ACP Physician Peer Coaching Program Rules

Coach Training ProgramEligibility: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, and Medical Students are not eligible for this program.Attendance:

ACP Physician Peer Coach Training Workshops

ACP Physician Peer Coach Training virtual workshops help you leverage evidence-based coaching skills to support your professional development and fulfillment.Upcoming WorkshopsBuilding a Coaching Culture at Your InstitutionThis 4-hour ACP Physician Peer Coach Training virtual workshop, led by Kerri Palamara, MD, MACP, will provide exclusive training on how to create a coaching culture at your institution. Designed for individuals with prior coaching experience and want to build a coaching program at their institution.The workshop focuses on:

Individual and Group Coaching Services

ACP’s Physician Peer Coaching program offers a suite of program offerings to provide you with ongoing support to help you thrive personally and professionally.

ACP Physician Peer Coaching - Career & Professional Development Support

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.

Professional Development for Women in Medicine

ACP’s Women in Medicine (WIM) initiative is a member-exclusive, longitudinal program designed to support your career and professional development needs through every stage of your career.

Career and Professional Development for Internal Medicine Physicians

Career 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

Benefits and Risks Associated With Statin Therapy for Primary Prevention in Old and Very Old Adults: Real-World Evidence From a Target Trial Emulation Study: Annals of Internal Medicine: Vol 177, No 6

Background: There is little consensus on using statins for primary prevention of cardiovascular diseases (CVDs) and all-cause mortality in adults aged 75 years or older due to the underrepresentation of this population in randomized controlled trials. Objective: To investigate the benefits and risks of using statins for primary prevention in old (aged 75 to 84 years) and very old (aged ≥85 years) adults. Design: Sequential target trial emulation comparing matched cohorts initiating versus not initiating statin therapy. Setting: Territory-wide public electronic medical records in Hong Kong. Participants: Persons aged 75 years or older who met indications for statin initiation from January 2008 to December 2015 were included. Participants with preexisting diagnosed CVDs at baseline, such as coronary heart disease (CHD), were excluded from the analysis. Among 69 981 eligible persons aged 75 to 84 years and 14 555 persons aged 85 years or older, 41 884 and 9457 had history of CHD equivalents (for example, diabetes) in the respective age groups. Intervention: Initiation of statin therapy. Measurements: Incidence of major CVDs (stroke, myocardial infarction, or heart failure), all-cause mortality, and major adverse events (myopathies and liver dysfunction). Results: Of 42 680 matched person-trials aged 75 to 84 years and 5390 matched person-trials aged 85 years or older (average follow-up, 5.3 years), 9676 and 1600 of them developed CVDs in each age group, respectively. Risk reduction for overall CVD incidence was found for initiating statin therapy in adults aged 75 to 84 years (5-year standardized risk reduction, 1.20% [95% CI, 0.57% to 1.82%] in the intention-to-treat [ITT] analysis; 5.00% [CI, 1.11% to 8.89%] in the per protocol [PP] analysis) and in those aged 85 years or older (ITT: 4.44% [CI, 1.40% to 7.48%]; PP: 12.50% [CI, 4.33% to 20.66%]). No significantly increased risks for myopathies and liver dysfunction were found in both age groups. Limitation: Unmeasured confounders, such as lifestyle factors of diet and physical activity, may exist. Conclusion: Reduction for CVDs after statin therapy were seen in patients aged 75 years or older without increasing risks for severe adverse effects. Of note, the benefits and safety of statin therapy were consistently found in adults aged 85 years or older. Primary Funding Source: Health Bureau, the Government of Hong Kong Special Administrative Region, China, and National Natural Science Foundation of China.

Trends and Disparities in Ambulatory Follow-Up After Cardiovascular Hospitalizations: A Retrospective Cohort Study: Annals of Internal Medicine: Vol 177, No 9

Background: Timely follow-up after cardiovascular hospitalization is recommended to monitor recovery, titrate medications, and coordinate care. Objective: To describe trends and disparities in follow-up after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations. Design: Retrospective cohort study. Setting: Medicare. Participants: Medicare fee-for-service beneficiaries hospitalized between 2010 and 2019. Measurements: Receipt of a cardiology visit within 30 days of discharge. Multivariable logistic regression models were used to estimate changes over time overall and across 5 sociodemographic characteristics on the basis of known disparities in cardiovascular outcomes. Results: The cohort included 1 678 088 AMI and 4 245 665 HF hospitalizations. Between 2010 and 2019, the rate of cardiology follow-up increased from 48.3% to 61.4% for AMI hospitalizations and from 35.2% to 48.3% for HF hospitalizations. For both conditions, follow-up rates increased for all subgroups, yet disparities worsened for Hispanic patients with AMI and patients with HF who were Asian, Black, Hispanic, Medicaid dual eligible, and residents of counties with higher levels of social deprivation. By 2019, the largest disparities were between Black and White patients (AMI, 51.9% vs. 59.8%, difference, 7.9 percentage points [pp] [95% CI, 6.8 to 9.0 pp]; HF, 39.8% vs. 48.7%, difference, 8.9 pp [CI, 8.2 to 9.7 pp]) and Medicaid dual-eligible and non–dual-eligible patients (AMI, 52.8% vs. 60.4%, difference, 7.6 pp [CI, 6.9 to 8.4 pp]; HF, 39.7% vs. 49.4%, difference, 9.6 pp [CI, 9.2 to 10.1 pp]). Differences between hospitals explained 7.3 pp [CI, 6.7 to 7.9 pp] of the variation in follow-up for AMI and 7.7 pp [CI, 7.2 to 8.1 pp]) for HF. Limitation: Generalizability to other payers. Conclusion: Equity-informed policy and health system strategies are needed to further reduce gaps in follow-up care for patients with AMI and patients with HF. Primary Funding Source: National Institute on Aging.

Understanding How Older Adults Use the U.S. Health Care System: From Measurement to Meaning

Quality Health Communication Is Critical to Optimal Adult Immunization

Beyond One-Size-Fits-All: Testing Insomnia Treatments in Special Populations

Excessive Alcohol Use and Alcohol Use Disorders: A Policy Brief of the American College of Physicians

Alcohol is used by more people in the United States than tobacco, electronic nicotine delivery systems, or illicit drugs. Several health conditions, including cancer, cardiovascular disease, and liver disease, are associated with excessive alcohol use and alcohol use disorder. Nearly 30 million people aged 12 years or older in the United States reported past-year alcohol use disorder in 2022, but—despite its prevalence—alcohol use disorder is undertreated. In this policy brief, the American College of Physicians outlines the health effects of excessive alcohol use and alcohol use disorder, calls for policy changes to increase the availability of treatment of alcohol use disorder and excessive alcohol use, and recommends alcohol-related public health interventions.

Diagnostic Strategy Using Color Doppler Ultrasound of Temporal Arteries in Patients With High Clinical Suspicion of Giant Cell Arteritis: A Prospective Cohort Study: Annals of Internal Medicine: Vol 177, No 6

Background: Giant cell arteritis (GCA) is the most prevalent systemic vasculitis in people older than 50 years. Any delay in diagnosis impairs patients' quality of life and can lead to permanent damage, particularly vision loss. Objective: To evaluate a diagnostic strategy for GCA using color Doppler ultrasound of the temporal artery as a first-line diagnostic test, temporal artery biopsy (TAB) as a secondary test, and physician expertise as the reference method. Design: Prospective multicenter study with a 2-year follow-up. (ClinicalTrials.gov: NCT02703922) Setting: Patients were referred by their general practitioner or ophthalmologist to a physician with extensive experience in GCA diagnosis and management in one of the participating centers: 4 general and 2 university hospitals. Patients: 165 patients with high clinical suspicion of GCA, aged 79 years (IQR, 73 to 85 years). Intervention: The diagnostic procedure was ultrasound, performed less than 7 days after initiation of corticosteroid therapy. Only ultrasound-negative patients underwent TAB. Measurements: Bilateral temporal halo signs seen on ultrasound were considered positive. Ultrasound and TAB results were compared with physician-diagnosed GCA based on clinical findings and other imaging. Results: Diagnosis of GCA was confirmed in 44%, 17%, and 21% of patients by ultrasound, TAB, and clinical expertise and/or other imaging tests, respectively. Their diagnosis remained unchanged at 1 month, and 2 years for those with available follow-up data. An alternative diagnosis was made in 18% of patients. The proportion of ultrasound-positive patients among patients with a clinical GCA diagnosis was 54% (95% CI, 45% to 62%). Limitation: Small sample size, no blinding of ultrasound and TAB results, lack of an objective gold-standard comparator, and single diagnostic strategy. Conclusion: By using ultrasound of the temporal arteries as a first-line diagnostic tool in patients with high clinical suspicion of GCA, further diagnostic tests for patients with positive ultrasound were avoided. Primary Funding Source: Tender “Recherche CH-CHU Poitou-Charentes 2014.”

Weighing In on the Body Mass Index: Addressing Criticisms and Embracing Purpose

Sensitivity and Specificity of Using GPT-3.5 Turbo Models for Title and Abstract Screening in Systematic Reviews and Meta-analyses

Background: Systematic reviews are performed manually despite the exponential growth of scientific literature. Objective: To investigate the sensitivity and specificity of GPT-3.5 Turbo, from OpenAI, as a single reviewer, for title and abstract screening in systematic reviews. Design: Diagnostic test accuracy study. Setting: Unannotated bibliographic databases from 5 systematic reviews representing 22 665 citations. Participants: None. Measurements: A generic prompt framework to instruct GPT to perform title and abstract screening was designed. The output of the model was compared with decisions from authors under 2 rules. The first rule balanced sensitivity and specificity, for example, to act as a second reviewer. The second rule optimized sensitivity, for example, to reduce the number of citations to be manually screened. Results: Under the balanced rule, sensitivities ranged from 81.1% to 96.5% and specificities ranged from 25.8% to 80.4%. Across all reviews, GPT identified 7 of 708 citations (1%) missed by humans that should have been included after full-text screening at the cost of 10 279 of 22 665 false-positive recommendations (45.3%) that would require reconciliation during the screening process. Under the sensitive rule, sensitivities ranged from 94.6% to 99.8% and specificities ranged from 2.2% to 46.6%. Limiting manual screening to citations not ruled out by GPT could reduce the number of citations to screen from 127 of 6334 (2%) to 1851 of 4077 (45.4%), at the cost of missing from 0 to 1 of 26 citations (3.8%) at the full-text level. Limitations: Time needed to fine-tune prompt. Retrospective nature of the study, convenient sample of 5 systematic reviews, and GPT performance sensitive to prompt development and time. Conclusion: The GPT-3.5 Turbo model may be used as a second reviewer for title and abstract screening, at the cost of additional work to reconcile added false positives. It also showed potential to reduce the number of citations before screening by humans, at the cost of missing some citations at the full-text level. Primary Funding Source: None.

Talking With Patients About the New Anti-amyloid Alzheimer Disease Medications

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Article, podcast address impact of physician-patient relationships on adult vaccination rates

ACP, Annals of Internal Medicine host forum on H5N1 influenza

MRAs appear effective for heart failure across the range of ejection fractions

MKSAP Quiz: 2-day history of cough, fever

Naming animals during gait test effectively distinguishes cognitive decline

Medications may help vaginal menopause symptoms, but data limited, reviews find

Put words in our mouth

Interns wanted for ACP's Washington, D.C., office

ACP offering webinars on AI and contract review in September

A phone call is not enough | ACP Hospitalist

Take a quiz about the Feb. 5 issue! | ACP Hospitalist

Women more likely to be hospitalized with TIA, have subsequent hemorrhage | ACP Hospitalist

Take a quiz about the Jan. 29 issue! | ACP Hospitalist

Rethinking AMA | ACP Hospitalist

Lending an ear | ACP Hospitalist

Home-based cardiac rehab noninferior to center-based for HF | ACP Hospitalist

Delaying broad-spectrum antibiotics does not affect outcomes, study finds | ACP Hospitalist

BMA discharge of Medicare patients with OUD associated with high readmission, mortality rates | ACP Hospitalist

Thinking harder about heparin | ACP Hospitalist

Cardiogenic Shock Secondary to Giant Cell Arteritis | Annals of Internal Medicine: Clinical Cases

This paper reports a case of type 1 nonatherothrombotic myocardial infarction caused by giant cell arteritis vasculitis.

Hypoglossal Nerve Paralysis Caused by Diffuse Idiopathic Skeletal Hyperostosis | Annals of Internal Medicine: Clinical Cases

Diffuse idiopathic skeletal hyperostosis (DISH) is a rare disease characterized by bony overgrowth of the spine. If severe enough, it can lead to dysphagia from many different mechanisms. These most commonly include mechanical obstruction, inflammation, or vocal cord paralysis. In our patient case, DISH caused paralysis of the hypoglossal nerve, which contributed to his dysphagia. Paralysis of the hypoglossal nerve as a result of DISH has not yet been reported in the literature.

Hydroxychloroquine-Induced Dilated Cardiomyopathy: A Case Report | Annals of Internal Medicine: Clinical Cases

Hydroxychloroquine (HCQ) cardiomyopathy (CM) usually presents with a hypertrophic or restrictive pattern. We present a patient case of dilated HCQ-CM with normal wall thickness in young woman with systemic lupus erythematosus and end-stage kidney disease. In patients undergoing renal replacement therapy, the daily dose should be lower than recommended by the manufacturer to avoid toxic effects.

Long-Term Use of Metronidazole Mimicking Hepatic Encephalopathy | Annals of Internal Medicine: Clinical Cases

Metronidazole, a widely used antibiotic is associated with a rare but serious set of adverse effects termed Metronidazole Induced Encephalopathy. This condition can be related to both short as well as long term use of the drug and manifests itself as a constellation of symptoms of neurotoxicity, which can include cerebellar dysfunction, speech abnormalities, seizures and an altered sensorium. In addition to a history and physical exam the backbone of diagnosis for this condition is a set of specific findings seen on Magnetic resonance imaging of the brain.

Abdominal Epilepsy as Sequelae of COVID-19 in a Patient With Granulomatosis and Polyangiitis | Annals of Internal Medicine: Clinical Cases

Abdominal epilepsy is characterized by chronic abdominal pain, and an epileptogenic focus in the temporal lobe is found in most patients. Here, we present a patient case of a 60-year-old woman hospitalized because of several episodes of epigastric pain preceded by visual and auditory hallucinations 1 month after having had COVID-19. The electroencephalogram obtained during an episode of pain showed temporo-occipital epileptiform activity. Infection by SARS-CoV-2 has been associated with neurologic disorders including epilepsy and, in this case, abdominal epilepsy.

A Case of Steroid-Responsive Multisystem Inflammatory Syndrome in Adults With SARS-CoV-2 | Annals of Internal Medicine: Clinical Cases

While the COVID-19 pandemic continues to evolve, different phenotypic variants of the disease are being recognized. Multisystem inflammatory syndrome in adults is an emerging entity that has yet to be fully characterized. The syndrome involves extrapulmonary multiorgan failure with hyperinflammation that typically affects young healthy males, approximately 2 to 12 weeks after infection with SARS-CoV-2. There are no formal guidelines for management, although the syndrome appears responsive to immunomodulators and supportive care. Clinicians should be aware of this unusual and severe clinical entity and the general principles of its management.

Spontaneous Ectopic Paraumbilical Variceal Bleeding in a Patient With Cirrhosis | Annals of Internal Medicine: Clinical Cases

Ectopic variceal hemorrhage is a rare sequela of portal hypertension, accounting for 5% of variceal bleeding events. Although mortality rates are high for this condition, there is no established management protocol. We present a patient case of spontaneous external hemorrhage from an ectopic paraumbilical varicosity in the setting of portal hypertension secondary to decompensated alcoholic cirrhosis that was treated effectively with transjugular intrahepatic portosystemic shunt placement.

Acquired Thrombotic Thrombocytopenic Purpura After ChAdOx1 nCoV-19 Vaccine: A Case Report | Annals of Internal Medicine: Clinical Cases

COVID-19, the illness caused by SARS-CoV-2, continues to cause significant morbidity and mortality across the world. An important step in overcoming SARS-CoV-2 is the global vaccination plan. Cases of acquired thrombotic thrombocytopenic purpura (aTTP) have been recently described after SARS-CoV-2 vaccination. We describe a patient case of aTTP occurring 25 days after ChAdOx1 nCov-19 (Vaxzervria/AstraZeneca) vaccination that was promptly treated with plasma exchange, corticosteroids, rituximab, and caplacizumab. Remission of aTTP was achieved in 2 weeks and the patient is currently in complete remission.

A Rare Manifestation of Chronic Gastric Ischemia With Ulceration | Annals of Internal Medicine: Clinical Cases

We present the patient case of a woman with significant cardiovascular disease, chronic abdominal pain, and repeated episodes of gastrointestinal bleeding, who was ultimately diagnosed with chronic gastric ischemia with recurrent gastric ulcers. The current literature suggests that gastric ischemia is more common than previously thought. A higher degree of suspicion for this relatively rare presentation may be required in the clinical setting.

Persistent Left Superior Vena Cava Resulting in Right-to-Left Cardiac Shunt: When to Treat? | Annals of Internal Medicine: Clinical Cases

Persistent left superior vena cava (PLSVC) is one of the most common thoracic venous anatomical variations. A PLSVC commonly drains into the right atrium via the coronary sinus. Anomalous drainage of a PLSVC into the left-sided circulation can occur, presenting as a stroke or hypoxia consequent to a right-to-left shunt. Herein, we describe a symptomatic patient with PLSVC communicating to the left upper pulmonary vein who had successful percutaneous closure with clinical improvement.