The American College of Physicians (ACP) is a national organization of internists, who specialize in the diagnosis, treatment, and care of adults. With 161,000 members, ACP is the largest medical-specialty organization and second-largest physician group in the United States, after the American Medical Association. Its flagship journal, the Annals of Internal Medicine, is considered one of the five top medical journals in the United States and Britain.
Importance:Despite the growing number of residents with disabilities, barriers to equitable access persist in medical training. Program access to accommodation has been linked to improved training and mental health outcomes, but little is known about possible resident and program characteristics associated with access to and requests for needed accommodations. Objective:To examine demographic, training, and disability-related factors associated with program access and accommodation requests among internal medicine (IM) residents with disabilities. Design, Setting, and Participants:This national cross-sectional study looked at accredited IM residency programs in mainland US and Puerto Rico. Participants were IM residents who took the 2023 Internal Medicine In-Training Examination and reported having at least 1 type of disability. Main Outcomes and Measures:The primary outcomes were program access, defined as receiving accommodations or not needing them, and requesting needed accommodations. Multivariable logistic regression models were conducted for each of the outcomes. Results:Of 19 205 respondents, 1824 (9.5%) reported a disability; participants were predominantly men (979 men [53.7%]), US medical graduates (1398 participants [76.6%]), and enrolled in categorical IM programs (1532 participants [84.0%]). With regard to race, 340 participants (18.6%) were Asian, 415 (22.8%) were from groups underrepresented in medicine (including self-reported Black or African American or Afro-Caribbean; Latinx or Latino or Hispanic; Native American or American Indian or Indigenous or Alaskan Native; Native Hawaiian or Pacific Islander), and 823 (45.1%) were White. Among 1052 with complete accommodation information, 811 (77.1%) had program access and 241 (22.9%) did not. In multivariable regression models, having cognitive disabilities (adjusted odds ratio [aOR], 0.27; 95% CI, 0.15-0.49) and identifying as women (aOR, 0.55; 95% CI, 0.40-0.75), Asian (aOR, 0.53; 95% CI, 0.34-0.82) and underrepresented racial or ethnic groups (aOR, 0.58; 95% CI, 0.38-0.87) were associated with lower odds of program access. Among 699 residents coded as needing disability accommodations with classifiable responses, 200 (28.6%) did not request them. Fear of stigma (164 respondents [82.0%]) and unclear institutional processes (60 respondents [30.0%]) were the most cited reasons for nonrequest for needed accommodations. Requesting accommodations was less likely among residents with cognitive disabilities (aOR, 0.16; 95% CI, 0.08-0.31) and who identify as women (aOR, 0.37; 95% CI, 0.25-0.54), genderqueer or nonbinary (aOR, 0.11; 95% CI, 0.02-0.68), Asian (aOR, 0.50; 95% CI, 0.30-0.85), or underrepresented in medicine (aOR, 0.60; 95% CI, 0.37-0.97). Conclusions and Relevance:These findings suggest that despite growing disability representation, substantial inequities in access to and requests for accommodations persisted for IM residents with disabilities, particularly those with cognitive disabilities and marginalized identities. Institutions should implement inclusive, transparent policies to foster psychological safety and disability inclusion.
Over the past several decades, federal laws have instituted sweeping antidiscrimination protections to foster inclusion for people with disabilities in education and employment, but substantial barriers remain to full and meaningful inclusion in the practice of medicine. In this position paper, the American College of Physicians (ACP) highlights the barriers to entering medicine and offers policy recommendations to improve the accessibility of medical schools, training programs, and the practice of medicine. ACP affirms that a diverse physician workforce, inclusive of disability, is a key component of reducing disparities in health and health care.
OBJECTIVES:This study aimed to determine the proportion of statistically nonsignificant meta-analyses that provide evidence favoring the null hypothesis of no difference, evidence favoring the alternative hypothesis, or inconclusive findings using likelihood ratios. STUDY DESIGN AND SETTING:In this meta-epidemiological study, Cochrane systematic reviews published in 2025 were screened. Eligible meta-analyses pooled data from two or more primary studies, reported a pooled effect estimate with a 95% CI including the value of no difference, and had a P value between 0.05 and 0.20. Meta-analyses using Hartung-Knapp/Sidik-Jonkman were excluded. In the primary analysis, likelihood ratios compared the null hypothesis against the observed pooled effect. In the secondary analysis, likelihood ratios were calculated against prespecified small, medium, and large effect thresholds; meta-analyses reporting weighted mean differences were excluded as no agreed-upon thresholds exist for these outcomes. RESULTS:A total of 936 meta-analyses from 172 Cochrane reviews were eligible. In the primary analysis, 693 (74%) provided weak evidence favoring the alternative hypothesis, and 243 (26%) were inconclusive; none favored the null hypothesis. All meta-analyses with P values between .05 and .10 showed weak evidence favoring the alternative, while those with P values between .11 and .20 were split between weak evidence favoring the alternative (55%) and inconclusive (45%) findings. In the secondary analysis of 732 meta-analyses, the proportion supporting the null hypothesis increased from 20% for small to 55% for medium to 75% for large effect thresholds, while inconclusive findings declined correspondingly. CONCLUSION:Most nonsignificant meta-analyses provide weak evidence favoring the observed treatment effect rather than supporting no difference, but evidence increasingly favors no difference as prespecified effect thresholds increase in magnitude. Likelihood ratios enable guideline developers and clinicians to distinguish evidence of no difference from inconclusive findings and support more informed clinical recommendations and better-targeted research prioritization. PLAIN LANGUAGE SUMMARY:When research combines results from multiple studies (called meta-analyses) and finds no statistically significant difference between treatments, researchers often interpret this to mean "there is no difference between the treatments." However, this can be a mistake. Sometimes the data truly show the treatments work the same, but other times the data are simply unclear, and we just do not have enough information to tell either way. We used a statistical method called likelihood ratios to determine whether meta-analyses supported "no difference" or whether the results were simply unclear or favored a difference between the treatments. By examining 936 nonsignificant meta-analyses, we found that most results (74%) provided weak evidence that there is a difference between treatments, not that treatments work the same. However, when we compared results to what would count as clinically important differences, the picture changed. For small important differences, most results were unclear, while for large important differences, 75% supported "no difference." This matters because misinterpreting unclear results as showing "no difference" can affect medical guidelines and patient care. It can also lead to wasted research by repeating studies when evidence already supports no difference or by stopping research when results are simply unclear and more data are needed. When researchers analyze combined results from studies, they should specify in advance what size of treatment difference would matter to patients, then use likelihood ratios to clearly state whether their results support no difference, are unclear, or suggest a treatment effect. This will help clinicians make better treatment decisions and researchers prioritize which questions still need more study.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have reshaped the clinical approach to managing obesity and type 2 diabetes. As approved indications have expanded, use of GLP-1RAs has increased rapidly in the United States. Although randomized trials demonstrate strong efficacy, many questions remain about their optimal use in clinical practice. Real-world data (RWD) from electronic health records, registries, insurance claims, and other sources offer a promising avenue to address these questions. However, concerns about data quality, selection bias, and incomplete ascertainment of medication use and outcomes pose significant challenges to the validity of the resulting evidence. In May 2025, the National Institute of Diabetes and Digestive and Kidney Diseases convened experts from regulatory agencies, payer organizations, and academia to explore these challenges. This second of 2 synopsis articles on the workshop summarizes the discussion around the strengths and limitations of various RWD sources and methodological approaches to strengthen causal inference and generalizability. Presenters highlighted pragmatic clinical trials and target trial emulation as strategies to generate stronger real-world evidence (RWE) that is relevant to both clinical practice and policy. The workshop underscored that careful attention to study design, data limitations, and analytic approach is essential to yield RWE that informs clinicians, patients, payers, and policymakers.
DESCRIPTION:The American College of Physicians (ACP) developed these rapid practice points addressing the efficacy, comparative effectiveness, and harms of respiratory syncytial virus (RSV) vaccines in adults aged 18 years or older who are not pregnant or immunocompromised. METHODS:The ACP Population Health and Medical Science Committee developed the rapid practice points based on a rapid review by the ACP Center for Evidence Reviews at Cochrane Austria. The practice points apply to adults aged 60 years or older who are not immunocompromised. PRACTICE POINT 1:Adults aged 75 years or older should receive a protein subunit RSV vaccine. PRACTICE POINT 2:Adults aged 60 to 74 years who are at increased risk for severe RSV may consider receiving a protein subunit RSV vaccine.
