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ACOI American College of Osteopathic Internists
Resident News January 2012
JANUARY 2012
TABLE OF CONTENTS



BOARD APPLICATION DEADLINES APPROACH

For those planning to sit for the AOBIM internal medicine and subspecialty certifying examinations in 2012, take note that the application deadlines are approaching. The internal medicine examination deadline is February 1. The subspecialty certifying exams deadline is April 1. While the AOBIM accepts late applications until April 1 for internal medicine and May 1 for the subspecialties, a $200 late fee is imposed. No applications are accepted after the late application deadlines.

Application materials are available at the AOBIM's website, www.aobim.org. The Board requires that paper copies of the completed applications be submitted and post-marked by the deadline.

Also note that in order to sit for the 2012 examinations, all training must be completed by August 15. The internal medicine certifying examination will be offered on September 13, 2012 at test sites across the country. The subspecialty examinations will be administered on August 25 in Chicago.

For further information, visit www.aobim.org.

Brian J. Donadio, FACOI

Brian J. Donadio, FACOI, is the Executive Director of the American College of Osteopathic Internists. He may be reached via email at bjd@acoi.org.




THE INTERNAL MEDICINE CLERKSHIP

I have to admit that the Internal Medicine clerkship was my favorite as a student. It changed my career plans and opened my eyes to what I thought about the practice of medicine. There are some things to remember when on Medicine, both as a student and as a Resident or Intern. To really do well during this time also requires a few things.

Let’s take a look at what I think is needed from anyone on Medicine.

Hard work: this is number one. Medicine is a wide-ranging field. That is the best thing about medicine. You get to see patients with diseases of all organ systems. No one is expected to know everything, but this means that we need to work hard to get the answers for our patients. Take the time to read about the malady your patient has, to be able to speak intelligently on rounds, and to form a plan of care based on what you have read. You may be wrong, but this is the way things are learned. If you are seeing many patients, this extra reading and research will also require more of your time. But if you can show that did your work and have a plan, you will be a superstar on rounds. Plan to put in the extra time and learn a lot.

Know your patients: As a student, you should know everything about your patient. You will have the fewest patients to see, so you should have done the best History and the most extensive physical exam. You should know all of the family history and each medicine that the patient takes. Patients at this point are a wealth of knowledge and represent many things to learn. Interns have more patients to see, but should also be more efficient than a student. An Intern who can gather all of the needed data, work independently to make sure all of the mundane issues are cared for (replete potassium, get medical reports, etc,) and then form a plan of action, is doing a great job. The resident who can pull everything together, understand all of the medical issues of a patient, but also make sure everything gets done (make sure the consultants have seen the patient, make sure the family is aware of all the issues and that all of the tests are ordered), in addition to quality medical care. Each person on the team has an expected role, the better you do with your responsibilities, the more you will learn and the better you will look to the staff physicians.

Read: The days are long on medicine. Night call maybe part of the clerkship. With all of the day-to-day practical things to get done, it seems crazy to read while on medicine. But if you read on a subject while caring for a patient with the disease process, you will remember things much more clearly. As Internists, we do not do surgery, we do only a limited amount of procedures, and the main aspect of our care is intellectual. Building a solid knowledge base is fundamental to our ability to provide quality care. If the days are crazy, just print out an article or book chapter that reviews what you are interested in and what applies to your current patients in the hospital, and then carry the article with you. When you have a few minutes, read it with a pen in your hand. Mark the important parts; you can review the highlights when you have more time. You should be able to get through one article a day (read it in the bathroom or before falling asleep, if needed). It has been said “the smartest person on rounds, is the person who read on the subject the night before.”

Be excited: With any clerkship, the people you work with will enjoy the time more if the people working with them are excited about the rotation. If you get in a little early, ask questions and appear genuinely excited to be on rounds, you are going to do well. I have heard more than one attending complain about unhappy residents and medical students. The days are long and stressful, and if you have to deal with angry or unmotivated house staff, it makes thing even worse.

Scott Girard, DO

Scott Girard, DO, is a hospitalist in Danville, PA. He completed his internal medicine training at Geisinger Medical Center in Danville in July, 2008, and now serves as a member of the ACOI Board of Directors. He may be reached at slgirard@geisinger.edu.



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NEW YEAR'S RESOLUTIONS

With 2012 upon us, many are deciding on new resolutions for the upcoming year. For some it will mean more exercise, for others the start of a new diet, and for several more finding a new hobby. While choosing a resolution is often easy, maintaining the diligence to carry out the change can prove to be challenging over the year.

Often our declarations fall within the confines of our personal lives. So much of our time is spent focusing on medicine during residency and fellowship that it is logical to concentrate on improving another aspect; however, considering resolutions for the hospital and office can lead to more productive workdays, meaningful relationships and better education.

Some resolutions to consider for the new year…

Step outside your comfort zone.
This year, push yourself beyond what you keep saying you are capable of doing. Have you been avoiding a particular rotation because it is not your favorite area? Been passing up a particular procedure when you are less than comfortable? Now is the time to challenge yourself and ask others for help if you need it. Not everything will become a new favorite, but certain things may, and you will not regret trying.

Listen, really listen, to patients.
Whether you are in the middle of your internship, residency or fellowship, you have at some point felt pressured for time. Too many calls to answer, notes to write, things to accomplish and the first thing to suffer can be time spent with patients. Allow patients to answer your questions and ask theirs. Try not to interrupt and inquire if there is anything else he/she believes it is important for you to know before leaving the room. Often that little extra time spent will not only improve patient perception and satisfaction, but will also aid in clinical decision making.

Learn AND teach something new everyday.
Easier said than done in the hectic pace we often keep; however, this is the only way to ensure you remain current. It can be as simple as familiarizing yourself with a new medication adverse effect, billing code or procedure approach. Garner and share information and you will find your knowledge base grows rapidly.

Look around and realize that you are not alone.
In the middle of a busy rotation or long night on call it can feel as though you are the only one trying to survive. Do not let that attitude and perception weigh you down. Ask for help and offer it to others around you. You will see that someone does actually understand what you are going through, and often that alone makes a difference.

Whether your resolution involves your personal or professional life, it is about making a change for the better. Good luck and Happy New Year!

As always, please feel free to send comments, questions and ideas to acoiresidentrep@gmail.com.

Kelly Schiers, DO

ACOI Board of Directors Resident Representative Kelly Schiers, DO, is a second year pulmonary fellow at the University of Medicine and Dentistry of New Jersey. She may be reached via email at acoiresidentrep@gmail.com.

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BOARD QUESTION OF THE MONTH

This series of questions is to help residents understand how board questions are written and what kind of infomation these questions are testing. In order for residents to better understand the process, the ACOI has asked several former certifying board members to write this feature. This month's question is by Vicky Leo, DO, a general internist and past chairwoman of the American Osteopathic Board of Internal Medicine. Dr. Leo practices in Leechburg, PA.


A 57 year old female presents to the ER with a several day history of malaise and headache. Her husband states that she was previously well with no history of any chronic illnesses and she does not take any chronic medications. He noticed that she seemed confused and forgetful regarding events of the previous 24 hours. Physical exam reveals a somewhat confused and lethargic woman. Vital signs are T 100.2 P 80 R 20 and BP 120/76. Neurologic exam is non-focal. There are no nuchal signs. Heart is regular with no murmurs or gallops, lungs are clear and abdominal exam is normal. Skin shows petechiae and a few purpuric lesions on her lower extremities. HEENT exam is normal. Laboratory results are: WBC 12,000, Hgb 7.8, HCT 24.1, platelets 20,000,BUN 48, serum creatinine 3.2, and normal PT and PTT. Peripheral smear shows polychromatophilic RBC’s and fragmented RBC’s. Which of the following lab results would be expected?

  1. Positive direct coombs
  2. Elevated haptoglobin
  3. Elevated LDH
  4. Increased fibrin degradation products
  5. Decreased reticulocyte count

The correct answer is 3. This patient has thrombotic thrombocytopenic purpura. She has the classic presentation of microangiopathic hemolytic anemia (with red cell fragmentation), thrombocytopenia, renal insufficiency and neurologic abnormalities. This is not antibody induced hemolysis so the direct coombs would be negative. There is hemolysis so the haptoglobin would be low and the reticulocyte count would be high. FDP would be normal or only mildly abnormal. In fact, if it were significantly elevated that would cast doubt on the diagnosis. The LDH would be significantly elevated in TTP.





INTERESTING CASE OF THE MONTH

Presented by Jermaine G. Clarke DO, Abraham Chacko DO, and Liu Jun DO, of the Department of Gastroenterology, Department of Internal Medicine, Department of Pathology at UMDNJ-Kennedy Health System in Stratford, NJ.
Click the case title to view the report.








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DATES SET FOR THE SUPREME COURT TO HEAR CHALLENGE TO THE AFFORDABLE CARE ACT
The U.S. Supreme Court announced that it will hear five-and-a-half hours of oral arguments in legal challenges to the Patient Protection and Affordable Care Act (PPACA, Pub. L. 111-148). The Court agreed to consolidate three cases and will address questions raised in Florida v. Department of Health and Human Services, National Federation of Independent Business v. Sebelius, and Department of Health and Human Services v. Florida. Oral arguments are scheduled to take place March 26 - 28.

The first hour of oral arguments will address whether the Anti-Injunction Act of 1867 (AIA) blocks a Commerce Clause challenge to the PPACA’s “individual mandate.” The AIA precludes courts from considering a matter prior to the assessment or collection of a tax. The individual mandate requirements set forth under the PPACA do not take effect until 2014. Two hours of oral arguments are scheduled for March 27 to examine the constitutionality of the individual mandate. Finally, two-and-a-half hours of oral arguments are scheduled for March 28 to explore the severability of the individual mandate as well as the constitutionality of the Medicaid expansion contained in the PPACA. The oral arguments will consume the Court’s entire schedule for the week. A ruling is expected as early as June.

Tim McNichol, JD

Timothy McNichol, JD, is the Deputy Executive Director of the ACOI and is responsible for the College's advocacy efforts. He may be reached via email at tmcnichol@acoi.org
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NEWS OF NOTE

AOBIM HAS NEW WEBSITE
The American Osteopathic Board of Internal Medicine (AOBIM) has developed a new website. All information regarding certification examinations in internal medicine and the subspecialties can be found on the website www.aobim.org. Applicants for all certification examinations must register on line on the website. After registering, the application materials can be downloaded and printed from the website.

The application materials must be mailed to the AOBIM with the examination fee. Deadline dates, policies and procedures and all pertinent information, including contact information, are on the website.

As a reminder, the deadline date for registration and receipt of the application materials and examination fee in the AOBIM office is February 1 for the Internal Medicine exam and April 1 for the subspecialty and added qualifications examinations.


ACOI STAFF RESOURCES FOR RESIDENTS AND FELLOWS
The ACOI staff and the Council on Education and Evaluation are important sources of information and assistance for osteopathic internal medicine residents and fellows. Two staff members are available on a daily basis to address questions and concerns. Christy Smith serves as postdoctoral administrative coordinator and can answer questions about general training requirements and specific individual training issues. Keisha Oglesby is the ACOI certification liaison. Residents and other certification candidates are urged to contact her to clarify questions about completion of certification requirements.

ACOI policy is that all phone calls and e-mails are acknowledged and returned within 24 hours of receipt. Please take advantage of these resources available to you.







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2012 CERTIFICATION EXAMINATION DATES/APPLICATION DEADLINES

Internal Medicine Certifying Examination
Computerized Examination 200 Sites Nationwide
September 13, 2012
Application Deadline: February 1, 2012
Late Registration Deadline: April 1, 2012

Subspecialty & Certification of Added Qualifications Examinations
August 25, 2012
Westin Lombard Yorktown Center, Lombard, IL
Application Deadline: April 1, 2012
Late Registration Deadline: May 1, 2012

  • Allergy/Immunology
  • Cardiology
  • Critical Care Medicine
  • Endocrinology
  • Gastroenterology
  • Hematology
  • Infectious Disease
  • Interventional Cardiology
  • Nephrology
  • Oncology
  • Pulmonary Diseases
  • Rheumatology

Sports Medicine Conjoint Examination For Certification of Added Qualifications
Tuesday, April 17, 2012
During AOASM 27th Annual Clinical Conference, April 18-22, 2012
Held at the Marriott Louisville Downtown Hotel, Louisville, Kentucky
Application Deadline: Tuesday, January 17, 2012 (no penalty)
Final Application Deadline: February 17, 2012 ($100.00 penalty)
Application packet available here



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ACOI Contacts
Jack D. Bragg, DO, FACOI
President
jackbragg0429@gmail.com
Robert G. Good, DO, FACOI
President-Elect
Robert.Good@carle.com
Kelly Schiers, DO
Board of Directors Resident Representative
schierka@umdnj.edu
Brian J. Donadio, FACOI
Executive Director
bjd@acoi.org
Timothy W. McNichol, JD
Deputy Executive Director
tmcnichol@acoi.org
Susan B. Stacy, FACOI
Director of Administration and Finance
susan@acoi.org
Christina A. Smith
Post-Doctoral Training Coordinator
christy@acoi.org
Keisha L. Oglesby
Membership Coordinator/
Certification Liaison
keisha@acoi.org



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Council on Education and Evaulation
John B. Bulger, DO, Chairman
jbulger@geisinger.edu
Robert A. Cain, DO, Vice Chair
racain@sbcglobal.net
Gary L. Slick, DO (AOBIM)
admin@aobim.org
Susan M. Enright, DO
senright@genesys.org
Joanne Kaiser-Smith, DO
jksdoc@aol.com
Robert T. Hasty, DO
hasty@nova.edu
Frederick A. Schaller, DO
frederick.schaller@touro.edu
John M. Kauffman, Jr., DO
Contact by Email
Jo Ann Mitchell, DO
Contact by Email
Maryanne Samuel, DO
Council Resident Representative
maryanne@nova.edu