Large Language Model Influence on Management Reasoning: A Randomized Controlled Trial.

Importance: Large language model (LLM) artificial intelligence (AI) systems have shown promise in diagnostic reasoning, but their utility in management reasoning with no clear right answers is unknown.

Objective: To determine whether LLM assistance improves physician performance on open-ended management reasoning tasks compared to conventional resources.

Design: Prospective, randomized controlled trial conducted from 30 November 2023 to 21 April 2024.

Assessing ChatGPT 4.0's test performance and clinical diagnostic accuracy on USMLE STEP 2 CK and clinical case reports.

While there is data assessing the test performance of artificial intelligence (AI) chatbots, including the Generative Pre-trained Transformer 4.0 (GPT 4) chatbot (ChatGPT 4.0), there is scarce data on its diagnostic accuracy of clinical cases.

A Predictive Algorithm for Discriminating Myeloid Malignancies and Leukemoid Reactions.

Background: Adults presenting with a neutrophil-predominant leukocytosis (white cell count >50,000/μL) often necessitate urgent medical management. These patients are diagnosed with either acute presentations of chronic myeloid malignancies or leukemoid reactions, yet accurate models to distinguish between these entities do not exist. We used demographic and lab data to build a machine learning model capable of discriminating between these diagnoses.

Rethinking the consultation paradigm: Validity evidence for a new framework, a multimethods study.

Background: In-hospital consultation is essential for patient care. We previously proposed a framework of seven specific consultation types to classify consult requests to improve communication, workflow, and provider satisfaction.

Methods: This multimethods study's aim was to evaluate the applicability of the consult classification framework to real internal medicine (IM) consults.

Novel interactive text-messaging curriculum for endocrinology board review.

Background: The ABIM certification exam is one of the measures to ensure that physicians have the clinical skills for good care delivery. The 5-year average pass rate for ABIM Endocrinology exam is 82%. The pass rate significantly decreased to a nadir of 74% in 2021 and 2022, lowest of all medicine subspecialties.

Consensus recommendations on peripheral blood smear review: defining curricular standards and fellow competency.

Graduate medical education training in hematology in North America is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Trainees routinely review peripheral blood smears (PBS) in providing clinical care. Competency in PBS review at graduation is required by the ACGME.

How Would You Treat This Patient With Pulmonary Embolism? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Pulmonary embolism can be acutely life-threatening and is associated with long-term consequences such as recurrent venous thromboembolism and chronic thromboembolic pulmonary hypertension. In 2020, the American Society of Hematology published updated guidelines on the management of patients with venous thromboembolism. Here, a hematologist and a cardiology and vascular medicine specialist discuss these guidelines in the context of the care of a patient with pulmonary embolism.

Engaging trainees within the virtual classroom: Teaching strategies for rheumatologists in a pandemic.

Social distancing during the COVID-19 pandemic has led to unprecedented challenges in medical education, including for rheumatology training programs. Many programs have adapted by transitioning educational curricula into virtual classrooms. Herein, we review strategies to optimize learning within the virtual classroom.

Invasive sinusitis in an immunocompetent patient using intranasal cocaine.

Invasive fungal sinusitis is a rare and potentially fatal infection that tends to occur in immunocompromised hosts. Presented is the case of a 33-year-old immunocompetent male with several months of recurrent facial and nasal pain refractory to several antibacterial courses before a diagnosis of invasive sinusitis was made. The patient's symptoms and infection were successfully treated with a combination of surgical debridement and voriconazole.

Implementing a Virtual Flipped Classroom in a Rheumatology Fellowship Program.

Objective: Active learning opportunities within graduate medical education may be underused. We aimed to assess whether active learning strategies increase after implementing a faculty development workshop and transitioning rheumatology fellowship didactics to a virtual flipped classroom.

Methods: We measured baseline faculty use of active learning strategies during lectures within the Introductory Rheumatology Curriculum by calculating an "active learning score" from a cognitive learning theory assessment tool.

Generalists as Clinical Physiologists: Bringing Science Back to the Bedside.

Background: Few generalists engage in basic science research or feel comfortable teaching physiology at the bedside. This may reflect a lack of understanding or confidence teaching physiologic principles.

Aim: To inspire general internists to relearn and teach physiology in clinical practice.

Availability of Specific Direct Oral Anticoagulant Reversal Agents in US Hospitals.

This cross-sectional study assesses the availability of the direct oral anticoagulant reversal agents idarucizumab and andexanet alfa in US hospitals.

More Specialties, Fewer Problems: Using Collaborative Competency Between Infectious Diseases, Podiatry, and Pathology to Improve the Care of Patients with Diabetic Foot Osteomyelitis.

Background: Diabetic foot osteomyelitis is a common infection where treatment involves multiple services, including infectious diseases, podiatry, and pathology. Despite its ubiquity in the hospital, consensus on much of its management is lacking.

Methods: Representatives from infectious diseases, podiatry, and pathology interested in quality improvement developed multidisciplinary institutional recommendations culminating in an educational intervention describing optimal diagnostic and therapeutic approaches to diabetic foot osteomyelitis (DFO).

A Retrospective Review of 193 Cases of Severe Eosinophilia in the Northeast United States.

Background: This retrospective review evaluated the causes of severe eosinophilia (≥5000 eosinophils/L). Higher eosinophilia levels are more likely to cause tissue damage and may reflect disease severity.

Methods: We reviewed 193 cases of patients seen at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and at the University of Vermont Medical Center in Burlington, Vermont, between January 2015 to May 2020 who had a peak absolute eosinophil count of at least 5000/μL.

Incidence and risk factors for PTT prolongation in patients receiving low-dose unfractionated heparin thromboprophylaxis.

Low-dose unfractionated heparin (LDUH) prophylaxis decreases the incidence of venous thromboembolism (VTE) in hospitalized patients, but increases the risk of bleeding events. Patients who develop a prolonged activated partial thromboplastin time (aPTT) while on LDUH may be at higher risk for bleeding complications. To determine the incidence and risk factors for aPTT prolongation in hospitalized patients receiving LDUH thromboprophylaxis, we performed a retrospective pharmacoepidemiologic cohort study of adult patients admitted to an academic medical center from September 2013 through September 2015.

Communication Skills Training for Internal Medicine Residents Using a Brief Animated Video.

Patient communication courses are time-intensive, making incorporation into residency curricula challenging. Using a short video could be an efficient means to teach residents communication skills. We created a 4-min animated video focused on the "ask more and summarize technique".