• Resident Research Recognized at Convention
• Why Do Research as a Student and Resident?
• Education Council Addresses Needs of Underserved Populations
• How Did I End Up Here?
• Board Question of the Month
• What is Driving Healthcare Reform: Politics or Policy?
• News of Note
• ACOI Staff Resources for Residents and Fellows
• Resident/Fellow Check List of Responsibilities
• ACOI Contacts
• Council on Education and Evaluation

RESIDENT RESEARCH RECOGNIZED AT CONVENTION

In this month's issue, Scott Girard, D.O., writes about the importance of resident and fellow involvement in research. The ACOI Board of Directors couldn't agree more. In fact, the mission of the ACOI is founded on the promotion of excellence in internal medicine patient care, education and research.

The College has put its money where its mouth is by funding a research competition for trainees at the annual convention. Entries may be submitted in two categories: clinical research and case presentations. Approximately $10,000 in cash prizes and travel costs to the convention are awarded each year.

For the recently-concluded meeting in Tucson, there were 38 entries to the competition. Many of these were excellent, and in the end, the judges selected three submissions for recognition in each category. The three finalists in the clinical research category were afforded the opportunity to present their work to a plenary session of the convention, following which the prizes were determined.

The First Place winner in the clinical research category was, "Differences in Perceived Stress, Depression, and Medical Symptoms among Medical, Nursing, and Physician Assistant Students: a Latent Class Analysis." In a first for us, the overall winner was an osteopathic medical student, Marlow Hernandez of NOVA-Southeastern University College of Osteopathic Medicine. His poster was presented by another student, Adam O'Mara, in Mr. Hernandez’s absence. The Second Place winner was, "Toradol (ketoralac) usage at USH," by Nhat Hoanh, D.O., an internal medicine resident at Wilson Memorial Hospital in Johnson City, New York. Third Place was awarded to George Ibraheim, D.O., for "Pseudo-Infarction Pattern in Pancreatic Disease." Dr. Ibraheim is a cardiology fellow at Plaza Medical Center in Fort Worth, Texas.

The winners in the case presentation category were: First Place -- "Sphincter of Oddi Dysfunction and Ampullary Carcinoma," by Jennifer Lamneck, D.O., an internal medicine resident at Mount Sinai Medical Center in Miami, Florida; Second Place -- "A 57-year-old man with AIDS secondary to HIV, melena, and bilateral pulmonary infiltrates, treated with corticosteroids," by Kimberly Rozengarten, D.O., an internal medicine resident at Kennedy Memorial Hospital in Stratford, New Jersey; and Third Place --"Hereditary Nonpolyposis Colorectal Cancer: an Ominous but Enlightening Scenario," by David Sosnoff, D.O., an internal medicine resident at St. John Macomb -- Oakland Hospital, Eastpointe, Michigan.

Congratulations to all who entered the competition, and especially to the winners. You can view the winning abstracts by clicking on their titles above. I would also like to thank the 145 residents and 17 students who attended the convention this year. I hope it is the first of many for you.

Brian J. Donadio, FACOI

WHY DO RESEARCH AS A STUDENT AND RESIDENT?

I have just returned from the ACOI’s Annual Convention in Tucson last month and the experience has inspired me to write about the importance of doing research as a student and resident. This year we had the opportunity to hear from Robert Chilton, DO, a world-renowned cardiologist, who has done a large body of research, starting as a resident. We also viewed and discussed a number of resident research posters. It reminded me of how important research is to the education of a well-rounded internal medicine physician.

Any research you do as a student will look great on your CV. You will be a much better candidate to any residency program you apply to (and some competitive programs will expect you to have done at least some amount of research to be accepted to their programs). If you have any intent of doing a fellowship, research will be necessary to get into that fellowship. Even if you are unsure of what you ultimately want to do with your career, doing research early will help in any case. The earlier you get involved with research, the better you get at it and the easier it becomes to get involved.

On a more practical note, if you want to join any type of fellowship, you need to be involved with research. A research resume has become essential for anyone applying to a fellowship. If you have not done any, you will likely not get the fellowship you are looking for.

Next month I will provide some suggestions on the how to get involved in research.

Back to top

EDUCATION COUNCIL ADDRESSES NEEDS OF UNDERSERVED POPULATIONS

Canadian physician Sir William Osler has been credited as being the father of medical residency and education. He spent much of his time laying the foundation for the training of physicians. Emphasizing the importance of the history and physical and rounding at the bedside, medical training was shifted to include bedside teaching as a supplement to didactics. During Osler’s time, he wrote Aequanimitas, a treatise on physician professionalism and conduct when confronted with an emergency.

Our own Andrew Taylor Still challenged the convention of his time by advocating and teaching holistic and preventive medicine. In our medical schools, we are taught from day one to view the body as a whole, incorporating a bio-psycho-social spiritual model with each patient. Rather than seeing only a disease state, we are taught to appreciate the entirety in the loss of homeostasis.

In keeping true to the great traditions of medical education and training, members of the ACOI’s Council on Education and Evaluation (CEE) and the Task Force on Minority Health and Cultural Competency have spent the last year working on a curriculum that addresses the ever-evolving environment of medicine. Consistent with the trends that our attendings have been noticing, the US Census Bureau released projections that by 2050, “…the nation will be more racially and ethnically diverse, as well as much older. Minorities…are expected to become the majority in 2042.”

The last few CEE meetings, discussion of a minority healthcare curriculum has revolved around implementation and expectations of residents. This part of the curriculum will be based heavily on residency programs’ involvement with the community. Time will be spent interviewing community members of different backgrounds with the goal of developing effective health action plans for underserved populations. As we reach out to the community, the doctor patient relationship strengthens.

The CEE is adding another layer to the foundation of our medical training. In sharpening the tools of awareness of the bio-psycho-social spiritual model, we will be advancing our practice of safe and effective medicine. A standard curriculum will ensure consistency of education for all residents.

Back to top

HOW DID I END UP HERE?

In August of 1998, I started my undergraduate career. I began school with the excitement of finally being out from under the thumb of my parents, but was terrified of what that might entail. I had chosen to become a biology major because it was the only way to take any but the most basic biology classes at my college, and I had enjoyed it in high school. My ultimate plans, however, were to change to a music major and become a band director. I was a trumpet player who was just good enough to think I was better than I actually was. And after my first year, my plan was in full swing. I hated Biology and loved performing. It is at this point that, as with other alterations in my plan, an educator came between me and a big mistake. She talked me out of dropping my major and into taking Cell Biology. After two weeks I was hooked and quickly became involved in the pre-med club at the school. I still loved music, but it had taken a back seat.

Because of that first detour in my life plan I suddenly found myself medical-school bound; but, I had no experience in the field and absolutely no idea how to get there. My lab partner for Cell just happened to be a pre-med major and he quickly got me involved with a state organization that helped prepare students for medical school. That group got me hooked up with the admission staff at ATSU/KCOM and soon I found myself on a first name basis with many of them. I took part in several programs and was able to see firsthand how the medical students were taught. I made the decision to go to ATSU/KCOM because they embodied everything that I loved about medicine: the relationships; the altruism; the compassion and the drive to teach.

Medical school was in-and-of-itself a shock to my system. Newly married and a new home owner, I got lost in the multitude of words, pathways and anatomical landmarks that were thrown at me. It was everything that I could do to stay afloat; and I simply didn’t realize that it was possible to consume that much caffeine and still function. During that time, I was encouraged by my fellow students and by several physicians who went out of their way to get involved in our lives. I was able to make it through those years only because of the support I had from my educators.

After the first two years of medical school I was sure that I was going to go to do a dual residency in family medicine and psychiatry. I had made plans to visit the likely programs I would match to, and had even gone so far as to look at possible sites to eventually practice. It was the mentorship of an amazing internal medicine physician and the support of my DME that pulled me toward internal medicine and the vast opportunities that it offered. I saw that when everything seemed to be falling apart, people turned to my mentor for help. I saw an opportunity to help not only patients, but also my fellow physicians. Internal medicine is the perfect match for me and my personality. Now I sit, just a few short months away from completing my residency. I teach at the same school that trained me. I am a part of the organization that inspired many before me. I have traveled all over the United States. How did I, a musician, ever get here? The answer is simple…my teachers. The person ultimately in charge of his or her education is the student, but truly great educators provide fuel to keep a person moving forward. There were several points in my life when I could have quit and pursued other careers, but it was my educators that continually revived my desire to learn.

Make every effort to give back what has been freely given to you.

BOARD QUESTION OF THE MONTH

A 28 year old internal medicine resident was in his usual state of good health until two weeks after attending the annual ACOI convention in Tuscon, Arizona. He then began to experience cough, fatigue, arthralgias, chest pain, headache and fevers between 101 and 102 degrees. A chest x-ray revealed a left lower lobe infiltrate and hilar adenopathy. WBC count was 10,000 with mild eosinophilia. Platelet count was normal. Sedimentation rate was 65. Electrolytes, BUN, creatinine, ALT, AST and LDH were normal. Urinalysis was also normal. Infection with which of the following is most likely:

The answer is C. Coccidioidomycosis (“Valley Fever”) is a common cause of community acquired pneumonia in Arizona. It frequently presents with the above symptoms. Eosinophila and an elevated sedimentation rate are fairly common. Aspergillous usually develops in a pre-existing cavity and is unlikely to occur in an otherwise healthy individual. Hantavirus usually causes thrombocytopenia and an elevated LDH. A history of rodent exposure can often be elicited (this author did not see any rodents at the Marriott in Tuscon.) Legionella often presents with associated gastrointestinal symptoms, hyponatremia, liver and renal function abnormalities and hematuria. Most adults (up to 90 %) with mycoplasma respiratory infection do not have radiographic pneumonia. In addition, hilar adenopathy would be uncommon with mycoplasma and thrombocytosis, not thrombocytopenia would be more likely.

Back to top

WHAT IS DRIVING HEALTHCARE REFORM: POLITICS OR POLICY?

The House approved the "Affordable Health Care for America Act" (H.R. 3962) on November 7 by a vote of 220-215; 219 democrats and one republican voted for the legislation; 176 republicans and 39 democrats voted against the bill. At first glance, it appears that the vote came down mostly along party lines. A closer look, however, suggests that there may be other factors in play. Of the democrats who voted against the legislation, 31 come from districts that voted for Senator John McCain in the 2008 presidential election. The one lone republican who voted for the bill, Anh “Joseph” Cao (R-LA), hails from a district that President Obama won with 75 percent of the popular vote. The district encompasses New Orleans and was previously held by a democrat.

At the core of each vote cast by a member of Congress is his or her constituency. It is the voters to whom an elected official must answer. As a result, political calculations must be made if a member wishes to stay employed. Each vote also has policy implications. For instance, prior to passage of H.R. 3962, the House considered and adopted an amendment offered by Representatives Bart Stupak (D-MI) and Joseph Pitts (R-PA) by a vote of 240-194 with one member voting present. The amendment prohibits the use of federal funds for abortions except in instances where the mother’s health is at risk, or in cases of rape or incest. Adoption of the amendment was crucial in garnering enough votes to secure the passage of H.R. 3962. The members voting for the amendment expressed the belief that a majority of their constituents required the legislative language to be included in the bill. Policy and politics collided. Perhaps at the end of day the two are inextricably linked.

Over the coming weeks and months you will hear a great deal about efforts to advance healthcare reform legislation in Congress. Discussions will center on policy concerns such as cost, coverage and what procedures federal funds may be used to provide. When analyzing the discussions, thought should also be given to the politics underlying the policies being discussed.

In an effort to keep ACOI members, including residents and fellows, informed about policy positions taken by the College, all correspondence sent to Congress and regulatory bodies is posted at www.acoi.org. We also provide a government affairs listserv where you can receive current healthcare policy news and updates as well as engage in dialogue with your peers. You may sign up for this listserv and others at www.acoi.org/InteractListserve.html. In addition, if you have any questions or concerns you may contact Tim McNichol directly at tmcnichol@acoi.org, or by calling 1-800-327-5183.

Back to top

Back to top

Back to top