Journal of General Internal Medicine最新文献

{"title":"Age-Related Differences in Clinician Communication About Colorectal Cancer Screening in the USA.","authors":"Jordan Baeker Bispo, Priti Bandi, Ahmedin Jemal, Farhad Islami","doi":"10.1007/s11606-026-10854-0","DOIUrl":"https://doi.org/10.1007/s11606-026-10854-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Low Breast Cancer Screening Rates by Resident Physicians.","authors":"Saul N Weingart, Katrina S Kufer, Meghan I Short, Joseph Gillis, Kinjalika Sathi, Prianka Chawla, Kimberly Schelling, Kristin T L Huang, Julie Tishler","doi":"10.1007/s11606-026-10899-1","DOIUrl":"https://doi.org/10.1007/s11606-026-10899-1","url":null,"abstract":"<p><strong>Background: </strong>While research has shown that medical residents often achieve poorer cancer screening rates than faculty in the same practice, residents' disadvantages in experience and continuity may be overcome in high-functioning primary care practices. To explore this observation, we compared breast cancer screening rates of resident and faculty physicians at an academic primary care practice with robust practice support.</p><p><strong>Methods: </strong>We measured breast cancer screening compliance in CY2025 using tools embedded in EPIC. Patients were considered compliant if they were women age 40-74 with a mammogram within 2 years and no disqualifying characteristics. We abstracted patient data from the electronic medical record and collected physician data on gender, language facility, and years in practice. We compared breast cancer screening rates by physician type in bivariate and multivariable logistic regression models.</p><p><strong>Results: </strong>Resident patients comprised 1024 (12%) of the 8825 patients eligible for breast cancer screening. Faculty panels included a higher percentage of patients who were white, English speakers, on commercial insurance, and with more medical comorbidities. The resident panel had more patients with serious mental illness and fewer primary care encounters. Faculty physician exceeded resident performance overall (83% vs. 66%, p < 0.001). The odds ratio of a resident patient having up-to-date breast cancer screening was 0.41 (95% confidence interval 0.35-0.47) in the unadjusted model. The adjusted odds ratios improved from 0.5 (0.40-0.62) in model 1 (patient sociodemographic only) to 0.59 (0.48-0.74) in model 2 (clinical and utilization variables) to 0.73 (0.54-0.98) in model 3 (physician attributes).</p><p><strong>Conclusion: </strong>In a teaching practice with a robust primary care infrastructure, disparities in breast cancer screening between faculty and resident panels improved with rigorous adjustment. However, residency training programs may need to be redesigned to eliminate remaining disparities in care.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Providers are Less Likely to Ask About and Advise Cessation for Non-Cigarette Tobacco Products: NSDUH 2021-2023.","authors":"Lauren R Pacek, Min-Jeong Yang, Melissa Mercincavage, Monica J Gilles, Kimberly Jordan-Casarona, Nicolette E Garthe, Cristine D Delnevo, Michael B Steinberg","doi":"10.1007/s11606-026-10925-2","DOIUrl":"https://doi.org/10.1007/s11606-026-10925-2","url":null,"abstract":"<p><strong>Background: </strong>Tobacco use assessment during clinical encounters is often suboptimal and has focused predominantly on cigarette smoking, to the exclusion of non-cigarette tobacco use. Current estimates of assessing non-cigarette tobacco use are needed.</p><p><strong>Objective: </strong>Evaluate differences in being asked about tobacco use and advice to quit by healthcare providers among exclusive cigarette and non-cigarette tobacco product users.</p><p><strong>Design and participants: </strong>Epidemiological study utilizing adult data from the 2021-2023 National Survey on Drug Use and Health (n = 139,524). Among exclusive cigarette, cigar, smokeless tobacco, e-cigarette, and multiple tobacco product (MTP) users, we evaluated the prevalence of being asked about tobacco use being advised to quit by healthcare providers. We examined correlates of both outcomes.</p><p><strong>Main measures: </strong>Being asked about tobacco use and receiving advice to quit by a healthcare provider during the past year.</p><p><strong>Key results: </strong>Fewer people who used cigars (74.3%; p = 0.040), smokeless tobacco (72.5%; p = 0.007), and e-cigarettes (73.2%; p < 0.001) were asked about tobacco use, versus cigarette smokers (78.9%). Among those asked about tobacco use, 77.1% of cigarette smokers were advised to quit, versus people who used cigars (25.4%; p < 0.001), smokeless tobacco (46.0%; p < 0.001), e-cigarettes (0.5%; p < 0.001), and MTPs (65.4%; p < 0.001). Correlates of being Asked and Advised varied based by tobacco product. Overall, more (e.g., ≥ 6) healthcare appointments (Ask: aOR = 1.51, 95% CI = 1.22-1.87; Advise: aOR = 1.50, 95% CI = 1.14-1.97), having a lifetime chronic health condition (Ask: aOR = 1.71, 95% CI = 1.47-2.00), and older age (e.g., ≥ 50; Advise: aOR = 3.80, 95% CI = 2.96-4.89) were associated with being asked about and advised to quit tobacco use.</p><p><strong>Conclusions: </strong>Non-cigarette product users were less likely than people who smoked cigarettes to be asked about or advised to quit tobacco use. Findings can inform clinical policies to help patients quit non-cigarette tobacco products and highlight the need for educational efforts and intervention development.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of Informal Medical Consultations via Digital Platforms Among Medical Students and Physicians: A Cross-Sectional Survey.","authors":"Kudret Selki, Mustafa Enes Demirel, Mustafa Boğan, Melek Karaduman, Havva Beyza Ertunç, Yasin Bozkurt, Ceren Akkaya, Ömer Akif Öztürk","doi":"10.1007/s11606-026-10944-z","DOIUrl":"https://doi.org/10.1007/s11606-026-10944-z","url":null,"abstract":"<p><strong>Introduction: </strong>Informal medical consultations via phone and messaging apps are increasingly common. Though perceived as practical, they may create stress and blur professional boundaries. This study evaluated the frequency and characteristics of these requests and their impact on occupational well-being.</p><p><strong>Methods: </strong>This cross-sectional, questionnaire-based study included 191 medical students and physicians. The questionnaire assessed the frequency and characteristics of informal medical consultation requests received within the previous week, their perceived impact on work-life balance, stress/anxiety, perceived boundary violation, and response behaviors. A modified version of the Mini-Z 2.0 instrument was used to assess domains such as stress, workload, and job satisfaction. A study-specific composite total occupational well-being score was calculated, with higher scores indicating better occupational well-being. Univariable and multivariable linear regression analyses were performed to identify factors associated with the Mini-Z total score.</p><p><strong>Results: </strong>Of the 191 participants, 29 (15.2%) reported receiving no requests, 140 (73.3%) reported 1-5 requests, and 22 (11.5%) reported ≥ 6 requests in the previous week. Requests were most commonly delivered via WhatsApp or similar applications (60.7%) and were most often initiated by family members or relatives (70.7%). Most participants reported that the requests were unrelated to their own specialty (80.1%) and mostly non-urgent (98.4%). Perceived stress/anxiety and boundary violation increased significantly according to request frequency (p = 0.027 and p = 0.021, respectively), whereas modified Mini-Z total scores did not (p = 0.528). In multivariable analysis, responding \"depending on the situation\" or \"did not respond\" was independently associated with lower modified Mini-Z total scores (B = -2.55; 95% CI -4.72 to -0.38; p = 0.022).</p><p><strong>Conclusions: </strong>Informal medical consultation requests through phone calls and messaging applications are common and, although mostly non-urgent, may generate stress and perceived boundary violation. Their impact on occupational well-being may depend less on request frequency itself than on how these requests are experienced and managed.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best Practices for Optimizing Recovery from Sepsis; Results of an Expert Panel.","authors":"Jeremy B Sussman, Cainnear K Hogan, Taylor Whittington, Kathleen M Akgün, Mel L Anderson, Reena Duseja, Tammy L Eaton, Jason R Falvey, David A Ganz, Joanne McPeake, Stephanie Parks Taylor, Scott Pawlikowski, Kirstin M Piazza, Sheila Cox Sullivan, Steven J Bernstein, Hallie C Prescott","doi":"10.1007/s11606-026-10926-1","DOIUrl":"https://doi.org/10.1007/s11606-026-10926-1","url":null,"abstract":"<p><strong>Background: </strong>Over one million patients survive sepsis annually in the USA. After sepsis, patients often experience new morbidity, with high rates of readmission and post-acute mortality. However, there are limited data to inform best practices to support recovery from sepsis.</p><p><strong>Methods: </strong>We convened an expert panel to rate the validity, importance, and resource intensity of 18 care practices aimed to support recovery from sepsis using the RAND/UCLA appropriateness method (a modified Delphi approach). The multidisciplinary panel consisted of 15 experts in sepsis, critical care, hospital medicine, primary care, geriatrics, nursing, and quality improvement, as well as Veteran patient representatives. In addition to the panel members' scores of care practices, panel deliberations were used to understand members' selections.</p><p><strong>Results: </strong>Among the 18 care practices considered, all received agreement in final grading, 10 (56%) were rated as valid, and eight (44%) were rated as uncertain validity. Among 10 valid practices, five were rated as high importance and only moderately resource-intensive-suggesting they should be prioritized for implementation. The high-importance, moderate resource-intensity practices were as follows: scheduling recommended follow-up prior to discharge; screening for limitations in basic and instrumental activities of daily living (I/ADLs) and need for durable medical equipment (DME); educating patients on signs and symptoms of sepsis; educating patients on common symptoms after sepsis (e.g., fatigue, shortness of breath, brain fog); and counseling patients and/or caregivers on discharge medications and their indications. Study limitations include the panel composition (majority VHA clinicians, no social work representation), which may have impacted ratings.</p><p><strong>Conclusions: </strong>The expert panel used a validated method to prioritize care practices for supporting recovery from sepsis. These ratings can be used to improve management, inform quality improvement efforts, and guide resource allocation.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online Searches for Xylazine Following The Pitt Episode Featuring Xylazine-Associated Skin Wounds.","authors":"David T Zhu","doi":"10.1007/s11606-026-10943-0","DOIUrl":"https://doi.org/10.1007/s11606-026-10943-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Urgency to Alignment: A Framework for Reflecting on Effort Allocation in Academic Medicine.","authors":"Christopher Sankey","doi":"10.1007/s11606-026-10940-3","DOIUrl":"https://doi.org/10.1007/s11606-026-10940-3","url":null,"abstract":"<p><p>Academic physicians often succeed in the visible work of our jobs while struggling to advance our long-term careers. Although widely used prioritization frameworks emphasize protecting important, non-urgent work, they do not fully explain why career-building efforts are consistently displaced by urgent daily responsibilities. Professional identity offers a critical additional lens. The Alignment Matrix reframes professional effort by mapping drivers (internal versus external) against identity (aligned versus misaligned), creating four categories of effort: critical work, career-building, others' priorities, and ancillary work. Unlike static prioritization frameworks, the Alignment Matrix recognizes that both professional identity and ownership of professional effort evolve over time, providing a snapshot of the relationship between us and our work within a particular role or career stage. When dominant patterns emerge, the framework supports reflection through quadrant-specific questions that facilitate opportunities for intentional realignment. Rather than prescribing uniform solutions, it distinguishes under-leveraged alignment, misdirected effort, and compounded misalignment as distinct challenges requiring different considerations. By shifting the focus from urgency to identity, the Alignment Matrix offers a framework for understanding the allocation of professional effort and supporting more intentional career development in academic medicine.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ACEs of Clinical Reasoning: a Formal, Longitudinal, Leadership Role for Medical Students to Augment Clinical Reasoning Education.","authors":"Zeyu Tang, Madisen A Swallow, Ryan C Bahar, Marina Gaeta Gazzola, Thilan P Wijesekera","doi":"10.1007/s11606-026-10904-7","DOIUrl":"https://doi.org/10.1007/s11606-026-10904-7","url":null,"abstract":"<p><strong>Background: </strong>Clinical reasoning (CR) is integral to undergraduate medical education but requires significant resources to deliver adequate practice and individualized feedback. Peer-assisted learning (PAL) may improve instructional capacity and enhance the learning climate.</p><p><strong>Aim: </strong>We describe the development, implementation, and impact of the Associate Course Educator (ACE) role, a structured PAL and leadership position for medical students within a CR longitudinal course.</p><p><strong>Setting: </strong>A private, not-for-profit U.S. medical school.</p><p><strong>Participants: </strong>Senior medical students who completed core clerkships.</p><p><strong>Program description: </strong>ACEs completed a 12-month term with optional term renewal for eligible students. They received close mentorship and instruction in CR pedagogy. ACEs delivered at least 20h of teaching annually, led educational projects, contributed to scholarship, and supported curricular review.</p><p><strong>Program evaluation: </strong>Across six recruitment cycles (2020-2026), 84 students applied and 44 were selected (52.4%). Annual CR sessions increased from eight to 22 and shifted from large-group to predominantly small-group and one-on-one formats. ACEs contributed multiple educational innovations and disseminated scholarship at regional and national venues.</p><p><strong>Discussion: </strong>The ACE role formalizes PAL as a mentored medical education experience that expands instructional capacity, supports instructor-intensive teaching formats, and enhances feedback mechanisms. For students, the role provides structured mentorship in CR, teaching, and scholarship while enabling meaningful contributions to institutional curricula.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arrivals and Departures.","authors":"Adrian Kalaw, Emily Harris, Karen Wood","doi":"10.1007/s11606-026-10909-2","DOIUrl":"https://doi.org/10.1007/s11606-026-10909-2","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Re: Untangling the Web of Hepatitis C Risk in Rural Communities.","authors":"Amelia Bailey, Samuel Tarplin, Augustine Kang","doi":"10.1007/s11606-026-10934-1","DOIUrl":"https://doi.org/10.1007/s11606-026-10934-1","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}