Aids Topics INTERNAL MEDICINE: Advances in Managing HIV and AIDS-A96 Diane V. Havlir, M.D. and Arthur Ammann, M.D. Discuss the benefits associated with early initiation of antiretroviral therapy. Implement evidence-based guidelines for initiating treatment in patients with HIV and AIDS-related complications. Detail the treatment options for treatment-naive and treatment-experienced patients with HIV infection. Identify patients at increased risk of transmitting HIV and initiate interventions that decrease that risk. Summarize the progress and remaining challenges related to the global AIDS epidemic.
(A96)
FAMILY PRACTICE: HIV: A Primary Care Update-A100 Monica Gandhi, M.D., M.P.H. and Gail Bolan, M.D. Incorporate routine HIV screening into health care maintenance. Describe current and newer methods for reducing HIV transmission. Counsel patients about when to start HIV treatment. Review screening options for syphilis. Select the best treatments of gonorrhea.
(A100)
OBSTETRICS/GYNECOLOGY: Clinical Challenges in Contraception and HIV-A101 Daniel R. Mishell, Jr., M.D. and Deborah Cohan, M.D. Discuss the efficacy, benefits, and drawbacks of different methods of contraception. Recognize contraindications for the use of combination oral contraceptives. Prescribe appropriate contraceptive methods for women with medical conditions. Determine the appropriate cervical cancer screening interval for women with HIV infection. Implement preconception and obstetric care in HIV-positive women.
(A101)
EMERGENCY MEDICINE: HIV Update-A102 Rachel L. Chin, M.D. and Arvind Venkat, M.D. Review the significance of the CD4 count in determining the stage of HIV infection and in monitoring therapy. Describe the metabolic complications associated with the use of HAART. Recognize and manage immune reconstitution inflammatory syndrome. Discuss how HAART increases the risk for cardiovascular and cerebrovascular disease. Recognize and treat complications associated with specific drugs used in HAART.
(A102)
FAMILY PRACTICE: Issues in HIV Medicine-A103 David M. Simpson, M.D. and Sally B. Slome, M.D. Describe effects of antiretroviral therapy on the incidence of common neurologic complications in HIV. Discuss findings about CD4 cell count in relation to risk for sustained neurocognitive impairment. Review drug data about central nervous system penetration, viral load, and cognitive impairment. Inform patients about sperm washing techniques and options for insemination. Counsel serodiscordant couples about transmission risk and risk reduction strategies.
(A103)
FAMILY PRACTICE: FYI on STDs-A104 Eva S. Hersh, M.D. and John W. Hering, M.D. Implement screening recommendations for HIV, Chlamydia trachomatis (CT), and gonorrhea. Incorporate HIV testing into routine screening procedures. Interpret HIV test results and select appropriate treatments. Describe new and established concepts in screening for CT and gonorrheal infections. Select appropriate treatment for CT and gonorrheal infections in pregnant women.
(A104)
Dermatology PEDIATRICS: Dermatologic Update-DERM4 Robert Sidbury, M.D., M.P.H. List the similarities and differences between atopic dermatitis (AD) and psoriasis. Explain how to clinically differentiate AD from psoriasis. Discuss the process whereby steroid use thins skin and enumerate measures for avoiding thinning. Describe the issues associated with exposure to the sun and vitamin D supplementation. Identify the health states recently linked to vitamin D deficiency.
(DERM4)
OB/GYN: Top to Bottom Problems in Dermatology-DERM5 Michael Policar, M.D. and Michelle Pelle, M.D. Recognize signs and symptoms of white vulvar lesions, such as lichen sclerosus, lichen simplex chronicus (LSC), lichen sclerosus with superimposed LSC, vulvar intraepithelial dysplasia, leukoderma, and vitiligo. Determine optimal treatment for different vulvar
lesions. Evaluate genital ulcers. Identify causes and prescribe appropriate treatment of alopecia in women. Discuss effective methods for treatment of unwanted facial hair in women.
(DERM5)
INTERNAL MEDICINE: Expert Advice: Vitamin D/Dermatology-DERM6 Craig A. Jaffe, M.D., Charles E. Crutchfield III, M.D. and Toby Maurer, M.D. Assess whether a patient is deficient in vitamin D. Employ vitamin D therapy to lower a patient’s risk for hip and nonvertebral fractures. Summarize recent findings on the potential role of vitamin D in the management of coronary artery disease and cancer. Recognize and treat a variety of dermatologic conditions, including psoriasis, allergic contact dermatitis, Bateman’s purpura, and atopic eczema. Choose the best course of treatment for the patient who presents with onychomycosis (tinea unguium).
(DERM6)
Domestic Violence EMERGENCY MEDICINE: Domestic Violence: The Hidden Epidemic-DV25 James W. Davis, M.D. Distinguish between the myths and realities surrounding domestic violence. Identify the stages in the cycle of abuse. Screen patients for possible domestic abuse and refer them for appropriate intervention. Describe the long-term sequelae of domestic abuse. Advocate for the need for hospitals and trauma centers to cooperate with law enforcement and prevention agencies and shelters in cases of domestic violence.
(DV25)
PEDIATRICS: Child Abuse-DV26 Jaime Pittenger, M.D. and Betsy McAlister Groves, M.S.W., L.I.C.S.W. Define child physical abuse and maltreatment. List the parent or caregiver, family, child, and environmental factors that increase risk for child physical abuse. Assess pediatric patients for potential child abuse. Identify cases of child medical and supervisional neglect. Utilize methods of preventing child maltreatment.
(DV26)
End-of-Life FAMILY PRACTICE: Management Issues in the Elderly-EOL5 Candice Garwood, PharmD and Jeffrey Rubin, M.D. Discuss the reasons behind the current underutilization of warfarin for anticoagulation therapy. Cite current American College of Chest Physician guidelines for anticoagulation in elderly patients. Recommend appropriate periprocedural management for an elderly patient on oral anticoagulant therapy. Describe the epidemiology and predisposing risk factors for abdominal aortic aneurysms. Effectively screen patients for aneurysms.
(EOL5)
INTERNAL MEDICINE: Palliative and End-of-Life Care-EOL8 and SR3 Melissa Hagman, M.D. and John F. MacMillan, M.D. Describe advanced care planning options and discuss them with patients and families. Evaluate patients’ desire for prognostic information and select the optimal timing and approach for discussion of palliative care with patients. Choose management strategies for anorexia in patients with terminal illnesses. Summarize the benefits of hospice care. Describe symptoms suffered by patients at the end of life and prescribe appropriate medical therapies for their treatment.
(EOL8)
GENERAL SURGERY: Outreach/Ethics-EOL9 Jonathan R. Hiatt, M.D., Lynette Cederquist, M.D. and Paul F. Mansfield, M.D. Provide support to families while caring for a dying patient. Utilize effective communication skills when delivering unwelcome news. Discuss end-of-life decisions in a manner that is helpful to patients, families, and physicians. Prioritize and respond to common end-of-life concerns. Implement institutional policies intended to prevent conflicts of interest and preserve academic integrity.
(EOL9)
FAMILY PRACTICE: The Complexities of Compassion-EOL10 James M. Risser, M.D. and Mary Faith Marshall, Ph.D. Define palliative care and the population of patients to whom it should be administered. Overcome potential side effects of long-term opioid use. Select appropriate medications to target varying degrees and causes of pain. Appropriately utilize services of ethics consultants to aid in end-of-life decision making. Recognize medical futility and appropriate use of advance directives.
(EOL10)
INTERNAL MEDICINE: Palliative Care Medicine-EOL11 Stuart J. Farber, M.D. and Scott A. Irwin, M.D., Ph.D. Create optimal conditions for the terminally ill patient and his or her family to discuss end-of-life concerns and decisions. Use an evidence-based approach to facilitate discussion of fears, concerns, and wants of the dying patient and his or her family. Recognize depression in patients in palliative care. Differentiate depression from delirium, dementia, adjustment disorders, and grief. Consider the use of psychostimulants for the management of depression at the end of life.
(EOL11)
PSYCHIATRY: Psychosocial and Spiritual Domains of Palliative Care-EOL12 William Breitbart, M.D. Expand the focus of palliative care to include psychiatric, psychosocial, existential, and spiritual domains. Reduce despair, loss of hope, depression, and anxiety in terminally ill patients. Identify unmet needs among cancer patients. Recognize basic sources of meaning critical to a patient’s spiritual well-being. Perform group-based and individual interventions to improve spiritual well-being.
(EOL12)
NEUROLOGY: Highlights from the West Coast Geriatric Psychiatry Conference-EOL13 Jody Corey–Bloom, M.D., Ph.D. and Elizabeth S. Menkin, M.D. Utilize patient history, mental status testing, neurologic examination, and clinical evaluation to diagnose dementia. Recognize the features and stages of Alzheimer disease and prescribe appropriate treatment. Differentiate Lewy body dementia from other forms of dementia and discriminate among the forms of frontotemporal dementia. Identify patients with dementia who qualify for hospice care. Counsel patients, families, and caregivers about hospice care, tube feeding, and other treatment decisions for patients with advanced dementia.
(EOL13)
Ethics INTERNAL MEDICINE: Trust Cycle: Saving Lives, Changing Lives from the Bedside to the Boardroom-E23 Brian D. Wong, M.D., M.P.H. Discuss the importance of trust in health care settings. Identify barriers to cooperation and teamwork. Recognize one’s personal role in suboptimal workplace dynamics. List the qualities of a TRUSTED colleague. Apply TRUSTED concept to facilitate positive change and effective solutions in the workplace.
(E23)
OTOLARYNGOLOGY: Ethical Issues in Medicine-E24 Peter Rosen, M.D. Explain the importance of having a well worked-out system of ethics in place. Define ethics and law, and describe the difference in these principles of conduct. Explore the current concept of an ethical relationship between the physician and the patient. List some of the general ethical problems that may be encountered in medical practice. Describe the recommended approach to resolving ethical dilemmas presented in case examples.
(E24)
GASTROENTEROLOGY: GI Ethical Issues-E26 David T. Rubin, M.D. and Carol Burke, M.D. Discuss some of the ethical dilemmas associated with genetic testing for IBD. Describe the influence of environmental factors on IBD. List the genes involved in IBD. Recognize the genetic features of familial adenomatous polyposis and Lynch syndrome. Explain the importance of informed consent for genetic testing in IBD and colorectal cancer.
(E26)
ANESTHESIOLOGY: Ethics-E28 Steven Z. Pantilat, M.D. and Carl W. Peters, M.D. Treat seriously ill patients with the goal of providing the best possible quality of life. Communicate sensitively with terminally ill patients and their families. Identify and manage symptoms that may add to a seriously or terminally ill patient’s suffering. List and discuss the fundamental ethical principles of the care of individuals with terminal illnesses. Describe the differences between goal-directed and procedure-directed approaches to DNR orders.
(E28)
GENERAL SURGERY: Ethical and Legal Conflicts in Medicine-E29 Andrew R. H. Newton, J.D. and David J. Satin, M.D. Assess the factors that define a corporation and govern its day-to-day operations. Avoid legal liabilities when serving on a corporate board. Fulfill obligations associated with belonging to a medical staff accredited by the Joint Commission on the Ac creditation of Healthcare Organizations. Describe how pay-for-performance programs link incentives to specific goals related to quality care. Develop an approach to managing new clinical evidence that conflicts with pay-for-performance guidelines.
(E29)
PEDIATRICS: Pediatric Medicine: Doing the Right Thing-E30 Douglas S. Diekema, M.D., M.P.H. and Michael R. Anderson, M.D. Describe examples of oversimplification of complex bioethical problems. Explain the 4 principles of principlism as they relate to issues in pediatric bioethics. List strategies for determining the need for intervention in parental decision making about children’s health care. Appreciate differences in children’s physioanatomy that increase their risk for serious injury in large-scale emergencies. Discuss pediatric triage strategies that decide courses of action in situations in which medical resources are limited.
(E30)
ANESTHESIOLOGY: Ethics Panel-E31 Wendy B. Kang, M.D., J.D. and Russell K. McAllister, M.D. Recognize the changes that have occurred in pain management practices over the last 50 years. Describe pain according to the definition and classifications provided by the International Association for the Study of Pain. Avoid oligoanalgesia stemming from misperceptions about differences in analgesic requirements among sexes and ethnicities. Cite the medicolegal consequences of inadequate pain treatment. Identify and avoid the unique risks run by physicians through participation in social networking.
(E31)
EMERGENCY MEDICINE: Posttraumatic Stress Disorder-E32 Donald Meichenbaum, Ph.D. Assess and diagnose PTSD, especially in veterans and victimized individuals. Communicate to patient with PTSD the benefits of participating in a therapeutic program. Establish a therapeutic alliance with the patient. Utilize cognitive behavioral therapy as a management tool for PTSD. Employ other psychotherapeutic strategies (eg, “clock” metaphor) in the management of PTSD.
(E32)
PSYCHIATRY: Ethics in Psychiatry-E33 Thomas G. Gutheil, M.D. Maintain a patient’s best interests when pressured to alter standards of practice. Avoid engaging in prescribing practices that encourage malpractice litigation. Manage risk by obtaining proper informed consent. Present objective testimony when acting as a forensic examiner. Limit exposure to ethical issues associated with legal cases involving the death penalty.
(E33)
PEDIATRICS: Palliative Care/Pediatric Assent-E35 Sarah Friebert, M.D. and Yoram Unguru, M.D. Define the role of palliative care in children with chronic, complex, or life-threatening illness. Compare and contrast the roles of ethics committees and palliative care teams in the management of pediatric patients. Identify situations in which dual or sequential ethics and palliative care consultations are appropriate. Recognize the importance of assent of pediatric patients when considering enrollment in clinical trials. Determine pediatric oncology patients’ comprehension of clinical trials and their roles as participants.
(E35)
OPTHALMOLOGY: Ethical Concerns-E37 Roberto Pineda, M.D. and Nancy M. Holekamp, M.D. Properly obtain informed consent for all patients undergoing ophthalmologic treatment. Define and describe the elements of informed consent. Disclose appropriate information about a proposed treatment to patients. Recognize situations that represent potential conflicts of interest in daily practice. Cite requirements of physicians who agree to provide expert testimony in a court of law.
(E37)
PEDIATRICS: Challenges in Ethics-E38 Lainie Friedman Ross, M.D., Ph.D. Delineate the roles and responsibilities of adult and pediatric surrogate decision-makers. Determine when it is appropriate to override refusals of treatment by parents, children, or both. Utilize strategies for negotiating with parents who refuse vaccinations, screening, and diagnostic tests for their children. Assess the risk to patients and the community associated with refusal of vaccination or medical treatment. Recognize factors that influence the legitimacy of refusals of life-saving treatment.
(E38)
Infectious Disease EMERGENCY MEDICINE: Infectious Disease Update 2009-ID7 Gregory J. Moran, M.D. Choose appropriate antibiotics for specific infections, including sepsis, septic shock, bacterial meningitis, and pneumonia. Recognize when antibiotics are not necessary or when a short course of antibiotics is appropriate. Discuss the differences between community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and hospital-acquired MRSA and the treatment of CA-MRSA infections of differing severity. Explain the epidemiology of West Nile virus infections and the treatment of Clostridium difficile infections. Describe the problems expected to be encountered in an influenza epiedemic and the challenges in preparing for one.
(ID7)
PEDIATRICS: Infectious Disease Consult-ID11 John S. Bradley, M.D. and Ravi Jhaveri, M.D. List the most common causes of CAP in children. Describe factors that vary with the etiology of CAP and that may provide clues when diagnosing a child’s CAP. Utilize the patients age, clinical presentation, physical examination, and laboratory tests to focus anti-infective therapy against the most likely disease-causing pathogens. Discuss recent studies documenting the impact of PCV7 on pneumococcal pneumonia and meningitis. Recognize indicators for switching from intravenous to oral antibiotics in the treatment of osteomyelitis.
(ID11)
PEDIATRICS: ENT Infections/Travel Medicine-ID12 S. Michael Marcy, MD Discuss the difficulty of using clinical criteria alone to diagnose acute otitis media (AOM). Describe the latest guidelines for antimicrobial therapy for AOM and treatment recommendations for the penicillin-allergic child. Explain methods that can be used to diagnose group A b-hemolytic streptococcal (GABHS) pharyngitis, and describe antibiotic agents available for its treatment. Cite recent data on observation vs antibacterial therapy for treatment of pediatric acute bacterial sinusitis. Describe safety and health precautions and recommended preparations for international travel with children.
(ID12)
OTOLARYNGOLOGY: Update on Prevention and Management-ID13 Andrew T. Kroger, M.D. and Sandro K. Cinti, M.D. Describe risk factors and give immunization recommendations for infectious diseases ranging from human papillomavirus to influenza. Assess the need for immunizations in individual health care providers. Explain the molecular mechanisms behind treatment resistance in Staphylcoccus aureus. Distinguish resistance patterns of hospital-acquired MRSA from those of community-acquired MRSA. Manage MRSA infections of varying severity using the appropriate antibiotics and strategies.
(ID13)
GASTROENTEROLOGY: Infectious Diseases-ID14 David A. Peura, M.D. and C. Bradley Hare, M.D. Assess patients with gastritis and dyspepsia for H pylori infections. Compare various treatment regimens for H pylori infection. Predict gastric cancer risks among patients with H pylori. Determine which early antiretroviral drug intervention is best for treatment-naive HIV-positive patients. Discuss findings of recent clinical trials on use of antiretroviral agents in the ongoing management of HIV-positive patients.
(ID14)
PEDIATRICS: Infectious Disease Consult-ID17 Wilbert H. Mason Jr, M.D. Describe the mechanisms of action and advantages of nucleic acid-based molecular diagnostic tests. Begin earlier and more effective treatment of common pediatric infectious diseases using nucleic acid- and im mune-based diagnostic methods. Effectively diagnose patients with seasonal influenza and pandemic influenza.Identify patients who are at increased risk of developing severe illness from influenza H1N1. Describe the safety profile and anticipated side effects of influenza vaccines, including the risk of developing Guillain-Barr�yndrome.
(ID17)
INTERNAL MEDICINE: Current Concepts in Infectious Disease Management-ID18 Bruce Farber, M.D. and David Coleman, M.D. Summarize recent changes and trends in infectious disease. Select the best treatment for outpatient and inpatient gram-positive infections, including methicillin-resistant Staph ylococcus aureus (MRSA) and Clostridium difficile. Reduce the use of antibiotics and the length of antibiotic therapy in the outpatient setting. Implement the principles of management of animal bites. Recognize physical findings that should heighten concern about deep soft tissue infections.
(ID18)
OB/GYN: Issues in Hepatitis-ID19 Dawn Sears, M.D. and Deborah Cohan, M.D. Compare and contrast the clinical features of acute and chronic hepatic injury. Diagnose and manage patients with viral hepatitis. Cite the risk factors for transmission of hepatitis viruses. Identify and manage cases of nonviral hepatitis, including autoimmune liver disease, hemochromatosis, primary biliary cirrhosis, primary sclerosing cholangitis, and nonalcoholic and alcoholic hepatitis. Implement the appropriate courses of screening, vaccination, treatment, and prophylaxis for pregnant women with hep atitis B or hepatitis C viral infection.
(ID19)
OTOLARYNGOLOGY: Infections and Inflammation-ID20 Henry F. "Chip" Chambers, M.D., Robert S. Lebovics, M.D. and Maura L. Gillison, M.D., P.h.D. Prescribe outpatient antibiotic treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections of the head and neck. Determine when vancomycin is contraindicated for treatment of MRSA infection. Recognize signs and symptoms of Wegener granulomatosis. Identify risk factors for oropharyngeal cancer, including presence of oral HPV 16 infection. Cite evidence of the association between sexual behaviors, risk for HPV 16 infection, and risk for development of oropharyngeal cancer.
(ID20)
OB/GYN: Infectious Threats to Women's Health-ID21 Lisa Winston, M.D. and Catherine Liu, M.D. Discuss the biology of influenza viruses. Determine appropriate candidates for influenza vaccination. Implement antiviral therapy for influenza. Manage complicated and uncomplicated skin and soft tissue infections in pregnant women. Prescribe antimicrobial therapy for an MRSA infection during pregnancy.
(ID21)
PEDIATRICS: Infectious Disease Issues-ID22 Kevin Coulter, M.D. Determine the appropriate timing for vaccinations. List contraindications to childhood vaccinations. Recognize signs and symptoms of infectious childhood diseases. Recommend appropriate treatments for infectious diseases, based on patient age, etiology, and radiographic and clin ical findings. Describe differential diagnoses of various infectious diseases.
(ID22)
FAMILY PRACTICE: Immunization Update: What's New, What's True?-ID23 Doug Campos-Outcalt, M.D. Describe new, established, and current concepts in immunization practice for adolescents and adults. Describe current concepts in immunizations for travelers. Customize vaccination programs to suit individual patient's needs. Design and implement clinical vaccination programs based on the prevalence in a particular community. Explain why current recommendations for administration of the pneumococcal polysaccharide vaccine in smokers are controversial.
(ID23)
INTERNAL MEDICINE: 'Tis the Season: Pneumonia/Influenza-ID24 Bradley A. Sharpe, M.D. and Sandro K. Cinti, M.D. Predict and determine the microbiologic etiology of a patients community-acquired pneumonia (CAP). Assess patients for potential drug resistance and provide appropriate therapy. Distinguish between unique features of health care-associated pneumonia (HCAP) and CAP. Implement polices designed to increase preparedness for an influenza epidemic or pandemic. Describe factors that alter virulence and mortality rates associated with specific influenza strains.
(ID24)
PEDIATRICS: Bugs and Drugs-ID25 Charles D. Mitchell, M.D. and Michael E. Pichichero, M.D Describe the pathogenesis of TB infection and disease. Discuss techniques of diagnostic microbiology and their usefulness in diagnosing childhood TB. Explain the basic premise of the in vitro interferon-g release assay (IGRA) and summarize recent studies on its role in the immunodiagnosis of TB. Cite national data on the overprescribing of antibiotics in pediatric patients. Describe and follow American Academy of Pediatrics guidelines for management of acute otitis media, group A streptococcal pharyngitis, bacterial sinusitis, upper respiratory infections, and cough illness or bronchitis.
(ID25)
FAMILY PRACTICE: HPV: Factual Analysis-ID26 Michael S. Policar, M.D. Review the human papillomavirus (HPV) DNA types and their oncogenic potential. Describe the timing of HPV infection, risk factors associated with infection, and the natural history of disease progression. Summarize current guidelines for screening for cervical cancer using the Papanicolaou test. State current guidelines for management of cervical abnormalities, including appropriate use of colposcopy. Discuss appropriate timing of HPV testing and guidelines for use of the HPV vaccine.
(ID26)
PEDIATRICS: Infectious Disease Update-ID27 Michael Anthony Moody, M.D. and Deborah Lehman, M.D. Describe the mechanisms of action of and indications for tigecycline, daptomycin, and linezolid. Avoid prescribing practices that lead to antibiotic resistance. Explain the etiology of osteomyelitis in pediatric patients. Choose laboratory and radiographic tests effective for the diagnosis of osteomyelitis. Recognize the microorganisms that are commonly implicated in pediatric osteomyelitis.
(ID27)
FAMILY PRACTICE: Directions for Difficult Infections-ID28 Joanne N. Engel, M.D., Ph.D. and Henry (Chip) F. Chambers III Distinguish viral, bacterial, and protozoal causes of diarrhea. Choose appropriate therapy for diarrhea, based on cause and clinical findings. Select antibiotics to reduce risk for Clostridium difficile infection. Recognize infectious chorioretinitis. Discuss reasons for inconsistent microbiologic test findings in bacterial pneumonia.
(ID28)
PEDIATRICS: Infectious Disease Consult-ID29 Russell W. Steele, M.D. and Michael E. Ryan, D.O. Recognize risks associated with the growing incidence of Chagas disease in the United States. Immunize pediatric patients within recent guidelines for vaccination. Consider treatment with an oral antiviral agent in infants testing positive for cytomegalovirus. Appropriately counsel parents who refuse or are reluctant to have their children vaccinated. Implement practices that prevent increases in resistance to antibiotic therapy and discourage the spread of resistant strains of bacteria.
(ID29)
PEDIATRICS: Update on Selected Infections-ID30 John S. Bradley, M.D. and Stephen C. Eppes, M.D. Recognize potential complications of MRSA infections. Provide appropriate therapy for patients with mild, moderate, and invasive MRSA infections. Recommend effective strategies for the prevention of recurrent infection with MRSA. Identify appropriate candidates for antiviral influenza treatment or prophylaxis. Administer the trivalent (TIV) and live attenuated (LAIV) influenza vaccines according to their indications and recommendations from the Centers for Disease Control and Prevention.
(ID30)
PEDIATRICS: Infectious Disease Consult-ID31 Christopher J. Harrison, M.D. Assess pediatric patients for potential group A Streptococcus (GAS) infection based on clinical presentation. Effectively utilize rapid antigen testing to confirm a diagnosis of GAS infection. Prescribe appropriate pharmacotherapy for resistant and/or recurrent GAS infection. Recognize Epstein-Barr virus (EBV) in patients who present with both typical and atypical symptoms. Accurately interpret laboratory findings in patients with suspected EBV infection.
(ID31)
INTERNAL MEDICINE: Antimicrobial Stewardship in Infectious Disease-ID32 Paul G. Auwaerter, M.D. and Paul Pottinger, M.D. Treat most upper respiratory tract infections (eg, bronchitis, sinusitis, pharyngitis) and simple cutaneous abscesses without unnecessary antibiotic use. Manage the expectations and concerns of patients who present desiring antibiotic therapy. Identify those sinusitis patients whose disease might have a bacterial etiology and prescribe appropriate first-line antibiotics when necessary. Evaluate and manage skin and soft tissue infections when methicillin-resistant Staphylococcus aureus is a consideration. Summarize recent data on the new antibiotics telavancin and tigecycline.
(ID32)
PEDIATRICS: Hot Topics-ID33 Stephen C. Eppes, M.D., Udayan K. Shah, M.D. and David E. Tunkel, M.D. Recognize the impact of antimicrobial resistance on pediatric antibiotic treatment strategies. Recommend appropriate antibacterial therapy in pediatric patients with bacterial and fungal infections. Treat pediatric patients with obstructive sleep apnea. Evaluate children with suspected otitis externa. Counsel parents on safe and effective utilization of over-the-counter cold and cough medications in pediatric patients.
(ID33)
FAMILY PRACTICE: Infectious Diseases: Pointers on Prevention-ID34 Philip J. Rosenthal, M.D. and Lisa G. Winston, M.D. Advise patients about vaccines (eg, hepatitis A, meningococcal, and typhoid fever vaccines) recommended for specific travel destinations. Counsel patients about prevention and treatment of traveler’s diarrhea. Treat malaria with new highly effective agents. Recognize limitations associated with vaccines for mumps and measles. Follow recommendations for use of meningococcal and pertussis vaccines in adults and adolescents.
(ID34)
FAMILY PRACTICE: Potentially Deadly Infections: New Directions in Management-ID35 Henry (Chip) F. Chambers III, M.D. and Catherine Liu, M.D. Assess septic arthritis through the use of appropriate laboratory test values. Use imaging studies appropriately in the diagnosis of osteomyelitis. Recognize risks and benefits of common oral antibiotics in the treatment of skin and soft tissue infections. Treat abscesses and cellulitis appropriately. Counsel patients with recurrent infections about decolonization regimens.
(ID35)
PEDIATRICS: Infectious Disease Update-ID36 Mark H. Sawyer, M.D. Compare and contrast different rapid diagnostic tests for pediatric infections. Select the appropriate rapid diagnostic test for detection of respiratory viruses in pediatric patients. Recognize epidemiologic factors behind the most recent pertussis outbreak in California. Diagnose pertussis in infants, children, adolescents, and adults. Identify and inoculate individuals who qualify for the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine.
(ID36)
PEDIATRICS: Travel Medicine-ID37 Karen A. Ravin, M.D. Recognize risk for infection in those traveling to particular parts of the world. Identify required and recommended immunizations for worldwide travel. Immunize pediatric patients appropriately on the basis of anticipated travel itineraries. Provide instructions to parents about avoiding contact with infectious pathogens while traveling to other countries. Determine causative pathogens of travel-associated illness on the basis of travel itinerary, physical findings, and laboratory findings.
(ID37)
EMERGENCY MEDICINE: Infectious Disease: Part I, Pediatrics, Bacterial Resistance-ID38 ID38 Determine when to administer rabies vaccine for postexposure prophylaxis. Prescribe the appropriate antibiotics for pediatric osteomyelitis based on the causative organism. Consider the epidemiologic setting when a conduction abnormality is found in a child in whom disseminated Lyme disease is suspected. Recognize the risk factors for resistance to penicillin and colonization with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Recommend the appropriate antibiotics and use of silver-impregnated gauze in the management of skin infections caused by CA-MRSA.
(ID38)
EMERGENCY MEDICINE: Infectious Disease: Part 2, The Elderly/Bacterial Resistance-ID39 Amal Mattu, M.D. and Peter DeBlieux, M.D. Recommend evaluation of the abdomen if unable to determine the source of infection in an elderly patient. Recognize the difference in the definition of fever in the elderly from that in young individuals. Evaluate an elderly patient for infection in the presence of delirium and tachypnea. Describe the risk factors for vancomycin-resistant enterococci (VRE) infection, health care-associated pneumonia, and Clostridium difficile infection. Prescribe the appropriate antibiotic regimen for VRE infection, health care-associated pneumonia, and C difficile infection.
(ID39)
EMERGENCY MEDICINE: Infectious Disease: Part 3, Chickenpox/Tick-Borne Disease-ID40 Manish Garg, M.D. and Stephen C. Eppes, M.D. Implement current recommendations for vaccination against varicella zoster virus (VZV). Recognize which patients exposed to VZV are likely to develop severe disease. Diagnose tick-borne infections based on their clinical features. Recognize and manage disseminated Lyme disease. Counsel patients on prevention of tick-borne diseases.
(ID40)
FAMILY PRACTICE: Infections of the Ear, Nose and Sinuses-ID41 S. Michael Marcy, M.D. and Mark A. Zacharek, M.D. Identify clinical signs and symptoms most predictive of AOM. Determine when observation alone may be appropriate in infants with uncomplicated AOM. Choose primary treatment options for children allergic to penicillin. Distinguish acute viral rhinosinusitis from acute bacterial rhinosinusitis based on clinical findings. Recognize fungal and allergic components of chronic sinusitis.
(ID41)
Medical Errors ANESTHESIOLOGY: Patient Safety-ME4 Kenneth F. Kuchta, M.D. and John J. Nance, J.D. Describe common anesthetic medication errors. List the likely contributing factors resulting in anesthetic medication errors. Provide recommendations to minimize anesthetic medication errors. Consider how culture change can be brought about in health care. Evaluate the roles of perception, assumption, and communication in medical errors.
(ME4)
OTOLARYNGOLOGY: Strategies for Improving Your Surgical Practice-ME5 John J. Nance, J.D. and Peter A. Adamson, M.D. Consider how culture change can be brought about in health care. Evaluate the roles of perception, assumption, and communication in medical errors. Describe unique ability and how it affects surgical practice. Apply delegation and growth strategies to a surgical practice. Discuss the frontstage/backstage model of surgical practice.
(ME5)
GENERAL SURGERY: GI Surgery-ME6 Jeffrey A. Sternberg, M.D., Michael J. Stamos, M.D. and David W. Easter, M.D. Distinguish between simple and complex fistulas. Describe techniques for the management of complex fistulas and determine their appropriate use. Identify instances in which mechanical bowel preparation for colorectal surgery is appropriate. Describe the efficacy of new techniques in the surgical management of GERD. xplain the appropriate use of pH monitoring of patients with GERD.
(ME6)
FAMILY PRACTICE: Patient Safety and Patient Satisfaction-ME7 Robert M. Wachter, M.D. and Michael L. Howell, M.D., M.B.A. Identify common practices in health care settings where medical errors occur. Describe the dominant mental model of patient safety and medical errors. Communicate with patients to reduce unmet concerns. Use consultation time effectively to complete patients' agendas. Provide feedback and acknowledge needs of patients, family, and staff.
(ME7)
ANESTHESIOLOGY: Patient Safety/Geriatrics-ME8 Martin A. Makary, M.D., M.P.H. and Jacqueline M. Leung, M.D., M.P.H. Recognize factors that complicate measurement of patient safety in hospitals. Identify the elements of a hospital’s culture that contribute to or detract from patient safety. Distinguish among delirium, dementia, and postoperative cognitive dysfunction. Screen for and diagnose delirium in high-risk patients. Develop appropriate anesthesia and pain management plans for patients at high risk of developing delirium.
(ME8)
Pain Management FAMILY PRACTICE: Pain and Behavioral Dilemmas-PM66 Mark S. Wallace, M.D. and Lloyd A. Darlow, M.D. Recognize fibromyalgia in patients who present with musculoskeletal pain. Address other features of fibromyalgia, such as sleep disturbances. Select effective therapy for fibromyalgia, based on clinical evidence. Select effective therapy for children with attention-deficit/hyperactivity disorder (ADHD). Differentiate ADHD from oppositional defiant disorder.
(PM66)
FAMILY PRACTICE: Pearls in Pain Management-PM67 Nathan J. Rudin, M.D. and James W. Leonard, D.O. Describe risks and benefits associated with use of nonsteroidal anti-inflammatory drugs. Target specific pain conditions such as diabetic neuropathy and fibromyalgia with appropriate medications. List risks and benefits of common adjuvant analgesics.Identify effective uses of ultrasonography and transcutaneous electrical nerve stimulation for pain. Counsel patients about rehabilitating with exercise and strength training.
(PM67)
FAMILY PRACTICE: Pain Management: A Primary Care Perspective-PM68 Richard C. Timming, M.D. and Edward C. Covington, M.D. Distinguish chronic pain from acute pain. Identify candidates for opioid use. Establish a care plan for patients experiencing chronic pain, based on clinical findings. Describe the effect of cognition and perceptions on chronic pain. Outline behavior modification techniques for comorbid pain and psychiatric disorders.
(PM68)
OBSTETRICS/GYNECOLOGY: Pain Issues in Women-PM69 Dawn A. Marcus, M.D. and Jan Lewis Brandes, M.D. Recognize hormonal influence on migraine headache. Individualize therapy for women with migraine headache during the perimenopausal period. Cite diagnostic criteria for fibromyalgia. Discuss the role of central sensitization in symptoms associated with fibromyalgia. Recognize and care for patients with fibromyalgia.
(PM69)
PSYCHIATRY: The Psychiatrist/Psychologist as Pain Manager-PM70 Barry Eliot Cole, M.D., M.P.A. and Robert Lynn Horne, M.D. State the contributions psychiatrists and psychologists can make to the field of pain management. Describe the pathophysiology of chronic pain. Discuss methods for managing chronic pain. Define fibromyalgia using the American College of Rheumatology criteria. Diagnose and treat fibromyalgia.
(PM70)
INTERNAL MEDICINE: Common Pain Disorders in Primary Care-PM71 Michael J. Battistone, M.D. and Stephanie J. Nahas, M.D., M.S. Ed. Use the American College of Physicians and American Pain Society clinical guidelines to distinguish among the 3 general etiologic categories of low back pain. Describe the comprehensive physical examination of the patient with back pain. Recognize psychosocial factors that affect prognosis in patients with back pain. Use clinical criteria for migraine and a detailed history to evaluate the patient presenting with headache. Identify signs and symptoms of underlying organic disease in patients presenting with headache.
(PM71)
PEDIATRICS: Pediatric Orthopedics-PM73 T. Desmond Brown, M.D. and Jennifer M. Weiss, M.D. Recognize red flags in the child with back pain that may indicate serious pathology. Choose appropriate imaging studies for pediatric back pain and sports injuries. Explain the role of exercise and stretching in treatment of pediatric back pain. List the most common sports injuries in pediatric patients. Identify pediatric sports injuries that require surgical intervention.
(PM73)
ANESTHESIOLOGY: Control of Chronic Pain and Acute Pain/Hemoglobinopathies-PM74 Teresa Dews, M.D., John E. Tetzlaff, M.D. and Stacy Ritzman, M.D. Describe the action and effects of opiates. Recognize the differences between addiction, dependence, and tolerance. Develop a treatment plan for prescribing opiates, including mutually agreed upon treatment goals and regular monitoring of the patient for compliance and side effects. Discuss the advantages of using peripheral nerve catheters for management of acute pain . List the most common hemoglobinopathies and coagulopathies, including sickle-cell disease and von Willebrand’s disease.
(PM74)
OTOLARYNGOLOGY: Trends in Treatment-PM75 J. Stephen Huff, M.D., Frederick G. Freitag, D.O. and Stewart J. Tepper, M.. Recognize common and serious causes for headache in the emergency department. Distinguish clinical features of cluster headache from those of migraine. Treat cluster headache using abortive agents and long- and short-term preventive agents. Explain the autonomic system pathogenesis of cluster headache. Describe mechanisms and outcomes of sphenopalatine ganglion stimulation in patients with chronic refractory cluster and migraine headaches.
(PM75)
ORTHOPEDICS: Low Back and Hip Pain-PM76 Brian A. Davis, M.D. and John P. Meehan, M.D. Identify which types of LBP are most amenable to acupuncture. Recommend manipulation and mobilization techniques as complements to the medical management of LBP. Explain prolotherapy treatments intended to alleviate pain by stimulating the repair of connective tissues. Diagnose patients presenting with hip pain of unknown origin. Determine appropriate treatment for conditions causing hip pain.
(PM76)
FAMILY PRACTICE: Pointers in Pain Management-PM77 Miles J. Belgrade, M.D. Distinguish between chronic and acute pain. Discuss the pitfalls or seven deadly sins in chronic pain management. Recognize flares of chronic pain and treat them appropriately. Identify forms of noncompliance in opioid users. Select patients for opioid use, based on risk and other factors.
(PM77)
UROLOGY: Interstitial Cystitis (Pelvic Pain)-PM78 C. Lowell Parsons, M.D. Diagnose IC based on symptoms and a simple patient history. Explain how diseases of the bowel may share a potassium-related etiology with IC. Discuss the role of healthy mucus in protecting the bladder and bowel. Recognize symptoms of overactive bladder or urethral syndrome that may be caused by IC. Provide treatment that allows patients immediate relief from symptoms of IC.
(PM78)
INTERNAL MEDICINE: Perspectives on Pain Management-PM79 Miles J. Belgrade, M.D. and Barak Gaster, M.D. Differentiate between chronic pain flares and other types of disease processes. Identify factors that contribute to pain flares. Treat episodic chronic pain flares with an emphasis on effective long-term care as well as prevention. Manage long-term opiate administration with an awareness of common pitfalls associated with chronic pain man agement. Detect and limit substance abuse while maintaining effective opiate-based treatment for patients suffering from chronic pain.
(PM79)
ANESTHESIOLOGY: Opioids and the Patient with Chronic Pain-PM80 Lauren Shaiova, M.D., Christopher G. Gharibo, M.D. and Charles E. Inturrisi, P.h.D. Avoid common errors related to prescribing pain medication. Prescribe analgesic doses of methadone to patients receiving methadone in drug rehabilitation programs. Appreciate the impact of undertreatment of chronic pain on individuals and society. Describe abuse-deterrent formulations of opioid medications currently in use or under development. Identify mechanisms which may be responsible for the development of opioid-induced hyperalgesia.
(PM80)
PEDIATRICS: Headache Update-PM81 A. David Rothner, M.D. Classify pediatric headaches based on clinical presentation. Screen pediatric patients presenting with headache using a definitive methodology. Distinguish headaches associated with organic disease from those with benign etiologies. Treat migraine headache in pediatric patients with pharmacologic and nonpharmacologic modalities. Determine when it is appropriate to institute preventive measures for pediatric headache.
(PM81)
PEDIATRICS: The Child in Pain-PM82 Murray H. Passo, M.D. and Robert M. Bernstein, M.D. Distinguish between inflammatory arthropathies and musculoskeletal pain syndromes in children. Perform clinical evaluations for diagnosis of various pediatric musculoskeletal pain syndromes. Prescribe appropriate treatment for different musculoskeletal pain syndromes in children. List possible causes of musculoskeletal back pain in children. Recognize red flags that indicate serious underlying pathology in children with back pain.
(PM82)
FAMILY PRACTICE: Rheumatic Diseases: An Update on Management-PM83 Kent A. Huston, M.D. and K. Kwas Huston, M.D. Reach target serum uric acid levels in patients with acute gout. Initiate corticosteroid therapy in patients with temporal arteritis. Discuss the value of vertebroplasty for painful compression fractures, and sensitivity of screening assays for lupus. Distinguish primary Raynaud’s phenomenon from secondary Raynaud’s phenomenon. Select appropriate therapy for Raynaud’s phenomenon and digital ischemic ulcers.
(PM83)
NEUROLOGY: Medication Overuse Headache: Part I-PM84 Jennifer S. Kriegler, M.D. Identify medications and comorbid conditions associated with the development of MOH. Describe shared mechanisms and etiologies of headaches and other pain disorders. Restore headaches to episodic patterns by weaning key medications. Provide adjunctive treatments to help patients wean from medications associated with MOH. Prevent dangerous symptoms associated with medication toxicity and withdrawal.
(PM84)
NEUROLOGY: Medication Overuse Headache: Part 2-PM85 Michael Liebenstein, Ph.D., Deborah E. Tepper, M.D. and Stewart J. Tepper, M.D. Identify psychiatric comorbidities in patients with MOH. Apply cognitive behavioral therapy and other behavioral interventions for treatment of MOH. Classify MOH and explain its physiologic basis. Describe the structural and functional changes that occur in the brain as the result of frequent migraine attacks and MOH. Discuss the role of long-term opioid use in the progression to chronic daily headache and opioid-induced hyperalgesia.
(PM85)
ANESTHESIOLOGY: Acute and Chronic Pain Update-PM86 Joseph M. Neal, M.D. and James P. Rathmell, M.D. Describe advantages of and indications for perineural catheters. Utilize techniques to ensure proper placement of perineural catheters. Administer appropriate doses of intrathecal analgesia at appropriate times during procedures. Recognize risk factors for the development of chronic postoperative pain. Identify measures that may lower the risk for chronic postoperative pain.
(PM86)
OB/GYN: Evaluating and Managing Chronic Pelvic Pain-PM87 Michael S. Policar, M.D., M.P.H. Identify the most common gastrointestinal (GI), urinary tract, and gynecologic causes of CPP in women. Explain the pain generator approach for evaluating CPP in women. Recognize the interaction of pain and depression in CPP. Choose among treatment options for endometriosis. Utilize appropriate management pathways for GI, urinary tract, and gynecologic causes of CPP in women.
(PM87)
PSYCHIATRY: Pain Management-PM88 Daniel J. Clauw, M.D. and Barry Eliot Cole, M.D. Appreciate pathophysiologic distinctions between acute and chronic pain. Identify factors that predispose patients to developing chronic widespread pain and central pain. Restore proper modulation of nociceptive signaling to relieve pain in patients with central pain. Explain pain-reducing mechanisms associated with different psychotropic adjuvants for pain. Provide adjuvants to relieve pain in treatment-resistant patients.
(PM88)
EMERGENCY MEDICINE: Chronic Pain Management-PM89 Kevin Klauer, D.O. and Mel Pohl, M.D. Distinguish addiction from pseudoaddiction. Identify the predictors of addiction and behaviors that indicate addiction. Recognize the issues that are considered barriers to effective pain management and implement solutions. Practice strategic and conservative prescribing to avoid opioid addiction in patients with chronic pain. Discuss the effect of emotions on a patient’s perception of pain.
(PM89)
PSYCHIATRY: Migraine-PM90 Robert B. Shulman, M.D. and Roger K. Cady, M.D. Identify etiologic factors shared among mood disorders, migraines, and chronic pain disorder. Distinguish patients with depressive traits due to bipolar disorder from those with unipolar depression. Explain mechanisms responsible for analgesic effects associated with multiple classes of psychiatric medications. Recognize neurologic traits that predispose patients to the development of migraine headaches. Educate patients about risk factors and protective influences that may affect the likelihood of a migraine attack.
(PM90)
NEUROLOGY: Migraine: Communicating with Patients-PM91 Mark W. Green, M.D. and Roger K. Cady, M.D. Explain potential causes and symptoms of migraines. Prevent migraine recurrence after medication use. Recognize potential causes and signs of medication overuse. Improve the efficacy of acute treatments by promoting early intervention. Recommend preventive medications and practices to reduce the frequency of headaches.
(PM91)
INTERNAL MEDICINE: Topics in Neurology-PM92 (PM92)
NEUROLOGY: Neuropathic Pain/Pressure Headaches-PM93 Steven B. Graff–Radford, D.D.S. and Robert G. Kaniecki, M.D. Explain the pathophysiology and pharmacotherapy of trigeminal neuralgia. Describe surgical interventions for trigeminal neuralgia. Review processes involved in the development of neuropathic pain after nerve injury. Treat post-lumbar puncture headaches. Relieve headaches due to intracranial hypertension by correcting intracranial pressure.
(PM93)
FAMILY PRACTICE: Management of Neuropathic Pain-PM94 Gregory L. Holmquist, Pharm.D. Differentiate neuropathic pain from other pain types. Explain opioid-induced hyperalgesia. Review risks, benefits, and efficacy of nonsteroidal anti-inflammatory drugs and antidepressants in treatment of neuropathic pain. Select an effective anticonvulsant for neuropathic pain. Discuss the role of topical agents and cannabinoids.
(PM94)
NEUROLOGY: Headache-PM95 Jan Lewis Brandes, M.D., M.S. and James W. Banks III, M.D. Summarize the effects of changing levels of estradiol on migraine headaches. Determine whether patients’ migraine headaches are influenced by hormonal changes and whether hormonal therapy is appropriate. Recognize the prevalence of self-medication with over-the- counter medications (OTCs) among patients with headaches and advise patients on the best use of these agents. Evaluate the strength of the clinical data that support the efficacy of OTCs. Identify the potential interactions of concern between triptans and other commonly used medications as well as drugs used for migraine prophylaxis.
(PM95)
INTERNAL MEDICINE: Pain and Aging-PM96 Perry G. Fine, M.D. Address the consequences of persistent pain in older patients. Identify and document a patient’s unique “pain signature.” Recognize the physical changes of aging that affect pharmacotherapy. Differentiate among tolerance, dependence, addiction, and pseudoaddiction in patients on pharmacotherapy. Adapt a patient’s pain management therapy to meet his or her changing medical, social, and/or psychologic circumstances.
(PM96)
EMERGENCY MEDICINE: Managing Pediatric Pain-PM97 Steven M. Selbst, M.D. Discuss the reasons for inadequate pain control. Utilize age-dependent pain scales to assess pain. Prescribe the appropriate analgesics for mild to moderate pain and moderate to severe pain. Implement the American Academy of Pediatrics guidelines for moderate sedation. Elaborate on the advantages and disadvantages of different local anesthetics and sedative agents.
(PM97)
Risk Management PSYCHIATRY: Risk Management: Part I Seclusion and Restraint-R106 Kim J. Masters, M.D. Examine the historical roots of seclusion and restraint procedures. Describe 3 elements of coercive treatment in a psychiatric service or child and adolescent residential treatment facility. Explain why institutions are never completely free of coercion, but should always strive toward collaboration. Discuss patients’ views of seclusion and restraint. Improve the safety of restraint by using pulse oximetry to monitor patients being restrained.
(R106)
OPHTHALMOLOGY: Medicolegal Issues-R107 Howard A. Slavin, J.D. and Tamara R. Fountain, M.D. Identify elements of a well-documented patient record. Enumerate elements of the informed consent for procedures. Recognize the 2 classes of medication that most commonly contribute to lawsuits. Avoid common mistakes when acting as an expert witness. Follow ethical guidelines when providing expert witness testimony.
(R107)
OTOLARYNGOLOGY: Improving Control of Health Care-Associated Infections-R108 Dennis G. Maki, M.D. and Ovid O. Meyer, Professor of Medicine Explain why the risk for HCAIs is higher in intensive care units (ICUs). Discuss possible reasons for failure of hospital to reduce the incidence of HCAIs. Describe how HCAIs are transmitted in the hospital, particularly in the ICU. Adopt evidence-based preventive measures, (eg, hand hygiene), barrier precautions, and chlorhexidine sponge baths). Utilize innovative technologies to prevent HCAIs.
(R108)
INTERNAL MEDICINE: Rules and Laws in Medical Malpractice Part II-R112 Michael R. Lowe, Esq. and Marvin C. Mengel, M.D., J.D. Cite the reasons for the increase in medical spas and retail medicine clinics. Describe some of the rules pertaining to licensure and proper supervision of physician extenders; medical records and privacy; the treatment of Medicare patients and the use of advance beneficiary notices (ABNs). Explain the regulatory and legal consequences of the improper off-label use of drugs, medications, and medical devices. Describe key considerations when selling a physician practice, or entering physician employment, physician recruitment, medical director, call coverage, joint venture, or gainsharing agreements. Avoid violations of the Stark Law and federal antikickback statute.
(R112)
EMERGENCY MEDICINE: High Risk Emergencies-R114 Robert Vissers, M.D. and Ron M. Walls, M.D. Determine the cause of abdominal pain, based on history, physical examination, laboratory tests, and imaging. Compare the efficacy of computed tomography and ultrasonography in the diagnosis of abdominal pain. Use symptoms, laboratory tests, and imaging to establish the diagnosis of appendicitis. Explain the decision-making process in managing difficult airways. Summarize the medicolegal responsibilities of emergency physicians, attending physicians, and consultants in the management of patients with difficult airways.
(R114)
EMERGENCY MEDICINE: Malprictice Prophylaxis-R115 Gary F. Pollock, M.D. and Michael J. Bresler, M.D. Recognize the importance of excellent care and of the physician’s attitude and leadership in the emergency department (ED) in avoiding a malpractice lawsuit. Interact with patients in an effective and respectful manner in various situations. Record relevant information in the patient’s chart. Recognize the importance of timing physicians’ orders. Manage combative and difficult patients in the ED.
(R115)
OB/GYN: Practical Issues in Risk Management-R117 Sarah Freymann Fontenot, B.S.N., J.D. Recognize the challenges that difficult patients present to a medical practice. Identify which types of patients are likely to file a medical malpractice lawsuit. Discuss the role of communication in reducing medical risk for malpractice litigation. Cite the 4 elements necessary for a successful medical malpractice lawsuit. Discuss exceptions to the statute of limitations governing obstetric cases.
(R117)
ANESTHESIOLOGY: Closed Claims/Medical Mistakes-R118 Robert A. Caplan, M.D. Use the information generated by the American Society of Anesthesiologists' Closed Claims Project to im prove clinical practice, evaluate new therapies, and anticipate problems. Recognize the procedures and injuries most likely to lead to malpractice lawsuits. Identify techniques that may prevent injuries associated with respiratory challenges. Discuss the implications of changes seen in claims for death and brain damage since the 1970s and the impact of these changes on anesthesiologists' insurance premiums. Describe the concept of source inspection.
(R118)
PSYCHIATRY: Basic Law for Psychiatrists-R119 Phillip J. Resnick, M.D. Distinguish between matters of fact and matters of law. Explain different types of court dismissals. Define such legal terms as stare decisis, amicus curiae, and habeas corpus. Briefly discuss issues related to the right to privacy. Discuss components of criminal and tort law that have bearing on medical malpractice and negligence.
(R119)
PSYCHIATRY: Psychiatric Malpractice-R120 Phillip J. Resnick, M.D. Describe the standards by which a physician’s actions are judged when faced with a malpractice claim. List legal concepts that apply to expert witness testimony in a courtroom setting. Assess negligence in cases in which psychiatric patients committed suicide. Provide patients with informed consent. Avoid behaviors and situations that could lead to allegations of sexual misconduct and malpractice.
(R120)
INTERNAL MEDICINE: Law and Order for the Internist-R121 George J. Heymach, M.D., Ph.D. Summarize the elements that must be established by the plaintiff’s attorney in order for a malpractice lawsuit to be successful. Adhere to practices that minimize the likelihood of malpractice litigation. Recognize warning signs of a possible behavioral problem in a coworker. Overcome barriers to intervening in cases of disruptive behavior in a health care professional. Distinguish between disruptive and nondisruptive behavior in medical colleagues.
(R121)
OB/GYN: Law and Order for the Obstetrician/Gynecologist-R122 Sarah Freymann Fontenot, J.D. Appropriately obtain consent from patients. Maintain proper documentation of all interactions with patients. Recognize the importance of causation in the disposition of malpractice lawsuits. Implement HIPAA regulations. Adhere to approved practices when participating in sales and marketing of medical services.
(R122)
EMERGENCY MEDICINE: Minimizing Lawsuits-R123 Gregory L. Henry, M.D. Recognize the role of the ED physician in setting the tone for how the ED is run and what the job entails. Establish credibility with patients in the ED. Communicate appropriately with patients in the ED. Implement practices that shorten perceived waiting time in the ED. Ensure that discharge instructions are properly understood by the patient and the family members or others who accompanied the patient to the ED.
(R123)
INTERNAL MEDICINE: The Business Side of Medicine-R124 Jon T. O'Neal, M.D., M.P.H. and Elizabeth A. Leedom, J.D. Assess the work-relatedness of a patient’s injury or illness. Fulfill an employer’s requirements in cases of occupational injury or illness. Determine which injuries and illnesses need to be reported to the Occupational Safety and Health Administration (OSHA). Identify the types of electronically stored medical information that are subject to discovery in a lawsuit. Avoid the creation of entries in electronic medical records that may lead to misinterpretation during a malpractice trial.
(R124)
EMERGENCY MEDICINE: Risk Management in the ED-R125 Michael Frank, M.D., J.D. and Elliott S. Nipomnick, M.D. Establish a workplace environment in the emergency department in which sexual harassment is not tolerated. Recognize the risks resulting from sexual misconduct and workplace romance. Elaborate on the exceptions to the Health Insurance Portability and Accountability Act privacy rule. Describe the physician’s assistant supervision agreement. Recognize the legal responsibility of the supervising physician for actions taken by a midlevel provider.
(R125)
Substance Abuse INTERNAL MEDICINE: Brief Interventions: Targeting Substance Use and Abuse-SA43 Richard L. Brown, M.D. and Douglas E. Jorenby, P.h.D. Explain the effect of substance use on the reward center of the brain and its clinical implications. Screen all patients for substance use and identify patients who may benefit from brief interventions. Appropriately prescribe pharmacotherapeutic agents to aid patients in stopping use of alcohol or opioids. Discuss the importance of targeted personal advice, specific quit plans, and follow-up for patients attempting to quit smoking. Compare mechanism of action and outcome of approved pharmacotherapies for smoking cessation.
(SA43)
PSYCHIATRY: Substance Abuse-SA44 David A. Fiellin, M.D. and Dorothy Hatsukami, P.h.D. Identify patients at risk for dependence on prescription opioids, heroin, and alcohol. Describe treatment strategies for opioid dependence. Compare and contrast traditional and newer treatment strategies for alcohol abuse and dependence. Explain some of the mechanisms, such as environmental cues, that contribute to nicotine addiction. Discuss pharmacotherapy for nicotine addiction.
(SA44)
FAMILY PRACTICE: Confronting Addiction-SA45 John D. Patz, D.O. and Steven M. Juergens, M.D. Recommend appropriate levels of care for detoxification. Recognize substances and conditions that warrant inpatient detoxification. Manage symptoms, such as insomnia and hypertension, during alcohol and opioid withdrawal. Discuss pharmacokinetic differences of commonly used benzodiazepines. Describe symptoms of benzodiazepine withdrawal, and effects of benzodiazepines on cognition and psychomotor performance.
(SA45)
PSYCHIATRY: Addiction-SA47 David B. Rosengren, P.h.D. and Richard Saitz, M.D., M.P.H. Describe the advantages and disadvantages of using motivational interviewing (MI) in treatment of addictions. Define MI and discuss some of the changes that have occurred in its philosophy. State some of the principles involved in learning and practicing MI. Explain why addictions may be better served by treating them as chronic conditions that require long-term management. Describe a model for chronic disease management of addictions in an integrated care setting.
(SA47)
PSYCHIATRY: Update on Alcoholism-SA48 Marc A. Schuckit, M.D. Discuss the differential risk of developing alcoholism in children of alcoholics vs children of non-alcoholics. Cite current theories on the effect of genetics on alcohol use and dependence. Explain the differences in response to alcohol between people of Asian ancestry and those of other ethnicities. Discuss how level of response to alcohol predicts alcohol outcome. Recognize the role of environment in alcohol outcome.
(SA48)
PSYCHIATRY: Psychiatric Comorbidity-SA49 David W. Oslin, M.D. and Helen M. Pettinati, P.h.D. Explain why the concept of comorbid psychiatric disorders, as presented in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), is oversimplified. Discuss whether moderate drinking influences the treatment of major depression. Describe alcohol dependence types A and B. Recognize the difficulties of diagnosing primary depression in the presence of current alcohol dependence. Assess the efficacy of various regimens for treating alcohol-dependent patients with comorbid depression.
(SA49)
PSYCHIATRY: Neuroscience of Addiction-SA50 Stanley D. Glick, M.D., Ph.D. Identify brain structures, processes, and chemicals universally implicated in addiction. Distinguish between psychologic dependence, physiologic dependence, and addiction. Assess patients for both tolerance and sensitization to the effects of addictive substances. Recognize common triggers of cravings and relapses in patients recovering from addiction. Describe mechanisms of action responsible for mediating the neuropsychiatric and toxic effects of addictive substances.
(SA50)
FAMILY PRACTICE: Alcohol and Drug Abuse: Concepts in Diagnosis and Management-SA51 Robert Mallin, M.D. and Mathias J. Kill, M.D. Describe the brain pathway that modulates addiction. Identify addiction in patients based on clinical cues and screening tests. Discuss management strategies such as abstinence, detoxification, and interventions. Recognize typical presentations of alcohol withdrawal syndrome and alcohol withdrawal delirium. Select appropriate drugs for treatment of alcohol withdrawal.
(SA51)
PSYCHIATRY: Addiction and Cognitive Impairment-SA52 Douglas J. Warn, L.C.S.W.–R., M.S.Ed. Identify critical areas of cognition frequently impaired in patients receiving treatment for substance abuse. Recognize neurologic and cognitive effects associated with the abuse of specific substances. Apply sophisticated screening tools to accurately assess neurocognitive deficits. Incorporate occupational therapy and cognitive remediation into treatment plans for patients with cognitive deficits and impairments. Adjust therapeutic modalities to improve efficacy in patients who have difficulties with cognition or comprehension.
(SA52)
VARIOUS OTHER TOPICS FAMILY PRACTICE: Cultural Pearls: Observations on Population-Based Care-CS1 Marc J. Altshuler, M.D. and Hilary Kessler Seligman, M.D. Review the epidemiology of immigrant health. Select appropriate testing tools for tuberculosis. Update immunization for foreign-born adults and children. List environmental factors in low-income neighborhoods that contribute to overweight and obesity. Identify ethnic and socioeconomic disparities that contribute to changes in dietary behavior.
(CS1)
PEDIATRICS: Cultural Conundrums-CS2 Paul A. Offit, M.D. and Elena Fuentes–Afflick, M.D., M.P.H. Cite the factors that contributed to the birth of the antivaccine movement. Review key legal cases that influenced current rights for vaccine refusal. Describe the consequences of the antivaccine movement. Define acculturation as it applies to pediatric care in the United States. Recognize child health outcomes that are influenced by acculturation.
(CS2)
EMERGENCY MEDICINE: Interpersonal Skills-CS3 Gus M. Garmel, M.D. and John G. King, M.D., M.P.H. Recognize areas and sources of conflict. Identify the key components of and barriers to conflict resolution. List the 6 steps to successful negotiation. Explain negotiating styles, and present a model for successful conflict resolution. Utilize verbal techniques and written strategies for more effective communication with patients.
(CS3)
Various State Requirements FAMILY PRACTICE: Geriatric Dilemmas-SR4 Michael D. McGonigal, M.D., Suzanne K. Goetschius, M.S.N., A.P.R.N. and Chrystian Pereira, PharmD. List risk factors for falls in the elderly. Outline an effective fall-prevention program. Counsel adult children with aging parents about developing a caregiving plan. Address concerns of caregiving, such as personal needs, housing, and financing. Define polypharmacy and assess medication compliance.
(SR4)
PSYCHIATRY: Treatment of Older Adults-SR5 ulie Loebach Wetherell, P.h.D. and Steven R. Thorp, P.h.D. Identify anxiety disorders in older adults. Compare pharmacotherapy and psychotherapy as treatment options for anxiety disorders in older adults. Cite barriers to the mental health treatment of older adults. Discuss the characteristics and hallmarks of cognitive behavioral treatment (CBT) and describe common tech niques used in CBT. Summarize the empirically supported treatments for posttraumatic stress disorder (PTSD).
(SR5)
FAMILY PRACTICE: When Mind and Body Fail: Coping with Complex Neurologic Diseases-SR6 Michelle S. Eslami, M.D. and James Boyd, M.D. Distinguish dementia from normal aging. Describe effects of medications used in AD, such as cholinesterase inhibitors, memantine, and antipsychotic drugs. Counsel patients, family, and caregivers about management of behavioral complications of AD. Detail the differential diagnosis for patients presenting with parkinsonian features. Compare and contrast Parkinson disease with the atypical parkinsonian syndromes in terms of presentation, progression, and management.
(SR6)
FAMILY PRACTICE: Common Medical Issues in the Elderly: Assessing Current Care Options-SR7 William B. Greenough III, M.D. and John Burton, M.D. Name the factors to be considered when prescribing antibiotics to people older than 50 yr of age. Explain why multidrug-resistant tuberculosis is spreading so rapidly. Describe strategies for preventing the spread of infectious disease among hospitalized elderly patients. List the most common types of urinary incontinence. Instruct patients in behavioral methods for managing incontinence, including maintenance of a voiding diary, prompted voiding, bladder retraining, and pelvic floor exercises.
(SR7)
PSYCHIATRY: Update on Alzheimer's Disease-SR8 Samuel Gandy, M.D., P.h.D. and Joshua Chodosh, M.D., M.S.H.S. Discuss the different types of amyloid in the brain. Describe the role of amyloid plaques in AD. Explain various antiamyloid approaches to treating AD. Develop a treatment plan for the patient with AD. Refer patients with AD and their families to community resources.
(SR8)
FAMILY PRACTICE: Issues Concerning the Elderly-SR9 Bruce E. Beacham, M.D., Michael Ankrom, M.D., M.H.S. and Carlos O. Weiss, M.D., M.H.S. Select appropriate treatment for actinic keratoses and pruritus. Determine causes of drug eruptions, based on clinical findings and drug history. List challenges and rewards associated with caregiving. Distinguish active problem-solving approaches from passive approaches. Identify red flags and counsel older patients about driving safety.
(SR9)
OPHTHALMOLOGY: Age-Related Macular Degeneration (AMD)-SR14 Jeffrey S. Heier, M.D. and Jeffrey S. Heier, M.D. Describe the anatomic and visual outcome measurements used in clinical trials of AMD therapies. Compare and contrast the different methods of measuring geographic atrophy. Evaluate the results of clinical studies using anti-VEGF agents to treat exudative AMD. Assess the benefits and drawbacks of new therapeutic agents under development for wet and dry AMD. Summarize the roles of extended delivery technologies in the treatment of AMD.
(SR14)
