Coaching Resources for Medical Educators

ACP has designed a series of 1-hr group coaching sessions specifically for Medical Educators. During each session, you and up to 5 of your peers will work with an ACP Physician Peer coach on the following topics. Catalyze Joy in Learning December 8, 2025, 12:00 – 1:00 PM ET Learn how to catalyze joy in learning and create an action plan to bring meaning, purpose and joy to learning for your residents.

Meet Your Lead Coach: Kerri Palamara, MD, MACP

Kerri Palamara, MD, MACP — LOCATION — Boston, MA (Massachusetts General Hospital) — PRACTICE TYPE — Outpatient — CAREER LEVEL — Mid-career

ACP Physician Peer Coaching Program Rules

Coach Training Program Eligibility: Participants must be an active physician member in good standing to be eligible to participate in this program. Active membership is required throughout the term of the program. If the participant’s membership expires during the program term, they will be required to renew their membership to continue accessing online materials. Residents, Fellows-in-Training, Medical Students, and non-physician Affiliate Members are not eligible for this program. Attendance:

ACP Physician Peer Coaching

Achieve your full potential with ACP’s coaching services. Coaching has a positive impact on physician professional development and fulfillment, well-being, practice performance, and patient outcomes.

Career and Professional Development

Career and Professional DevelopmentCareer and Professional Development resources and opportunities to support your personal and professional growth and career journey.

Video Visits | ACP

During the COVID pandemic, many patients utilize telemedicine and will continue seeking this option. Learn about incorporating physician video visits into your practice.

Telephone Visits with Patients | ACP

For patients who do not want to utilize video visits, there is an option to telephone with patients. Find the applicable regulations and waivers you need.

Video Visits: Beyond Simple Cases

Learn best practices for conducting virtual physical exams in these recorded presentations. View Additional Telemedicine 201 Education Programs

Teaching Telemedicine in Undergraduate and Graduate Medical Education

In this session, experienced educators will explain why specific training is needed to prepare medical students and residents to practice telemedicine, and will offer practical tools and strategies for teaching and sup

Leveraging Telehealth for Chronic Disease Management in Ambulatory Care

Practicing internists share their experiences using video visits, RPM, and other telehealth modalities to manage patients with chronic diseases. The speakers cover:

Artificial Intelligence for Real-Time Prediction of the Histology of Colorectal Polyps by General Endoscopists

Background: Real-time prediction of histologic features of small colorectal polyps may prevent resection and/or pathologic evaluation and therefore decrease colonoscopy costs. Previous studies showed that computer-aided diagnosis (CADx) was highly accurate, though it did not outperform expert endoscopists. Objective: To assess the diagnostic performance of histologic predictions by general endoscopists before and after assistance from CADx in a real-life setting. Design: Prospective, multicenter, single-group study. (ClinicalTrials.gov: NCT04437615) Setting: 6 centers across the United States. Participants: 1252 consecutive patients undergoing colonoscopy and 49 general endoscopists with variable experience in real-time prediction of polyp histologic features. Intervention: Real-time use of CADx during routine colonoscopy. Measurements: The primary end points were the sensitivity and specificity of CADx-unassisted and CADx-assisted histologic predictions for adenomas measuring 5 mm or less. For clinical purposes, additional estimates according to location and confidence level were provided. Results: The CADx device made a diagnosis for 2695 polyps measuring 5 mm or less (96%) in 1252 patients. There was no difference in sensitivity between the unassisted and assisted groups (90.7% vs. 90.8%; P = 0.52). Specificity was higher in the CADx-assisted group (59.5% vs. 64.7%; P < 0.001). Among all 2695 polyps measuring 5 mm or less, 88.2% and 86.1% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be resected and discarded without pathologic evaluation. Among 743 rectosigmoid polyps measuring 5 mm or less, 49.5% and 47.9% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be left in situ without resection. Limitation: Decision making based on CADx might differ outside a clinical trial. Conclusion: CADx assistance did not result in increased sensitivity of optical diagnosis. Despite a slight increase, the specificity of CADx-assisted diagnosis remained suboptimal. Primary Funding Source: Olympus America Corporation served as the clinical study sponsor.

Comparative Performance of Common Fecal Immunochemical Tests: A Cross-Sectional Study: Annals of Internal Medicine: Vol 177, No 10

Background: Despite widespread use of fecal immunochemical tests (FITs) for colorectal cancer (CRC) screening, data to guide test selection are limited. Objective: To compare the performance characteristics of 5 commonly used FITs, using colonoscopy as the reference standard. Design: Cross-sectional study. (ClinicalTrials.gov: NCT03264898) Setting: Three U.S. academic medical centers and affiliated endoscopy units. Participants: Patients aged 50 to 85 years undergoing screening or surveillance colonoscopy. Intervention: Participants completed 5 different FITs before their colonoscopy, including 4 qualitative tests (Hemoccult ICT, Hemosure iFOB, OC-Light S FIT, QuickVue iFOB) and 1 quantitative test (OC-Auto FIT, which was run at the manufacturer's threshold for positivity of >100 ng/mL). Measurements: The primary outcome was test performance (sensitivity and specificity) for each of the 5 FITs for advanced colorectal neoplasia (ACN), defined as advanced polyps or CRC. Positivity rates, positive and negative predictive values, and rates of unevaluable tests were compared. Multivariable models were used to identify factors affecting sensitivity. Results: A total of 3761 participants were enrolled, with a mean age of 62.1 years (SD, 7.8); 63.2% of participants were female, 5.7% were Black, 86.4% were White, and 28.7% were Hispanic. There were 320 participants with ACN (8.5%), including 9 with CRC (0.2%). The test positivity rate varied 4-fold (3.9% to 16.4%) across FITs. Rates of unevaluable FITs ranged from 0.2% to 2.5%. The sensitivity for ACN varied from 10.1% to 36.7%, and specificity varied from 85.5% to 96.6%. Differences in sensitivity between FITs were all statistically significantly different except between Hemosure iFOB and QuickVue iFOB, and specificity differences were all statistically significantly different from one another. In addition to FIT brand, distal location of ACN was also associated with higher FIT sensitivity. Limitation: The study did not assess the programmatic sensitivity of annual FIT. Conclusion: Although considered a single class, FITs have varying test performance for detecting ACN and should not be considered interchangeable. Primary Funding Source: National Institutes of Health.

A Tale of Three Hospitals

To My Doctor on the Day of My Death

Annals Video Summary - Computer-Aided Diagnosis for Leaving Colorectal Polyps In Situ

Association Between the SaFETy Score and Self-reported Firearm Violence Among Young Adults Presenting to Emergency Departments in Three Cities: A Cross-Sectional Study

Effectiveness of Integrating Suicide Care in Primary Care: Secondary Analysis of a Stepped-Wedge, Cluster Randomized Implementation Trial: Annals of Internal Medicine: Vol 177, No 11

Background: Primary care encounters are common among patients at risk for suicide. Objective: To evaluate the effectiveness of implementing population-based suicide care (SC) in primary care for suicide attempt prevention. Design: Secondary analysis of a stepped-wedge, cluster randomized implementation trial. (ClinicalTrials.gov: NCT02675777) Setting: 19 primary care practices within a large health care system in Washington State, randomly assigned launch dates. Patients: Adult patients (aged ≥18 years) with primary care visits from January 2015 to July 2018. Intervention: Practice facilitators, electronic medical record (EMR) clinical decision support, and performance monitoring supported implementation of depression screening, suicide risk assessment, and safety planning. Measurements: Clinical practice and patient measures relied on EMR and insurance claims data to compare usual care (UC) and SC periods. Primary outcomes included documented safety planning after population-based screening and suicide risk assessment and suicide attempts or deaths (with self-harm intent) within 90 days of a visit. Mixed-effects logistic models regressed binary outcome indicators on UC versus SC, adjusted for randomization stratification and calendar time, accounting for repeated outcomes from the same site. Monthly outcome rates (percentage per 10 000 patients) were estimated by applying marginal standardization. Results: During UC, 255 789 patients made 953 402 primary care visits and 228 255 patients made 615 511 visits during the SC period. The rate of safety planning was higher in the SC group than in the UC group (38.3 vs. 32.8 per 10 000 patients; rate difference, 5.5 [95% CI, 2.3 to 8.7]). Suicide attempts within 90 days were lower in the SC group than in the UC group (4.5 vs. 6.0 per 10 000 patients; rate difference, −1.5 [CI, −2.6 to −0.4]). Limitation: Suicide care was implemented in combination with care for depression and substance use. Conclusion: Implementation of population-based SC concurrent with a substance use program resulted in a 25% reduction in the suicide attempt rate in the 90 days after primary care visits. Primary Funding Source: National Institute of Mental Health.

Shifting Trends in the Indication of Glucagon-like Peptide-1 Receptor Agonist Prescriptions: A Nationwide Analysis

WCNSF

The Effect of Denosumab on Risk for Emergently Treated Hypocalcemia by Stage of Chronic Kidney Disease: A Target Trial Emulation: Annals of Internal Medicine: Vol 178, No 1

Background: There is a paucity of data on treatment of osteoporosis in patients with advanced chronic kidney disease (CKD). Objective: To assess the risk for emergently treated hypocalcemia with denosumab by stage of CKD and presence of CKD–mineral and bone disorder (CKD-MBD). Design: Target trial emulation. Setting: Medicare fee-for-service data with prescription drug coverage, 2012 to 2020. Participants: Female patients aged 65 years or older initiating denosumab, oral bisphosphonates, or intravenous (IV) bisphosphonates for osteoporosis. Measurements: Hospital and emergency department admissions (that is, emergent care) for hypocalcemia were assessed in the first 12 treatment weeks. Inverse probability of treatment weighted cumulative incidence and weighted risk differences (RDs) were calculated. Results: A total of 361 453 patients treated with denosumab, 829 044 treated with oral bisphosphonates, and 160 413 treated with IV bisphosphonates were identified. Risk for emergently treated hypocalcemia with denosumab versus oral bisphosphonates increased with worsening CKD stage (P < 0.001), with greatest risk among dialysis-dependent (DD) patients (3.01% vs. 0.00%; RD, 3.01% [95% CI, 2.27% to 3.77%]) and non–dialysis-dependent (NDD) patients with CKD stages 4 and 5 (0.57% vs. 0.03%; RD, 0.54% [CI, 0.41% to 0.68%]). Among patients with stages 4 and 5 CKD (NDD + DD), denosumab had a greater risk for emergently treated hypocalcemia versus oral bisphosphonates in those with CKD-MBD (1.53% vs. 0.02%; RD, 1.51% [CI, 1.21% to 1.78%]) than in those without CKD-MBD (0.22% vs. 0.03%; RD, 0.19% [CI, 0.08% to 0.31%]). Denosumab also showed increased risk compared with IV bisphosphonates. Limitation: Generalizability to men and non-Medicare populations. Conclusion: Risk for emergently treated hypocalcemia with denosumab increased with worsening CKD stage and was highest in DD patients and those with CKD-MBD. Primary Funding Source: U.S. Food and Drug Administration.

Longer counseling improved tobacco abstinence in older patients screened for lung cancer

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Vital facts about vector-borne diseases

Traditions, surprises at Internal Medicine Meeting 2025

The cost crisis: An existential threat to our health

Self-motivation for stroke prevention

I.M. Puzzled: March 2025

Peer review for beginners

Officers and Regents election results announced

Nonopioid treatment for moderate to severe pain approved

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Improving palliative care in cirrhosis | ACP Hospitalist

As-needed blood pressure medication associated with acute kidney injury | ACP Hospitalist

AHA statement addresses management of systemic stroke complications | ACP Hospitalist

AGS advises on making treatment decisions for unrepresented older adults | ACP Hospitalist

The vibes were off | ACP Hospitalist

Socioeconomic disparities to come | ACP Hospitalist

Reflections on a future past | ACP Hospitalist

OrthoCoin | ACP Hospitalist

An Atypical Case of Relapsing Polychondritis Associated With Waldenström Macroglobulinemia | Annals of Internal Medicine: Clinical Cases

Relapsing polychondritis is a rare disease characterized by relapsing-remitting inflammation of cartilage and has been found to be associated as a paraneoplastic syndrome to hematologic malignancies. Here, we present an atypical case of relapsing polychondritis associated with lymphoplasmacytic lymphoma or Waldenström macroglobulinemia, responsive to rituximab but complicated by simultaneous relapse of both conditions when observed off therapy.

Complete Resolution of Bulky Cutaneous Squamous Cell Carcinoma by Programmed Death-1 Inhibitor | Annals of Internal Medicine: Clinical Cases

A 94-year-old White man presented for the treatment of a recurrent cutaneous squamous cell carcinoma of the forehead. The lesion started 1 year ago and was treated initially with electrodesiccation and curettage followed by topical fluorouracil. At recurrence, the patient was offered surgery and radiation therapy but opted for systemic therapy targeting programmed death-1 inhibition (pembrolizumab). Accelerated regression and complete resolution of the tumor was observed after the first 3 infusions with no major side effects. Immunotherapy represents a major step forward in the treatment of advanced cutaneous squamous cell carcinoma, with high efficacy and a modest side effect profile favorable for many patients.

Euglycemic Ketoacidosis After the Addition of Glucagon-Like Peptide-1 Receptor Agonist: A Case Report | Annals of Internal Medicine: Clinical Cases

Euglycemic diabetic ketoacidosis (euDKA) is an acute, life-threatening metabolic emergency. It has been associated with several factors, including sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists. Fewer cases of euDKA have been associated with glucagon-like peptide 1 receptor agonists, and this we hypothesize might be the result of underreporting. With increasing use of these agents in the treatment of diabetes, perhaps more cases of euDKA will be encountered in the clinics, urgent care, emergency departments, and inpatient settings. Hence, a high index of suspicion is key for early diagnosis and appropriate management. Here, we present a case report of euDKA associated with semaglutide.

Post–COVID-19 Vaccine Myopericarditis in a Transgender Man Undergoing Gender-Affirming Testosterone Therapy | Annals of Internal Medicine: Clinical Cases

Myopericarditis is a rare complication seen after mRNA COVID-19 vaccination. This complication has been seen most frequently in young adult men, ages 16 years and older, within 1 week of receiving a second dose of the mRNA COVID-19 vaccine (Pfizer–BioNtech and Moderna).  In this case report, we describe a transgender man who was receiving testosterone-based gender affirmation therapy and developed myopericarditis after receiving his second mRNA COVID-19 vaccination.  This case highlights that sex-based health risks may be related to specific sex-traits.

The Importance of Detecting the Signs of Primary Hyperoxaluria—Cardiac Oxalosis in Primary Hyperoxaluria Type 1 | Annals of Internal Medicine: Clinical Cases

A 27-year-old man presented with influenza-like symptoms and rapidly progressing respiratory failure requiring mechanical ventilation and venovenous extracorporeal membrane oxygenation on the day of admission. With a medical history consisting of only 2 episodes of kidney stones, this patient's sudden multiorgan failure affecting kidneys, heart, lungs, and liver posed a diagnostic challenge. A myocardial biopsy revealing crystalloid myocardial deposits led to the diagnosis of cardiac oxalosis due to primary hyperoxaluria. Because of the rarity of this genetic disease, it is frequently overlooked in patients, causing delays in diagnosis and treatment. This case demonstrates the dire and potentially irreversible consequences this may cause.

A Case of Haemophilus haemolyticus Meningitis | Annals of Internal Medicine: Clinical Cases

Haemophilus haemolyticus is a gram-negative bacillus respiratory tract commensal with reduced capacity to invade mucosal epithelia. Nontypeable (that is, nonencapsulated) Haemophilus influenzae and H haemolyticus are difficult to differentiate from each other but, due to advancements in genotype assays, H haemolyticus has been found to cause invasive disease. We describe a rare case of H haemolyticus bacteremia and meningitis in a 50-year-old man who presented with altered sensorium. He was found to have a low IgM level, leading to speculation that a decreased immune system contributed to his presentation. However, he ultimately declined further immunosuppressive work-up.

Spontaneous TLS Preceding the Diagnosis of Metastatic Prostate Cancer | Annals of Internal Medicine: Clinical Cases

Tumor lysis syndrome (TLS) is an oncologic emergency characterized by electrolyte abnormalities that arise with rapid turnover of tumor cells and subsequent release of intracellular contents. Although TLS is commonly associated with hematologic malignancies, there is a growing body of evidence demonstrating the occurrence of TLS in patients with solid tumors. Although TLS is typically associated with the start of chemotherapy, it can rarely occur in its absence, a phenomenon termed “spontaneous TLS” (STLS). While diagnostic criteria for TLS are widely accepted, there are no clearly defined criteria for the diagnosis of STLS. Here, we report a case of STLS secondary to previously unidentified metastatic prostate cancer and discuss the challenges of diagnosing STLS in the setting of acute renal injury.

Recurrent Cellulitis as Clinical Presentation of Klippel–Trénaunay Syndrome: A Case Report | Annals of Internal Medicine: Clinical Cases

A 32-year-old man presented with a history of recurrent cellulitis since his teenage together with nonpitting unilateral edema of the left leg. Further clinical examination and imaging studies revealed port-wine stains along the torso with extrathoracic capillary, lymphatic, and venous malformations. A diagnosis of Klippel–Trénaunay syndrome was established, and the patient was treated with complex decompression therapy. After 7 months, the left leg volume was reduced by more than half, and he was able to reinitiate physical activity with no new recurrences. This case highlights the importance of considering subjacent causes in patients with recurrent cellulitis episodes and lymphedema.

Chronic Pulmonary Silicone Embolism Syndrome Following Saline Breast Implants | Annals of Internal Medicine: Clinical Cases

Chronic pulmonary silicone embolism syndrome (CPSE) presents as progressive dyspnea occurring after silicone prosthesis implantation. Diagnostic criteria for CPSE include imaging findings of intraparenchymal ground-glass opacities and histologic evidence of silicone microdroplets. CPSE is a very rare entity but has been reported previously secondary to ruptured silicone filled breast implants. Due to safety concerns, many plastic surgeons and patients consider saline-filled breast implants to be a sound alternative. Here, we report a middle-aged woman with biopsy-proven CPSE secondary to saline breast implants, nearly a decade after prosthesis removal.

Early Diagnosis to Prevent Carbon Monoxide Poisoning Complications | Annals of Internal Medicine: Clinical Cases

Carbon monoxide (CO) is a toxic gas with undetectable features. Every year in the United States, there are approximately 6000 deaths from CO poisoning. Patients usually present with signs of unresponsiveness but may have nonpathognomonic preceding symptoms. Some literature shows benefits of hyperbaric oxygen therapy (HBOT) within the first 24 hours of exposure to reduce the incidence of myocardial injury and neurologic impairment. This case report presents a 67-year-old man with CO poisoning who developed delayed neurologic sequelae (DNS) due to delayed diagnosis and missed therapeutic window for HBOT. Investigation of CO poisoning requires taking a detailed history to avoid delays in diagnosis and treatment.