Student personality type and preferred rounding methods in an internal medicine advanced pharmacy practice experience.

BACKGROUND: Pharmacy students completing Internal Medicine rotations may be exposed to different stylistic approaches from providers on routine activities like patient rounds. This may be beneficial as students can learn in different ways. Conversely, extensive exposure to approaches that do not suit them may hinder student learning or lead students to feel they don't belong in a clinical setting. EDUCATIONAL ACTIVITY: This study sought to assess how students of different personality types perceived benefits to their learning based on the rounding styles of two providers. One provider (Dr. Bedside) used a team-based, bedside rounding method with direct patient interaction, while the other (Dr. Table) used a tableside team-based discussion for each patient. In the final week of a 5-week Internal Medicine APPE rotation, a cohort of ten students completed a 12-item survey that collected details on two personality assessments and assessed perspectives of the two rounding styles. EVALUATION FINDINGS: Ten students completed the personality assessments and survey. Students represented a diverse set of StrengthsFinder strengths and DOPE personality types, with the highest concentration (60%) of students receiving the Executing strength. All students agreed or strongly agreed that the exposure to two different rounding styles was valuable to their learning, with 80% of students preferring Dr. Bedside's approach. ANALYSIS OF EDUCATIONAL ACTIVITY: Overall, no trends were identified between preference of rounding style and results from personality assessments, which indicates the current approach of exposing students to two rounding styles does not negatively impact certain learners based on DOPE and StrengthsFinders personality types.

[HYPNOSTRESS study: Interest of medical hypnosis in the evaluation of perceived stress and the experience of hospitalization in an internal medicine department]. / Étude HYPNOSTRESS : intérêt de l'hypnose médicale dans l'évaluation du stress ressenti et le vécu d'une hospitalisation dans un service de médecine interne.

BACKGROUND: Patients with chronic illnesses, especially rare autoimmune and/or systemic diseases associated with significant diagnostic uncertainty, have a representation of their illness and a sometimes prolonged hospitalization experience that can be traumatic and anxiety-provoking. OBJECTIVE: The aim of this study was to evaluate the impact of a non-medicinal medical hypnosis intervention in reducing the stress state and improving the experience of patients hospitalized in an internal medicine department. METHODS: We conducted a prospective study of 24 patients hospitalized in the Internal Medicine Department of Lille University Hospital in 2023. Twelve patients received a non-drug medical hypnosis intervention known as the "place of safety" (case group) and were compared with 12 patients who did not (control group). Stress was assessed by the STAI questionnaire and hospitalization experience by a satisfaction questionnaire. RESULTS: The 24 patients, 13 of whom were women, had a mean age of 55±17 years at inclusion. On admission to hospital, the median STAI-ETAT between the two groups was 43.5 (38.0; 56.6) in the case group versus 42.0 (37.0; 48.5) in the control group (P=0.45). In the case group, the median STAI-ETAT questionnaire taken immediately after the hypnosis session was significantly lower than at the start of hospitalization (30.0 [25.5; 36.5] vs. 43.5 [38.0; 56.5] P=0.003), indicating a significant reduction in stress. At the end of hospitalization, there was also a significant persistence of the median significant reduction between cases and controls (29.5 [26.5; 35.0] for cases vs. 41.5 [33.5; 45.5] for controls P=0.002). Experience of hospitalization was better in the case group (median 5.0 [4.5; 5.0] vs. 4.0 [4.0; 4.5], P=0.016). CONCLUSION: This study suggests that medical hypnosis is a promising non-medicinal supportive intervention for reducing perceived stress and improving the experience of stress in patients hospitalized on an internal medicine ward.

Improving clinical reasoning and communication during handover: An intervention study of the BRIEF-C tool.

BACKGROUND: Existing handover communication tools often lack a clear theoretical foundation, have limited psychometric evidence, and overlook effective communication strategies for enhancing diagnostic reasoning. This oversight becomes critical as communication breakdowns during handovers have been implicated in poor patient care. To address these issues, we developed a structured communication tool: Background, Responsible diagnosis, Included differential diagnosis, Excluded differential diagnosis, Follow-up, and Communication (BRIEF-C). It is informed by cognitive bias theory, shows evidence of reliability and validity of its scores, and includes strategies for actively sending and receiving information in medical handovers. DESIGN: A pre-test post-test intervention study. SETTING: Inpatient internal medicine and orthopaedic surgery units at one tertiary care hospital. INTERVENTION: The BRIEF-C tool was presented to internal medicine and orthopaedic surgery faculty and residents who participated in an in-person educational session, followed by a 2-week period where they practised using it with feedback. MEASUREMENTS: Clinical handovers were audiorecorded over 1 week for the pre- and again for the post-periods, then transcribed for analysis. Two faculty raters from internal medicine and orthopaedic surgery scored the transcripts of handovers using the BRIEF-C framework. The two raters were blinded to the time periods. RESULTS: A principal component analysis identified two subscales on the BRIEF-C: diagnostic clinical reasoning and communication, with high interitem consistency (Cronbach's alpha of 0.82 and 0.99, respectively). One sample t-test indicated significant improvement in diagnostic clinical reasoning (pre-test: M=0.97, SD=0.50; post-test: M=1.31, SD=0.64; t(64)=4.26, p<0.05, medium to large Cohen's d=0.63) and communication (pre-test: M=0.02, SD=0.16; post-test: M=0.48, SD=0.83); t(64)=4.52, p<0.05, large Cohen's d=0.83). CONCLUSION: This study demonstrates evidence supporting the reliability and validity of scores on the BRIEF-C as good indicators of diagnostic clinical reasoning and communication shared during handovers.

The need for the GREAT+ score to predict relapse in Graves' disease: a questionnaire among patients and internal medicine specialists.

PURPOSE: Graves' disease (GD) is an auto-immune cause of hyperthyroidism. First-line treatment often consists of a 12-18 month course of antithyroid drugs (ATD). After discontinuation of ATD, GD relapses in approximately 50% of patients. The 'Graves recurrent event after therapy+ ' (GREAT+) score may predict individual relapse chances after ATD discontinuation more accurately based on clinical and laboratory parameters at diagnosis. We investigated the need for the GREAT+ score through an online questionnaire among GD patients and physicians treating GD. METHODS: An anonymous online questionnaire was distributed to patients and physicians between June 2022 and August 2023. RESULTS: The questionnaire was completed by 532 patients and 44 physicians. Results showed that 94% of patients were interested in knowing their GREAT+ score at the start of treatment. 55% would consider definite treatment (radioiodine/thyroidectomy) as first-line treatment in case of a high relapse chance. 98% of the physicians indicated the GREAT + score would support patient counseling. 84% may change their advice for first-line treatment if a patient has a high relapse chance based on the score. CONCLUSION: Patients and physicians considered the GREAT+ score as a valuable addition to the current available information which could change treatment decisions. Therefore, external validation of the GREAT+ score is justified to implement this score in clinical practice.

[The spring of artificial intelligence: AI vs. expert for internal medicine cases]. / Les Printemps de la Médecine Interne : l'intelligence artificielle face aux experts internistes.

INTRODUCTION: The "Printemps de la Médecine Interne" are training days for Francophone internists. The clinical cases presented during these days are complex. This study aims to evaluate the diagnostic capabilities of non-specialized artificial intelligence (language models) ChatGPT-4 and Bard by confronting them with the puzzles of the "Printemps de la Médecine Interne". METHOD: Clinical cases from the "Printemps de la Médecine Interne" 2021 and 2022 were submitted to two language models: ChatGPT-4 and Bard. In case of a wrong answer, a second attempt was offered. We then compared the responses of human internist experts to those of artificial intelligence. RESULTS: Of the 12 clinical cases submitted, human internist experts diagnosed nine, ChatGPT-4 diagnosed three, and Bard diagnosed one. One of the cases solved by ChatGPT-4 was not solved by the internist expert. The artificial intelligence had a response time of a few seconds. CONCLUSIONS: Currently, the diagnostic skills of ChatGPT-4 and Bard are inferior to those of human experts in solving complex clinical cases but are very promising. Recently made available to the general public, they already have impressive capabilities, questioning the role of the diagnostic physician. It would be advisable to adapt the rules or subjects of future "Printemps de la Médecine Interne" so that they are not solved by a public language model.

Deciphering cytopenias in internal medicine: a single-center observational study.

Cytopenia is a common finding in patients admitted to internal medicine wards and the clinical workup may be long and time-consuming. In this single-center observational study, we analyzed a series of 151 inpatients who received hematologist referral due to cytopenia observed during hospital admission. Patients were mainly elderly (median 71 years, 15-96) and 87% had at least one comorbidity. Anemia was the most common cytopenia (91%), followed by thrombocytopenia (51%), and neutropenia (22%); 73 (48%) patients had a bicytopenia and 5 (3%) pancytopenia. Cytopenias were mainly severe, 66% of cases required RBC transfusions, and 21% platelet pools. During a median hospital stay of 15 days (1-166), 53 subjects (35%) received a hematologic discharge diagnosis, whilst the two-thirds had secondary cytopenia mainly due to associated comorbidities. Only about 34% of 2,728 diagnostic tests performed (including laboratory, imaging, and histology) clearly informed the discharge diagnosis in this heterogenous setting. Specifically, bone-marrow evaluation indicated in 46 (30%) patients, was diagnostic in 32 (69.6%). Eleven percent of patients died due to progression of the oncohematologic disease (29%), sepsis (24%), and solid tumor progression (24%). In conclusion, cytopenias in the internal medicine setting are mainly severe, more frequently secondary to associated comorbidities (2/3 of patients) and deserve proper workup before second/third-level tests (immune-hematological assays and CT scan or PET and bone-marrow evaluation, respectively).

[Easing the patients' trajectories from private practice to hospital: One-year experiment of the RAPIDO project]. / Fluidification du parcours ville-hôpital : analyse de la trajectoire des patients impliqués dans le dispositif RAPIDO après un an de mise en place.

INTRODUCTION: Internal medicine departments manage patients referred by emergency departments or private practitioners. Considering the overcrowding of emergency departments and lack of beds for inpatients, this specialty must be part of an "ambulatory shift", particularly by strengthening the links between community and hospital medicine. Our objective was to evaluate a new care pathway in internal medicine at Nîmes university hospital. METHODS: Our department has developed the RAPIDO project (Réseau d'Aide à la PrIse en Charge Diagnostique et d'Orientation). The referring general practitioner contacts a senior internist on a dedicated phone line. After careful evaluation, he may offer a consultation within 15 days. A summary report is then given to the patient. RESULTS: Between November 2020 and November 2021, 254 patients were seen via RAPIDO. The average call-consultation time period was 6.4 (±4.5) days, for symptoms lasting for 2 weeks to 3 months in 43% (n=109) of cases. The reason for the call was a suspicion of systemic disease in 28% of cases (n=84), or a dysfunction of an organ in 16%. A diagnosis was made in 89% of cases. The budget of the whole procedure was balanced. CONCLUSION: A quick internal medicine consultation pathway for general practitioners seems to be a relevant, feasible and economically viable healthcare trajectory, which can be transposed to any type of healthcare institution, as soon as sufficient human resources are dedicated.

Advancing Internal Medicine Training: Experience of a Bedside Procedure Service as a Resident Elective.

BACKGROUND: In 2007, the American Board of Internal Medicine eliminated numeric procedure requirements for licensing. The level of exposure to procedures during residency, and subsequent competence of graduating residents, is variable. In 2015, our institution developed a bedside procedure service (BPS) with the intent to teach ultrasound guidance and procedural training to internal medicine residents with direct supervision of technique by Hospital Medicine faculty to optimize learning, increase confidence, and improve patient safety. OBJECTIVE: In this study, we review the number and complication rates of resident procedures on a dedicated internal medicine bedside procedure service (BPS) as a resident elective. METHODS: In this retrospective, observational, single-center study, we reviewed internally collected data from BPS procedures performed from 2015-2019. The BPS offers a variety of procedures done with ultrasound guidance at an adult tertiary care referral center. BPS services are available to all inpatient hospital services. A rotation with the BPS was offered as a stand-alone resident elective for the first time in 2015. RESULTS: 69 residents performed a total of 2700 ultrasound-guided/assisted procedures and 146 diagnostic ultrasound scans from 2015-2019. Residents performed an average of 40 procedures during their elective month. There were 5 resident performed procedural complications with an overall complication rate of 0.19%. CONCLUSIONS: Our BPS increased procedural opportunities for residents and allowed for real-time feedback by an experienced faculty member in a one-on-one setting. A dedicated rotation allows the time to focus on becoming proficient in invasive procedures with expert supervision.

Awareness of sex and gender dimensions among physicians: the European federation of internal medicine assessment of gender differences in Europe (EFIM-IMAGINE) survey.

Sociocultural gender is a complex construct encompassing different aspects of individuals' life, whereas sex refers to biological factors. These terms are often misused, although they impact differently on individuals' health. Recognizing the role of sex and gender on health status is fundamental in the pursuit of a personalized medicine. Aim of the current study was to investigate the awareness in approaching clinical and research questions on the impact of sex and gender on health among European internists. Clinicians affiliated with the European Federation of Internal Medicine from 33 countries participated to the study on a voluntary basis between January 1st, 2018 and July 31st, 2019. Internists' awareness and knowledge on sex and gender issues in clinical medicine were measured by an online anonymized 7-item survey. A total of 1323 European internists responded to the survey of which 57% were women, mostly young or middle-aged (78%), and practicing in public general medicine services (74.5%). The majority (79%) recognized that sex and gender are not interchangeable terms, though a wide discrepancy exists on what clinicians think sex and gender concepts incorporate. Biological sex and sociocultural gender were recognized as determinants of health mainly in cardiovascular and autoimmune/rheumatic diseases. Up to 80% of respondents acknowledged the low participation of female individuals in trials and more than 60% the lack of sex-specific clinical guidelines. Internists also express the willingness of getting more knowledge on the impact of sex and gender in cerebrovascular/cognitive and inflammatory bowel diseases. Biological sex and sociocultural gender are factors influencing health and disease. Although awareness and knowledge remain suboptimal across European internists, most acknowledge the underrepresentation of female subjects in trials, the lack of sex-specific guidelines and the need of being more informed on sex and gender-based differences in diseases.

Predictors of in-hospital mortality of COVID-19 patients and the role of telemetry in an internal medicine ward during the third phase of the pandemic.

OBJECTIVE: The first pandemic phase of COVID-19 in Italy was characterized by high in-hospital mortality ranging from 23% to 38%. During the third pandemic phase there has been an improvement in the management and treatment of COVID-19, so mortality and predictors may have changed. A prospective study was planned to identify predictors of mortality during the third pandemic phase. PATIENTS AND METHODS: From 15 December 2020 to 15 May 2021, 208 patients were hospitalized (median age: 64 years; males: 58.6%); 83% had a median of 2 (IQR,1-4) comorbidities; pneumonia was present in 89.8%. Patients were monitored remotely for respiratory function and ECG trace for 24 hours/day. Management and treatment were done following the timing and dosage recommended by international guidelines. RESULTS: 79.2% of patients necessitated O2-therapy. ARDS was present in 46.1% of patients and 45.4% received non-invasive ventilation and 11.1% required ICU treatment. 38% developed arrhythmias which were identified early by telemetry and promptly treated. The in-hospital mortality rate was 10%. At multivariate analysis independent predictors of mortality were: older age (R-R for≥70 years: 5.44), number of comorbidities ≥3 (R-R 2.72), eGFR ≤60 ml/min (RR 2.91), high d-Dimer (R-R for≥1,000 ng/ml:7.53), and low PaO2/FiO2 (R-R for <200: 3.21). CONCLUSIONS: Management and treatment adherence to recommendations, use of telemetry, and no overcrowding appear to reduce mortality. Advanced age, number of comorbidities, severe renal failure, high d-Dimer and low P/F remain predictors of poor outcome. The data help to identify current high-risk COVID-19 patients in whom management has yet to be optimized, who require the greatest therapeutic effort, and subjects in whom vaccination is mandatory.

Rapid Development and Deployment of an Intensivist-Led Venovenous Extracorporeal Membrane Oxygenation Cannulation Program.

OBJECTIVES: To determine the safety and efficacy of a rapidly deployed intensivist-led venovenous extracorporeal membrane oxygenation cannulation program in a preexisting extracorporeal membrane oxygenation program. DESIGN: A retrospective observational before-and-after study of 40 patients undergoing percutaneous cannulation for venovenous extracorporeal membrane oxygenation in an established cannulation program by cardiothoracic surgeons versus a rapidly deployed medical intensivist cannulation program. SETTING: An adult ICU in a tertiary academic medical center in Camden, NJ. PATIENTS: Critically ill adult subjects with severe respiratory failure undergoing percutaneous cannulation for venovenous extracorporeal membrane oxygenation. INTERVENTIONS: Percutaneous cannulation for venovenous extracorporeal membrane oxygenation performed by cardiothoracic surgeons compared with cannulations performed by medical intensivists. MEASUREMENTS AND MAIN RESULTS: Venovenous extracorporeal membrane oxygenation cannulation site attempts were retrospectively reviewed. Subject demographics, specialty of physician performing cannulation, type of support, cannulation configuration, cannula size, imaging guidance, success rate, and complications were recorded and summarized. Twenty-two cannulations were performed by three cardiothoracic surgeons in 11 subjects between September 2019 and February 2020. The cannulation program rapidly transitioned to an intensivist-led and performed program in March 2020. Fifty-seven cannulations were performed by eight intensivists in 29 subjects between March 2020 and December 2020. Mean body mass index for subjects did not differ between groups (33.86 vs 35.89; p = 0.775). There was no difference in days on mechanical ventilation prior to cannulation, configuration, cannula size, or discharge condition. There was no difference in success rate of cannulation on first attempt per cannulation site (95.5 vs 96.7; p = 0.483) or major complication rate per cannulation site (4.5 vs 3.5; p = 1). CONCLUSIONS: There is no difference between success and complication rates of percutaneous venovenous extracorporeal membrane oxygenation canulation when performed by cardiothoracic surgeons versus medical intensivist in an already established extracorporeal membrane oxygenation program. A rapidly deployed cannulation program by intensivists for venovenous extracorporeal membrane oxygenation can be performed with high success and low complication rates.

National Resident Matching Program Rank Order and Performance in an Internal Medicine Residency.

OBJECTIVES: Prospective first-year house staff and residency program leaders spend substantial time, effort, and expense preparing a rank order list for the National Resident Matching Program (NRMP). Previous studies have mostly shown minimal or no relation between rank order and subsequent resident performance, raising questions about the value of this process. Furthermore, no previous studies have been done with Internal Medicine residencies. As such, the purpose of this study was to compare NRMP rank order to multiple objective outcomes of an Internal Medicine residency. METHODS: A retrospective cohort of Internal Medicine residents from five consecutive graduating classes, trained between July 1, 2013 and July 31, 2020, were evaluated for five objective outcomes: Accreditation Council for Graduate Medical Education (ACGME) milestones, faculty rankings of quality, National In-Training Examination scores, chief resident attainment, and fellowship attainment. Outcomes were analyzed in relation to eight potential predictors: NRMP rank, medical school type and grades, immigration status, added qualifications, sex, age and US Medical Licensing Examination (USMLE) scores, using univariate and multivariate analyses. RESULTS: From a cohort of 61 residents, 56 were eligible. All eligible residents' data were included, for a participation rate of 100% (56 of 56). There were no statistically significant univariate or multivariate predictors for the endpoint of fellowship attainment. Higher USMLE scores were predictive of chief resident status in univariate analysis only. NRMP rank was significantly correlated with ACGME milestones in the univariate analysis. The multivariate analysis revealed that higher USMLE score was statistically significantly predictive of more favorable milestones, faculty ranking, and National In-Training Examination score. CONCLUSIONS: Higher USMLE score was statistically significantly associated with multiple favorable objective residency outcomes in an Internal Medicine residency. A better NRMP rank was correlated with favorable ACGME milestones in univariate analysis, but USMLE score emerged as the strongest predictor in multivariate analysis.

How did COVID-19 affect medical and cardiology journals? A pandemic in literature.

BACKGROUND AND AIMS: The spreading speed of the COVID-19 pandemic forced the medical community to produce efforts in updating and sharing the evidence about this new disease, trying to preserve the accuracy of the data but at the same time avoiding the potentially harmful delay from discovery to implementation. The aim of our analysis was to assess the impact of the COVID-19 pandemic on medical literature in terms of proportion of COVID-19-related published papers and temporal patterns of publications within a sample of general/internal medicine and cardiology journals. METHODS: We searched through PubMed scientific papers published from 1 January 2020 to 31 January 2021 about COVID-19 in ten major medical journals, of which five were in general/internal medicine and five in the cardiology field. We analyzed the proportion of COVID-19-related papers, and we examined temporal trends in the number of published papers. RESULTS: Overall, the proportion of COVID-19-related papers was 18.5% (1986/10 756). This proportion was higher among the five selected general/internal medicine journals, compared with cardiology journals (23.8% vs 9.5%). The vast majority of papers were not original articles; in particular, in cardiology journals, there were 28% 'original articles', 17% 'review articles' and 55.1% 'miscellaneous', compared with 20.2%, 5.1% and 74.7% in general/internal medicine journals, respectively. CONCLUSIONS: Our analysis highlights the big impact of the COVID-19 pandemic on international scientific literature. General and internal medicine journals were mainly involved, with cardiology journals only at a later time.

Telemetry Overuse and the Effect of Educational and Electronic Health Record-Based Interventions on an Academic Internal Medicine Ward.

OBJECTIVES: Guidelines for appropriate use of telemetry recommend monitoring for specific patient populations; however, many hospitalized patients receive telemetry monitoring without an indication. Clinical data and outcomes associated with nonindicated monitoring are not well studied. The objectives of our study were to evaluate the impact of an education and an order entry intervention on telemetry overuse and to identify the diagnoses and telemetry-related outcomes of patients who receive telemetry monitoring without guidelines indication. METHODS: A retrospective cohort study of hospitalized patients on internal medicine (IM) wards between 2015 and 2018 examining the effects of educational and order entry interventions at an academic urban medical center. A baseline cohort examining telemetry use was established. This was followed by the delivery of IM resident educational sessions regarding telemetry guidelines. In a subsequent intervention, the telemetry order entry system was modified with a constraint to require American Heart Association guidelines justification. RESULTS: Across all of the cohorts, 51% (n = 141) of patients lacked a guidelines-specified indication. These patients had variable diagnoses. The educational intervention alone did not result in significant differences in telemetry use by IM residents. The order entry intervention resulted in a significant increase in the proportion of guidelines-indicated patients and a decrease in nonindicated patients on telemetry. No safety events were noted in any group. CONCLUSIONS: A telemetry order entry system modification implemented following an educational intervention is more likely to reduce telemetry use than an educational intervention alone in IM resident practice. A variety of patients are monitored without evidence of need; therefore, the clinical impact of telemetry reduction is unlikely to be harmful.