Population-Based Trends in Complexity of Hospital Inpatients.

Importance: Clinical experience suggests that hospital inpatients have become more complex over time, but few studies have evaluated this impression.

Objective: To assess whether there has been an increase in measures of hospital inpatient complexity over a 15-year period.

Design, Setting And Participants: This cohort study used population-based administrative health data from nonelective hospitalizations from April 1, 2002, to January 31, 2017, to describe trends in the complexity of inpatients in British Columbia, Canada.

Improving internal medicine residents' performance, knowledge, and confidence in central venous catheterization using simulators.

Background: Efficacy of simulators in teaching central venous catheterization (CVC) in an internal medicine residency program is unknown.

Objective: To determine whether or not learning CVC on simulators is associated with improvement in performance of CVC, knowledge about the procedure, and self-reported confidence.

Methods: All consenting first-year internal medicine residents who completed training in CVC on simulators were included.

Assessing the relationship between cardiac physical examination technique and accurate bedside diagnosis during an objective structured clinical examination (OSCE).

Background: Many standardized patient (SP) encounters employ SPs without physical findings and, thus, assess physical examination technique. The relationship between technique, accurate bedside diagnosis, and global competence in physical examination remains unclear.

Method: Twenty-eight internists undertook a cardiac physical examination objective structured clinical examination, using three modalities: real cardiac patients (RP), "normal" SPs combined with related cardiac audio-video simulations, and a cardiology patient simulator (CPS).

Does physical examination competence correlate with bedside diagnostic acumen? An observational study.

Aim: To examine the relationship between a physician's ability to examine a standardized patient (SP) and their ability to correctly identify related clinical findings created with simulation technology.

Method: The authors conducted an observational study of 347 candidates during a Canadian national specialty examination at the end of post-graduate internal medicine training. Stations were created that combined physical examination of an SP with evaluation of a related audio-video simulation of a patient abnormality, in the domains of cardiology and neurology.

Assessing the mini-Clinical Evaluation Exercise in comparison to a national specialty examination.

Purpose: To evaluate the reliability and validity of the Mini-Clinical Evaluation Exercise (mini-CEX) for postgraduate year 4 (PGY-4) internal medicine trainees compared to a high-stakes assessment of clinical competence, the Royal College of Physicians and Surgeons of Canada Comprehensive Examination in Internal Medicine (RCPSC IM examination).

Methods: Twenty-two PGY-4 residents at the University of British Columbia and the University of Calgary were evaluated, during the 6 months preceding their 2004 RCPSC IM examination, with a mean of 5.5 mini-CEX encounters (range 3-6).

Incorporating simulation technology in a canadian internal medicine specialty examination: a descriptive report.

High-stakes assessment of clinical performance through the use of standardized patients (SPs) is limited by the SP's lack of real physical abnormalities. The authors report on the development and implementation of physical examination stations that combine simulation technology in the form of digitized cardiac auscultation videos with an SP assessment for the 2003 Royal College of Physicians and Surgeons of Canada's Comprehensive Objective Examination in Internal Medicine. The authors assessed candidates on both the traditional stations and the stations that combined the traditional SP examination with the digitized cardiac auscultation video.

Clostridium difficile-associated diarrhea: predictors of severity in patients presenting to the emergency department.

Objective: Experiences with Clostridium difficile-associated diarrhea (CDAD) were reviewed to determine predictors of severity in patients presenting from the community.

Methods: All patients admitted to two hospitals over 4.5 years with a primary diagnosis of CDAD were reviewed.

Hypertension and nephritic urine sediment following retroperitoneal lymph node dissection.

Retroperitonela lymph node dissection (RPLND), cisplatin-based chemotherapy, and tumor surveillance has dramatically improved survival of patients with non-seminomatous germ cell tumors. Complications, including renal vascular injuries, have been encountered with post-chemotherapy RPLND. We report on a patient with delayed renovascular hypertension and nephritic sediment following RPLND.