Evaluation of Outpatient Procedures Simulation Curriculum for Internal Medicine Residents.

Background: Outpatient procedure training in internal medicine residency has not been shown to produce high-level outcomes such as improved volume and quality of procedures performed on real patients.

Objective: The objective of this study was to improve the volume and quality of outpatient procedures performed by internal medicine residents by administering a simulation-based curricular intervention.

Design: Validated teaching materials and local faculty input were used to design a simulation curriculum for teaching the knee joint injection/aspiration and skin abscess incision and drainage.

GPT-4 assistance for improvement of physician performance on patient care tasks: a randomized controlled trial.

While large language models (LLMs) have shown promise in diagnostic reasoning, their impact on management reasoning, which involves balancing treatment decisions and testing strategies while managing risk, is unknown. This prospective, randomized, controlled trial assessed whether LLM assistance improves physician performance on open-ended management reasoning tasks compared to conventional resources. From November 2023 to April 2024, 92 practicing physicians were randomized to use either GPT-4 plus conventional resources or conventional resources alone to answer five expert-developed clinical vignettes in a simulated setting.

Large Language Model Influence on Diagnostic Reasoning: A Randomized Clinical Trial.

Importance: Large language models (LLMs) have shown promise in their performance on both multiple-choice and open-ended medical reasoning examinations, but it remains unknown whether the use of such tools improves physician diagnostic reasoning.

Objective: To assess the effect of an LLM on physicians' diagnostic reasoning compared with conventional resources.

Design, Setting, And Participants: A single-blind randomized clinical trial was conducted from November 29 to December 29, 2023.

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.

SIMPLE procedures: Survey of Internal Medicine Providers' Limitations and Experiences with procedures and medical procedure services.

Background: In response to a decline in bedside procedures performed by hospitalists, some hospital medicine groups have created medical procedure services (MPSs) concentrating procedures under the expertise of trained hospitalist-proceduralists.

Objectives: To characterize the structure, breadth, and heterogeneity of academic medical center MPSs, as well as compare the procedural landscape for groups with and without an MPS.

Methods: The Survey of Internal Medicine Providers' Limitations and Experiences with Procedures and MPSs, is a cross-sectional study, conducted in the United States and Canada through a web-based survey administered from October 2022 to March 2023.

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.

Validation of an Educational Tool for Skin Abscess Incision and Drainage by Delphi and Angoff Methods.

Background: Bedside incision and drainage (I&D) of skin abscesses is a common medical procedure performed in a variety of medical settings. Yet, there is a paucity of published validated educational tools to teach and assess competency for this procedure.

Objective: To validate an educational tool to teach and assess competency for bedside I&D of skin abscesses via the Delphi consensus and Angoff standard setting methods.

Procedural Competency Among Hospitalists: A Literature Review and Future Considerations.

Background: As general internists practicing in the inpatient setting, hospitalists at many institutions are expected to perform invasive bedside procedures, as defined by professional standards. In reality, hospitalists are doing fewer procedures and increasingly are referring to specialists, which threatens their ability to maintain procedural skills. The discrepancy between expectations and reality, especially when hospitalists may be fully credentialed to perform procedures, poses significant risks to patients because of morbidity and mortality associated with complications, some of which derive from practitioner inexperience.

Portal vein thrombosis prevalence and associated mortality in cirrhosis in a nationally representative inpatient cohort.

Background And Aim: Portal vein thrombosis (PVT) is increasingly common in cirrhotics, but its impact on mortality and outcomes is unclear. Studies evaluating PVT have been limited by small sample size. This study analyzes the trend of the prevalence of PVT and its associated mortality in hospitalized decompensated cirrhotics.

Subarachnoid Hemorrhage and Long-Term Stroke Risk After Traumatic Brain Injury.

Background: Recent studies suggest that traumatic brain injury (TBI) is a risk factor for subsequent ischemic stroke, even years after the initial insult. The mechanisms of the association remain unclear. The presence of traumatic subarachnoid hemorrhage (tSAH) may mediate the effect of TBI on long-term stroke risk, as it has previously been linked to short-term vasospasm and delayed cerebral ischemia.