Background: Incoming interns must understand the specific culture of safety at their new institution as well as processes that they are expected to know on day 1 of residency. As part of an immersive half-day simulation program for incoming interns called First Night On Call (FNOC), we developed a hypotension Group Observed Standardized Clinical Encounter [...]

Background: The transition from medical student to intern presents a major patient safety concern. Incoming interns must understand the specific culture of safety at their new institution and processes that they are expected to perform on day 1 of residency without direct supervision. We developed an immersive, integrated First Night On Call (FNOC) simulation to [...]

Background: Nearly half of incorrect procedures occur outside the operating room, and failure to conduct a robust time-out is a frequent root cause. Mannequin-based simulation (MBS) has been shown to improve self-confidence and performance of time-outs, but is expensive, time-consuming, and difficult to scale up effectively for large groups of medical learners. Screen-based simulation (SBS) [...]

Background: Lumbar puncture and paracentesis are core competencies in internal medicine, but residents frequently report discomfort performing these procedures unsupervised. Simulation-based training (SBT) has previously been shown to improve resident performance of lumbar punctures on patients, but outcomes after paracentesis SBT have only been assessed on simulators. We hypothesized that SBT would improve internal medicine [...]

Background: Warfarin and other anticoagulants increase the risk of hemorrhagic complications, including upper gastrointestinal hemorrhages (UGIB). Warfarin is commonly used in the management of atrial fibrillation to reduce the risk of ischemic stroke, and frequently resumed following UGIB. However, optimal timing of reinitiation remains unclear. Theory suggests that resuming warfarin immediately after UGIB would lead [...]

Background: Heart rate (HR) assessment is a vital component in the neonatal resuscitation (NR) algorithm. Research has consistently found auscultation to be an inaccurate means of assessing neonatal HR and may lead to incorrect resuscitation interventions. Current Neonatal Resuscitation Program (NRP) recommendations include auscultation for initial HR determination. Whether HR assessment via auscultation during NR [...]

Background: The Intermediate Care Unit was developed in the 1960s and 70s as a level of care between general medicine (GMU) and intensive care units (ICU) [1]. While all IMU patients could be cared for in an ICU, hospitals have too few ICU beds to accommodate patients who are not critically ill, and higher levels [...]

Background: The Intermediate Care Unit (IMU) was developed in the 1960s – 1970s as a level of care between general medicine (GMU) and intensive care units (ICU) [1]. The Society of Critical Care Medicine has established guidelines for admitting patients to an IMU based on severity of illness or need for frequent or complex nursing [...]

Case Presentation: A 63-year-old woman woman presented after multiple episodes of seizure. She had no prior history of seizures or alcoholism. The patient had a deceased donor renal transplant 6 months prior complicated by persistent right perinephric fluid collection treated with long term piperacillin-tazobactam therapy. Attempts to obtain microbiology were unsuccessful and patient was started [...]