UNCORRECTED PROOF (Hashimoto's thyroiditis) and receives substitute treatment. She developed an osteomalacia with bilateral femoral neck fracture without traumatism. She had benefited from a total hip prosthesis. Another way, we found that renal tubular acidosis complicated from hypokalemic paralysis and bilateral nephrocalcinosis. This renal acidosis is due to Sjögren's syndrome. She was treated with corticosteroid, calcium and phosphorus with good clinical evolvement. During Sjögren's syndrome, osteomalacia can complicate the distal renal tubular acidosis. In spite of the rare cases of osteomalacia revealing Sjögren's syndrome, this auto-immune disease must appear in the list of the aetiologies of osteomalacia. doi:10.1016/j.ejim.2013.08.624 ID: 396 The importance of internal medicine internship for young doctors' training S. Sovaila a , A. Purcarea b , A. Froissart c , L. Federici d , B. Ranque e , T. Hanslik f , J.C. Weber b , J.F. Bergmann g , A. Bourgarit b , TCS Study group:Emanuel Andres, Jean-benoit Arlet, Elisabeth Aslangul, Jean-François Bergman, Anne Bourgarit, Bruno Fantin, Laurence Fardet, Laure Federici, Antoine Froissart, Gecile Goujard, Fabienne Grunenberger, Thomas Hanslik, Adrien Kettaneh, Pierre h a Internal Medicine Department, Hautepierre Hospital, Strasbourg, France b Internal Medicine Department, Civil Hospital, Strasbourg, France c Internal Medicine Department, Beaujon Hospital, Paris, France d Internal Medicine Department, Colmar Hospital, Colmar, France e Internal Medicine Department, Georges-Pompidou Hospital, Paris, France f Internal Medicine Department, Ambroise-Paré Hospital, Paris, France g Internal Medicine Department, Lariboisière Hopital, Paris, France h Internal Medicine Department, Hospital, Strasbourg, France Introduction: Internal Medicine is a “broad base” specialty where students are confronted with various clinical problems, often complex, essential for training in clinical reasoning and the acquisition of medical professional competence. The educational value of training in this specialty in early internship has never been objectively evaluated. The script concordance test (SCT) assesses the ability of doctors to prioritize assumptions in clinical situations with a degree of uncertainty. With no single correct answer, the result is expressed in “agreement” with the responses of a panel of experts. We present a pilot study evaluating by SCT, the educational value of internship in internal medicine at the beginning of the third cycle. Methods: We present a prospective multicenter controlled study from six departments of internal medicine in France. The SCTs were created and calibrated on medical students, young doctors and experts. The calibrated series of tests was then used to evaluate young doctors making their first internship in internal medicine at the beginning and the end of their first semester. The control group is represented by different interns that arrive in internal medicine after the first 6 months of training in another specialty. Results: A series of 60 versatile questions of general and internal medicine was created and then validated by a panel of 18 internal medicine experts (E) with more than 10 years of experience. Our study population (SP1) consists of 18 interns at the beginning of the semester. 14 completed the test at the end of the semester (SP2). The control group consists of 14 interns at the beginning of the second semester (CP). We note a progression of our study population at the end of the study (SP2) M = 48.1 SD = 3.9 range [41.4; 55.04] as compared to the beginning of the rotation (SP1) M = 45.96 SD = 4.7 range [36.4; 56.3]. The experts (E) were at 53.3 SD4 [44; 60]. Nonparametric statistic using the Friedman test confirms the significant difference between the beginning and the end of the internal medicine rotation as compared to the expert's results: SP1 mean rank 1.92, SP2 mean rank 2.5, E mean rank 3.67, χ 2 = 14.7 p = 0.02.The control population of interns having completed a medical rotation other than internal medicine (CP) had results similar to those preceding the internal medicine rotation M = 45.46 SD = 3.8 range [35.5; 48.5]. Conclusion: The Internal Medicine rotation seems to improve the clinical reasoning training capacity of young doctors. SCT is able to evaluate its role in the formation of young doctors, but a larger study may be necessary for validation of our results. doi:10.1016/j.ejim.2013.08.625 ID: 404 Malnutrition is associated with worse clinical outcome in internal medicine wards. A study comparing screening tools, functional indices and biochemical markers S. Lucia, C. Gori, M. Stronati, G. Di Lazzaro Giraldi, F. Rossi Fanelli, A. Laviano Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy Aims/Objectives: Although prevalence of hospital malnutrition is high ranging from 20% to 50%, its inclusion in the clinical charts is limited. Besides, it is still a matter of debate which functional, biochemical or screening tool is superior in identifying clinical risk. The nutritional screening tools recommended for hospitalized patients are: the Mini-Nutritional Assessment (MNA), the Nutritional Risk Screening 2002 (NRS-2002) and the Malnutrition Universal Screening Tool (MUST). Our aims were: I) to compare the predictive value of screening tools, phase angle, handgrip strength, and CRP levels in identifying patients with longer hospital stay; II) to assess the consistency between the presence of nutrition risk and its inclusion in the charts; and, III) to evaluate the 90-day mortality between malnourished and non-malnourished patients. Material and Methods: Patients consecutively admitted to the Internal Medicine ward at our institution, and who gave their consent, were enrolled in the study. Malnutrition was screened by MNA, NRS-2002 and MUST. Handgrip strength (HG; kg), CRP levels (mg/dL), phase angle (PhA) and body composition (BIA 101, AKERN srl), were assessed upon admission. Length of stay and the inclusion of malnutrition in the diagnosis reported in the chart were recorded. A 90-day follow-up was performed by recall. Data have been statistically analyzed by non-parametric test (Wilcoxon–Mann– Whitney test), ANOVA, Student's t-test, and Kruskal–Wallis test. Spearman correlation was used when appropriate. Results are reported as M ± SD. Results: 151 patients (79 M:72 F; 71 ± 15 yrs) were studied. The prevalence of malnourished patients was 51.1% (73/151) by NRS-2002, 16.3% (22/151) by MNA and 29.9 (41/151) by MUST, but malnutrition was reported in the charts in only 3 cases, whereas nutritional consultation was requested for only 20 patients. Malnourished patients screened with NRS-2002 and MNA were older than non-malnourished patients (p b 0.001 and p = 0.006, respec- tively). Moreover, compared with non-malnourished patients, mal- nourished patients screened by NRS-2002 showed: lower BMI (p = 0.004), lower fat mass index (FFMI) (p = 0.003) and increased C-reactive protein (CRP) (p = 0.039). In addition, malnourished patients screened with MNA and MUST reported a significant reduction in HG (p = 0.01 and p = 0.004, respectively). Well nourished patients were significantly younger (p b 0.01), and their median hospital stay was 6 days shorter than in malnourished patients screened by MNA (12 vs. 18 days, respectively). Length of stay was significantly correlated with MNA (r = -199; p b 0.05), Abstracts e243