ACP MKSAP - Help

Find answers to your questions about how to use ACP MKSAP.

App Store Links and System Requirements

AppsThe MKSAP app provides seamless and efficient access, with offline functionality for uninterrupted learning anywhere and enhanced features designed for convenience and flexibility.

ACP MKSAP’s New ABIM Data Download Feature

ACP MKSAP’s new “Data Download” feature, made possible by a collaboration with ABIM, allows ACP MKSAP® subscribers to build a personalized ACP MKSAP Learning Plan based on topics relating to their most recent ABIM assessment results.

ACP MKSAP Webinar

Questions and Answers Will there be a non-computer version of the MKSAP published in future? ACP MKSAP will be a digital-only program.

ACP MKSAP Tracker

Targeted Learning Assessment and Remediation

ACP MKSAP Learning Objectives and CME/MOC/CPD

Learning Objectives The learning objectives of ACP MKSAP are as follows:

ACP MKSAP - Frequently Asked Questions

Access and FunctionalityHow do I access my ACP MKSAP subscription?Log in to your ACP MKSAP account here. ACP MKSAP shares the same username and password as ACP Online, Annals of Internal Medicine, and most other online products from ACP. If you created a username and password when you purchased ACP MKSAP or if you are an ACP member and already have an ACP Online username and password, your username and password are the credentials you should enter to access ACP MKSAP.

ACP MKSAP CORE

The American College of Physicians (ACP) has launched a new Medical Knowledge Self-Assessment (ACP MKSAP®) feature, Confirmation of Relevant Education (CORE), to support internal medicine physicians in demonstrating their continuous learning.

ACP MKSAP Copyright and Restrictions

ACP MKSAP is a package that includes a feature-rich online application and a collection of mobile apps that enable you to work offline and later sync your answers. The online application includes the entirety of content, launching with nearly 2,000 multiple-choice questions and updated information on hundreds of topics in the field of internal medicine, organized into subspecialty sections, with content refreshes and new questions added regularly. ACP MKSAP is a state-of-the-art learning system, enabling learners to have unprecedented control and unparalleled ease of use.

Order ACP MKSAP

Dive into ACP's MKSAP. Our MKSAP is an all-digital subscription program designed to be updated and stay current. Order today!

The Grandmother's Letter: A villanelle on embryo adoption: Annals of Internal Medicine: Vol 176, No 3

Effectiveness of Molnupiravir and Nirmatrelvir–Ritonavir in Hospitalized Patients With COVID-19: A Target Trial Emulation Study: Annals of Internal Medicine: Vol 176, No 4

Background: Whether hospitalized patients benefit from COVID-19 oral antivirals is uncertain. Objective: To examine the real-world effectiveness of molnupiravir and nirmatrelvir–ritonavir in hospitalized patients with COVID-19 during the Omicron outbreak. Design: Target trial emulation study. Setting: Electronic health databases in Hong Kong. Participants: The molnupiravir emulated trial included hospitalized patients with COVID-19 aged 18 years or older between 26 February and 18 July 2022 (n = 16 495). The nirmatrelvir–ritonavir emulated trial included hospitalized patients with COVID-19 aged 18 years or older between 16 March and 18 July 2022 (n = 7119). Intervention: Initiation of molnupiravir or nirmatrelvir–ritonavir within 5 days of hospitalization with COVID-19 versus no initiation of molnupiravir or nirmatrelvir–ritonavir. Measurements: Effectiveness against all-cause mortality, intensive care unit (ICU) admission, or use of ventilatory support within 28 days. Results: The use of oral antivirals in hospitalized patients with COVID-19 was associated with a lower risk for all-cause mortality (molnupiravir: hazard ratio [HR], 0.87 [95% CI, 0.81 to 0.93]; nirmatrelvir–ritonavir: HR, 0.77 [CI, 0.66 to 0.90]) but no significant risk reduction in terms of ICU admission (molnupiravir: HR, 1.02 [CI, 0.76 to 1.36]; nirmatrelvir–ritonavir: HR, 1.08 [CI, 0.58 to 2.02]) or the need for ventilatory support (molnupiravir: HR, 1.07 [CI, 0.89 to 1.30]; nirmatrelvir–ritonavir: HR, 1.03 [CI, 0.70 to 1.52]). There was no significant interaction between drug treatment and the number of COVID-19 vaccine doses received, thereby supporting the effectiveness of oral antivirals regardless of vaccination status. No significant interaction between nirmatrelvir–ritonavir treatment and age, sex, or Charlson Comorbidity Index was observed, whereas molnupiravir tended to be more effective in older people. Limitation: The outcome of ICU admission or need for ventilatory support may not capture all severe COVID-19 cases; unmeasured confounders, such as obesity and health behaviors, may exist. Conclusion: Molnupiravir and nirmatrelvir–ritonavir reduced all-cause mortality in both vaccinated and unvaccinated hospitalized patients. No significant reduction in ICU admission or the need for ventilatory support was observed. Primary Funding Source: Health and Medical Research Fund Research on COVID-19, Government of the Hong Kong Special Administrative Region; Research Grants Council, Collaborative Research Fund; and Health Bureau, Government of the Hong Kong Special Administrative Region.

Recommended and Prevalent Use of Glucagon-like Peptide-1 Receptor Agonists and Sodium–Glucose Cotransporter-2 Inhibitors in a National Population-Based Sample

Ending Medical Complicity With Skilled-Nursing Facility Discrimination Against People With Opioid Use Disorder

Monkeypox: Challenging Clinical Questions

Subclinical Coronary Atherosclerosis and Risk for Myocardial Infarction in a Danish Cohort: A Prospective Observational Cohort Study: Annals of Internal Medicine: Vol 176, No 4

Background: Coronary atherosclerosis may develop at an early age and remain latent for many years. Objective: To define characteristics of subclinical coronary atherosclerosis associated with the development of myocardial infarction. Design: Prospective observational cohort study. Setting: Copenhagen General Population Study, Denmark. Participants: 9533 asymptomatic persons aged 40 years or older without known ischemic heart disease. Measurements: Subclinical coronary atherosclerosis was assessed with coronary computed tomography angiography conducted blinded to treatment and outcomes. Coronary atherosclerosis was characterized according to luminal obstruction (nonobstructive or obstructive [≥50% luminal stenosis]) and extent (nonextensive or extensive [one third or more of the coronary tree]). The primary outcome was myocardial infarction, and the secondary outcome was a composite of death or myocardial infarction. Results: A total of 5114 (54%) persons had no subclinical coronary atherosclerosis, 3483 (36%) had nonobstructive disease, and 936 (10%) had obstructive disease. Within a median follow-up of 3.5 years (range, 0.1 to 8.9 years), 193 persons died and 71 had myocardial infarction. The risk for myocardial infarction was increased in persons with obstructive (adjusted relative risk, 9.19 [95% CI, 4.49 to 18.11]) and extensive (7.65 [CI, 3.53 to 16.57]) disease. The highest risk for myocardial infarction was noted in persons with obstructive-extensive subclinical coronary atherosclerosis (adjusted relative risk, 12.48 [CI, 5.50 to 28.12]) or obstructive-nonextensive (adjusted relative risk, 8.28 [CI, 3.75 to 18.32]). The risk for the composite end point of death or myocardial infarction was increased in persons with extensive disease, regardless of degree of obstruction—for example, nonobstructive-extensive (adjusted relative risk, 2.70 [CI, 1.72 to 4.25]) and obstructive-extensive (adjusted relative risk, 3.15 [CI, 2.05 to 4.83]). Limitation: Mostly White persons were studied. Conclusion: In asymptomatic persons, subclinical, obstructive coronary atherosclerosis is associated with a more than 8-fold elevated risk for myocardial infarction. Primary Funding Source: AP Møller og Hustru Chastine Mc-Kinney Møllers Fond.

Comparative Safety Analysis of Oral Antipsychotics for In-Hospital Adverse Clinical Events in Older Adults After Major Surgery: A Nationwide Cohort Study: Annals of Internal Medicine: Vol 176, No 9

Background: Antipsychotics are commonly used to manage postoperative delirium. Recent studies reported that haloperidol use has declined, and atypical antipsychotic use has increased over time. Objective: To compare the risk for in-hospital adverse events associated with oral haloperidol, olanzapine, quetiapine, and risperidone in older patients after major surgery. Design: Retrospective cohort study. Setting: U.S. hospitals in the Premier Healthcare Database. Patients: 17 115 patients aged 65 years and older without psychiatric disorders who were prescribed an oral antipsychotic drug after major surgery from 2009 to 2018. Interventions: Haloperidol (≤4 mg on the day of initiation), olanzapine (≤10 mg), quetiapine (≤150 mg), and risperidone (≤4 mg). Measurements: The risk ratios (RRs) for in-hospital death, cardiac arrhythmia events, pneumonia, and stroke or transient ischemic attack (TIA) were estimated after propensity score overlap weighting. Results: The weighted population had a mean age of 79.6 years, was 60.5% female, and had in-hospital death of 3.1%. Among the 4 antipsychotics, quetiapine was the most prescribed (53.0% of total exposure). There was no statistically significant difference in the risk for in-hospital death among patients treated with haloperidol (3.7%, reference group), olanzapine (2.8%; RR, 0.74 [95% CI, 0.42 to 1.27]), quetiapine (2.6%; RR, 0.70 [CI, 0.47 to 1.04]), and risperidone (3.3%; RR, 0.90 [CI, 0.53 to 1.41]). The risk for nonfatal clinical events ranged from 2.0% to 2.6% for a cardiac arrhythmia event, 4.2% to 4.6% for pneumonia, and 0.6% to 1.2% for stroke or TIA, with no statistically significant differences by treatment group. Limitation: Residual confounding by delirium severity; lack of untreated group; restriction to oral low-to-moderate dose treatment. Conclusion: These results suggest that atypical antipsychotics and haloperidol have similar rates of in-hospital adverse clinical events in older patients with postoperative delirium who receive an oral low-to-moderate dose antipsychotic drug. Primary Funding Source: National Institute on Aging.

Chess Lessons: Harnessing Collective Human Intelligence and Imitation Learning to Support Clinical Decisions

Moving From Idealism to Realism With Data Sharing

Retiring the “Against Medical Advice” Discharge

Put words in our mouth

ACP updates obesity learning series

SGLT-2 inhibitors more effective than sulfonylureas, DPP-4 inhibitors as second-line therapy

MKSAP Quiz: 6-month history of low back pain

Melatonin not associated with increased diabetes, cardiovascular disease risk

Low testosterone levels in men associated with mortality risk

Put words in our mouth

ACP President featured on Sirius XM Doctor Radio episode

Updated apps available for ACP journals, guidelines

Self-administered aspirin immediately after myocardial infarction saves lives, study finds

Elevated NT-proBNP levels may predict adverse renal outcomes in AKI | ACP Hospitalist

Doxycycline for CAP associated with lower C. diff risk than azithromycin | ACP Hospitalist

Alcohol use disorders | ACP Hospitalist

A job for AI | ACP Hospitalist

Unit-based teamwork intervention for nurses, hospitalists did not improve patient care | ACP Hospitalist

Systemic corticosteroids improved outcomes in CAP, meta-analysis finds | ACP Hospitalist

Spinal epidural abscess | ACP Hospitalist

Life as a health equity officer | ACP Hospitalist

Latest COVID-19 trials show convalescent plasma worked, vitamin C did not | ACP Hospitalist

ED visits after discharge to SNF cost Medicare $24 million in 2019 | ACP Hospitalist