The "Difficult" Inpatient, a Qualitative Study of Physician Perspectives.

Background: Previous studies exploring difficult inpatients have mostly focused on psychiatric inpatients.

Objective: To explore the characteristics of difficult medicine inpatients.

Design: Qualitative study using focus groups and semi-structured interviews.

Influence of the COVID-19 Pandemic on Health-Care Career Interests Among High School Students.

Purpose: This study investigates the influence of the COVID-19 pandemic on high school students' interest in health-care careers.

Methods: A voluntary web-based survey, approved by the Medical College of Wisconsin's Institutional Review Board, was administered across eight high schools in Milwaukee and its suburbs in Wisconsin. The survey collected students' demographic details, opinions on the health-care system's pandemic response, and their interest in health-care careers before and after the pandemic.

Multicenter Study of Optional In-Person Visits to Residency Programs After Virtual Interviews.

Compared to in-person recruitment, virtual interviewing reduces costs and promotes equity. However, many residency applicants believe that visiting programs helps inform their rank decisions. We assessed the feasibility of and stakeholder opinions about optional in-person visits after virtual interviewing and program rank list finalization.

Effect of Implementing a Commercial Electronic Early Warning System on Outcomes of Hospitalized Patients.

Despite the widespread adoption of early warning systems (EWSs), it is uncertain if their implementation improves patient outcomes. The authors report a pre-post quasi-experimental evaluation of a commercially available EWS on patient outcomes at a 700-bed academic medical center. The EWS risk scores were visible in the electronic medical record by bedside clinicians.

A Reflection and Discussion Exercise on Racial Justice and Equity.

Background: Residents have valuable perspectives about diversity and equity in medical training, yet many graduate medical education curricula lack dedicated activities focused on such issues.

Objectives: To describe and report feasibility and acceptability of an innovation that uses individual reflection and group discussion to create conversation in our residency program about equity and injustice through the lens of the Black Lives Matter movement.

Methods: In July 2020, we sent a survey with reflection prompts to all postgraduate year 2 and above internal medicine residents.

Preparing Residents to Respond to Incidences of Gender Discrimination and Sexual Harassment: An Interactive Workshop.

Objectives: Gender discrimination and sexual harassment are common in academic medicine. There are limited data on how to prepare medical trainees to respond to these incidents. The objective of this work was to understand the experience of residents with sexual harassment and to evaluate the impact of a low-cost educational intervention to better prepare residents to respond to incidents of gender discrimination and sexual harassment.

A Comparative Study of Scripted versus Unscripted Morning Reports: Results from a Prospective Multicenter Study.

Objectives: Morning report is one of the central activities of internal medicine residency education. The two most common morning report formats are scripted reports, which use preselected cases with prepared didactics, and unscripted reports in which a case is discussed without preparation. No previous study has compared these two formats.

Nursing implications of an early warning system implemented to reduce adverse events: a qualitative study.

Background: Unrecognised changes in a hospitalised patient's clinical course may lead to a preventable adverse event. Early warning systems (EWS) use patient data, such as vital signs, nursing assessments and laboratory values, to aid in the detection of early clinical deterioration. In 2018, an EWS programme was deployed at an academic hospital that consisted of a commercially available EWS algorithm and a centralised virtual nurse team to monitor alerts.

A Proposed Systematic Approach to the Cognitive Autopsy for Internists.

The cognitive autopsy has been a proposed tool for physicians to evaluate misdiagnosis. However, prior iterations of this tool are cumbersome, not designed for the internist, and may cause users to isolate cognition from systems issues. A 10-point tool was created to be utilized individually or by a group when evaluating an adverse event.

Outcomes of an Interprofessional Patient Safety Fellowship Program.

Background: Interprofessional training for patient safety is essential in developing leaders and advocates who are versed in patient safety science and interprofessional collaboration. We describe an interprofessional patient safety fellowship program and its outcomes over 8 years.

Methods: Programmatic data were reviewed and a survey was sent to all program graduates with a known email address (N = 18).

Patient-Physician Concordance for Quantitative Formats and Treatment Options and the Relationship with State Anxiety.

Patient-physician concordance about topics discussed in a clinic visit is essential for effective communication but may be difficult to achieve in cancer care. We conducted a multicenter, observational study at two Midwestern oncology clinics. A sample of 48 English-speaking or Spanish-speaking women with newly diagnosed stage 0-3 breast cancer completed surveys before and after a visit with an oncologist.

Spanish Medical Interpreters' Management of Challenges in End of Life Discussions.

Objective: Professional medical interpreters facilitate patient understanding of illness, prognosis, and treatment options. Facilitating end of life discussions can be challenging. Our objective was to better understand the challenges professional medical interpreters face and how they affect the accuracy of provider-patient communication during discussions of end of life.

Barriers to Accessing Nighttime Supervisors: a National Survey of Internal Medicine Residents.

Background: Single-center studies have reported residents experience barriers to accessing supervising physicians overnight, but no national dataset has described barriers perceived by residents or the association between supervision models and perceived barriers.

Objective: To explore residents' perception of barriers to accessing overnight supervision.

Design: Questions about overnight supervision and barriers to accessing it were included on the American College of Physicians Internal Medicine In-Training Examination® (IM-ITE®) Resident Survey in Fall 2017.

Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study.

Background: Peripherally inserted central catheters (PICCs) provide reliable intravenous access for delivery of parenteral therapy. Yet, little is known about PICC care practices or how they vary across hospitals. We compared PICC-related processes across hospitals with different insertion delivery models.

Impact of Fellows-as-Teachers Workshops on Teaching Rounds: An Observational Study in an ICU.

Unlabelled: During training, fellows serve as teachers and role models for junior colleagues. Fellows-as-teachers curricula may support these roles, but little is known about their effectiveness and durability. We sought to measure the long-term effects on ICU rounds after administering fellows-as-teachers workshops.

Hospitalized Medical Patients With Posttraumatic Stress Disorder (PTSD): Review of the Literature and a Roadmap for Improved Care.

Posttraumatic stress disorder (PTSD) is common in the United States, with a prevalence of nearly 8% in the general population and between 10% and 30% in veterans. Despite how common PTSD is, inpatient providers may not be familiar with its manifestations or feel comfortable taking care of patients who may exhibit symptoms related to it. In our combined experience as VA-based hospital medicine care providers, we have cared for thousands of patients hospitalized for a primary medical condition who also have PTSD as a comorbidity.

The Hospital Experience Through the Patients' Eyes.

Background: Posthospital syndrome is associated with a decrease in physical and cognitive function and can contribute to overall patient decline. We can speculate on contributors to this decline (eg, poor sleep and nutrition), but other factors may also contribute. This study seeks to explain how patients experience hospitalization with particular attention on what makes the hospital stay difficult.

A Multicenter VA Study of the Format and Content of Internal Medicine Morning Report.

Background: There are more than five hundred internal medicine residency programs in the USA, involving 27,000 residents. Morning report is a central educational activity in resident education, but no recent studies describe its format or content.

Objective: To describe the format and content of internal medicine morning reports.

Sexual Harassment of Female Providers by Patients: a Qualitative Study.

Background: Sexual harassment of women is a pervasive problem. Prior studies found that sexual harassment of female providers by patients is common, but guidance on addressing this problem is limited.

Objective: To understand the experiences of female providers with sexual harassment by patients with a focus on how practicing providers address these events.

Emotional Content of Comics Drawn by Medical Students and Residents.

Objective: Medical students and residents face high rates of burnout. Drawing comics may help trainees process their experiences and feel both valued and connected to those who read their work. In this study, the authors sought to elucidate the predominant emotions and themes conveyed in medical students' and residents' comics about stressful situations.

Developing a Patient- and Family-Centered Research Agenda for Hospital Medicine: The Improving Hospital Outcomes through Patient Engagement (i-HOPE) Study.

Background: Patient, caregiver, and other stakeholder priorities have not been robustly incorporated into directing hospital-based research and improvement efforts.

Objective: To systematically engage stakeholders to identify important questions of adult hospitalized patients and to create a prioritized research agenda for improving the care of adult hospitalized patients.

Design: A collaborative approach to stakeholder engagement and research question prioritization.