - Dhaka

  • Iftekhar Mahmood, MBBS, FACP - Kushtia
  • Aminur Rahman, MD, FACP - Dhaka


  • Patrick Lacor, MD, FACP - Brussels


  • Gibran Avelino Frandoloso, MD, FACP - Curitiba


  • Mowaffaq A. Almikhlafi, MBBS, FACP - London

  • Kevin R. Imrie, MD, FRCPSC, FACP - Toronto
  • Chris J. Mahoney, MD, FACP - Delta


  • Mauricio E. Burotto, MD, FACP - Santiago


  • Lina M. Toledo Franco, MD, FACP - Bogota

Dominican Republic

  • Fausto Hiraldo Zabala, MD, FACP - Santo Domingo


  • Manish Agarwal, MD, FACP - Ahmedabad

  • Rajeev Chawla, MD, MBBS, FACP - New Delhi
  • Sunil Surajprasad Gupta, MD, FACP - Nagpur
  • Seikh Jahangir Alam, MBBS, FACP - Kolkatta West Bengal
  • Rifat Jehan, MD, FACP - Srinagar J&K
  • Shailaja Kale, MD, FACP - Pune
  • Jothydev Kesavadev, MD, FACP - Kerala
  • Anuj Maheshwari, MD, FACP - Lucknow
  • Amitabh Sagar, MD, MBBS, FACP - Faridabad
  • Ashis K. Saha Sr., MBBS, MD, FACP - Kolkata
  • Abdul Rashid Shah, MD, FACP - Srinagar J&K
  • Asha N. Shah, MD, FACP - Ahmedabad
  • Vyankatesh K. Shivane, MBBSBCh, FACP - Mumbai
  • Hemant P. Thacker, FACP - Mumbai
  • Anil Kumar Yadav, MBBS, MD, FACP - Delhi


  • Epistel P. Simatupang, MD, FACP - Jakarta Barat


  • Richard M. Wilson, MD, FACP - Kingston


  • Shigeki Fujitani, MD, FACP - Urayasu City

  • Naohiko Imai, MD, FACP - Kawasaki


  • Boon Phoe Ooi, MBBS, FACP - Butterworth Penang


  • Tinmgchit Mg Chit, FACP - Pathein


  • Olarinde J. Ogunmola - Akure


  • Pedro J. Ortiz, MD, FACP - Lima

  • Francisco Villanueva, MD, FACP - Trujilloi


  • Rene D. Huinda, MD, FACP - Roxas City, Capiz

  • Maria Encarnita B. Limpin, MD, FACP - Paranaque City
  • Rodolfo S. Pagcatipunan Jr., MD, FACP - Makati City


  • Regula Capaul Ammann, MD, FACP - Zurich


  • Amorn Leelarasamee, MD, FACP - Bangkok

United Arab Emirates

  • Muhammad Adnan Raufi, MD, FACP - Dubai


Highlights from ACP Internist and
ACP Hospitalist

ACP Internist June/July/August 2015

  • Changing thinking on chronic fatigue
    A recent report might shed some diagnostic insight on the profound fatigue, unrefreshing sleep, and other nagging symptoms that could indicate myalgic encephalomyelitis/chronic fatigue syndrome.
  • Guidelines diminish cholesterol worries
    Physicians can expect questions from patients confused by a committee's report stating that dietary cholesterol should no longer be considered "a nutrient of concern for overconsumption."
  • Prescribe opioids, but with caution
    Use of opioids for chronic pain quadrupled in a 10-year span, despite scant evidence that they are effective for noncancer pain and ample evidence of harm. Learn more about how to prescribe them safely.
  • Know your kidney stones
    Knowing what makes up a patient's kidney stones determines how an internist might treat the problem. But, one expert cautions, while 1 type of kidney stone is far more prevalent, there are 4 other kinds, and they may require subspecialty treatment.

ACP Hospitalist June 2015