Core IM | Internal Medicine Podcast

If your patient asks you about a left atrial appendage closure device, what should you tell them?

In the latest episode of the Beyond Journal Club podcast from CORE IM and NEJM Group, the hosts will help you:

• Understand the trade-offs: stroke prevention, bleeding, procedural risks, and medications afterward.
• Build clinical judgment: weigh which approach may better serve the individual patient, beyond the trial’s headline.
• Learn from thoughtful counseling: hear how you might discuss the evidence, acknowledge uncertainty, and explore what matters to your patients.

🔹Sponsor: ACP MKSAP Oakstone CME

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🔹Transcript and Show Notes

01:09 | What the Watchman is, and why it should work?

05:58 | The checkered history: PROTECT-AF and PREVAIL

09:06 | The plot continues: PRAGUE-17, OPTION, OCEAN, and CLOSURE-AF

12:35 | CHAMPION-AF: the biggest test yet

15:03 | Reading the fine print

19:23 | A local solution to a systemic problem

22:45 | How patients hear about it

25:44 | So what do we tell our patients?

29:52 | Takeaways

Tags: IMCore, Internal Medicine, Medical Education, WATCHMAN device, Atrial Fibrillation, Cardiology, DOAC Anticoagulation, Primary Care, Hospital Medicine

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“Should you stop screening for colorectal cancer (CRC) at 75?”

This episode explores how to individualize screening decisions based on life expectancy, prior colonoscopy findings, and procedural risks. Learn how to navigate these nuanced conversations, avoid age-based assumptions, and use strategies like mailed FIT kits and offering screening choices to help more patients get screened.

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🔹Transcript and Show Notes

01:18 | Screening >75 yo?

10:06 | Takeaways on Colorectal Cancer Screening After 75

10:37 | Systems thinking: How do we get to an 80% screening rate

Tags: Core IM, Internal Medicine, Colorectal Cancer Screening, Gastroenterology, Cancer Screening

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“What’s the best way to screen?” This episode breaks down the pros, limitations, and follow-up needs of FIT, Cologuard, CT colonography, and colonoscopy to help you choose the right CRC screening option for your patients. Also learn practical colonoscopy surveillance intervals based on polyp size, number, and pathology.

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🔹Transcript and Show Notes

01:24 | Screening Options Besides Colonoscopy

11:22 | How FIT, FIT-DNA, and CT colonography differ and when each makes sense.

12:52 | Colonoscopy and Frequency

19:29 | How adenoma number, size, and histology guide surveillance intervals.

Tags: Core IM, Internal Medicine, Colorectal Cancer Screening, Gastroenterology, Cancer Screening

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“The triglycerides are high. Now what?” This episode breaks down a practical approach to elevated TGs, from knowing when to check ApoB or non-HDL-C to choosing lifestyle changes, lipid-lowering medications, and when to suspect an underlying genetic disorder.

🔹Transcript and Show Notes

02:17 | Check a non-HDL-C or ApoB if TGs are ≥150 mg/dL

07:18 | Address waist circumference and lifestyle before meds for high TGs

10:52 | Dr. Watson’s 3-day carbohydrate responsiveness trial

17:07 | Order a fasting or nonfasting lipid panel?

19:00 | When do you reach for TG-lowering medications?

25:26 | Familial chylomicronemia syndrome (FCS)

Tags: CoreIM, Medical Education, Hypertriglyceridemia, ACC AHA lipid guidelines, lipid guidelines 2026, cardiovascular risk

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“Too young for colon cancer.” This episode unpacks the red flags of early-onset colorectal cancer (CRC), from blood in the stool and iron deficiency anemia to persistent abdominal pain and changes in bowel habits, and offers practical pearls for closing the clinical loop. Also learn why a “negative” family history may need a yearly refresh.

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🔹Transcript and Show Notes

01:45 | Colorectal cancer rising in younger adults

06:42 | Why screening starts at age 45

08:15 | What may be driving early-onset colorectal cancer

13:37| Key takeaways: symptoms, follow-up, and family history

Tags: Colorectal Cancer Screening, Internal Medicine, Gastroenterology, Cancer Screening, Oncology

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“It didn’t work.” This episode breaks down practical treatment options (dosing options for naltrexone, acamprosate, topiramate, gabapentin) and counseling pearls to help you meet patients where they are and support their recovery. Also discover blind spots in detox and rehab centers.

🔹Transcript and Show Notes

🔹 Explore ACP’s Substance Use Disorder Education Hub for videos and an AI-powered patient simulation to practice alcohol-use conversations: https://www.coreimpodcast.com/SUDhub

Alcohol Use and Chronic Health Conditions Mini Video Series

01:55 | #1: Naltrexone

12:06 | #2 Acamprosate

16:15 | #3: Topiramate

21:12 | #4: Other meds

29:31 | #5: Detox and rehab blind spots

Tags: CoreIM, Medical Education, Addiction Medicine, Alcohol Withdrawal, Addiction Treatment, GLP-1, pharmacology

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Have you ever lost a patient and found yourself thinking about them long after the shift ended? This episode explores the grief clinicians can carry after a patient dies, including the losses that aren’t always obvious. We also discuss ways to work through that grief, recognize when it becomes complicated, and lean on your team for support.

🔹Transcript and Shownotes

04:12 | What is Clinician Grief?

10:02 | Types of Losses

10:22 | Loss of a close relationship with a particular patient

12:56 | Loss due to a professional's identification with the pain of family members

13:56 | Loss of one's unmet goals and expectations and one's professional self-image and role

18:47 | Loss related to one's personal system of beliefs and assumptions about life

21:30 | Past unresolved losses or anticipated future losses

23:29 | The death of the self

25:44 | Coping

Tags: CoreIM, Medical Education, Clinician Wellbeing, Burnout, Secondary Traumatic Stress, Complicated Grief, Coping With Grief, Medical humanities, medical ethics

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How to choose between RUQ ultrasound, CT, HIDA, MRCP, EUS, and ERCP based on the clinical picture? When should you move from diagnostic imaging to therapeutic ERCP, and what should you know about sphincterotomy, stents, and stone removal? Plus, how to interpret bile duct dilation without jumping straight to obstruction?

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🔹Transcript and Shownotes

02:11 | Pearl 1: Gallbladder Problems Spectrum

07:33 | Pearl 2: Choose Imaging Strategically: Start with RUQUS, Escalate as Needed

14:34 | Pearl 3: Biliary Tree Diagnostics

19:19 | Pearl 4: Invasives that are Diagnostic and Therapeutic

27:06 | Pearl 5: Stenting in ERCP

Tags: CoreIM, Internal Medicine, Medical Education, Gallstones, Cholecystitis, Biliary Disease, ERCP, Biliary Imaging

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Throwback: Should you really fluid-restrict every patient with SIADH? When can IV fluids make hyponatremia better or worse? Are salt tabs actually doing enough? And what can urine studies tell you before you start treatment? Join us for a practical, physiology-driven approach to hyponatremia management, from fluids and solutes to loop diuretics and identifying the underlying cause.

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🔹Transcript and Shownotes

6:46 | Pearl 1: Key Principles

15:13 | Pearl 2: Fluids in hyponatremia

26: 03 | Pearl 3: Solutes in hyponatremia management

35:49 | Pearl 4: Lasix in hyponatremia management

40:05 | Pearl 5: Etiologies

Tags: CoreIM, Internal Medicine, Medical Education, SIADH, Fluid Restriction, Nephrology, Hospital Medicine, Urine Osmolality

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Why can lower-dose combinations be more effective and better tolerated than maximizing one medication? How to troubleshoot common challenges such as amlodipine edema, gout, electrolyte abnormalities, and the patient who says they cannot tolerate anything? Why ACT (ARBs, Calcium Channel Blockers, Thiazides) is the preferred first-line framework, and how to personalize medication choices based on comorbidities and side effects.

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🔹Transcript and Shownotes

03:00 | Diagnosing Hypertension

04:10 | When to Start Combination Therapy Instead of Monotherapy

07:00 | Choosing First-Line Therapy Using the ACT Framework

13:23 | Why ARBs Are Often Preferred Over ACE Inhibitors

16:02 | Choosing the Right ARB: Candesartan vs Losartan

18:39 | Comparing Potency & Duration Across First-Line Antihypertensives

20:54 | Amlodipine Edema: Why It Happens and How to Fix It

23:54 | Thiazides: Practical Tips, Electrolyte Problems & Class-Killer Side Effects

29:33 | Managing Patients Who 'Can't Tolerate' Blood Pressure Medications

Tags: Hypertension Management, High Blood Pressure, Primary Care, Internal Medicine, Core IM

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Learn from primary care docs what has been practiced and changed from the 2026 ACC/AHA Lipid Guidelines! Learn how the new CPR framework (Calculate, Personalize, Reclassify) and PREVENT risk calculator change statin decisions, why LDL targets are back, and when to use Lp(a), ApoB, and coronary artery calcium (CAC) testing. Discover updated risk-enhancing factors, expanded indications for non-statin therapies, and practical strategies to personalize lipid management for both primary and secondary

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🔹Transcript and Shownotes:

01:17 | Highlight #1 & #2: CPR and PREVENT Score

03:14 | Highlight #3: Updated ASCVD Risk Categories Using the PREVENT Score

05:30 | Highlight #4: LDL Targets Are Back

07:20 | Highlight #5: High-Risk Conditions That Bypass the PREVENT Score

08:41 | Highlight #6: Lp(a) Screening for Everyone

11:51 | Highlight #7: When to Use ApoB Testing

13:16 | Highlight #8: Reproductive Risk Factors

15:29 | Highlight #9: Using CAC to Guide Statin Therapy

19:09 | Highlight #10: Non-Statin Therapies

Tags: CoreIM, Internal Medicine, Medical Education, Cholesterol, Statins, LDL, ASCVD, Preventive Cardiology, LpA, ApoB, CAC, ACC2026, Cardiology, PrimaryCare

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MASLD affects nearly one in three adults worldwide, yet many patients remain undiagnosed until advanced fibrosis or cirrhosis develops. So, which patients should clinicians actually be screening? When is a FIB-4 enough, and when should we move to elastography or hepatology referral? And are we finally entering an era where we can meaningfully treat MASH?

In this Beyond Journal Club episode, we unpack the evolving language of steatotic liver disease and take a close look at two major trials: MAESTRO-NASH studying resmetirom, the first FDA-approved liver-directed therapy for MASH, and ESSENCE, evaluating semaglutide in biopsy-confirmed disease.

Along the way, we explore what these biopsy-based histologic endpoints really mean, why placebo responses were surprisingly high, and whether improvements in steatohepatitis and fibrosis will ultimately translate into better clinical outcomes for patients.

This episode is for clinicians trying to understand where the field is headed, which patients deserve closer attention, and how metabolic liver disease is increasingly becoming part of everyday primary care and hospital medicine.

🔹Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹Transcript and Shownotes:

01:57 | Understanding MASLD as a Systemic Disease

05:45 | MASLD vs MASH vs Met-ALD: Spectrum Steatotic Liver Disease

08:55 | How to Screen for Fibrosis (FIB-4 & FibroScan)

16:15 | Lifestyle Treatment & Weight Loss Targets

19:00 | ESSENCE Trial: Semaglutide for MASH

21:58 | MAESTRO-NASH Trial: Resmetirom

27:27 | Future Treatments for MASH

30:51 | Key Takeaways for Clinicians

Tags: CoreIM, Internal Medicine, Medical Education, Hepatology, Fatty Liver Disease, Metabolic Dysfunction Associated Steatohepatitis, Nonalcoholic Fatty Liver Disease, Liver Fibrosis

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What blood pressure should we target in patients on hemodialysis? Why volume control remains the foundation of treatment? How blood pressure targets differ from the general population. Learn practical pearls on medication timing around dialysis, drug dialyzability, antihypertensive selection, and strategies to prevent intradialytic complications while optimizing long-term outcomes.

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🔹Transcript and Shownotes:

02: 19 | Pearl 1: Blood Pressure Targets

09: 40 | Pearl 2: Timing Medications and Dialyzability

15: 31 | Pearl 3 - Pharmacologic Management Nuances in Dialysis Patients

22: 57 | Putting It All Together: The Medication Hierarchy

Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, ESRD, End-Stage Kidney Disease, Hypertension, Kidney Health, Dry Weight, Volume Overload

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Why is fluid management the most important part of dialysis care? This episode explores the fundamentals of hemodialysis, why ESKD patients have unique physiology, and how volume overload, not just hypertension, drives many complications. Learn practical pearls on dry weight, sodium restriction, diuretics, and the strategies that can reduce hospitalizations and improve patient outcomes.

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🔹Transcript and Shownotes:

02:49 | Pearl 1: Foundations of Dialysis

09:21 | Pearl 2: Distinct Physiology

11:42 | Pearl 3: Why is fluid management so important?

19:43 | Pearl 4: Fluid Management Pro-tips

25:31 | Pearl 5: Diuretics in Patients with Residual Kidney Function

Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, Dialysis, End-stage kidney disease, Hypertension, Kidney Health, Dry Weight, Volume Overload

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Can AI manage post-op atrial fibrillation or does medicine still require human judgment? Using post-op AFib as a case study, we explore where algorithms help, where evidence falls short, and why clinical context still matters. When evidence is incomplete, and every patient is different, can AI truly practice medicine or only assist the clinicians who do? This episode explores the space between algorithms, uncertainty, and human judgment in modern medical care.

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🔹Transcript and Shownotes:

02:51 | Broad workup for reversible causes and other etiologies of AFib that may occur post-op

05:10 | Considerations for management of post-op atrial fibrillation

13:00 | Stroke risk in atrial fibrillation

20:49 | Outpatient management of atrial fibrillation

25:54 | The role of AI in medical decision-making

Tags: CoreIM, Internal Medicine, Medical Education, Atrial Fibrillation, Cardiology, Open Evidence

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We start with a gripping story of seizures and use it as a jumping-off point to unpack practical pearls for in-flight emergencies. Along the way: what’s actually in the emergency medical kit, when planes divert, how ground medical support works, altitude physiology, legal protections, and how to stay calm when medicine suddenly happens at 35,000 feet. By the end, you may still sweat a little…but hopefully less than before.

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🔹Transcript and Shownotes:

04:40 | Emergency Medical Kit (EMK) Standard Contents

08:50 | Role of Ground-Based Medical Support & Flight Diversion Decision-Making

19:35 | Interpreting Hypoxia at Altitude

22:06 | In-Flight Liability

23:35 | Common Chief Concerns & Useful Additional Medications

24:53 | How to Be Resourceful in an Austere Environment

Tags: CoreIM, Internal Medicine, Medical Education, In-flight Care, Medical Emergencies, Clinical Reasoning, Seizure Management, Hypoxia, Airway Management, Cardiac Emergency, Syncope, Respiratory Distress

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Can you distinguish benign eosinophilia from a sign of serious disease, and know exactly when to act at the bedside?

In this high-yield episode, test your clinical reasoning as we tackle:

• When eosinophilia becomes dangerous and why it matters
• How to distinguish if its from atopy vs. systemic disease
• Which medications to stop (and which to watch)
• How travel, diet, and exposure history shape your workup
• When to suspect malignancy before giving steroids

🔹Transcript and Shownotes:

02:34 | Why Do We Care About Eosinophilia? (Pearl 1)

10:24 | Atopy and Eosinophilia (Pearl 2)

18:57 | Drugs and Eosinophilia (Pearl 3)

27:29 | ID and Eosinophilia (Pearl 4)

33:54 | Pearl 5: Eosinophilia, Steroids, and Neoplasms (Pearl 5)

Tags: CoreIM, Internal Medicine, Medical Education, Eosinophilia, Hypereosinophilia, Allergy Immunology, Hematology, Pulmonology, Parasitic Infections, Atopy

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Is coffee helping or harming our patients’ hearts?

In this Beyond Journal Club, we unpack the CRAVE trial and use it as a lens to answer a bigger question:

How should clinicians interpret nutrition research, especially when it feels inconsistent or hard to trust?

Listen for a concise, practical framework you can use the next time a patient asks about coffee, diet, or lifestyle.

🔹Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹 Transcript and Show notes

00:00 | Challenges of interpreting nutritional research.

02:22 | Best practices for evaluating studies in nutrition.

12:35 | Delve into the CRAVE trial as an example of critically appraising nutritional investigations.

26:41 | Applying this to clinical practice for your patients.

Tags: IMCore, Internal Medicine, Medical Education, Epidemiology, Diet and Lifestyle

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Why can these infections be tricky? How to diagnose osteomyelitis at the bedside? Do we always need IV vs oral antibiotics? And the best for last: Simple, practical wound care strategies for medical students, residents, and clinicians who want a clear, usable approach.

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🔹Transcript and Shownotes:

02:15 | Pearl 1: Pathophysiology

08:20 | Pearl 2: Diagnosis

16:35 | Pearl 3: Treatment

20:35 | Pearl 4: Antibiotics

27:39 | Pearl 5: Wound Care

Tags: CoreIM, Internal Medicine, Medical Education, Diabetic Foot Infections, Osteomyelitis, Foot Ulcer, Wound Care

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A dialysis patient with a chronic cough: is it COPD, or are they still volume overloaded?

A patient with AKI and hyperkalemia says they’re still peeing — does that rule out post-obstructive AKI?

A patient arrives in the ED with uremic symptoms and a newly created AV fistula. Can you safely use it, or do you need to place a temporary dialysis catheter?

And the classic inpatient dilemma: your heart failure patient looks better after diuresis, but the creatinine is rising. Is it time to stop, or should you keep going?

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See here for Neph Madness details

See here for the POCUS region of NephMaddness

VOTE here to build your bracket!

🔹Transcript and Shownotes:

00:52 | What is NephMadness?

02:19 | Detecting post-renal obstruction in a patient who reported normal urination

11:26 | POCUS for discharge or continue diurese

17:25 | Distinguishing COPD from volume overload in a dialysis patient using lung ultrasound

23:55 | Assessing AV fistula maturity at the bedside to potentially avoid placing a temporary dialysis line

Along the way, we discuss practical ways clinicians can use renal, lung, and venous ultrasound to clarify uncertain clinical situations and make faster decisions at the bedside.

If you’ve ever paused on rounds, wondering “what should we do next?” in a patient with kidney disease, this episode explores how POCUS can help answer that question.

Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, AKI Management, POCUS

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