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Work & Life

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Guidance for navigating your career and life

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, including your finances...

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

Communication is key in all relationships. Effective and compassionate communication by physicians and other health care providers has been demonstrated to improve clinical outcomes, treatment adherence, patient satisfaction, and to reduce malpractice claims. For health care providers...

Delivering Difficult News: Stocking the Toolbox

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

The medical profession in the U.S. has a remarkable international flair. One in four U.S. physicians is an international medical graduate (IMG), and every year around 12,000 IMGs apply for U.S. residency positions. But the path to practicing in the U.S. is not an easy one when you must navigate...

Applying for Residency as an International Medical Graduate

Journal clubs are a longstanding tradition in residency training, dating back to William Osler in 1875. The original goal of the journal club in Osler’s day was to share expensive texts and to review literature as a group. Over time, the...

Journal Club: How to Build One and Why

Clinical Pearls & Morning Report

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Transcatheter arterialization of deep veins resulted in 6-month amputation-free survival in 66.1% of 105 patients with chronic limb-threatening ischemia and no conventional options for treatment.

Transcatheter Arterialization for Limb Ischemia

In this multicenter trial, a single oral dose of azithromycin reduced the risk of maternal but not newborn sepsis or death in women planning a vaginal delivery.

Azithromycin to Prevent Sepsis or Death during Birth

In a pragmatic trial involving older persons with treatment-resistant depression, augmentation of existing antidepressants with aripiprazole was better than augmentation with bupropion or a switch to bupropion.

Augmenting or Switching Antidepressants in Older Adults

In the induction period of two phase 3 trials, 16 weeks of treatment with lebrikizumab was effective in adolescents and adults with moderate-to-severe atopic dermatitis.

Lebrikizumab for Moderate-to-Severe Atopic Dermatitis

A 71-year-old woman with breast cancer and systemic sclerosis was admitted because of refractory hemolytic anemia. A diagnostic test was performed.

A Woman with Refractory Hemolytic Anemia

In children 2 to younger than 6 years of age with type 1 diabetes, a closed-loop control system was associated with a greater percentage of time in the target glycemic range than standard care.

Closed-Loop Control in Children with Diabetes

In this trial involving patients after out-of-hospital cardiac arrest, fever prevention for 36 or 72 hours did not result in different percentages of patients dying or having severe disability or coma.

Device-Based Fever Prevention after Cardiac Arrest

A 70-year-old man who had recently undergone kidney transplantation was evaluated because of rashes that had developed during an admission for Covid-19, respiratory failure, and bacteremia. A diagnosis was made.

A Man with Covid-19, Respiratory Failure, and Rashes

In a placebo-controlled trial involving immunosuppressed organ-transplant recipients, oral nicotinamide (500 mg twice daily) for 12 months did not lead to lower numbers of keratinocyte cancers or actinic keratoses.

Nicotinamide for Skin-Cancer Chemoprevention

In a trial involving patients with recurrent kidney stones who received oncedaily 12.5-mg, 25-mg, or 50-mg doses of hydrochlorothiazide or placebo, the incidence of stone recurrence was similar in all groups.

Hydrochlorothiazide and Prevention of Kidney Stones

A 68-year-old man was admitted with confusion. In the past 7 weeks, imaging had shown evidence of multifocal strokes despite therapeutic anticoagulation, as well as kidney and lung masses. A diagnosis was made.

A Man with Recurrent Strokes

The authors review the pathophysiology, revised diagnostic definitions, and management of acute kidney injury, a common condition in patients with cirrhosis.

Acute Kidney Injury in Patients with Cirrhosis

Respiratory syncytial virus causes clinically significant illness in children and adults. In a placebo-controlled trial, a prefusion stabilized F protein vaccine led to an 83% lower risk of RSV infection.

Respiratory Syncytial Virus Vaccine

A 67-year-old man with interstitial lung disease presented with fever and myalgias. Laboratory testing revealed pancytopenia and elevated aminotransferase levels. A diagnostic test was performed.

A Man with Interstitial Lung Disease, Fever, and Myalgias

Rheumatoid arthritis is a chronic, systemic autoimmune disease manifested primarily as inflammatory arthritis, typically involving the small joints of the hands and feet. It can lead to severe disability and death.

Rheumatoid Arthritis

A 56-year-old man was evaluated for abnormal results on liver testing. He had a history of alcohol and opioid use. Imaging revealed a nodular hepatic contour. Additional diagnostic tests were performed.

A Man with Abnormal Results on Liver Testing

In patients with treatment-resistant hypertension and blood pressure of 130/80mm Hg or higher, the aldosterone synthase inhibitor baxdrostat reduced blood pressure in a dose-related manner.

Baxdrostat for Treatment-Resistant Hypertension

A 76-year-old man presented with a 1-month history of worsening exertional dyspnea and fatigue. He reported feeling breathless with light activities, such as getting dressed, and also had a new onset of headaches.

A Breathtaking Discovery

Use of antiretroviral therapy has led to a major decline in perinatal infections, but the regimen with the best safety profile is still not known. The literature on ART and pregnancy outcomes is reviewed.

ART and Adverse Pregnancy Outcomes

A 16-year-old girl was admitted with abdominal pain and bloody diarrhea of 5 weeks’ duration. Colonoscopy revealed multiple friable lesions in the sigmoid colon. A diagnostic test was performed.

A Girl with Abdominal Pain and Bloody Diarrhea

Literature

Resources that summarize, explain, and put research into context

From Pages to Practice

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

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...

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

The ubiquitous respiratory syncytial virus (RSV) has historically affected millions of children worldwide. The viral infection is associated with the clinical syndrome of bronchiolitis, consisting of rhinorrhea, a fluctuating physical examination, and varying levels of respiratory distress. The rhinorrhea (also known as coryza) is such a prominent...

The MELODY Trial: A New Tune in the Song and Dance of Bronchiolitis

Bronchopulmonary dysplasia (BPD) is a common morbidity in preterm infants. At the core of the disease, an insult leads to disruption of normal lung development and ultimately presents as respiratory insufficiency. In the past few decades, the epidemiology of BPD has shifted as our understanding of the disease has evolved,...

Hydrocortisone to Prevent Bronchopulmonary Dysplasia: A Coup de Grâce for Corticosteroids?

Mrs. Smith is a 61-year-old woman with a history of recurrent urinary tract infections (UTIs). She reported the onset of dysuria and hematuria a few days ago and thought the symptoms felt similar to prior UTI episodes. She promptly made an appointment to see her primary care doctor the next...

Oral Tebipenem for Complicated Urinary Tract Infection

Ms. Cooper is a 32-year-old primigravida at 19 weeks and 2 days’ gestation, based on last menstrual period (LMP) and confirmed on 8-week ultrasound. She presented to the resident continuity clinic for routine prenatal care. You discuss how she is feeling and her upcoming anatomy sonogram and glucose tolerance test....

Treatment for Pregnant Women with Mild Chronic Hypertension

Mr. Strickland is a 77-year-old man who presents to the emergency department with fever and dysuria. He is febrile to 38.5°C, has a heart rate of 130 beats per minute and blood pressure of 80/50 mmHg. His white blood cell count is elevated at 16,000/mm<sup>3</sup> and urinalysis demonstrates >50...

Fluids in the ICU: Are Balanced Electrolyte Solutions Better than Normal Saline?

Lauren is a healthy, physically active 28-year-old medical student who is looking forward to graduating from medical school next month. She has exactly one month off between the end of medical school and the start of residency, and she plans to make the most of it. Although the COVID pandemic...

Acetazolamide for Altitude Illness

A 66-year-old woman with metastatic HER2-positive breast cancer returns to her oncologist after treatment with trastuzumab and pertuzumab, the standard first-line treatment, only to learn that her disease has progressed. The oncologist offers her two choices for second-line treatment: trastuzumab deruxtecan (T-DXd), a HER2 antibody...

A Preferred Second-line Option for Metastatic HER2-Positive Breast Cancer

Asthma is a condition driven by persistent airway inflammation with symptoms resulting from variable airflow limitation. The primary goal of therapy is to optimize symptom control and reduce the risk of exacerbations, which are associated with high morbidity and mortality. Because asthma was initially thought to be a disease primarily...

Asthma Rescue Therapy: Can Albuterol Monotherapy Be Rescued?

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

Curbside Consults

In this episode of Curbside Consults, Jaclyn Albin, MD and Milette Siler, RD share their passion for food as medicine and talk about their experiences at The Culinary Medicine Program at UT Southwestern Medical Center. Jaclyn believes food as medicine delivers...

Culinary Medicine with Dr. Jaclyn Albin and Milette Siler, RD

In this episode of Curbside Consults, we examine the Endocrine Society’s 2022 Clinical Practice Guideline on management of hyperglycemia in hospitalized adults in non-critical care settings. We are joined by Dr. Mary Korytkowski, Emeritus Professor of Medicine at the University of...

Management of Hyperglycemia in Hospitalized Adults with Dr. Mary Korytkowski

In this episode of Curbside Consults, we examine the American College of Chest Physicians recent clinical practice guideline on Perioperative Management of Antithrombotic Therapy. We are joined by Dr. James Douketis, Chair in Thromboembolic Disease at McMaster University and the first...

American College of Chest Physicians Clinical Practice Guideline on Perioperative Management of Antithrombotic Therapy with Dr. James Douketis

In this episode of Curbside Consults, we examine the 2022 revision of the clinical practice guideline on the management of hyperbilirubinemia in the newborn infant by the American Academy of Pediatrics (AAP). We are joined by two authors of the revised...

Management of Hyperbilirubinemia in the Newborn Infant with Drs. Alex Kemper and Tom Newman

In this episode of Curbside Consults, we examine an update on management of opiate use disorder in hospitalized adults by the SHM (Society of Hospital Medicine). We are joined by Dr. Susan Calcaterra, Associate Professor of Medicine, Director of the Addiction...

Management of Opiate Use Disorder in Hospitalized Adults with Dr. Susan Calcaterra

In this episode of Curbside Consults, we examine the American Thoracic Society Clinical Practice Guideline (CPG) on Sarcoidosis. We are joined by one of its co-authors, Dr. Kevin Wilson, Chief of Guidelines and Documents at the American Thoracic Society and Professor...

American Thoracic Society Clinical Practice Guideline on Sarcoidosis with Dr. Kevin Wilson

In this episode of Curbside Consults, we examine an update on sleep-related infant deaths by the American Academy of Pediatrics (AAP). We are joined by Rachel Moon, Harrison Distinguished Teaching Professor of Pediatrics of at the University of Virginia and Chair...

Sleep-Related Infant Deaths with Dr. Rachel Moon

In this episode of Curbside Consults, we are joined by Dr. Cheri Blauwet, Chief Medical Officer at Spaulding Rehabilitation Hospital, Associate Professor of Physical Medicine and Rehabilitation at Harvard Medical School, and retired Paralympian in the sport of competitive wheelchair...

Understanding Disability with Dr. Cheri Blauwet

In this episode of Curbside Consults, we examine the latest guidelines on the diagnosis and management of idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) by the American Thoracic Society (ATS). We are joined by Mary Strek, Professor of Medicine...

Update on Idiopathic and Progressive Pulmonary Fibrosis with Dr. Mary Strek

In this episode of Curbside Consults, we examine the latest standards of medical care published by the American Diabetes Association (ADA). We are joined by Dr. Bob Gabbay, who is Chief Science and Medical Officer at the American Diabetes Association, an...

ADA Standards of Medical Care in Diabetes with Dr. Bob Gabbay

In this episode of Curbside Consults, we examine the latest recommendation statement on the use of aspirin to prevent cardiovascular disease from the United States Preventive Services Task Force (USPSTF). We are joined by Michael Barry, who is Director of the Informed Medical Decisions Program in the Health Decision Sciences...

USPSTF Recommendation Statement on Aspirin Use with Dr. Michael Barry

In this episode of Curbside Consults, we are joined by Dr. Clyde Yancy, Chief of Cardiology at the Feinberg School of Medicine, past chair of the American College of Cardiology/American Heart Association Heart Failure Guidelines Committee, and a senior member of the committee that authored the new 2022 Guideline for...

Guideline for the Management of Heart Failure with Dr. Clyde Yancy

In this episode of Curbside Consults, we examine the latest guidelines from the Centers for Disease Control (CDC) on the treatment of sexually transmitted infections (STIs). We are joined by Dr. Kimberly Workowski, a Professor of Medicine in the Division of Infectious Diseases at Emory, and one of the guideline...

CDC Sexually Transmitted Infections Treatment Guidelines with Dr. Kimberly Workowski

As Editor-In-Chief of the <em>New England Journal of Medicine</em> , Dr. Eric Rubin is an authority on medical publishing, but he didn’t always know this was the job he wanted. In this special episode of Curbside Consults, we explore the highlights and challenges of being a physician editor at a...

Pursuing a Career in Medical Publishing: A Conversation with Dr. Eric Rubin

In this episode of Curbside Consults, we examine the latest guidelines on the diagnosis and management of Barrett’s esophagus by the American College of Gastroenterology (ACG). We are joined by Dr. Nick Shaheen, a Professor of Medicine and Chief of Gastroenterology and Hepatology at UNC Chapel Hill, and one of...

Diagnosis and Management of Barrett’s Esophagus with Dr. Nicholas Shaheen

In this episode of Curbside Consults, we examine the latest guidelines on the diagnosis and management of pediatric osteomyelitis by the Infectious Diseases Society of America (IDSA) and Pediatric Infectious Diseases Society (PIDS). We are joined by Dr. Samir Shah, a Professor of Pediatrics at Cincinnati Children’s Hospital, Editor-in-Chief of...

Diagnosis and Management of Pediatric Osteomyelitis with Dr. Samir Shah

In this episode of Curbside Consults, we examine the latest guidelines on the management of <em>Clostridiodes difficile</em> (<em>C. difficile</em> ) infection. This year, updated guidelines were developed by the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America, as well as the American College...

Diagnosis and Treatment of C. difficile Infection with Dr. Jessica Allegretti

In this episode of Curbside Consults, we examine the latest guidelines on the evaluation and management of well-appearing febrile infants 8-60 days old by the American Academy of Pediatrics (AAP). We are joined by Dr. Benard Dreyer, a Professor of Pediatrics at NYU, the past president of the AAP, who...

Evaluation and Management of Febrile Neonates with Dr. Benard Dreyer

In this episode of Curbside Consults, we discuss the intersection of climate change, health, and education with a group of residents and medical students who are leading initiatives to incorporate climate change into the curriculum at institutions across the country. We are joined by Dr. Jacob Fox, second year internal medicine resident at...

Climate Change, Health and Education with Dr. Jake Fox, Dr. Thomas Kuczmarski, and Karly Hampshire

The coronavirus pandemic has meant that for one of the first times ever, the entire world is experiencing the same thing at the same time. It has given me pause to think though, isn’t this exactly what climate change has been trying to highlight all along- that climate...

Climate Change and Health Care with Drs. Caren Solomon and Renee Salas

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

Jeffrey Drazen, MD, is a pulmonologist, critical care physician, and NEJM Group Editor. He is a Senior Physician at Brigham and Women’s Hospital, Distinguished Parker B. Francis Professor of Medicine at Harvard Medical School, Professor of Physiology at the Harvard School of Public Health, and Adjunct Professor of Medicine at the Boston University School of Medicine. Dr. Drazen served as Editor in Chief of the New England Journal of Medicine from 2000–2019.

In the intensive care unit (ICU), you learn how to care for the sickest patients in the hospital. In critical care, every second counts. In this rotation guide, our goal is to help you understand the studies that support clinical decisions...