The Impact of an Acute Medical Unit in Internal Medicine on Resident Education.

Background: Medical trainees are expected to provide care for increasingly sick and treatment intensive patients. To improve patient care, hospitals worldwide have developed acute medical units (AMUs), dedicated medical wards that provide care for patients during the first 24 to 72 hours of an emergency medical hospital admission. A distinguishing feature of these units is that they are supervised by senior clinicians and offer multidisciplinary patient-centered care. Little is known about the impact of AMUs on trainee supervision and education. Methods: In this educational case study, we describe the evolution, process and structure of our AMU service. We also provide resident and teaching faculty perceptions of the impact of this intervention on education and supervision. Results: Questionnaire results showed that residents and teaching attendings believed that supervision and education were improved on the AMU, as compared to the traditional medical ward model. Residents also felt that their knowledge and clinical skills in managing acute patients improved. Procedure skills were less impacted by the intervention. A small number of residents believed that the AMU model worsened supervision and education. Conclusion: Integrating medical trainees into an AMU allowed for early evaluation and input from senior clinicians and increased opportunities to work in and learn from multidisciplinary teams, contributing to improved resident supervision and education. Future studies are needed to assess the long-term impact of the AMU on educational outcomes.

COVID-Related Leukoencephalopathy: Unusual MRI Features and Comparability to Delayed Post Hypoxic Ischemic Encephalopathy.

COVID-19 related leukoencephalopathy can be multifactorial given the systemic effects of the viral disease. We present couple of cases with typical clinico-imaging stigmata of COVID-19 resulting in severe respiratory insufficiency. MR brain imaging revealed confluent diffuse supratentorial white matter T2 hyperintensity with restricted diffusion during the sub-acute course of the disease. The MR imaging pattern of leukoencephalopathy was non-specific but more comparable to delayed post-hypoxic leukoencephalopathy (DPHL) as also previously reported in COVID-19. Interestingly, T2 imaging showed unusual but peculiar finding of "accentuated medullary veins" in the superficial zones. No dural venous sinus thrombosis or micro-hemorrhages were present to explain "dots and stripes" due to dilated medullary veins. The patho-mechanism of this findings is not clear but may possibly be related to demyelination as DPHL has shown to be a demyelinating process. We present a review of COVID-related leukoencephalopathy with discussion on hypoxia-induced demyelinating process with accentuated medullary veins as possible associated marker.