Introduction: Burnout in medical students is extensive and a critical issue. It is associated with increased rates of depression, suicide, and poor perception of the educational environment. Enhancing resilience, the ability to adapt well in the face of adversity, is a potential tool to mitigate burnout and improve medical student wellness. Methods: Our resilience curriculum consisted of facilitated workshops to cultivate resilience in medical students during their core clerkship rotations. This curriculum served as an introduction to the concept of resilience and taught skills to cultivate resilience and promote wellness. The sessions allowed for identification of and reflection on stressors in the clinical learning environment, including straining team dynamics, disappointment, and uncertainty. Educational sessions included resilience skill-building exercises for managing expectations, letting go of negative emotions, dealing with setbacks, and finding meaning in daily work. Associated materials included lesson plans for small-group facilitators, learner pre-and postcurriculum surveys, and a social media activity guide. Results: This curriculum was delivered to 144 clerkship students at two academic institutions over the 2017-2018 academic year. Sessions were well received by medical students, with the majority of students stating that the sessions should continue. The majority of attendees found the sessions valuable and learned new ways to approach challenges. Discussion: Students valued connecting with peers and feeling less alone through their participation. A challenge was constructing a setting conducive to comfortable reflection for all learners. Not all students found these sessions necessary. Sessions may have improved resilience levels.

An incidental lung nodule on CT scan can create uncertainty for clinicians and anxiety for patients and families, given that lung cancer is the leading cause of cancer mortality in the United States. Incidental lung nodules are not uncommon. A systematic review of CT screening lung cancer trials noted that a lung nodule was detected in up to 51% of study participants. 1 More than 95% of detected nodules are benign and have a wide variety of causes, including infections, granulomatous disease, hamartomas, arteriovenous malformations, round atelectasis, and lymph nodes. Characteristics of the Guideline SourceThe Fleischner Society is an international multidisciplinary society that publishes standards, guidelines, and consensus statements on the diagnosis and treatment of chest diseases. In 2017, the society published updated guidelines for the management of incidental pulmonary nodules detected on CT images in adults aged 35 years or older (Table ). 2 The new guidelines offer more precise recommendations based on patient risk, the number of nodules (single vs multiple), and the subtyping of subsolid nodules (GGN vs partly solid); discuss additional risk factors for malignancy; and add flexibility regarding follow-up imaging (Figure).

This JAMA Clinical Guidelines Synopsis summarizes the American College of Rheumatology’s 2020 guideline for the management of gout.

A 59-year-old man who had been taking warfarin for 16 years for recurrent deep vein thrombosis and a left ventricular thrombosis presented to the anticoagulation management service for a follow-up visit. His warfarin had been managed via point-of-care (POC) testing for the past 4 years with a goal international normalized ratio (INR) of 2.0 to 3.0. On presentation, his POC INR was 3.7. He reported no extra warfarin doses, medication changes, dietary nonadherence, or bleeding. His warfarin dosage was 36 mg/wk (3 mg every Wednesday and Saturday and 6 mg all other days) for the past year. The Table shows the patient's laboratory test results. Answer D. Perform a plasma INR test to confirm POC INR test results.

BackgroundAlthough the Clerkship Directors in Internal Medicine (CDIM) has created a core subinternship curriculum, the traditional experiential subinternship may not expose students to all topics. Furthermore, academic institutions often use multiple clinical training sites for the student clerkship experience.ObjectiveThe objective of this study was to sustain a Web-based learning community across geographically disparate sites via enterprise microblogging to increase subintern exposure to the CDIM curriculum.MethodsInternal medicine subinterns used Yammer, a Health Insurance Portability and Accountability Act (HIPAA)–secure enterprise microblogging platform, to post questions, images, and index conversations for searching. The subinterns were asked to submit 4 posts and participate in 4 discussions during their rotation. Faculty reinforced key points, answered questions, and monitored HIPAA compliance.ResultsIn total, 56 medical students rotated on an internal medicine subinternship from July 2014 to June 2016. Of them, 84% returned the postrotation survey. Over the first 3 months, 100% of CDIM curriculum topics were covered. Compared with the pilot year, the scale-up year demonstrated a significant increase in the number of students with >10 posts (scale-up year 49% vs pilot year 19%; P=.03) and perceived educational experience (58% scale-up year vs 14% pilot year; P=.006). Few students (6%) noted privacy concerns, but fewer students in the scale-up year found Yammer to be a safe learning environment.ConclusionsSupplementing the subinternship clinical experience with an enterprise microblogging platform increased subinternship exposure to required curricular topics and was well received. Future work should address concerns about safe learning environment.