American College of Physicians: Internal Medicine — Doctors for Adults ®


Annual Session agenda features new ways to stay up-to-date

First-time tracks will focus on challenging clinical cases, diabetes care and research developments

From the March ACP Observer, copyright 2005 by the American College of Physicians.

By Janet Colwell

In addition to perennial favorites like update sessions, practice management workshops and hands-on learning opportunities, this year's Annual Session will give internists several new ways to stay up-to-date in their specialty.

This year's meeting, which will take place in San Francisco from April 14 to 16, will feature more than 260 CME courses led by experts in their fields. But an expanded pre-Session menu and a number of new learning formats make this year's program particularly rich.

Internists learn new sports medicine techniques during a musculoskeletal exam workshop at the Herbert S. Waxman Learning Center.

"We've got a big meeting with something for everyone, from physicians who might be preparing for their boards to practicing internists who want to update or expand their knowledge in particular areas," said Jeffrey Glassroth, FACP, Chair of this year's Scientific Program Subcommittee.

The opening ceremony on Thursday morning will feature a keynote address by Risa Lavizzo-Mourey, MACP, president and chief executive officer of the Robert Wood Johnson Foundation, a major supporter of efforts to promote access to quality health care. Dr. Lavizzo-Mourey's topic will be "Leadership in Quality Care: Changing the Future of Medicine."

The Welcome Reception, to be held Wednesday evening in the Exhibit Hall, will feature the debut of "Internists as Artists," a program that gives internists an opportunity to showcase their artistic talents. A gallery in the Exhibit Hall featuring artwork of members will highlight paintings, sculptures, photography, jewelry, ceramics and other artwork selected for display.

Also new this year is "Hot off the Press," a session devoted to discussing very recent trends and scientific findings that have appeared in journals and the popular press. This interactive session, slated for Saturday from 8:30 a.m.-10 a.m., will tackle timely, sometimes controversial, issues that have important implications for internal medicine. Faculty facilitators were handpicked for their ability to stay on top of recent developments and place new findings into a broader medical context.

"In 'Hot off the Press,' experts will be reviewing topics that we think have the potential to change the way people practice," said Dr. Glassroth. "Given the pace at which medical knowledge evolves, this session will be extremely valuable in keeping members abreast of the very latest findings."

Seasoned attendees will know to arrive early for the Clinical Pearls and Multiple Small Feedings of the Mind sessions, which have become member favorites over the years. In the Clinical Pearls series, audience members respond to case-based questions using interactive keypads. Multiple Small Feedings of the Mind sessions feature faculty experts covering timely, practice-oriented topics, and answering questions about common patient management issues.

If you're a first-timer, try attending an orientation on Thursday from 7:45 a.m.-8:30 a.m. And if you can't make it to as many sessions as you would like, attend Annual Session Highlights Saturday from 5:15 p.m.-6:30 p.m. Three physicians will share highlights and important take-home messages at the popular wrap-up session.

Once you get home, remember that handout materials for most scientific sessions are available online. Registered attendees can download the information by clicking on the Annual Session logo. Printed copies of handout materials will not be distributed at most sessions, but self-serve printer stations will be available for attendees' use.

Other highlights

New additions to this year's meeting include:

  • Pre-Session courses. On April 12 and 13, the College will offer one- and two-day pre-Session courses. This year's offerings include programs on faculty development, neurology for the internist, common bone and joint disorders, advances in drug therapy, critical care medicine, a recertification preparation course, and the ABIM SEP (self-evaluation process) recertification modules, Physical Exam and General Internal Medicine (00-A) modules.

  • Diabetes care. A new diabetes educational track will be unveiled, including eight unique sessions offered 15 different times. Look for the announcement listing all diabetes sessions in the Annual Session program book. One of the sessions covers a new ACP practice-based quality improvement program for diabetes care. Kevin B. Weiss, FACP, director of the program, will lead a panel discussion on how practice-based learning can help physicians analyze and improve how they care for diabetics. The session will also give pointers on how internists can set up—and get reimbursed for—group visits.

    Another session will focus on improving diabetes outcomes using a model developed by the National Diabetes Education Program. Both sessions are particularly timely as health plans move towards pay-for-performance programs.

  • Clinical skills workshops. A lecture on increasing patients' physical activity will be followed by a complementary workshop where you can practice coaching and counseling techniques with standardized patients. Also new this year is a workshop featuring help on completing American Board of Internal Medicine recertification PIM (practice improvement module), Preventive Cardiology, along with sessions on lower leg edema and wounds, screening for osteoporosis, communicating with difficult patients, and practical asthma skills. (Other workshops also will be offered. See "Session offers help detecting the telltale signs of mental illness."

  • The Herbert S. Waxman Learning Center. The Learning Center will once again feature a host of hands-on learning opportunities that complement many of the scientific presentations. Attendees will have the opportunity to brush up on their physical examination skills, communications skills, and office-based procedures, and also explore the latest in medical software.

    New Learning Center topics this year will focus on treating developmentally challenged adults, with a special focus on autism and mental retardation. After attending a one-hour lecture, attendees will have an opportunity to practice their skills with standardized patients. Other new lecture topics include endometrial biopsy, soft tissue injection techniques and vaginal wet prep microscopy.

    As in years past, the Learning Center will offer sessions on basic skills for gynecological, breast, genitourinary, joint and neurological examinations. Special three-hour sessions will focus on musculoskeletal screening and sports medicine exams.

    Expert faculty will also be on hand to provide feedback on office-based procedures such as skin biopsy, joint injection, and applying splints and casts. Technology tutorials will focus on using handheld computers and other point-of-care tools and incorporating technology like e-prescribing into your practice.

    The Learning Center will be open on Thursday from 10 a.m.-5 p.m. and on Friday and Saturday from 8 a.m.-5 p.m. On-site registration is required for all activities except the interactive resources area. Standbys are welcome, and there is often space available during off-peak times, particularly on Friday afternoon and Saturday.

  • Challenging Cases. This new format will explore practical issues in hematology/oncology and infectious diseases. Attendees will hear two to three cases in a 90-minute session presented by an expert in the field. Following the case-based presentations, the expert will address relevant clinical issues and common conundrums that occur in everyday practice. Both sessions will be held on Friday.

  • International volunteering. A new workshop on international volunteer opportunities is especially relevant in the wake of the devastating tsunami disaster in Asia and Africa. Moderator Susan Thompson Hingle, FACP, will talk about how to get involved and how to handle logistical issues surrounding visas, housing, safety, legal liabilities and language. The session will be held on Friday from 11 a.m.-12:30 p.m.

  • Doctor's Dilemma. The Jeopardy-style quiz game that tests residents' knowledge of internal medicine is back due to overwhelming demand. For the first time, the championship round will be held during Saturday evening's Wrap Up (5:15 p.m. to 6:30 p.m.). As many as 40 teams are expected to compete, with the field narrowed to eight teams for the semi-finals, and a final four vying for the Osler Cup—ACP's equivalent to the Stanley Cup.

  • Practice management. A series of sessions being offered on Thursday and Friday will focus on the most critical aspects of practice management, including financial management, coding and reimbursement, electronic medical records, practice efficiency, and profitability.

  • Meet and Eat with the Professor. These popular sessions allow small groups of physicians to meet with distinguished internists to discuss a wide range of topics. The informal breakfast and lunch programs cover recent developments in medicine and provide an opportunity to have an open dialog with faculty. The sessions require advance reservations.

  • 5K Fun Run and 3.5K Walk. This annual event will be held on Saturday from 6 a.m. to 7 a.m. starting at Crissy Fields at the Presidio. The cost is $25, with proceeds benefiting the UCSF Students' Homeless Clinic.


Session offers help detecting the telltale signs of mental illness

Robert K. Schneider, FACP, recalls when selective serotonin reuptake inhibitors first came on the market in 1989 and he began prescribing them to his depressed patients. As a primary care physician, he was impressed with the efficacy of these new drugs, but he felt ill-prepared to diagnose psychiatric conditions.

"All of a sudden, my patients who had depression or anxiety had tremendous functional improvement," said Dr. Schneider, facilitator of "The Psychiatric Interview in Primary Care" Learning Center workshop at Annual Session. "The problem was that I had no training in how to accurately diagnose these diseases. I incorrectly believed that psychiatry only involved schizophrenics in institutions."

That experience prompted him to do a residency in psychiatry. His plan was to teach general internists the psychiatry they needed to know to handle basic psychiatric issues confronting them everyday. He now works full time training medical residents at Richmond's Virginia Commonwealth University (VCU) in how to recognize, diagnose, and treat psychiatric disorders seen in the primary care setting.

On each day of Annual Session, Dr. Schneider, chair of the division of ambulatory psychiatry at VCU, will give a one-hour lecture on the basics of the psychiatric interview. Those sessions will be followed by a workshop in the Learning Center, where attendees can practice their interviewing skills on standardized patients.

About one-quarter of all primary care visits involve a diagnosable mental illness, he noted. Yet, many primary care physicians either do not recognize or incorrectly diagnose these conditions.

Internists should be able to recognize the symptoms of major depression, generalized anxiety disorder, post-traumatic stress disorder, bipolar disorder and schizophrenia, Dr. Schneider said. The internist's level of knowledge and skill in psychiatry should be similar to his facility with other specialties, such as cardiology.

In the workshop, sponsored last year and this year by Pfizer, attendees will have an opportunity to interview three different standardized patients simulating different conditions, he explained. At the end of the interview, the patient comes out of role and gives the internist very specific feedback. Internists must ask the right questions in order to make an accurate diagnosis.

"Just as we learn to ask about chest pain—what provokes it, what palliates it, does it radiate—internists should be doing the same thing for psychiatric symptoms," Dr. Schneider explained. "We are not interested in making internists into psychiatrists; rather we want to help make better internists."


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