Core IM | Internal Medicine Podcast

Latest Episodes:

#200: Insulin and QWINT-1 Trial in T2DM: Beyond Journal Club Segment with NEJM Group Feb 11, 2026

Show notes

From metformin to basal insulin to overlooked older medications, this episode reviews the T2D medication toolkit clinicians use every day. We then dive into new evidence on once-weekly insulin to help you individualize therapy while reducing treatment burden.

🔹 Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/

🔹Transcript and Shownotes:

00.58 | Insulin Hx & Types

06:00 | Indications for Insulin and the Burden on Patients

08:26 | What is the QWINT-1 Trial?

16:18 | Discussion

Tags: CoreIM, Internal Medicine, Evidence-Based Medicine, Insulin Resistance, Clinical Reasoning, Hospital Medicine, Medical Education, Endocrine, Endocrinology

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#199 Privacy & Confidentiality: At the Bedside Segment Jan 28, 2026

Show notes

Is patient confidentiality absolute or conditional? When does protecting privacy put others at risk? Can you follow a former patient in the EHR for learning? Should you post a compelling case online even if it’s “de-identified”? And when does the law force you to betray patient trust? In this episode of At the Bedside, learn how clinicians should act when ethics, law, and trust collide.

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🔹Transcript and Shownotes:

03:51 | What is the difference between Privacy and Confidentiality?

05:50 | Guidelines and laws

10:06 | Limits/appropriate breaches (competing principles/obligations)

22:03 | Privacy vs education

35:34 | Conclusion

**#198 Microskills for Change That are Big Enough to Matter, Small Enough to Win** Jan 21, 2026
Show notes

**Baby alligators** - those betrayals of purpose , or, death by a thousand paper cuts !
Check out our latest episode, where Dr. Eileen Barrett walks us through how to tackle baby alligators with:
**Regulated curiosity**
**Strategic empathy**
**Small, well-chosen moves...**
...and change that is ***big enough to matter, and small enough to win!***

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🔹 Transcript & Shownotes
00:00 | What are “baby alligators” in medicine?
02:24 | Rifaximin & Workflow Fixes
14:17 | Verbal Orders Policy
18:39 | Micro Skills for Change
25:12 | Key Takeaways

#PhysicianBurnout #DoctorLife #HealthcareEfficiency, CoreIM, Internal Medicine, Career Development, Quality Improvement, QI

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#197 Hypercoagulability Part 2: 5 Pearls Segment Jan 07, 2026

Show notes

Gray zones of VTE management! How to approach anticoagulation duration in unprovoked, provoked-irreversible, and provoked-reversible clots?

When dose-reduced DOACs make sense for long-term secondary prevention? What truly constitutes DOAC failure? We also devle into how APLAS a critical do-not-miss diagnosis that changes management entirely.

🔹 Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/

🔹 Transcript & Shownotes

(2:56) - (13:15) | PEARL 1: Managing clots in the “unprovoked”/provoked-irreversible patient

(13:21) - (18:10) | PEARL 2: Managing provoked, “reversible” clots

(18:14) - (25:14) | PEARL 3: DOAC failure: time to step it up?

(25:20) - (37:25) | PEARL 4: APLAS: the exception to everything

Tags: CoreIM, Internal Medicine, ClinicalPearls, Medical Education, IMCore, hospitalist, physician assistant, nurse practitioner, medical student, internal medicine, hematology

#196 Stories of Courage and Career Development with Horn Award Dec 17, 2025

Show notes

We hope these stories resonate with anyone who has felt pulled between professional purpose and personal life, and remind you that you’re not alone in wanting both.

🔹 Sponsor: Oakstone CME

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🔹 Transcript and Shownotes

(1:09) | How the Horn Award Opened the Door to Growth in Dr. Tyra Fainstad’s Career and Life

(10:28) | How Dr. Carol Ward Created the Horn Award and Honored Mary Horn’s Legacy

(14:16) | Dr. Hilit Mechaber’s Story of Courage, Vision, and Impact Beyond the Award

(17:55) | Why does the Horn Award Matter?

Tags: CoreIM, Internal Medicine, Career Development Award, Mary O'Flaherty Horn Award, Clinical Care, Scholarship, Teaching, Leadership, Wellness and Care, Family Responsibilities

#195 Antibiotic Duration & BALANCE Trial: Beyond Journal Club with NEJM Group Dec 10, 2025

Show notes

Antibiotic duration for bacteremia is something most of us learned by habit, not by trial data. In this episode, we walk through the BALANCE trial and use it as a lens to revisit how 1) host, 2) organism, and 3) source should guide treatment. When shorter really is enough, and when it isn’t?

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🔹 Transcript and Shownotes

Timestamp

(02:58) | Host, Organism, Source: The Core Framework Behind Duration

(09:02) | How Evidence Shifted Practice

(11:27) | The BALANCE Trial: Short-Course vs Standard-Course Therapy

(18:55) | Where does this leave us?

Tags: CoreIM, Internal Medicine, Infectious disease, Evidence-Based Medicine, Clinical Reasoning, Hospital Medicine, Medical Education

#194: Severe Hypertriglyceridemia: 5 Pearls Segment Dec 03, 2025

Show notes

How quickly can triglycerides rise? At what threshold are patients at risk of pancreatitis or cardiovascular adverse outcomes? What do you have to rule out? How do you counsel on lifestyle changes? Which medications do you start with why and when?

🔹 Transcript and Shownotes

(03:19) | Lipoprotein Lipase and Why Triglycerides Fluctuate Fast

(05:27) | Triglycerides as a Cardiovascular Risk Marker

(09:28) | Acute Management For Pancreatitis induced by Triglycerides

(14:34) | Lifestyle Counseling

(17:31) | Medications That Lower Triglycerides

(25:29) | How to Choose the Right Triglyceride Therapy

(27:56) | Genetic Causes and When to Suspect Familial Disorders

Tags: CoreIM, Internal Medicine, Lipidology, lipid, Cardiology, Metabolic Health, Triglycerides, Evidence-Based Medicine, Clinical Reasoning, Hospital Medicine, Medical Education, primary care

#193 Venous Congestion & VEXUS Interview with Dr. Ross Prager Nov 19, 2025

Show notes

Why is venous congestion not the same as volume overload? How can looking at IVC as well as doppler on the hepatic vein, portal vein, and/or intrarenal vein help? Can venous congestion explain someone's delirium? Or be at play in septic shock? What are the limitations of the VEXUS score?

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🔹Transcript and Shownotes

(00:00) | Volume overload vs. Venous Congestion

(05:49) | Venous Congestion and AKI, mortality, possible delirium

(10:10) | Measuring Venous Congestion and the Role of VEXUS

(15:05) | Common Mistakes and Best Practices of VEXUS score

(23:13) | Assessing Fluid Tolerance and Risks with Venous Doppler in Acute Care

(25:29) | Fluid vs. Vasopressor Strategy Guided by Venous Assessment

Tags: CoreIM, Internal Medicine, Critical Care, Nephrology, Cardiology, Fluid Management, POCUS, Ultrasound, Doppler, Hospital Medicine, Clinical Reasoning, Medical Education

#192 Debate on First-Line Medications for Diabetes Nov 05, 2025

Show notes

SGLT-2i vs. GLP-1? vs Metformin? How do you balance the cost and coverage of first-line options like metformin, SGLT-2, and GLP-1s? How do you choose between SGLT-2 and GLP-1s for comorbidities like CAD or CKD? And how do you weigh their side effects and practical use?

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🔹 Transcript and Show Notes

Timestamps:

(01:43) | Case 1: Managing Uncontrolled Diabetes in a 47-Year-Old Male

(07:15) | Understanding Cost and Insurance Barriers in Diabetes Care

(09:26) | Case 2: Addressing Weight Gain and Financial Stress in a 52-Year-Old Male

(14:16) | Case 3: Managing Coronary Artery Disease and CKD in a 66-Year-Old Male

(19:41) | Case 4: Severe Obesity and Pain Management in a 59-Year-Old Female

(24:19) | Case 5: High A1C and Vascular Comorbidities in a 67-Year-Old Female

(35:34) | Weighing Side Effects and Practical Use of GLP-1 and SGLT2 Inhibitors

Tags: CoreIM, Primary Care, Endocrinology, Diabetes Mellitus, Type 2 Diabetes, Type 1 Diabetes, Metformin, GLP-1, SGLT2, Insulin, CGM, A1C, DKA, Medical Education, Clinical Reasoning, Hospital Medicine

#191 Hepatorenal Syndrome Part 2 on Management: 5 Pearls Segment Oct 22, 2025

Show notes

What really works when treating HRS? Vasoconstrictors like terlipressin vs. norepinephrine vs. midodrine: how do we decide which to use? Do you give albumin? When do you give Lasix or another diuretic? When is the better choice transplant, dialysis, or even palliative care?

🔹 Sponsor: Oakstone CME

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🔹 Transcript & Show Notes

Timestamps:

(00:12) | Introduction and Overview of Hepatorenal Treatment

(03:38) | Vasoconstrictors Focus: Terlipressin, Norepinephrine, and Midodrine

(12:32) | Finding the Right Dose of Albumin and Knowing When to Stop

(15:06) | Volume Management: Balancing MAP, Diuretics, and Creatinine

(21:42) | Understanding the High Mortality of HRS-AKI

(32:30) | Transplant, Dialysis, or Palliation Care

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Hepatorenal Syndrome, HRS-AKI, Cirrhosis, Nephrology, Liver Disease

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