Journal of general internal medicine
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Long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs) and implants are highly effective and increasingly popular. Internal Medicine (IM) clinics and residency curricula do not routinely include LARCs, which can limit patient access to these methods. In response, internists are integrating LARCs into IM practices and residency training. ⋯ The model for integration of LARCs into IM clinics and resident education depends upon the clinical resources, patient needs, stakeholder support, and educational goals of the program.
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Prior to the COVID-19 pandemic, telemedicine (TM) experiences in undergraduate medical education were uncommon. When students' clinical experiences were interrupted due to the pandemic, TM education provided opportunities for students to participate in clinical care while adhering to social distancing guidelines. ⋯ The extent to which TM was used in the IM clinical clerkship, and across clinical clerkships, increased substantially when medical students were removed from in-person clinical duties as a response to COVID-19. When students returned to in-person clinical duties, experiences in TM continued, suggesting the continued value of TM as part of the formal education of students during the medicine clerkship. Curricula and faculty development will be needed to support TM education.
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Robotic prostatectomy is a costly new technology, but the costs may be offset by changes in treatment patterns. The net effect of this technology on Medicaid spending has not been assessed. ⋯ A full accounting of the costs of a new technology will depend on when it is used and the payment rate for its use relative to payment rates for substitutes.
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Recent clinical trials suggest that e-cigarettes may be more effective for smoking cessation than traditional cessation aids, yet primary care physician (PCP) practices regarding e-cigarette recommendations for smokers have not been studied in-depth. ⋯ Considering the increased patient use of e-cigarettes and increasing use for cessation, this study highlights the need for guidelines and education to aid PCPs' counseling of patients about e-cigarette use.
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Due to concerns of inadequate primary care access, national agencies like the Health Resources and Services Administration (HRSA) support primary care (PC) residencies. Recent research demonstrates that up to 35% of PC alumni lost interest in PC during residency. These alumni who lost interest noted that their continuity clinic experience influenced their career choice. The purpose of this study was to identify the specific aspects of PC residency experience that influenced career choice. ⋯ Strong interpersonal relationships with patients and clinic mentors were associated with a PC career. These factors may compensate for the reported frustrations of clinic. Enhancing patient and mentor relationships may increase the retention of PC residents in ambulatory careers and may help address the current and projected shortage of primary care physicians.