Peri-Interview Communication in the Otolaryngology Residency Match: The Applicant Perspective.

OBJECTIVES/HYPOTHESIS: To evaluate peri-interview communication in the otolaryngology Match from the applicant's perspective. STUDY DESIGN: Cross-sectional survey study. METHODS: A survey link was emailed to 401 otolaryngology residency applicants from the 2019 Match cycle. Survey items queried peri-interview communication practices and applicants' attitudes toward communication in the postinterview period. Data were collected anonymously. Qualitative analysis was performed for descriptive statistics. Responses from female and male participants were compared using Fisher exact tests. RESULTS: The survey yielded a 44% (56% male, 44% female) response rate and a 100% completion rate. Of applicants, 18% were told they were ranked to match, and 19% were asked how highly they planned to rank a given program. Interview questions regarding marital status and plans for children were asked to 38% and 12%, respectively. The majority (75%) believe peri-interview communication should be allowed. Most (65%) participants felt obligated to inform top program(s) of their high rank; however, only 45% of applicants found this to be stressful. Peri-interview communication may have altered the rank list for 10% of applicants. Of applicants, 96% created their final rank list based on where they most wanted to match rather than where they would most likely match. CONCLUSIONS: National Resident Matching Program peri-interview communication violations occur in the otolaryngology Match at similar rates when compared to other specialties. Although peri-interview communication can cause significant stress, the majority of otolaryngology residency applicants believe peri-interview communication should be allowed and do not believe it alters applicants' rank lists. LEVEL OF EVIDENCE: NA Laryngoscope, 131:28-32, 2021.

A Multispecialty Critical Airway Simulation Course for Medical Students.

OBJECTIVES: To develop a novel multispecialty simulation-based course that teaches both technical and nontechnical skills in the management of adult and pediatric critical airways to graduating medical students and 2) to encourage a collaborative, multispecialty approach to the management of a difficult airway amongst fourth-year medical students who have enrolled in otolaryngology, anesthesia, and emergency medicine residency programs. METHODS: Fourth-year medical student who had matched into otolaryngology, anesthesia, and emergency medicine participated in an intensive half-day course consisting of a series of hands-on skills stations with increasing complexity, followed by simulated complex patient scenarios designed for shared management of airway emergencies. Participants completed questionnaires prior to and immediately after the course. Fischer's exact test was utilized to compare data between the precourse and postcourse surveys. Free-text responses were qualitatively assessed to inform course development. RESULTS: Thirty-four medical students were enrolled (6 otolaryngology, 15 anesthesia, 13 emergency medicine), and 30 students completed both surveys. Fisher's exact test demonstrated improved confidence (P < .05) for every skill. More than 85% of participants strongly agreed or agreed that the intervention was useful in developing their knowledge, technical skills, and self-confidence and in improving clinical performance prior to residency. CONCLUSIONS: This critical airway course introduces a multispecialty simulation-based course designed to impart graduating medical students with the necessary knowledge, skills, and behaviors for critical airway management while fostering interprofessional collaboration. Our course was successful in improving confidence and was perceived as useful in developing knowledge, technical skills, self-confidence, and clinical performance prior to residency. LEVEL OF EVIDENCE: NA Laryngoscope, 131:1482-1486, 2021.

Physician Perspectives on Fertility Preservation Discussions with Premenopausal Breast Cancer Patients: Results from a Multihospital Health Care System.

BACKGROUND: Ten percent of new breast cancer diagnoses occur in premenopausal women, and oncologic therapies may compromise fertility. Thus, fertility preservation discussions (FPDs) and referral to fertility specialists are imperative prior to initiation of therapy. A previous retrospective chart review showed 45% FPD rates at our institution. The aim of this study is to investigate physician perspectives and limitations regarding FPD. METHODS: An electronic survey was distributed to 30 surgical, medical, and radiation oncologists across ten regional hospitals. Questions addressed provider demographics, and barriers to and facilitators of FPD. RESULTS: The survey response rate was 63.3%. Only 31.6% of physicians reported "always" documenting FPD. Respondents opined that the physician prescribing systemic therapy was the most appropriate person to provide FPD. Patient age, treatment with chemotherapy, and patient desire for FPD were more likely to increase FPD (p < 0.0001, p < 0.05, and p < 0.0001, respectively). The majority of physicians (84.2%) expressed intent to increase FPD rates. CONCLUSIONS: Fertility preservation is an integral aspect of breast cancer care, requiring thorough discussion and clear documentation. This study identified that physicians believe the medical oncologist is the most appropriate person to have FPDs with patients and that empowering patients to bring up fertility concerns may improve rates of FPDs. Education of physicians and patients about fertility preservation techniques is likely to improve FPDs.

Gabapentin potentiates sensitivity to the interoceptive effects of alcohol and increases alcohol self-administration in rats.

Gabapentin, a drug used in the treatment of epileptic seizures and neuropathic pain, has shown efficacy in the treatment of alcohol dependence. Moreover, given that gabapentin is used in the general population (e.g., non-dependent individuals, social drinkers), we sought to utilize preclinical assessments to examine the effects of gabapentin on sensitivity to moderate alcohol doses and alcohol self-administration in rats with a history of moderate drinking. To this end, we assessed whether gabapentin (0, 10, 30, 120 mg/kg, IG) pretreatment alters sensitivity to experimenter- and self-administered alcohol, and whether gabapentin alone has alcohol-like discriminative stimulus effects in rats trained to discriminate alcohol dose (1 g/kg, IG) vs. water. Second, we assessed whether gabapentin (0, 10, 30, 60 mg/kg, IG) would alter alcohol self-administration. Gabapentin pretreatment potentiated the interoceptive effects of both experimenter-administered and self-administered alcohol in discrimination-trained rats. Additionally, the highest gabapentin doses tested (30 and 120 mg/kg) were found to have partial alcohol-like discriminative stimulus effects when administered alone (e.g., without alcohol). In the self-administration trained rats, gabapentin pretreatment (60 mg/kg) resulted in an escalation in alcohol self-administration. Given the importance of interoceptive drug cues in priming and maintaining self-administration, these data define a specific behavioral mechanism (i.e., potentiation of alcohol effects) by which gabapentin may increase alcohol self-administration in non-dependent populations.