Internal Medicine Meeting 2023 Pre-Courses

Tuesday and Wednesday, 8:00 a.m.-5:00 p.m.

Fred A. Lopez, MD, MACP
Richard Vial Professor and Vice Chair, Department of Internal Medicine, LSU Health Sciences Center-New Orleans, New Orleans, LA

George Nicholas Verne, MD, FACP
Professor & Chair, Department of Medicine, Senior Associate Dean, Statewide Operation, University of Tennessee College of Medicine, Memphis, TN

Whether preparing for the initial board exam or refreshing your knowledge for maintenance of certification, this popular 2-day Pre-Course provides an effective, fast-paced overview of core topics in internal medicine designed to focus on material that has a high probability of being included on the ABIM General Internal Medicine examinations. Taught by a faculty of clinician-educators, each an expert in their subspecialty, this condensed, high-yield review uses an audience-response system to actively engage participants and allow them to compare their answers with those of their peers. Each topic is introduced with a clinical case and a related multiple-choice question, the rationale for the correct answer is explained, and key clinical points are emphasized to promote learner retention. Participants also receive valuable tips for successful test-taking strategies included with course materials. This Pre-Course is an efficient way to prepare for an ABIM exam if you are short on time and seek a high-quality review.

Learning Objectives:

1. Enhance your knowledge of internal medicine by working through challenging clinical cases and questions guided by expert faculty.
2. Become adept at working through difficult exam-type questions logically and successfully.
3. Implement changes in clinical practice in accordance with recent advances and evidence-based guidelines.

Tuesday and Wednesday, 8:00 a.m.-5:00 p.m.

Noelle M. Northcutt, MD, FACP
Associate Professor of Medicine, Division of Hospital Medicine, Denver Health, Aurora, CO

David Tierney, MD, FACP
Program Director - Internal Medicine Residency, Director - Internal Medicine Bedside Ultrasound (IMBUS) Program, Departments of Graduate Medical Education and Internal Medicine, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN

Point-of-care ultrasound (POCUS) is an emerging patient assessment tool for internists. This intensive 2-day Pre-Course is designed to teach core POCUS skills to internists who practice in various settings.

If you are excited about the potential for POCUS to expand your clinical assessment skills, join this course taught by internationally acclaimed faculty. Online prelearning assignments and live lectures will provide a comprehensive foundation of core ultrasound knowledge. Using a small-group, hands-on format, attendees will practice ultrasound scanning on live models to support the development of bedside image-acquisition skills.

Learning Objectives:

1. Identify indications and rationale for performing the following examinations: pulmonary ultrasound, focused cardiac ultrasound, kidney and bladder ultrasound, evaluation of abdomen for free fluid, and evaluation of lower extremity for deep venous thrombosis.
2. Perform the ultrasound exams listed above.
3. Interpret normal and abnormal images for the applications listed above.
4. Interpret POCUS findings in clinical case scenarios.
5. Describe the principles of ultrasound operation, artifacts, and image optimization.

Note: This is a POCUS foundation course. Internists who complete this course will meet prerequisite training requirements for enrollment in additional internal medicine POCUS courses that will be offered by ACP. Visit acponline.org/pocus for more information.

Tuesday, 8:00 a.m.-5:00 p.m.

Robert A. Balk, MD, MCCM, MACP, FCCP
Professor of Medicine, Rush Medical College, Division of Pulmonary, Critical Care, and Sleep Medicine, Rush University Medical Center, Chicago, IL

This Pre-Course will provide the opportunity to discuss a focused update on the diagnosis and management of common clinical issues encountered in the management of patients in the intensive care unit. Particular attention will be placed on new developments in the recognition of disease process, acute management of critical illness, and prevention of complications in the critically ill adult patient.

Some of the topics discussed include management of acute coronary syndromes and myocardial infarction, acute stroke, acute respiratory failure (including acute respiratory distress syndrome), circulatory shock, pulmonary embolism, sepsis and septic shock, surgical emergencies (i.e., ischemic bowel and necrotizing fasciitis), and severe pneumonia. Also discussed will be the management of patients with acute encephalopathy, blood product utilization, and methods for preventing common complications in the critically ill patient.

Learning Objectives:

1. Update the internist on common disorders and diseases encountered in the intensive care unit.
2. Review the diagnostic techniques used in the management of the critically ill adult.
3. Discuss recommendations for the management of common critical illnesses encountered in the intensive care unit and strategies for the prevention of complications of critical illness.

Tuesday, 8:00 a.m.-5:00 p.m.

Jennie T. Clarke, MD
Professor of Dermatology, Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT

Patients often present to their internist with skin concerns. Many of these concerns are common conditions that, once identified, can be easily addressed without a referral to a dermatologist. In addition, many skin conditions are known to be associated with systemic comorbidities for which screening and management in primary care is indicated. Faculty in this course will engage participants in identifying many of these conditions and will review appropriate steps for their diagnosis and management. Practical approaches, including biopsy techniques, will also be reviewed.

Learning Objectives:

1. Identify common dermatologic problems that present in the primary care setting and initiate appropriate treatment.
2. Recognize dermatology urgencies/emergencies.
3. Recognize skin findings and conditions associated with short- and long-term systemic complications/risk in the inpatient and outpatient settings.
4. Recognize common skin cancers and benign skin growths and understand indications for various approaches to management.

Tuesday, 8:00 a.m.-5:00 p.m.

Irl B. Hirsch, MD, MACP
Professor of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington School of Medicine, Seattle, WA

In the United States and around the world, the number of people with diabetes continues to increase, particularly at younger ages and with the increase in rates of overweight and obesity. With longer duration of diabetes, more people develop chronic kidney disease and other microvascular complications as well as cardiovascular disease and stroke. Fortunately, therapeutic options are advancing rapidly, giving greater opportunities to improve the health of our patients, but the complexity of care is also increasing. This Pre-Course will discuss the diagnosis of prediabetes and diabetes, including less common forms such as maturity-onset diabetes of the young and latent autoimmune diabetes in adults. Faculty will review the role of lifestyle interventions as well as appropriate indications and practical use of weight loss medications in patients with overweight and diabetes. The risks and benefits of new insulin and noninsulin pharmacologic therapies will be presented. The role of diabetes medications, cholesterol-lowering agents, and blood pressure control to reduce cardiometabolic risk will be thoroughly discussed.

Learning Objectives:

1. Review current guidelines for the management of patients with diabetes and prediabetes.
2. Provide guidance on the evaluation, classification, and treatment of diabetes, including less common conditions such as latent autoimmune diabetes in adults and medication-induced diabetes.
3. Review new insulin products and diabetes technology (including new pens, pumps, and sensors) available for patients with type 1 and 2 diabetes.
4. Review the rapidly expanding role of noninsulin therapeutics in the management of type 2 diabetes.
5. Discuss the role of nutrition and weight management in patients with overweight and diabetes.
6. Discuss the prevention and treatment of cardiovascular disease in patients with diabetes.
7. Within a panel discussion format, review questions and challenges that arise in your practice.

Tuesday, 8:00 a.m.-5:00 p.m.

Geno J. Merli, MD, MACP, FHM, FSVM
Professor, Medicine & Surgery, Associate Chief Medical Officer and Senior Vice President, Co-Director, Jefferson Vascular Center, Director, Vascular Medicine, Division of Vascular Medicine-Department of Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA

Howard H. Weitz, MD, MACP, FRCP (Lond.), FACC
Bernard L. Segal Professor of Clinical Cardiology, Senior Associate Dean, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA

This Pre-Course will review the assessment and management of patients with medical comorbidities undergoing noncardiac surgical procedures. Expert faculty will discuss postoperative nausea and vomiting, preoperative blood pressure control, postoperative headache, and fasting time prior to surgery. Venous thromboembolism (VTE) prophylaxis in the postoperative period for patients with renal impairment, hereditary or acquired coagulation disorders, history recurrent VTE, and the best VTE prophylaxis for surgery will be reviewed. Preoperative validated risk assessment tools, mitigation strategies for identified comorbidities, and management of postoperative complications will be emphasized. Topics will include perioperative medication management; cardiac, pulmonary, and COVID-19 testing and frailty risk indices with modification strategies; postoperative cardiac complications; managing cannabis, suboxone, and methadone; using direct oral anticoagulants; treating postoperative delirium; and new diabetes medications.

Learning Objectives:

1. Understand the assessment and management of patients with medical comorbidities undergoing inpatient and outpatient surgical procedures.
2. Review guidelines and best practices for preoperative laboratory testing, perioperative medication use, and common anesthesia-related issues.
3. Review preoperative validated risk assessment tools, strategies to mitigate risk, and management of patients with various pre- and post-surgery cardiac and pulmonary problems.
4. Understand management of cardiac indicated antiplatelet agents and the appropriate use of direct oral anticoagulants in the perioperative period, which will include rescue and reversal agents for emergent surgery.
5. Assess key management strategies for the frail elderly, type II diabetic agents, and patients with drug dependence.
6. Understand COVID-19 testing prior to surgery.

Tuesday, 8:00 a.m.-5:00 p.m.

Gigi Liu, MD, MSc, FACP
Assistant Professor of Medicine, Director of Point of Care Ultrasound, Osler Internal Medicine Residency Program, Division of Hospital Medicine, Department of Medicine, Johns Hopkins Hospital University School of Medicine, Baltimore, MD

Manpreet S. Malik, MD, Member
Associate Professor, Program Director, Emory Transitional Year Program, Division of Hospital Medicine, Department of Medicine, Emory University, Atlanta, GA

The Ultrasound-Guided Procedures course combines bedside procedure simulation learning with point-of-care ultrasound (POCUS) skills related to these procedures. Learners will receive guided simulation training for common bedside procedures, including peripheral and central venous catheter placement, lumbar punctures, paracentesis, thoracentesis, and arthrocentesis. National experts on POCUS and procedures will guide attendees through didactics, live scanning on models, and procedure simulation on manikins. This is an excellent course for those who wish to refresh their procedural skills, those who seek in-depth experience on procedures with the addition of ultrasound, and those who plan to lead in training and supervising others in procedures.

It is preferred that attendees have ultrasound experience, but we welcome attendees who wish to enhance their procedural skills with ultrasound if ultrasound was not emphasized in their training. Learner to instructor ratio is 2:1, which will provide ample hands-on experience and opportunity to practice troubleshooting tips.

Learning Objectives:

1. Master the in-plane and out-of-plane ultrasound needle guidance technique, which is the core foundation for all ultrasound-guided procedures.
2. Identify relevant sonoanatomy related to ultrasound guidance for thoracentesis, paracentesis, lumbar puncture, arthrocentesis, and vascular access.
3. Understand the limitations and pitfalls of ultrasound regarding each procedure.
4. Perform ultrasound-guided vascular access, thoracentesis, paracentesis, lumbar puncture, and arthrocentesis using simulators.

Wednesday, 8:00 a.m.-5:00 p.m.

Douglas S. Paauw, MD, MACP
Professor of Medicine, Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA

This Pre-Course will focus on pearls to help the practicing internist maximize the utility of drug therapies. Newer medications and new uses for older medications will be covered. Current recommendations for “best therapy” for different diseases will also be covered. Common side effects of medications will be emphasized. Faculty will provide practical information on medications used for common medical problems, diabetes, and infectious diseases; safe use of medications in elderly patients; and drug interactions.

Learning Objectives:

1. Prescribe appropriate drug therapies for diseases commonly seen in the office.
2. Recognize benefits and risks of psychiatric treatments.
3. Understand the use and appropriate utility of new diabetes therapies.
4. Gain a better understanding of drug reactions and interactions.

Wednesday, 8:00 a.m.-5:00 p.m.

Howard H. Weitz, MD, MACP, FRCP (Lond.), FACC
Bernard L. Segal Professor of Clinical Cardiology, Senior Associate Dean, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA

David L. Fischman, MD, FACP
Professor of Medicine, Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA

This Pre-Course will provide a focused update of the diagnostic, preventive, and therapeutic approaches to the patient at risk for, or with known, cardiovascular disease. Expert clinician-educators will focus on the cardiovascular disease issues that internists most frequently encounter and will provide “Key Points” to update the audience and foster patient care. Subjects covered will include identification and management of acute and chronic coronary artery disease, management of the patient with cancer and heart disease, optimal treatment of acute and chronic heart failure, update in the treatment of hypertension, risk assessment and risk reduction for the patient with cardiac disease who undergoes noncardiac surgery, approach to the patient with valvular heart disease, indications for and interpretation of advanced cardiac imaging modalities, atrial fibrillation update, approach to the patient with deep venous thrombosis and pulmonary embolus, and electrocardiogram case review.

Learning Objectives:

1. Update the internist on the diagnostic and therapeutic approaches to the patient with known cardiovascular disease.
2. Become familiar with the guidelines and recent studies regarding hypertension, valvular heart disease, optimal blood pressure control, and care of the patient with cardiovascular disease who undergoes noncardiac surgery.
3. Understand approaches for decreasing the risk for complications and decreasing hospital readmissions for patients with various cardiovascular issues.
4. Become familiar with optimal surgical and pharmacologic treatments for the care of patients with coronary artery disease, heart failure, valvular heart disease, and atrial fibrillation.
5. Become familiar with the transition of care after hospital discharge for patients with various cardiac issues.
6. Become familiar with the role of technologic advances in cardiac care that the internal medicine specialist may use in patient care: electrocardiography, echocardiography, cardiac computed tomography (CT) imaging, cardiac magnetic resonance imaging (MRI), and wearable cardiac rhythm monitoring devices.
7. Become familiar with approaches to prevention and treatment of the cardiac complications of cancer therapy.

Wednesday, 8:00 a.m.-5:00 p.m.

Jamie Newman, MD, MHA, MACP
Associate Professor, Department of Hospital Medicine, Mayo Clinic, Rochester, MN

Roger Yu, MD, MACP, FHM
Clinical Professor of Medicine, Division of Hospital Medicine, Department of Medicine, Scripps Clinic, La Jolla, CA

The hospital is a complex environment. Navigating it on behalf of our patients requires a broad and constantly growing body of clinical knowledge combined with an understanding of the systems that support them. This Pre-Course will take you through the challenges of common and uncommon clinical presentations. Individual lectures will involve review of up-to-date medical care using a case-based format and an audience-response system. Attendees will be presented with an advanced and practical perspective of hospital medicine.

Learning Objectives:

1. Improve assessment of common inpatient clinical conditions.
2. Refresh current evidence-based approach to common hospital problems.
3. Apply best practice for the treatment of common acute medical issues.
4. Review updates in the latest hospital medicine literature.

Wednesday, 8:00 a.m.–5:00 p.m.

Edward (Ted) Parks, MD
Associate Professor, Department of Medicine, University of Colorado, Denver, CO

Musculoskeletal complaints and sport-related injuries are common in primary care, but internists receive little instruction in office-based orthopedics. Most of these conditions do not require surgery and can therefore be managed by the knowledgeable internist. This Pre-Course is designed to provide participants with the knowledge and tools needed to correctly evaluate, diagnose, and treat most orthopedic complaints seen in the internal medicine office. The Pre-Course will use a case-based approach to familiarize participants with basic joint and tendon anatomy and landmarks and make participants comfortable with performing a concise, targeted office examination. This will be combined with knowledge of the epidemiology of musculoskeletal complaints in primary care to develop an accurate diagnostic approach. Treatment of these common conditions will be discussed, with special emphasis on a practical, evidence-based, and cost-effective approach to physical therapy and medical devices (e.g., splints).

Learning Objectives:

1. Know the epidemiology of the most common orthopedic and sports medicine conditions seen in the internal medicine office.
2. Identify basic joint and tendon anatomy in major joint and musculoskeletal regions.
3. Perform targeted, practical, and evidence-based diagnostic maneuvers for common musculoskeletal complaints.
4. Feel competent and confident in diagnosing musculoskeletal problems through history and physical examination.
5. Recognize indications for judicious use of imaging.
6. Develop treatment plans, including medication, exercises, and use of splints or braces.
7. Identify clinically appropriate resources for patient education and for home exercise plans.
8. Recognize which patients require further testing or orthopedics consultation and which can be safely treated under the guidance of the internist.

Wednesday, 8:00 a.m.-5:00 p.m.

Robert M. McCarron, MD, Member
Director of Education, Susan Samueli Integrative Health Institute, Associate Dean, Continuing Medical Education, Director, UCI Train New Trainers Primary Care Psychiatry Fellowship University of California, Irvine, CA

Jane P. Gagliardi, MD, FACP
Professor of Psychiatry and Behavioral Sciences, Professor of Medicine, Division of Adult Psychiatry & Psychology, Department of General Internal Medicine, Duke University School of Medicine, Durham, NC

Internal medicine physicians are often on the “front lines” in both specialty and primary care settings for the assessment and treatment of psychiatric disorders. Most psychiatric disorders are treated by nonbehavioral specialists, and more than 80% of antidepressants are prescribed by nonpsychiatrists. Formal psychiatric training for internists is often limited and does not cover foundational topics, which are relevant to everyday practice in the general medical setting.

This Pre-Course will provide a practical, evidence-based update for internists on approaches to interviewing patients with the goal of recognizing, diagnosing, treating, and/or referring patients with mental health disorders. Expert clinician-educators with training in both internal medicine and psychiatry will emphasize the importance of a patient-centered approach, motivational interviewing, and basic cognitive behavioral techniques that can be quickly used in medical settings. An overview on psychopharmacology strategies in the general medical setting will also be discussed. Faculty will focus on psychiatric diagnoses that are prevalent in medical practice, including major depressive disorder, anxiety disorders, trauma-related disorders, and bipolar mood disorders, with a goal of improving recognition, confidence in management, and effectiveness of referral.

Learning Objectives:

1. Update the internist on patient-centered interview strategies to detect treatable mental illness. 
2. Provide the internist with familiarity about current best practices regarding management of depression in primary care and specialty medical settings.
3. Provide the internist with a practical approach to prescribing and monitoring common psychotropic medications, with a goal of facilitating management as well as communication with psychiatric care providers.
   • Antidepressants in medical practice.
   • Antipsychotics in medical practice.
   • Drug–drug interactions relevant to psychotropic medications.
4. Give the internist an overview and examples of the use of motivational interviewing in a busy medical practice.

Wednesday, 8:00 a.m.-5:00 p.m.

Julie L. Oyler, MD, FACP
Professor, Associate Program Director, Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL

Darlene Tad-y, MD, MBA, SFHM, Member
Associate Professor of Medicine, Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO

ACP's annual quality improvement (QI) leadership training program provides meaningful implementation support of QI strategies based on principles of clinician engagement, patient and family partnership, team-based care, promotion of health equity, and maximizing efficiency while minimizing burden. Participants will receive step-by-step guidance, based on the ACP Advance QI approach, to help them through their QI journey, including how to establish the what and why for change, identify how to measure change, plan for change and identify solutions, and implement and sustain change.

Participants will have the opportunity to work in small groups to apply each step of the ACP Advance QI approach to their own practice challenge under the guidance of national expert physician coaches. At the conclusion of this Pre-Course, participants will be able to understand and apply QI strategies to tackle a wide range of practice issues that are meaningful to their highest priority challenges. Participants will be invited to join ACP's engaging peer-to-peer learning network to support continued implementation of QI activities following the Pre-Course. This full-day Pre-Course will launch you on your QI journey and provide you with the skills you will need throughout your career to lead the way through the changing tides of health care.

Learning Objectives:

1. Describe the four steps of the ACP QI approach, including establishing the what and why for change, identifying how to measure change, planning for change and identifying solutions, and implementing and sustaining change.
2. Explain the rationale for integrating clinician engagement, team-based care, patient and family partnership, promotion of health equity, and the need to maximize efficiency and minimize burden into QI implementation.
3. Identify and apply practical strategies for QI implementation using ACP resources and tools.

Wednesday, 8:00 a.m.-5:00 p.m.

Mike Wagner, MD, FACP, FAIUM
Director of Internal Medicine Ultrasound, Department of Internal Medicine, Prisma Health-Upstate and University of South Carolina-Greenville School of Medicine, Greenville, SC

Point-of-care ultrasound (POCUS) is an emerging patient assessment tool for internists. This 1-day course is designed to build on ACP’s 2-day Point-of-Care Ultrasound: Foundational Skills for Internists* course and will focus on extended and advanced POCUS applications tailored for internists who practice in the outpatient setting.

Internationally acclaimed faculty will provide proctored instruction so that attendees can gain experience with POCUS and expand their outpatient clinical assessment skills. The learning format will alternate between didactic lectures and small-group, hands-on training. Attendees will practice with live models to develop bedside image-acquisition skills. Attendees will have an opportunity to customize their learning by working on solidifying challenging concepts, learning additional techniques and applications, and receiving individualized feedback from instructors.

Learning Objectives:

1. Identify indications and rationale for performing the following examinations: PEARLS approach to a multisystem ultrasound physical; abdominal aortic aneurysm screening; gallbladder pathology; skin and soft tissue: lumps and bumps; and musculoskeletal ultrasound: joint, tendon, and nerve pathology.
2. Perform the ultrasound exams listed above.
3. Interpret normal and abnormal images for the applications listed above.
4. Interpret POCUS findings in clinical case scenarios.
5. Review practical strategies for successful integration of POCUS into the outpatient setting.

* Prerequisite Requirement:
Registrants for this course must have attended ACP’s Point-of-Care Ultrasound: Foundational Skills for Internists 2-day course. Alternate 2-day introductory courses that include a minimum of 50% hands-on time might be considered as a surrogate for ACP’s course. A course agenda and certificate of completion must be submitted for approval. Attestation of significant experience might also be considered as a surrogate at the course director’s discretion. Please submit this information to ACPPOCUS@ acponline.org. You will receive a response within 10 days. If you are not approved for the course, you will receive a full refund.