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Work & Life

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Guidance for navigating your career and life

The New England Journal of Medicine invites applications from physicians at any career stage for a one-year, full-time, paid editorial fellowship beginning in July 2024. Several fellows will be selected for the 2024–25 year; applications are due by August 15, 2023. Learn more about the NEJM editorial fellowship and how...

The NEJM Editorial Fellowship

Most physicians remember the day they discovered where they would spend the next several years in residency training. Many also remember the moment elation gave way to reality as they began to calculate the cost of living and loans (averaging nearly $200,000) and realize it was more than their future...

Valuing the Resident Physician: Advocating for Change

In the first part of this series, Improving Feedback Exchanges with Residents: Can You Hear Me Now? , we reviewed basic knowledge and skills related to feedback exchanges in medical training. We defined the difference between feedback and assessment, highlighted the key components of high-quality feedback, identified barriers to feedback...

How to Receive and Deliver High-Quality Feedback

Feedback is defined as information describing an individual’s performance in a given activity that is intended to guide their future performance. Medical trainees are becoming increasingly aware that feedback is a critical component of clinical training. In a two-part series on improving formal feedback exchanges, we will focus on the...

Improving Feedback Exchanges with Residents: Can You Hear Me Now?

Whether you are a student, resident, or faculty member, no doubt you have attended obligatory talks on well-being and burnout. The attention to high rates of burnout in the U.S. health care workforce, and its unsurprising increase during the pandemic , has been beneficial, but concerns have been raised that...

It’s OK to Not Be OK

When you dedicate years to studying and practicing medicine, you learn that certain steps are required to maintain good health and prevent illness and disease. However, the concept of systematically and proactively cultivating good habits applies to many aspects of life,...

Five Steps to Improve Your Financial Health in Residency

Conflict is a natural part of everyday life; disagreements are bound to happen when we interact with others. As physicians, we often work in time-pressured, high-stakes circumstances and engage with teams comprised of people with different backgrounds and perspectives.

Conflict Management and Resolution as a Resident

Welcome new doctors! Yesterday you were medical students and today you are physicians! What a scary feeling. Remember that everyone shares similar concerns and fears as they start their residency and wants to succeed. Getting into residency is the beginning of an incredible journey. Savor it, relax, enjoy the ride,...

Surviving the First Month as a Doctor: Advice from the Community

Physician burnout and well-being are hot topics among medical professionals throughout the health care delivery and educational continuum — for good reason. Current estimates of the impact of physician burnout approach or exceed 50%, and most experts suggest that the percentage is growing.

Connection and Meaning: Resident Leadership to Combat Burnout

The fields of precision medicine and digital health have the potential to transform medicine by increasing access to health-related data at the touch of a finger, seamlessly sharing electronic medical records among institutions, improving the efficiency of healthcare delivery, and providing access to unprecedented granularity of patient data...

Precision Medicine: Help Pave the Way

The global effort to share data and resources about the ongoing Covid-19 pandemic has led to a flood of information as infections peak at different times around the world. 

Using Artificial Intelligence to Help Manage the Covid-19 Data Burden

Quality improvement (QI) is a disciplined effort to make healthcare delivery safer, more effective, patient-centered, timely, equitable, and efficient (less wasteful). These six domains were established by the National Academy of Medicine in 1999 as the tenets of... ...

What Is Quality Improvement?

Although every resident develops his or her own style for each of these roles, the following practical strategies were discussed in a NEJM Resident 360 discussion (How to Lead a Team on the Wards: The Art to Being an Effective Resident).

The Art of Leading with the Right Balance as a Senior Resident

The last time you stepped inside an operating room may have been the third year of medical school, but during residency you will care for many patients who require surgery, either electively or emergently. Calling a surgical consult can be daunting or intimidating, especially if the problem or situation is...

Advice for Calling a Surgical Consult

Notes are often the last thing standing between you and (finally) going home.  In one large-scale survey of internal medicine residents, two-thirds reported spending more than 4 hours per day on medical record documentation and clerical duties; only one-third...

Note to Self: Principles for Better Documentation

Internship and residency are incredibly demanding intellectually, emotionally, physically, and socially. This post addresses ways to establish habits that will lead to a successful and healthy transition to the practice of medicine during residency.    ...

Addressing Wellness in Residency: Ready, Set, Go!

Dr. Richard Brian Gunderman offers guidance for preventing burnout in residency.

Recognizing and Surviving Burnout

After many long nights huddled over textbooks, agonizing over the brachial plexus, committing childhood exanthems to memory, and making surgical knots of any loose fiber within arm’s reach, you have finally received the news of a lifetime: You’re accepted to a...

Prepping for PGY-1

Dr. Carol McLaughlin, director of the Global Health Equities Track in the internal medicine residency program at the University of Pennsylvania, writes about what it takes to pursue a career in global health and how can you plan for it during residency.

Opportunities in Global Health for Residents 

When most people think of librarians, they picture the stereotypical older woman with glasses and a bun who shushes them for talking too loudly. In the past, librarians were the keepers of information but have now evolved to become navigators of...

How to Take Advantage of Your Medical Librarian

Clinical Pearls & Morning Report

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In patients with atrial high-rate episodes, edoxaban did not significantly reduce the incidence of stroke and cardiovascular outcomes as compared with placebo, but it led to a higher incidence of bleeding. ...

Anticoagulation and Atrial High-Rate Episodes

A 50-year-old woman with a history of Roux-en-Y gastric bypass presented with confusion. She had anasarca and an albumin level of 1.9 g per deciliter (reference range, 3.3 to 5.0). A diagnosis was made. ...

A Woman with Confusion

A 34-year-old woman was admitted to the hospital because of abdominal distention, fatigue, and acute kidney injury that occurred 10 months after orthotopic liver transplantation. A diagnosis was made.

A Woman with Abdominal Distention and Acute Kidney Injury

The author reviews the patient, provider, and device factors that contribute to central line–associated bloodstream infections and discusses preventive strategies.

Central Line–Associated Bloodstream Infections

Asthma is characterized by recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and underlying inflammation. A stepped approach to symptom control and reduction of exacerbations is recommended.

Asthma in Adults

A 37-year-old man was admitted because of difficulty with swallowing and a diffuse maculopapular rash. Laboratory evaluation revealed lymphopenia and an elevated globulin gap. A diagnosis was made.

A Man with a Rash

A 55-year-old man with acute myeloid leukemia began to have shortness of breath, cough with blood-tinged sputum, and hypoxemia 17 days after receiving a myeloablative allogeneic stem-cell transplant from a haploidentical donor. ...

It’s All in the Timing

Wilson’s disease, which may lead to severe copper overload and multiorgan dysfunction, is best managed collaboratively by specialists in hepatology, neurology, psychiatry, and clinical genetics.

Wilson’s Disease

In this randomized trial, primary surgery for isolated cleft palate at 6 months of age led to better velopharyngeal function at the age of 5 years than primary surgery at 12 months of age. ...

Timing of Primary Surgery for Cleft Palate

A 53-year-old woman with celiac disease was admitted with diarrhea and hemorrhagic shock. Imaging was notable for a retroperitoneal mass and horseshoe kidney. A diagnosis was made.

A Woman with Celiac Disease and Upper Gastrointestinal Bleeding

Loss of plasma proteins into the gastrointestinal tract may be due to capillary diffusion of proteins into the interstitium, epithelial permeability, or leakage and rupture of dilated lacteals.

Protein-Losing Enteropathy

A 15-year-old girl was evaluated for abdominal pain and leukocytosis. Ultrasonography revealed ascites and a large mass that was inseparable from the right ovary. A diagnosis was made.

A Girl with Abdominal Pain and an Ovarian Mass

Mutations in isocitrate dehydrogenase 1 or 2 are common in low-grade glioma. The IDH inhibitor vorasidenib improved progression-free survival as compared with placebo.

Vorasidenib for IDH-Mutant Low-Grade Glioma

CAP is an acute lung infection that causes 1.5 million hospitalizations in the United States each year. Most outpatients with mild CAP can be treated empirically without diagnostic testing for bacteria. ...

Community-Acquired Pneumonia

A 43-year-old man was evaluated because of a lung nodule. A PET scan showed FDG uptake in the nodule and adjacent lymph nodes. A diagnostic test was performed.

A Man with a Pulmonary Nodule

In patients with lung cancer, neoadjuvant treatment with nivolumab and chemotherapy resulted in a significantly higher percentage of patients with a pathological complete response than chemotherapy alone.

Neoadjuvant Nivolumab in Stage III Lung Cancer

The authors outline the three major forms of brain injury in very preterm infants and the role of injury in subsequent brain development, noting mediating factors and their neurodevelopmental consequences. ...

A Race to the Finish

Neurologic Consequences of Preterm Birth

In a phase 3a trial involving adults with type 2 diabetes who had not previously received insulin, glycemic control was better with once-weekly insulin icodec than with once-daily insulin glargine U100. ...

A Young Man with Progressive Dyspnea

Weekly Icodec or Daily Glargine in Type 2 Diabetes

Literature

Resources that summarize, explain, and put research into context

From Pages to Practice

Glucagon-like peptide 1 (GLP-1) receptor agonists are gaining attention for the management of type 2 diabetes and obesity. These drugs have multifactorial effects that include stimulating glucose-dependent insulin secretion, delaying gastric emptying, and inhibiting postprandial glucagon secretion. Consequently, GLP-1 receptor agonists...

Promising Results for GLP-1 Receptor Agonists in Obesity-Related HFpEF

A 40-year-old man with bipolar I disorder who is currently on a mood stabilizer is feeling better after a recent depressive episode. During the episode, he was treated with an adjunctive antidepressant. Now that his depression is in remission, you are...

Duration of Adjunctive Antidepressants After Remission of Depression in Bipolar I Disorder

Ms. Apple is a 74-year-old woman with a history of overweight but otherwise very active and still working as a part-time schoolteacher. At a primary care visit, she explains that she is concerned about memory loss because her mother developed dementia...

Diet for Prevention of Cognitive Decline in Older Adults

Mr. Wang is a 73-year-old male with a history of atrial fibrillation (AF) and diabetes who presented with left-sided weakness. Head imaging showed an ischemic stroke affecting the superficial cortical branch of the right middle cerebral artery. When should he restart...

Early Anticoagulation After Stroke Due to Atrial Fibrillation Prevents Recurrent Ischemic Events

Men who receive a diagnosis of low- or intermediate-risk clinically localized prostate cancer can live for decades. Each treatment option is associated with different effects on quality of life and sexual, urinary, and bowel function. To compare the effectiveness of these...

Similarly Low 15-Year Mortality After Monitoring, Surgery, or Radiotherapy for Prostate Cancer

Pulmonary arterial hypertension (PAH) involves the obliteration of the small arterioles of the pulmonary vasculature. PAH is categorized as World Health Organization (WHO) group 1 pulmonary hypertension, based on the presence of elevated pulmonary arterial pressures, normal pulmonary capillary wedge/left heart...

Lung Story Short: A New Therapy for Pulmonary Arterial Hypertension

The perennial question of whether to use glucocorticoids to treat patients with community acquired pneumonia (CAP) continues to consume hours of discussion in intensive care units (ICUs). Pneumonia elicits an inflammatory response in the lung, which left unchecked, can lead to a deleterious decline in pulmonary function and oxygenation. Glucocorticoids...

Should Glucocorticoids Be All the Rage in the Treatment of CAP?

Some anticoagulation decisions in patients with thrombosis are straightforward, thanks to a preponderance of data. First provoked deep-vein thrombosis (DVT)? There’s a guideline for that (no less than 3 months of anticoagulation). Recurrent DVT, pulmonary embolism, or decisions between a direct...

Hydrochlorothiazide or Chlorthalidone for Hypertension?

Venous thromboembolism (VTE) is the most common cause of preventable death in hospitalized medical patients, yet pharmacologic prophylaxis remains underutilized. The Virchow’s triad of venous stasis, vascular injury, and hypercoagulability is key in the assessment of VTE risk. Based on the Padua Score — a validated risk assessment model that...

Broken Bones and Thromboprophylaxis: Is Aspirin Enough?

Opioid use disorder (OUD) continues to be a national crisis in the United States. President Biden has identified battling the opioid crisis as a top priority and the U.S. Department of Health and Human Services (HHS) has awarded $1.6 billion to...

Methadone or Buprenorphine in Mothers and Neonates: A Tale of Two Drugs for OUD

Going with the Flow — Rivaroxaban Prophylaxis in Noncirrhotic Portal Venous Thrombosis

Tuberculosis (TB) is the leading cause of death worldwide from a single infectious agent. TB is caused by the bacillus Mycobacterium tuberculosis , infecting about a quarter of the world’s population. Drug-resistant TB continues to be a threat to public health; in 2019, approximately 465,000 patients worldwide had rifampicin-resistant disease,...

Assessing What’s PRACTECAL in Rifampicin-Resistant Tuberculosis

Eosinophils are granulocytes theorized to have developed in humans to guard against parasitic infections, including nematodes that reside in human intestines. As a result, eosinophils appear to be normal constituents of gastrointestinal tissue, with an increasing gradient... ...

Dupilumab for Eosinophilic Esophagitis: Therapy for a Tough Diagnosis to Swallow?

Mr. Pool is a 64-year-old man with high blood pressure while taking lisinopril, diabetes (HbA1c level, 7.3), obesity (BMI, 32 kg/m<sup>2</sup> ), and dysplipidemia while taking statin therapy (elevated triglyceride of 270 mg/dL and low HDL of 33 mg/dL...

Fibrate Therapy Does Not Reduce Cardiovascular Events in Patients with Mild-to-Moderate Hypertriglyceridemia

The pancreas is a notoriously complex endocrine organ and when inflamed can cause a wide range of clinical symptoms, ranging from simple epigastric pain, nausea, and vomiting, all the way to circulatory collapse and acute respiratory distress syndrome (ARDS). As...

Fluid Resuscitation in Pancreatitis

Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD). More than 3 million people worldwide die of COPD each year, accounting for approximately 6% of all deaths. COPD is a heterogenous condition with various phenotypes including emphysema...

Inhalers for Smokers' Cough? Time for a RETHINC

When an area of the myocardium is not moving normally, it is important to realize that all may not be lost. Although ischemia can lead to infarction —or death of the cardiomyocytes— the cells may survive by “hibernating” or suspending the...

To PCI or Not to PCI — a Revascularization Question

The idiopathic inflammatory myopathies (IIM) are a group of diseases characterized by muscle inflammation with resultant weakness, the potential presence of other autoimmune signs (e.g., rash and calcinosis), specific autoantibodies that correspond to unique syndromes, and a variable clinical course ranging...

The ProDERM Trial: Muscling Ahead for Dermatomyositis

Lung cancers tend to be more highly mutated than other solid organ malignancies. Over the past decade, an increasing number of targeted therapies have been developed against specific mutations that drive tumor growth. Their use is largely responsible for the recent...

The KRYSTAL-1 Study: Expanding Options in KRAS-Mutated Lung Cancer

Esophageal cancer is the eighth most common cancer worldwide, with squamous cell carcinoma being the most common subtype. During the last 60 years, the 5-year survival rate for esophageal cancer has increased from 5% to 20% with the implementation of platinum-based therapy and radiotherapy; yet both esophageal adenocarcinoma...

Nivolumab Combination Therapy in Advanced Esophageal Squamous Cell Carcinoma

Resources that summarize, explain, and put research into context.

Beyond Journal Club Podcast from Core IM

Does adding revascularization by percutaneous coronary intervention (PCI) to optimal medical therapy improve survival and heart failure hospitalizations in patients with severe ischemic left ventricular systolic dysfunction? Some evidence suggests that patients with low ejection fraction benefit from revascularization by PCI....

The REVIVED Trial: Does PCI save lives in Heart Failure and CAD?

Skills

Educational and interactive tools to sharpen your diagnostic abilities

Rotation Prep

Curated and distilled information to get you up to speed fast

Featured Rotation

Jon Adler, MD, is an emergency physician at Lahey Hospital and Medical Center. He served as a clinician and educator at Massachusetts General Hospital and Harvard Medical School for 23 years. He has been author or editor of 14 books and 4 medical journals. Jon is currently faculty at Tufts University School of Medicine.

Emergency medicine is a fast-paced practice involving the care for any patient with an emergency condition, including pediatric and trauma patients. Acuity ranges from patients with straightforward concerns to those with complicated problems received in extremis by emergency medical systems, helicopter,...