Background: In hospital medicine, around 250,000 diagnostic errors occur yearly in American hospitals and a significant proportion are attributed to failures in clinical reasoning. Feedback on the diagnostic process has been proposed as one method of improving clinical reasoning. However, in the current healthcare system barriers to the delivery and receipt of feedback include limited [...]

Background: In hospital medicine, around 250,000 diagnostic errors occur yearly in American hospitals and a significant proportion are attributed to failures in clinical reasoning. Feedback on the diagnostic process has been proposed as one method of improving clinical reasoning. However, in the current healthcare system barriers to the delivery and receipt of feedback include limited [...]

Background: The Association of American Medical Colleges identifies consideration of social determinants of health (SDoH) and patient-specific factors as key components of entrustable professional activities (Englander 2016). Prior studies of medical students and Internal Medicine (IM) residents demonstrated baseline gaps in integrating SDoH into clinical reasoning (CR) in the outpatient setting (Schwartz 2010, Wilhite 2020), [...]

Background: The diagnostic process, inherently fraught with uncertainty and susceptible to errors, has been associated with adverse outcomes when physicians exhibit lower tolerance for uncertainty (1,2). The Diagnostic Time-Out (DTO) serves as a structured tool to outline a problem representation, prioritize the differential diagnosis, and communicate diagnostic uncertainty in high-risk situations for diagnostic errors. In [...]

Background: Clinical handbooks support patient care, with studies demonstrating positive effects in areas such as quality of chart documentation, clinical knowledge, and value of inpatient care. Internal medicine residents rotating through inpatient services are particularly likely to benefit from handbooks, especially when handbooks share local, system-specific, and practical guidance. However, less is known about how [...]

Case Presentation: A 70-year-old man with a history of bladder cancer treated with intravesical Bacillus Calmette-Guerin (BCG) therapy presented with acute on chronic back pain. Six months prior, he presented with lower back pain, was diagnosed with culture negative bacterial osteomyelitis, and underwent an L3-L5 laminectomy. He was discharged with an empiric 6-week antibiotic course [...]