Journal of general internal medicine
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Graduate medical education is a critical period for fostering self-directed learning (SDL). This study introduced an academic coaching program to support SDL among internal medicine (IM) residents, leveraging Gallimore and Tharp's four-stage model as a scaffolding framework. ⋯ Sustained coaching, defined as two or more coaching meetings, is associated with improved IM-ITE performance. Qualitative findings underscore the program's role in enhancing residents' SDL.
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Millions of Americans remain infected with hepatitis C (HCV). Innovation in care delivery is required to achieve the goal of national elimination. ⋯ It is possible to both diagnose HCV and complete the entire pre-treatment evaluation in a single encounter and initiate treatment within 1 month, even for predominantly uninsured populations in rural areas.
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Long-acting injectable cabotegravir (CAB-LA), approved in 2021, is a more effective HIV prevention method than daily oral PrEP. CAB-LA expansion addresses key HIV prevention gaps, especially in the Southern United States (U.S.), to support national Ending the HIV Epidemic (EHE) goals. However, complex implementation requirements hinder CAB-LA expansion, highlighting the need for real-world data to guide effective and equitable scale-up. ⋯ We successfully implemented a CAB-LA PrEP program in a safety-net primary care center in the U.S. South, using an approach designed to address structural barriers to PrEP uptake and persistence.
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Nocturnists are the principal means by which hospital medicine groups currently ensure continuous overnight coverage of hospitalized patients within academic medical centers and community hospitals. Yet despite their involvement in most aspects of overnight care, a comprehensive review of the impact of nocturnists in the hospital is absent. Here we examine the physiologic effects of overnight work on clinicians, the quality of medical care delivered by nocturnists in floor and intensive care units, the impact of nocturnist presence on trainee supervision and graduated autonomy in academic settings, and prevalent staffing models. ⋯ Compensation is typically greater for nocturnists, but the role's sustainability and impact on overall group retention remain unknown. Nocturnist programs are essential to provide continuous care of hospitalized patients and meet trainee supervision mandates, yet their full impact on patient and educational outcomes requires further investigation. Future research should aim to optimize staffing models to enhance patient care, trainee education, and clinician well-being.