• Annual Reports Play Important Role in Program Quality
• Certifying Exam Preparation Tips
• Medical Mission Work Will Change You
• Board Question of the Month
• Interesting Case of the Month
• IRS Changes View of "Student Exception" For FICA Tax Purposes
• News of Note
• Resident Research Abstract Contest
• ACOI Staff Resources for Residents and Fellows
• Resident/Fellow Check List of Responsibilities
• ACOI Contacts
• Council on Education and Evaluation

ANNUAL REPORTS PLAY IMPORTANT ROLE IN PROGRAM QUALITY

As the training year draws to an end, residents and fellows should be mindful of the responsibility to complete your annual reports in a timely manner. Reports must be submitted within 30 days of the end of the year or significant fines could be imposed. In addition, the American Osteopathic Board of Internal Medicine will not let anyone sit for its exams before all reports are completed.

Brian J. Donadio, FACOI

CERTIFICATION EXAM PREPARATION TIPS

The summer is nearly here, and those of you who are finishing your residency are approaching a very exciting time. More than likely, you have your first job lined up, or you know where you will be starting your fellowship. No matter what you plan to be doing on July 1st, one thing that you need to start thinking about is Board certification.

This is the big exam. We have all taken so many standardized tests over the past 10 years that they start to run together. But this one is the important one. Not passing your Boards will mean problems for your future employment. Luckily, almost everyone passes (High 80 to low 90 percent of exam takers pass on the first try). This does not mean that you should take this test lightly. I have included some hints and tips below to make this experience as pain-free as possible.

1. Take the exam. Having Board certification is becoming a requirement for many insurance companies and for many Internal Medicine positions. Being “Board Eligible” is not a good way to market yourself and will likely lead to issues down the road.
2. Take the exam this year. You know as much as you will ever know for this test your first year out of residency. The longer you work and are occupied with other things, the less you will remember for the test. Take the exam the first opportunity after residency you have.
3. Take time to study. Many fellowships allow you to have an easy rotation prior to your Boards so that you have time to study and take time off to study. If you can take time off before the exam to study, then do so. This is the most important test you are going to take, take the time to be ready for it. Do a little bit of studying every day, and start now. Do half an hour of questions, or read half-an-hour of review material. If you put in the time, you will not have a problem with the exam.
4. What about a Board review course? This depends on what kind of studier/learner you are. If you need motivation, or do better when someone “teaches” to you, then many of these courses are very good.
5. Take at least the night before and the day of the exam off from clinical duties. You do not want to have to worry about anything other than the exam on the day of the test. Even if the testing center is semi-local, consider renting a hotel room close by the center, the night before the exam. This will allow you to sleep later, be well rested, and you will not have to worry about a traffic accident keeping you from getting to the exam on time.
6. Use the in-service exams to guide your studying. That is why you took them. If you did poorly in a particular subject area during the in-service, spend extra time on these subjects. If you do not remember how you did on the in-service, ask your program director to get you your scores for you to review.
7. Go to the exam website and read the instructions. Take the mock exam and case examples that are provided. If you know what the exam is going to look like before you get there, then you will have one less thing to worry about.

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MEDICAL MISSION WORK WILL CHANGE YOU

As I sat down to write this month’s article, cup of green tea in hand, a commercial on the recent earthquake in Haiti came across the screen. I started to reminisce about my time in India. Rather than traipsing across Europe like all my graduating friends from med school, I chose to spend the five weeks before my residency training in India, doing medical mission work.

The months leading up to my trip were filled with excitement. I planned on doing some siteseeing, but more importantly, I had decided that I was going to live like the common citizen. I brought very few Western clothes and spent the majority of my time there in traditional Indian garb. I ate, drank and slept alongside the people. I spent one week in Calcutta, working at Mother Teresa’s home for the destitute, sick and dying, and another with the outcasts of society in a leper colony. Each human interaction, each disease state, filled me with compassion and shaped my development as a human being. I saw disease states that we read about in books and stood next to moms who were trying to get the best for their children. I was experiencing humanity in its most primal form.

I write about my experiences because as I saw that commercial about the people suffering in Haiti, I wanted to pick up my doctor's bag and go help. Oftentimes, we get caught within our own worlds and the bigger human picture gets missed. I highly recommend that if any of you have the opportunity to travel to another country for medical mission work, you take it! Your perspective changes and it is my honest belief that you become a better person for it. Spending a month elective in another country or experiencing another medical system will truly be a worthy life-changing event.

BOARD QUESTION OF THE MONTH

A 62 year old male presents for follow up of recently diagnosed type II diabetes. Diet and lifestyle modification has been implemented and his HgbA1C is still 7.9%. Past medical history is significant for hypertension, congestive heart failure and pancreatitis. Current medications are carvedilol 6.25 mg BID, lisinopril 20 mg qd and furosemide 20 mg qd. Electrolytes are normal, BUN is 28 mg/dl and creatinine is 1.7 mg/dl. Which of the following medications would be the best choice for initial treatment of his diabetes.

1. Metformin
2. Sitagliptin (Januvia)
3. Repaglinide (Prandin)
4. Pioglitazone (Actos)
5. Exenatide (Byetta)

The correct answer is 3. Repaglinide is a short acting glucose lowering drug that acts similarly to a sulfonylurea. It is acceptable as a first line agent for type II diabetes. Metformin should be avoided when the serum creatinine is greater than 1.5. Januvia has been associated with pancreatitis and should be avoided in patients with a history of pancreatitis. Actos is contraindicated in patients at risk for CHF. Exenatide is not contraindicated but is an expensive and injectable drug that is generally not considered a first line agent.

INTERESTING CASE OF THE MONTH

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IRS CHANGES VIEW OF "STUDENT EXCEPTION" FOR FICA TAX PURPOSES

In response to a mounting number of losses in courts across the country, the Internal Revenue Service (IRS) has altered its stance on Federal Insurance Contributions Act (FICA) taxes paid by medical residents and their employers during tax periods ending before April 1, 2005.

Beginning in the early 1990s employers and medical residents began filing FICA refund claims stating that medical residents are students and as such should be exempt from FICA taxes under the Internal Revenue Code. The refund claims were for both the employer and employee share of the taxes paid to the IRS. According to the IRS, some claims were filed by individual medical residents for both their own claim and for the share of the employer. The IRS held the claims in suspense because there was a dispute as to whether the student FICA exception applied.

The IRS recently announced that it made an administrative determination to accept the position that medical residents are exempted from FICA taxes for tax periods ending before April 1, 2005, when new IRS regulations went into effect. Additional information is available at www.irs.gov.

The U.S. Supreme Court has been asked to hear a case involving the University of Minnesota and the Mayo Foundation for Medical Education and Research first reported here in September, 2009 that upheld the IRS’ earlier determination. More information will be provided as it becomes available.

Research Symposium 2010 - Research Abstract Contest
The ACOI is pleased to announce the 2010 awards for Research Abstract Posters prepared by residents and fellows in internal medicine and its subspecialties.

• To download application form and submission instructions, click here.
• Please clearly specify to which category (Research abstracts or Case presentations) you are submitting your entry.
• The deadline for submission is July 26, 2010.

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