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TEMPORARY VISITATION POLICY CHANGE:

Stead (Faculty) Inpatient Service

Stead (Faculty) Inpatient Service Competency-Based Curriculum

This service was named after Dr. Eugene A Stead, Jr., MD, 1908-2005

Dr Stead trained with Soma Weiss, MD, was acting chief at the Brigham after Weiss' death, was professor, chair and dean at Emory, then became professor and chair at Duke in 1947 (at age 39 years), and emeritus chair after 1967. Drs. Richard Panush former chair and Alexander Kisch, former assistant chair of our department of medicine, both trained in his program in the days of "iron men" and "giants". Stead said "I had the opportunity to test out the value of selection during the 26 years that I held the power of appointments in departments of medicine--5 years at Emory and 21 at Duke. I agreed with Osler's statement that the magic word was work, and I was never attracted to the potentially brilliant person who might have performed but usually didn't. I baited my trap by establishing the reputation that medical services at Emory and later at Duke were by far the most demanding of any in the world, and that only a few iron men and women could survive." Stead was arguably the most charismatic and influential figure in medicine in the postwar era, training over 33 residents who subsequently became department chairs, deans, or other senior leaders at academic health centers. He created the physician assistant program in this country, innovated computer-based databanks, pioneered clinical investigation of heart failure and syncope, received every possible award in medicine, and essentially developed the model for modern academic internal medicine departments and faculty. Stead's philosophy was reflected by statements like "what this patient needs is a doctor", "take care of the people, not illness," "I never feel sorry for the doctor; the sick never inconvenience the well", and "life is hard". Still vigorous until his recent death at age 97, he could be reached at the web site he created (http://easteadjr.org/index.html)!

Overview

This assignment blends several overlapping educational experiences. First, it offers interns and junior (second-year) residents opportunities to independently care for inpatients with a variety of medical illnesses, under direct supervision of full-time faculty members. Residents will focus on managing patients using evidence-based therapies; direct care, discharge, and after care for their patients; and carry out and learn the principles of general medical consultation (within the hospital) also under direct full-time faculty supervision. On this service residents will also care for patients from our residents' continuity panels, giving them a chance to care for patients before, during, and after hospitalization.

Residents function under the direct supervision of full-time faculty. Additional valuable aspects of this assignment include opportunities to independently triage patients in the emergency department and to mimic the roles of attending physicians (especially coordinating care choosing consultants, communicating with patients and family members, and care coordination upon discharge).

Principal Teaching / Learning Activities

-Resident Morning Report (RMR)—
Three mornings each week (Monday, Tuesday, & Thursday) from about 7:45-8:30 AM all Interns, Junior Assistant Residents and Senior Assistant Residents on inpatient floor teams meet with assigned faculty to review patients admitted the previous day. Patients are presented briefly by the intern or resident who admitted them and discussed by the group, facilitated by the attending physician. The focus of the discussion is selected by the presenting resident and may reflect differential diagnosis, specific management issues, or other topics. Faculty members include general internists and subspecialists.

Each Friday from 8:00-9:00 AM the Senior residents meet with assigned specialist attending physicians to review patients admitted the previous day. Selected patients are presented by the residents and further discussion including literature review and didactic teaching is guided by the attending physician.

-Sign-out Rounds (SR) --
Every evening, Monday through Friday, the senior residents (Chief Resident, or his/her designate will be present during the first few months of the academic year), supervise sign-out rounds, which are attended by the out-going day team and incoming ADMITTING team. These may include topical discussions.

-Teaching Attending Rounds (AR) –
Attending rounds format will vary depending on the preference of the attending. There should be discussion of the patients with concurrent teaching.. At the very least this should include bedside rounds on the new patients and others whom the resident/attending feel should be seen by the team. If possible beside rounds should be done on all patients.

-Management Rounds (MR) --
Each day the Attending physician responsible for care of patients on this service will meet with the residents at the mutually agreeable and arranged times, to review specific aspects of patient management. It will be during these occasions that residents are supervised in details of recordkeeping, interaction with other healthcare team members, communication with consultants and family members, and all other aspects of patient management.

-Palliative Care and/or Ethics Rounds (PCR)—
Once each month a voluntary faculty member with special interest and expertise in medical ethics and palliative care conducts palliative care rounds for all residents on inpatient teams. A particular patient or patients is/are selected for presentation. Discussion is directed and facilitated by the faculty member, emphasizing issues pertaining to death and dying, and relevant care and communication skills necessary for residents to develop.

-Noon Conference (NC) --
Each weekday usually from 12 noon to 1 p.m. all residents attend a scheduled conference reviewing core topics in Internal Medicine.

-Journal Club (JC) --
Journal Club is held monthly. Following an annual presentation on the fundamentals of evidence-based medicine, individual residents are assigned a single article to critically review and present, facilitated by a faculty member, and followed by a group discussion.

-Grand Rounds (GR) --
Medical Grand Rounds are held each Wednesday from 8:00 -9:00
a.m. in the Medical Center Auditorium. Formats vary and include invited guests/visiting professor presentations, clinical-pathological conferences, resident presentations, or other didactic, topical, or patient related topics.

-Ambulatory Care Conference --(ACC)
Each month faculty members meet with residents to review individual topics pertaining to ambulatory care medicine. This follows a three-year cyclic schedule of topics, so that our ambulatory care curriculum is presented in its entirety during the time of training for individual residents.

-Back to Basics (BTB)-
Each month the residents choose a key topic in medicine to review in detail form pathophysiolgy to clinical manifestations and management. The topics are chosen by the residents and reviewed by the chief resident prior to discussion Topics generally follow a triennial cycle, covering all subspecialty areas within internal medicine during the time of training of individual residents.

-Turnover Rounds (TR)--
Turnover rounds occur at the end/beginning of each rotation and from 6:30-7:30 a.m. daily. These facilitate transfers of patient care from one resident to another. (Sign in Rounds are a daily version of turnover rounds.)

-EBM conference (EBM)-
Each month the ambulatory resident and intern are expected to investigate a clinical question that they do not have the answer for. Under the guidance of the faculty, they then formulate the question in a scientific format, search the literature for evidence, and develop an answer to the question. This is presented in a conference. Included in the presentation are the question, the search methods, the evidence found, and the conclusions derived.

-Patient Safety and Quality Improvement Conference (PSQI) –
Formerly the Morbidity and Mortality Conference. We now have a monthly conference dedicated to identifying issues that affect patient safety. The issues maybe as varied as knowledge gaps in care for patients with unusual diseases to errors that occur in the course of care. There is a discussion about the residents' role in preventing such issues in the future. If warranted an action plan is made with follow up at subsequent meetings.

-Autopsy Rounds (AuR)
When a death occurs on any of the teaching teams the family is offered the option of performing an autopsy. If an autopsy is performed, we hold a multidisciplinary presentation of the findings that includes medicine, pathology, radiology, surgery, and/or ob/gyn residents and faculty that were involved.

-MKSAP study pan (MKSAP)-
This self directed study plan helps residents stay on track with their didactic reading and helps them evaluate their medical knowledge (strengths and areas of deficit). Residents can help develop individualized study plans to fill in any knowledge gaps and reinforce what they already know. This also helps residents develop skills and habits needed for lifelong learning.

-In-Training Examination (ITE) --
All of our residents must take this examination annually for their own assessment of progress and for edification. When examination results become available, the program director discusses these individually with residents and counsels residents about individualized study programs to facilitate their acquisition of knowledge.

Description of the Rotation

One intern and a junior/senior assistant resident are assigned to these services each month. Residents will admit patients with attending physicians. Patient care responsibilities will be for patients anywhere in the hospital. Rounds will be made daily with the attending physicians, as described previously.

The resident should arrive each morning sufficiently early to be intimately familiar with his/her patients, through interview and physical examination. The resident will review all notes from other care givers, events of the preceding evening or day, objective data, and diagnostic studies. Residents will be familiar with all new admissions, diagnostic information, and therapeutic interventions. The resident should be prepared to comprehensively present patients to the team on rounds. The resident should also have examined the relevant medical literature and be conversant with patients' problems. Rounds will be made with faculty on a daily basis. These will not merely focus on management but will emphasize didactic education and follow the principles and practices of evidence-based medicine. All rounds/activities will be recognize residents' many responsibilities, other patients, and therefore will be conducted efficiently and with time constraints and respectful of the binding nature of all ACGME educational and work-hour mandates. Round will include beside interview, examination, and counseling of patients. All notes will be reviewed and residents will receive feedback on their knowledge of the case, presentation skills, and clinical thinking. Residents will write all orders and carry out all procedures for these patients when appropriate.

Residents should attend morning reports whenever possible. They should attend noon conferences, grand rounds, and all other didactic conferences. He/she should attend his/her continuity experience twice weekly.

Goals & Objectives

The principle objective for this month is to complement other resident experiences enabling residents to learn how to function independently for sick hospitalized patients, facilitated by the unique relationships with volunteer faculty, representing generalist clinician/educators. As noted, this involves routine admissions, medical consultations, and acute emergent problems.

1. Residents will gain familiarity with, above and beyond other general medical experiences, with differential diagnosis, diagnosis, work-up and management of the following complaints:

a) chest pain
b) dyspnea
c) headache
d) mental status changes
e) acute abdominal pain
f) new fever and persistent fever
g) new rash
h) lower extremity edema/ lower extremity pain
i) common GI complaints such as anorexia, constipation, diarrhea, nausea/emesis
j) hematochezia/melena/hematemesis
k) cough/wheezing
l) dizziness
m) swollen joint(s)
n) weakness
o) syncope
p) unexplained weight loss

2. Resident should be able to diagnose and generate an appropriate treatment plan for the following common medical illnesses:

a) DVT/PE
b) DKA/HHNK/New Onset DM
c) CAP and Aspiration Pneumonia
d) Acute Kidney Injury
e) Cellulitis/Osteomyelitis/Diabetic foot ulcers
f) Asthma/COPD exacerbation
g) UTI/Pylonephritis/Urosepsis
h) Endocarditis
i) Meningitis
j) Acute coronary syndromes
k) Pre-op evaluation
l) Atrial Fibrillation and other arrthymias
m) CHF
n) Anemia
o) Hypo/hypernatremia, kalemia and calcemia
p) Decubitis ulcers, prevention and treatment
q) Septic Arthritis/acute gout flare
r) Obstipation/partial SBO
s) CVA
t) Dementia/delirium
u) Depression
v) ETOH intoxication/withdrawal
w) PUD/Diverticulosis/Diverticulitis
x) Pancreatitis/cholecystitis/cholangitis
y) Neutropenic fever/Fever in a patient with HIV infection
z) Sickle cell crisis

3) Residents will learn or reinforce their interpretive skills for the following tests:

a) Serum electrolytes and routine chemistry panel
b) Urinalysis and microscopic examinations of urine
c) Liver function tests
d) Coagulation studies
e) Arterial blood gases
f) Chest x-ray interpretation
g) Electrocardiogram
h) Non-contrast head CT
i) Peripheral smear
j) Abdominal obstructive series
k) electrocardiogram

Evaluations

Assessment Methods (of Resident)

The evaluation methods that apply to these rotations include some or all of the following:

  • Evaluation of resident competence by faculty attendings (AE)-Formal formative evaluations should occur at the completion of the specific rotation. It is to be based on direct observation on rounds, at conferences, and at the bedside. All faculty members are encouraged to complete the form prior to the completion of the rotation and review their impressions directly with the resident. All completed evaluation forms are returned to the Program Director for review and placed in the resident's permanent file.
  • Mini CEXs may be used when warranted, particularly in the beginning of the academic year.
  • Self-evaluation by In-service training examination scores
  • MKSAP study plan (MKSAP)
  • Participation and presentations at didactic conferences (DC)
  • Multi Source evaluations by patients and staff (MS)

Assessment Method (of Program)

Residents have the ability to evaluate teaching faculty and experience at the end of each rotation. They are encouraged to use this opportunity to give constructive feedback.

Residents are encouraged to maintain a high level of communication with the Program Director and faculty. These informal meetings can be used to disseminate information, receive timely feedback, and for other purposes.

Annually, all residents are required to complete and return an evaluation form of the faculty and the program. Evaluations are collected in a fashion to assure the anonymity of the resident. The feedback received during informal meetings, formal meetings, and the semi-annual evaluation form will be used to make programmatic change.

Principle Educational Goals by Relevent Competency

In the tables below, the principle educational goals for the Faculty Inpatient Service rotation are indicated for each of the six ACGME competencies. The second column of the table indicates the most relevant principle teaching/learning activity for each goal, using the legend below.

* Legend for Learning Activities (See preceding for descriptions)

MS-Multisource evaluations
ACC-Ambulatory Care Conference
AE-Attending Evaluations
AR-Attending Rounds
AuR-Autopsy Rounds
BTB-Back to Basics
DPC-Direct Patient Care
EBM-Evidence Based Medicine
GR-Grand Rounds
ITE-In-Training Exam
JC-Journal Club
MKSAP-Knowledge Self Study Plan
MR-Management Rounds
NC-Noon Conference
DPC-Direct Patient Care
PCR-Palliative Care/Ethics Rounds
PSQI-Patient Safety/Quality Improvement
RMR-Resident Morning Report
SR-Signout Rounds
TR-Turnover Rounds

1.) Patient Care

Goals and Objectives: PGY-1 Learning Activities* Assessment
Master basic patient interviewing skills DPC, AR, MR AE, AR, MR, MS
Master basic patient exam skills DPC, AR, MR AE, AR, MR,
Master basic psycho-social evaluation skills DPC, AR, MR, PCR AE, AR, MR,
Define and prioritize patients' medical problems DPC, AR, MR AE, AR, , MR, RMR
Generate and prioritize differential diagnoses DPC, AR, MR AE,, AR, , MR, RMR
Develop rational, evidence-based management strategies DPC, AR,PCR, JC, MR AE, AR, PR, MR, RMR
Goals and Objectives: : PGY-2 (in addition to above) Learning Activities* Assessment
Interview patients more skillfully DPC, AR, MR AE, AR, MR, TR
Examine patients more skillfully DPC, AR, MR AE, AR, MR, TR
Evaluate psycho-social issues more skillfully DPC, AR, MR, PCR AE, AR, MR, PCR, TR
Define and prioritize patients' medical problems DPC, AR, MR, RMR AE, AR, MR, RMR, TR
Generate and prioritize differential diagnoses DPC, AR,RMR, MR AE, AR, MR, RMR, TR
Develop rational, evidence-based management strategies DPC, AR, RMR, PCR, JC, MR AE, AR, JC, MR, RMR, TR
Manage a large volume of patients DPC, AR, RMR , MR AE, AR, MR, TR
Develop and display leadership skills and responsibility DPC, AR, RMR, PCR, JC, MR AE, AR, MR, RMR, SR TR
Learn to be team leaders DPC, AR,RMR, JC, MR AE, AR, NC, , MR, TR
Learn to be efficient teachers DPC, AR, ,RMR, JC, MR AE, AR, MR, CMR, TR
Goals and Objectives: : PGY-3 (in addition to above) Learning Activities* Assessment
Efficiently and effectively direct the initial evaluation and continued management of patients requiring hospitalization including appropriate discharge planning. DPC, AR, PR, MR AE, AR, MR, TR
Complete obtainment of certification in required Internal Medicine procedures. Supervises junior trainees in these procedures once certified to teach DPC, AR, PR, MR AE, AR, MR, TR
Systematically obtains and reviews all prior/obtainable medical records pertinent to patient care. DPC, AR, PR, MR AE, AR, MR, TR
Understands significance of all diagnostic test results affecting patient care. DPC, AR, PR, MR AE, AR, MR, TR
Clinical judgment – makes informed decisions using risk/benefit analysis based on sound scientific evidence, patient performance after informed consent and consultation with consultants and more senior physicians (attending). DPC, AR, PR, MR, JC AE, AR, MR, JC
Begin to function as independent primary care givers DPC, AR, PR, MR AE, AR, MR, TR


2.) Medical Knowledge

Goals and Objectives: : PGY-1 Learning Activities* Assessment
Read and expand clinically applicable knowledge base of the basic and clinical sciences DPC, AR, RMR, AuR, SR, NC, GR, BTB, MKSAP AE, AR, MKSAP, MR
Access and critically evaluate medical information and scientific evidence relevant to patient care DPC, AR, RMR, AuR, SR, NC, GR, BTB AE, AR, MKSAP, MR
Goals and Objectives: : PGY-2 (in addition to above) Learning Activities* Assessment
Read and expand clinically applicable knowledge base of the internal medicine specialties DPC, AR, RMR, AuR, S NC, GR, BTB, MKSAP AE, AR, MKSAP, MR
Access and critically evaluate medical information and scientific evidence relevant to patient care DPC, AR, RMR, JC, MKSAP AE, AR, PR, JC, SR TR
Teach medical students and interns DPC, AR, RMR, AuR, SR, NC, GR, BTB, MKSAP AE, AR, MKSAP, MR

Read relevant articles and literature in journals
DPC, AR, RMR, AuR, SR, NC, GR, BTB, MKSAP AE, AR, MKSAP, MR
Goals and Objectives: : PGY-3 (in addition to above) Learning Activities* Assessment
Develop medical knowledge about each patient illness so as to be able to make independent decisions based on scientific evidence and patient preference. DPC, AR, RMR, AuR, SR, NC, GR, BTB, MKSAP AE, AR, MKSAP, MR
Demonstrates knowledge by leading discussions on areas of pathophysiology concerning patient care including ongoing management of hospitalized patients. DPC, AR, RMR, JC, MKSAP AE, AR, PR, JC,
Demonstrates ability to access information from 3 different sources and to synthesize sources into an in-depth understanding. DPC, AR, RMR, AuR, SR, NC, GR, BTB, MKSAP AE, AR, MKSAP, MR,
Develop medical knowledge adequate to practice independently DPC, AR, RMR, AuR, SR, NC, GR, BTB, MKSAP AE, AR, MKSAP, MR


3.) Practice-Based Learning and Improvement

Goals and Objectives: : PGY-1 Learning Activities* Assessment
Identify and acknowledge gaps in personal knowledge and skills DPC, AR, PR, MR, MKSAP, AuR AE, AR, MR, MKSAP
Develop and implement strategies for filling gaps in knowledge and skills DPC, AR, PR, MR, MKSAP, AuR AE, AR, MR, MKSAP
Accepts guidance from more experienced physicians and uses scientific evidence and practice outcomes for practice improvement. DPC, AR, PR, MR AE, AR, MR
Readily acknowledges practice omissions (errors) determined by self or supervisors and takes corrective measures. DPC, AR, PR, MR, PSQI AE, AR, MR, PQSI
Goals and Objectives: : PGY-2 (in addition to above) Learning Activities* Assessment
Develop plans for practice improvement from feedback. DPC, AR, PR, MR, PSQI AE, AR, MR, PQSI
Reduces level/rate of practice omissions from PGY-1 level (errors). DPC, AR, PR, MR, PSQI AE, AR, MR, PQSI
Improves efficiency of patient care (timelines) while maintaining quality and thoroughness. DPC, AR, PR, MR, PSQI AE, AR, MR, PQSI
Goals and Objectives: : PGY-3 (in addition to above) Learning Activities* Assessment
Continues to progressively reduce practice omissions/commissions from R-1, R-2 levels. DPC, AR, PR, MR, PSQI AE, AR, MR, PQSI
From medical knowledge and patient care experiences is able to question patient care practices not supported by scientific evidence/evidenced based care. DPC, AR, PR, MR, PSQI, EBM AE, AR, MR, PQSI
Develop PI skills to use in independent practice DPC, AR, PR, MR, PSQI AE, AR, MR, PQSI

4) Interpersonal Skills and Communication

Goals and Objectives: : PGY-1 Learning Activities* Assessment
Communicate effectively with patients and families DPC, AR, MR, PCR AE, AR, RMR, MS
Communicate effectively with physician colleagues at all levels DPC, AR, MR, PCR AE, AR, RMR, MS
Communicate effectively with all non-physician members of the health care team to assure comprehensive and timely care of patients DPC, AR, MR, PCR AE, AR, RMR, MS
Present patient information clearly, in notes and during presentations DPC, AR, MR, PCR AE, AR, RMR, MS
Goals and Objectives: : PGY-2 (in addition to above) Learning Activities* Assessment
Successfully communicate with patients and families in a group meeting DPC, AR, MR, PCR AE, AR, RMR, MS
Supervise, lead, manage and teach more junior housestaff and medical students. DPC, AR, MR, PCR AE, AR, RMR, MS
Present patient information concisely and clearly, verbally and in writing at an advanced level DPC, AR, MR, PCR AE, AR, RMR, MS
Goals and Objectives: : PGY-3 (in addition to above) Learning Activities* Assessment
Successfully communicate with patients and families that may be considered difficult (angry, anxious, etc) advanced level DPC, AR, MR, PCR AE, AR, RMR, MS
Become fascicle at discussing difficult issues such as end of life care and delivering bad news DPC, AR, MR, PCR AE, AR, RMR, MS
Effectively teach students and junior trainees to improve their communication skills DPC, AR, MR, PCR AE, AR, RMR, MS


5) Professionalism

Goals and Objectives: : PGY-1 Learning Activities* Assessment
Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues while maintaining confidentially. DPC, AR, MR, PCR AE, AR, RMR, MS
Always act in a moral, honest professional manner, and maintain appropriate relations with patients. DPC, AR, MR, PCR AE, AR, RMR, MS
Respect and defend each patient's autonomy and privacy and always act in the patients' best interest DPC, AR, MR, PCR AE, AR, RMR, MS
Goals and Objectives: : PGY-2 (in addition to above) Learning Activities* Assessment
Maintain a good record of attendance at conferences, completion of assignments, participation in clinical and didactic activities, prompt completion of dictations DPC, AR, MR, PCR, MKSAP AE, AR, RMR, MS
Understand and apply principles of medical ethics toward patients, families, colleagues, and all members of the health care team DPC, AR, MR, PCR AE, AR, RMR, MS
Goals and Objectives: : PGY-3 (in addition to above) Learning Activities* Assessment
Understand the principles of moral and ethical behavior required of an independent practitioner DPC, AR, MR, PCR AE, AR, RMR, MS
Become familiar with actual or potential conflicts of interest; particularly those involving personal financial gain. DPC, AR, MR, PCR AE, AR, RMR, MS


6) Systems-Based Practice

Goals and Objectives: : PGY-1 Learning Activities* Assessment
Understand and utilize the multidisciplinary resources necessary to care optimally for patients DPC, MR, AR, AuR AE, AR, RMR, SR
Collaborate with other members of the health care team to assure comprehensive patient care DPC, MR, TR, SR, AR AE, AR, RMR,
Use evidence-based, cost-conscious strategies in the care of patients DPC, AR, EBM , JC AE, AR, RMR, EBM, JC
Goals and Objectives: : PGY-2 (in addition to above) Learning Activities* Assessment
Apply evidence-based and cost-conscious strategies toward disease prevention, diagnosis and disease management. DPC, MR, TR, SR, AR AE, AR, RMR,
Develop understanding of the role of non-physician personnel in the care of patients DPC, MR, TR, SR, AR AE, AR, RMR,

Learn to efficient lead a team through management rounds
DPC, MR, TR, SR, AR AE, AR, RMR,
Goals and Objectives: : PGY-3 (in addition to above) Learning Activities* Assessment
Develop lifelong strategies to optimize care for individual patients as an independent practitioner DPC, MR, TR, SR, AR AE, AR, RMR,

Procedures

Residents will learn, as appropriate to individual patients, the indications and contraindications and the performance of those medical procedures required by the American Board of Internal Medicine and Residency Review Committee (as detailed in the inpatient general medicine curriculum) and perform all procedures on patients under their care.

Reference List

All residents are expected to read about their patients in an appropriate general medicine text. In addition, a vast variety of print and on-line reference material is available though the library (24-hour access for all residents) and the on-line portal. Because it is frequently updated, extensively referenced, and includes abstracts of reference articles, the program highly recommends UpToDate as an adjunctive information source.

MDConsult is also a valuable resource and residents should become familiar with use as a rapid search engine for clinical information

The following is a partial list of key articles related to hospital medicine.

Adams J, Murray R. The general approach to the difficult patient. Emergency Medicine Clinics of North America 1998; 16:689-99.

O'Keefe KP, Sanson TG. Elderly patients with altered mental status. Emergency Medicine Clinics of North America 1998; 4:701-15.

Fuller GF. Falls in the elderly. American Family Physician 2000; 7:2159-68.

Chandratheva A, Mehta Z, et al. Population-based study of risk predictors of stroke in the first few hours after a TIA. Neurology 2009;72 (June 2):1941-1947.

Mahoney J. Immobility and falls. Clinics in Geriatric Medicine 1998; 14:699-726.

Cunningham R, Mikhail M. Management of patients with syncope and cardiac arrhythmias in an emergency department observation unit. Emergency Medicine Clinics of North America 2001; 19:105-21.

Michelson E, Hollrah S: Evaluation of the patient with shortness of breath: An evidence based approach. Emergency Medicine Clinics of North America 1999; 17:221-37.

Moghissi ES, Korytkowski MT, DiNardo M. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009; 32:1119-31

Moghissi ES, Korytkowski MT, DiNardo M American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocrine Practice 2009; 15:353-69

Standard of Medical Care in Diabetes -2010 Diabetes Care, Volume 33, Supplement 1, January 2010

PJ, Berenholz SM, Goeschel C, et al Ten patient safety tips for hospitals. Agency for Healthcare Research and Quality Agency for Healthcare Research and QualityPronovost Revised 2009

Prevention of Venous thromboembolism Chest 2012

Update in the Treatment of Venous Thromboembolism. Seminars in Respiratory and Critical Care Medicine Volume 29 No 1, 2008

Diagnosis and Management of Lower Gastrointestinal Bleeding . Gastroenterology and
Heptalogy, Volume 6, November 2009

International Consensus Recommendations on the Management of Patients with Nonvariceal Upper Gastrointestinal Bleeding. Annals of Internal Medicine 2010: 152; 101-113

Pain Management in the Hospitalized Patient. Medical Clinics of North America 2008; 92:371-385

Management of Adult Patients with Ascites Due to Cirrhosis: An Update Hepatology 2009; 49: 2087-2107

Systolic Heart Failure. NEJM 2010; 362: 228-238

IDSA/ATS Consensus on the Management of Community Acquired Pneumonia CID 2007; 44: s27-s72

Health Care Associated Pneumonia CID 2008; 46: s296-s333

Stage IV Chronic Kidney Disease. NEJM 7 2010; 362:56-65

Approach to the Anemias Goldman Cecil Medicine

Diagnosis from the Blood Smear . NEJM Aug 2005 353; 5: 498-507

Managing Exacerbations of Asthma ATS Guidelines 2007 Pages 396-429

Management of Stable Chronic Obstructive Pulmonary Disease. Annals of Internal Medicine 147 (9): 639-653