Are Text Pages an Effective Nudge to Increase Attendance at Internal Medicine Morning Report Conferences? A Cluster Randomized Controlled Trial.

Background: Despite the importance of medical educational conferences, low attendance remains an issue. The utility of reminder text pages as a behavioral nudge to increase attendance is unknown. Our objective was to determine whether reminder text pages increase daily morning report attendance. Methods: We conducted a multiple-crossover cluster randomized controlled trial among medical students and internal medicine interns and residents (learners) at the Veteran Affairs Boston Healthcare System during the 2019 to 2020 academic year. During intervention periods, all residents and interns received a text page reminder 5 minutes before the upcoming 8:00 am morning report conference; no page was sent during control periods. The primary outcome was conference attendance 10 minutes after the start of the conference. Results: The study period included 85 morning report conferences, which 211 unique learners were eligible to attend; outcome data were available for 100% of eligible learners. On days when no page was sent, 44.4% of eligible learners attended the conference by 8:10 am ; on days when a reminder page was sent, 49.5% of eligible learners attended (P = .007). Accounting for clustering within individuals and controlling for date and team, the adjusted risk difference in morning report attendance associated with a reminder page was 4.0% (95% CI, 0.5%-7.6%) compared with no reminder page. No effect modification by overnight admissions was detected. Conclusions: Our results suggest that daily reminder pages may result in a small increase in conference attendance. Whether this small increase is educationally significant will vary across training programs that apply this strategy.

The Last Beat: Contemporary Ethical Controversies Surrounding Determination of Cardiopulmonary Death.

Part one of this series tracked the evolution of the death examination, noting its stability over the last century despite changing diagnostic and therapeutic technologies and social contexts. In part two, we discuss the practical and ethical debates surrounding the exact timing of death. Although the irreversible cessation of cardiopulmonary systems remains the most common criteria used for the determination of death, identification of the moment of irreversibility is imprecise. In most cases, this imprecision is not problematic, but, when the cessation of circulation is used to identify the time of organ procurement for transplantation, it becomes critical. The phenomenon of autoresuscitation highlights these issues because patients who meet all the criteria for circulatory death (sometimes for periods of observation well beyond the norm) apparently return to life. Were these patients resurrected (like Lazarus) or did we simply not wait long enough?

Tweetorials: Digital scholarship deserving of inclusion in promotion portfolios.

Since their first appearance in 2018, tweetorials have emerged as a popular tool for medical education. Despite some calls for their inclusion in educational and promotion portfolios, questions have been raised about the appropriateness of these forms of digital scholarship. Also unclear is how a promotion committee might identify educational tweetorials most deserving of inclusion. We argue that educational tweetorials do warrant consideration as digital scholarship and offer a means of evaluation that promotion committees might use when assessing an individual tweetorial.

The Last Breath: Historical Controversies Surrounding Determination of Cardiopulmonary Death.

Cardiopulmonary determination of death is a mainstay of the practice of internal medicine and pulmonary physicians. Despite this, there is considerable variability in death examinations. This article tracks the evolution of the tripartite death examination, initially developed in the middle of the 19th century to protect against premature burial. Although the societal context for controversies about death determination has shifted to discussions about end-of-life care in ICUs and organ transplantation, the cardiopulmonary death examination has largely remained unchanged from its original formulation. The recognition of coma dépassé and brain death has further pushed the focus of the death examination onto the neurological system. Despite advancing diagnostics and legislative attempts to standardize the definition of death, cardiopulmonary death determination largely remains an ad hoc process.

Clinical guideline highlights for the hospitalist: 2020 American Society of Addiction Medicine clinical practice guideline on alcohol withdrawal management.

GUIDELINE TITLE: The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management RELEASE DATE: May 2020 PRIOR VERSION: 2004 American Society of Addiction Medicine guideline on management of alcohol withdrawal delirium DEVELOPER: American Society of Addiction Medicine FUNDING SOURCE: American Society of Addiction Medicine TARGET POPULATION: Adults hospitalized with alcohol withdrawal syndrome of any severity.

#LiverTwitter: An Emerging Tool for Liver Education and Research.

#LiverTwitter has emerged as an academic forum that has begun to advance the field of hepatology by disseminating content on chronic liver diseases to a global audience. This article summarizes the content presented in a panel discussion at the 2019 Liver Meeting by highlighting the perspectives of several key types of participants in Twitter: the trainee, the medical educator, the divisional account, the scientific journal, and the passive participant.

From Tweetstorm to Tweetorials: Threaded Tweets as a Tool for Medical Education and Knowledge Dissemination.

Tweetorials are a form of threaded tweets that have emerged as a tool for medical education and knowledge dissemination. Making use of features not available in traditional formats, tweetorials offer novel opportunities for educators of all levels to engage with a potential audience of millions. Despite their increased use, questions remain about how best to create, post, and track the impact of individual tweetorials. In addition, uncertainties about how tweetorials fit into the portfolio of medical educators remain unanswered. This review discusses the emergence of tweetorials, their benefits and drawbacks, recommendations for their creation, and outlines unanswered questions.

Should You Treat This Acutely Ill Medical Inpatient With Venous Thromboembolism Chemoprophylaxis?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Venous thromboembolism (VTE), which includes both deep venous thrombosis and pulmonary embolism, is a common and potentially fatal condition. Medical inpatients are at high risk for VTE because of immobility as well as acute and chronic illness. Several randomized trials demonstrated that chemoprophylaxis, or low-dose anticoagulation, prevents VTE in selected medical inpatients. The 2018 American Society of Hematology clinical practice guideline on prophylaxis for hospitalized and nonhospitalized medical patients conditionally recommends chemoprophylaxis for non-critically ill medical inpatients, leaving much to the discretion of the treating physician. Here, 2 experts, a hematologist and a hospitalist, reflect on the care of a woman hospitalized with a rheumatologic disorder. They consider the risks and benefits of chemoprophylaxis, discuss VTE risk stratification, and recommend which patients should receive chemoprophylaxis and with which agents.