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To compare the length of stay and charges for patients with pneumonia admitted in 1995 to the teaching and nonteaching services of a Northeastern teaching hospital, we reviewed the charts of 237 patients. Patients cared for by hospitalbased generalists working with housestaff (teaching service) were discharged more quickly and with lower or equivalent charges than patients cared for by community-based attending physicians working either with housestaff (private teaching service) or alone (nonteaching service). Academic teaching services staffed by general medicine faculty may provide efficient inpatient pneumonia care. A t a time when managed care contracting has created fiscal pressures at academic centers, hospital stays continue to account for a high proportion of overall patient care costs. Not surprisingly, traditional models of inpatient care at teaching hospitals are being reevaluated. 1 Residency teaching services are thought to be particularly inefficient in providing care. The average cost of hospitalization has been reported to be 30% to 40% higher at academic centers than in nonacademic institutions. 2 Whether this reported difference derives from overutilization of services, differences in severity mix, or a higher intrinsic cost structure remains unclear. Although medical decisionmaking at teaching hospitals is shared between housestaff and attending physicians, at most programs housestaff independently order tests and arrange for consultations, which may accelerate or impede hospital discharge. Again, it has been assumed that housestaff participation adds to the cost of care, and educational programs targeted at unnecessary diagnostic tests by housestaff have been attempted. 3 At Rhode Island Hospital, three models of inpatient care exist, providing the grounds for a natural experiment. Using a single diagnosis, pneumonia, that has a well-defined measure of severity of illness, we compare the economic implications of three models of inpatient care in order to gain insight into practice style differences between housestaff teaching services and a nonteaching service.

Physicians' care-seeking behavior covers a broad spectrum, ranging from self-care, to informal consultation, to formal treatment by another physician. Physicians appear to be low users of formal services overall, but high users of preventive care.

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Background Case-based Morning Report (MR) has long been the predominant educational conference in Internal Medicine (IM) residency programs. The last comprehensive survey of IM MR was in 1986. Much has changed in the healthcare landscape since 1986 that may impact MR. Objective We sought to determine the current state of MR across all US IM programs. Design In 2018, US IM program directors (PDs) were surveyed about the dynamics of MR at their institutions, perceived pressures, and realized changes. Key Results The response rate was 70.2% (275/392). MR remains highly prevalent (97.5% of programs), although held less frequently (mean 3.9 days/week, SD 1.2), for less time (mean 49.4 min, SD 12.3), and often later in the day compared to 1986. MR attendees have changed, with more diversity of learners but less presence of educational leaders. PD presence at MR is associated with increased resident attendance (high attendance: 78% vs 61%, p=0.0062) and punctuality (strongly agree/agree: 59% vs 43%, p=0.0161). The most cited goal for MR is utilizing cases to practice clinical reasoning. Nearly 40% of PDs feel pressure to move or cancel MR; of those, 61.2% have done so, most commonly changing the timing (48.5%), reducing the length (18.4%), and reducing the number of sessions per week (11.7%). Compared to community-based and to community-based, university-affiliated programs, university-based programs have 2.9 times greater odds (95% CI: 1.3, 6.9; p = 0.0081) and 2.5 times greater odds (95% CI 1.5, 4.4; p =0.0007), respectively, of holding MR after 9 AM, and 1.8 times greater odds (95% CI: 0.8, 4.2; p = 0.1367) and 2.0 times greater odds (95% CI: 1.2, 3.5; p = 0.0117), respectively, of reporting pressure to cancel or move MR compared to their counterparts. Conclusions While MR ubiquity reflects its continued perceived value, PDs have modified MR to accommodate changes in the healthcare environment. This includes reduced frequency, shorter length, and moving conferences later in the day. Additional studies are needed to understand how these changes impact learning. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07010-1.

Gatifloxacin is a synthetic broad-spectrum 8-methoxyfluoroquinolone approved by the United States Food and Drug Administration in December 1999. Few side effects of this new antibiotic have been reported, and there are no previous case reports of bradyarrhythmias. We report 2 cases of syncope due to bradycardia in patients who recently began treatment with gatifloxacin.

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