Teaching Students to Care (Coordinate): A Randomized Controlled Trial.

INTRODUCTION: Interdisciplinary rounds are a vital part of discharge planning; however, medical students receive little training in how to contribute effectively. Many existing discharge planning curricula are either prohibitively time consuming or narrowly focused. Addressing this gap can help improve interdisciplinary care and enhance the role of medical students on inpatient teams. METHODS: We developed a 30-minute curriculum on the purpose of interdisciplinary rounds, expected presentation content, and team members' roles and conducted a randomized controlled trial among medical students on their inpatient internal medicine rotation. Outcomes were measured using pre- and post-curriculum surveys and comparison of evaluations of student participation in interdisciplinary rounds. RESULTS: Eighty-six medical students participated in the study (59 intervention, 27 control), and we received 142 presentation evaluations (91 intervention, 51 control). There was significant post-curriculum improvement in all students' understanding of and comfort presenting in interdisciplinary rounds and knowledge of team members' roles. Presentation evaluations did not show a significant difference; however, students in the intervention group were better able to answer questions about their patients, with a difference approaching statistical significance (70% vs 57%, P = 0.069). CONCLUSIONS: A brief, just-in-time curriculum improved learners' knowledge of interdisciplinary discharge rounds and showed a trend towards improvement in their ability to answer questions during rounds. Our curriculum can empower medical students to help their inpatient teams by participating in discharge rounds and can be integrated into existing curricula with minimal disruption.

Bone marrow biopsies: A hospitalist bedside procedure service 5-year experience.

BACKGROUND: Bone marrow aspiration and biopsies (BMAB) are a relatively frequent procedure needed in the inpatient setting, especially in a tertiary care center. OBJECTIVE: Procedure-focused hospitalists can provide an excellent option for doing inpatient BMAB. Here we present five years of experience with a hospitalist bedside procedure service (BPS) performing BMAB. DESIGN: In 2016, the BPS partnered with the oncology service to begin performing inpatient BMAB. SETTINGS AND PARTICIPANTS: We evaluated internally collected data from the procedures performed by the BPS from 2016-2020. INTERVENTION: From 2015-2016, faculty members on the BPS team were trained by the oncology department to do a BMAB, which was then offered as an inpatient procedure by the BPS from 2016-2021. MAIN OUTCOME AND MEASURES: Total number of BMAB performed, success rates, bleeding risk profiles of patients, rate of trainee participation, and complication rates. RESULTS: The BPS performed a total of 432 BMAB from 2016-2021. Forty-six (10.6%) were unsuccessful and required referral for CT guidance. Elevated bleeding risk was present in 88 (20.4%) of patients. Trainees assisted in 62 (14.4%) of the procedures.There was one complication (0.2%).

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.

Comparison of four handheld point-of-care ultrasound devices by expert users.

BACKGROUND: Point-of-care ultrasound (POCUS) is rapidly becoming ubiquitous across healthcare specialties. This is due to several factors including its portability, immediacy of results to guide clinical decision-making, and lack of radiation exposure to patients. The recent growth of handheld ultrasound devices has improved access to ultrasound for many clinicians. Few studies have directly compared different handheld ultrasound devices among themselves or to cart-based ultrasound machines. We conducted a prospective observational study comparing four common handheld ultrasound devices for ease of use, image quality, and overall satisfaction. Twenty-four POCUS experts utilized four handheld devices (Butterfly iQ+™ by Butterfly Network Inc., Kosmos™ by EchoNous, Vscan Air™ by General Electric, and Lumify™ by Philips Healthcare) to obtain three ultrasound views on the same standardized patients using high- and low-frequency probes. RESULTS: Data were collected from 24 POCUS experts using all 4 handheld devices. No single ultrasound device was superior in all categories. For overall ease of use, the Vscan Air™ was rated highest, followed by the Lumify™. For overall image quality, Lumify™ was rated highest, followed by Kosmos™. The Lumify™ device was rated highest for overall satisfaction, while the Vscan Air™ was rated as the most likely to be purchased personally and carried in one's coat pocket. The top 5 characteristics of handheld ultrasound devices rated as being "very important" were image quality, ease of use, portability, total costs, and availability of different probes. CONCLUSIONS: In a comparison of four common handheld ultrasound devices in the United States, no single handheld ultrasound device was perceived to have all desired characteristics. POCUS experts rated the Lumify™ highest for image quality and Vscan Air™ highest for ease of use. Overall satisfaction was highest with the Lumify™ device, while the most likely to be purchased as a pocket device was the Vscan Air™. Image quality was felt to be the most important characteristic in evaluating handheld ultrasound devices.