Internal Medicine: A Clinical Update for Both the Inpatient and Outpatient

Day 1

Irritable Bowel Syndrome

Upon completion of this session, the participant should be able to:

• Appraise possible etiologies for Irritable Bowel Syndrome.
• Select and utilize diagnostic criteria to identify IBS, based on the current medical evidence and expert recommendations.
• Use the current medical literature to assess and screen for other conditions that can present with similar IBS symptoms.
• Detect “red flag” signs and symptoms that should make one question the diagnosis of IBS.
• Formulate an EBM diagnostic evaluation for patients with signs and symptoms of IBS.
• Use the current medical literature to develop an EBM treatment plan for Irritable Bowel Syndrome.

Dyspepsia

Upon completion of this session, the participant should be able to:

• Appraise symptoms and common etiologies for dyspepsia.
• Use EBM to detect “alarm symptoms” that are suspicious for GI malignancy.
• Apply current medical evidence and expert guidelines to construct a diagnostic evaluation for Dyspepsia.
• Determine appropriate treatment for Dyspepsia based on current medical evidence and the likely etiology.

Treatment of Primary Headache Syndromes

Upon completion of this session, the participant should be able to:

• Appreciate the role of abortive therapy for migraine, tension-type, and cluster headaches.
• Recognize the range of options for pharmacologic acute and preventive therapy, as recommended by the AHS 2015 Evidence-Based recommendations for migraine, as well as options for tension-type, and cluster headaches.
• Develop non-pharmacologic treatment strategies for migraine as per the most recent Cochrane Systematic Review.

Hypertension: Recent Trials and Rational Therapy

Upon completion of this session, the participant should be able to:

• Appreciate that all antihypertensive medications do not equally reduce cardiovascular risk.
• Apply the current JNC guidelines to clinical care of hypertensive patients.
• Recognize compelling indications for selection of initial antihypertensive therapy.
• Identify which drugs most effectively reduce the risk of cardiovascular disease.

Day 2

Rational Management of Depression in Primary Care

Upon completion of this session, the participant should be able to:

• Employ an appropriate initial approach to use of the updated USPSTF Guidelines for screening of the patient with depression.
• Determine the proper role of second generation antidepressants as per the ACP Guideline.
• Assess the effectiveness of augmentation and switching strategies.
• Specify the most common side effects, as per the 2016 ACP Guidelines, of commonly used antidepressants.

New Drugs for the Primary Care Physician: What You Need to Know

Upon completion of this session, the participant should be able to:

• Survey important advances in pharmacotherapy that pertain to primary care practice.
• Discuss the efficacy and list the side effects for each drug.
• Differentiate key new drugs with previously available medications for similar indications.

Dementia

Upon completion of this session, the participant should be able to:

• Detect symptoms consistent with the diagnosis of dementia.
• Distinguish dementia from treatable conditions that have similar presentations.
• Construct a diagnostic plan utilizing EBM and Expert Guidelines.
• Differentiate the common Dementia syndromes and distinguish the characteristics between them.
• Use EBM to design a treatment plan for dementia.

Hyperlipidemia and CV Disease Prevention – A Review of the Literature and Recent AHA Guidelines

Upon completion of this session, the participant should be able to:

• Create a diagnostic and treatment plan for patients based on the current evidence and AHA Guidelines.
• Explain similarities and differences between the most recent and previous guidelines.
• Identify areas of strength and weakness in the recent AHA Guidelines.
• Utilize the most recent cholesterol guidelines at the point of care.

Day 3

Carpal Tunnel Syndrome

Upon completion of this session, the participant should be able to:

• Apply an evidence-based approach to the identification of Carpal Tunnel Syndrome.
• Detect clues that can help identify likely etiologies for Carpal Tunnel Syndrome.
• Construct a differential diagnosis for Carpal Tunnel Syndrome.
• Determine which patients would benefit from nerve conduction studies.
• Discriminate the severity of Carpal Tunnel Syndrome.
• Use EBM to select an appropriate treatment plan for Carpal Tunnel Syndrome.

Evaluation and Treatment of Respiratory Infections Commonly Seen in Primary Care

Upon completion of this session, the participant should be able to:

• Formulate appropriate evaluation strategies for patients who present with respiratory conditions.
• Identify history and exam findings that help differentiate common respiratory conditions.
• Determine situations when antibiotics are appropriate for the treatment sinus infections.
• Utilize severity index tools in the evaluation of pneumonia.
• Utilize EBM to determine appropriate treatment for common respiratory conditions.
• Discuss some of the controversies in the treatment of common respiratory infections seen in primary care.

Approach to the Management of Chest Pain

Upon completion of this session, the participant should be able to:

• Evaluate the complaint in the context of history, physical exam, and EKG findings.
• Develop a strategy to use cardiac biomarkers in the evaluation of ACS.
• Use recent research studies and guidelines to develop an approach to the patient with chest pain.

Practical Approach to the Diagnosis and Management of Heart Failure

Upon completion of this session, the participant should be able to:

• Appraise the symptoms of congestive heart failure and detect the common causes of systolic heart failure.
• Employ the current standard-of-care therapies.
• Determine which patients will benefit from device therapy and specify when to refer patients for more advanced cardiac care.
• Be familiar with, and be able to apply, the 2013 ACCF/AHA Guidelines for the Management of Heart Failure.

Day 4

Lyme Disease and Other Topics in Rheumatology.

Upon completion of this session, the participant should be able to: ^{EBM, GL, COMP}

1. Apply CDC and Infectious Diseases Society of America Guidelines for the diagnosis, treatment, and prevention of Lyme disease.
2. Evaluate skin rashes as manifestations of systemic diseases.
3. Using the Guidelines of the Bone Research Society of the United Kingdom to prescribe appropriate therapy for patients with Paget’s disease of the Bone.

Spondyloarthropathies.

Upon completion of this session, the participant should be able to: ^{EBM, COMP}

1. Distinguish the clinical features of the different spondyloarthropathies to improve diagnostic accuracy.
2. Utilize clinical features, laboratory studies, and radiological studies to make a diagnosis of axial spondyloarthropathy.
3. Prescribe pharmacologic agents according to ACR and EULAR recommendations and evidence-based results from clinical trials for patients with spondyloarthropathies.

Strategies to Address the Issue of Preventable Hospital Readmissions.

Upon completion of this session, the participant should be able to: ^{EBM, COMP}

1. Identify the factors which contribute to increase risk of readmission.
2. Stratify the risk for readmission utilizing evidence-based tools.
3. Develop a transition of care strategy to reduce the likelihood of a preventable readmission.

 Approach to the Management of Diabetes in the Hospitalized Patient.

Upon completion of this session, the participant should be able to utilize the latest evidence based medicine and guidelines to: ^{EBM, GL, COMP}

1. Develop a diabetes treatment strategy that identifies and reaches a target glucose.
2. Develop a diabetes treatment strategy that integrates the issues of chronic management.

Develop a diabetes treatment strategy that utilizes insulin effectively.

Day 5

Practical Approach to the Patient with Potential DVT.

Upon completion of this session, using multiple research trials as well as applying recommendations from the ACCP, AAFP/ACP, and the AHA/ACC, the participant should be able to: ^{GL, COMP}

1. Obtain an appropriate medical history to better identify those patients at risk.
2. More confidently evaluate and assess the patient suspected of having DVT.

Better manage patients with the confirmed diagnosis of DVT.

Practical Approach to Thyroid Disease:                 1. Hypothyroidism/Elevated TSH 2. Patient with a Thyroid Nodule.

Upon completion of this session, by applying recommendations from the AAFP, AACE, ACP, ATA, USPSTF, IOM, and ACOG, the participant should be able to: ^{GL, COMP}

1. Appreciate the role of the screening TSH and what to do with the results.
2. Develop a reasonable and cost-effective approach to diagnosing the thyroid nodule.
3. Discuss the management of hypothyroidism.

Systemic Lupus Erythematosus.

Upon completion of this session, the participant should be able to: ^{GL, EBM, COMP}

1. Describe the varied clinical presentations and manifestations in the course of systemic lupus erythematosus.
2. Order and interpret laboratory testing used in the diagnosis of systemic lupus erythematosus in accordance with ACR Guidelines.
3. Monitor and employ treatment options for patients with systemic lupus erythematosus according to EULAR recommendations and evidence-based results from clinical studies.

Septic Arthritis.

Upon completion of this session, the participant should be able to: ^{GL, EBM, COMP}

1. Determine the risk factors associated with septic arthritis.
2. Utilize the British Society of Rheumatology Guidelines for management of the hot swollen joint in adults to differentiate septic arthritis for other causes of acute monoarticular arthritis.

Utilize epidemiological and clinical clues to determine bacterial etiology in patients with septic arthritis.