The Influence of COVID on Emergency Medicine Career Choice: A Survey of Medical Students.

Background The COVID-19 pandemic has led to substantial changes in the delivery of healthcare and medical education. Little is known about how the pandemic has altered medical students' perceptions in regard to career choice. Methods The authors developed and implemented a multi-center survey that evaluated medical students' preferred career choice before and during the coronavirus pandemic, as well as the influence of pandemic-related factors on that choice. The survey was distributed to all levels of medical students (MS) at nine medical schools across the country from November 2020 to January 2021 and represented a convenience sample. Preferred career choice was assessed through the use of a Likert scale and additional factors affecting career choice were solicited. The degree of interest before and during the pandemic, as well as factors influencing the shift, were treated as ordinal variables and compared using chi-squared testing. Cohen's Kappa statistic was calculated to assess the degree of shifts of interest in Emergency Medicine among students. The study was deemed exempt by the Institutional Review Board at the host institution, Sidney Kimmel Medical College at Thomas Jefferson University, and all participating sites. Results A total of 1431 of 6710 (21.3%) eligible students completed the survey. The COVID pandemic was cited as a reason for a changed interest in specialty by 193 (13.5%) students. The most common reason for specialty change was the students' clinical experience, followed by a desire to be on the front lines, and personal/family health concerns. There was a significant association between career change and degree of interest among students interested in emergency medicine (EM) as their future specialty before the COVID pandemic as well as during the COVID pandemic. Living with an immunocompromised individual had a significant association with a reduced interest in EM. There was a significant association between EM rotation completion and how interested students were in EM as their future specialty before the COVID pandemic and during the COVID pandemic. Among EM-interested students whose specialty interest was changed by the COVID pandemic, 34 (41.5%) became less favorable to EM, 28 (34.2%) stayed the same, and 20 (24.4%) students became more favorable to EM. Conclusions The impact of COVID-19 on medical students' career choice is a complicated matter that involves both personal and professional factors. It appears that there is a trend towards less interest in the field of EM with multifactorial influences, some of which are related to the COVID-19 pandemic.

Measuring and Predicting Faculty Consensus Rankings of Standardized Letters of Evaluation.

Background Standardized letters of evaluation (SLOE) are becoming more widely incorporated into the residency application process to make the letter of recommendation, an already critical component in a residency application packet, more objective. However, it is not currently known if the reviewers of these letters share consensus regarding the strength of an applicant determined by their SLOE. Objective We measured the level of faculty agreement regarding applicant competitiveness as determined by SLOEs and the ability of 2 algorithms to predict faculty consensus rankings. Methods Using data from the 2021-2022 Match cycle from the Council of Residency Directors in Emergency Medicine SLOE Database as a blueprint, authors created 50 fictional SLOEs representative of the national data. Seven faculty then rated these SLOEs in order of applicant competitiveness, defined as suggested rank position. Consensus was evaluated using cutoffs established a priori, and 2 prediction models, a point-based system and a linear regression model, were tested to determine their ability to predict consensus rankings. Results There was strong faculty consensus regarding the interpretation of SLOEs. Within narrow windows of agreement, faculty demonstrated similar ranking patterns with 83% and 93% agreement for "close" and "loose" agreement, respectively. Predictive models yielded a strong correlation with the consensus ranking (point-based system r=0.97, linear regression r=0.97). Conclusions Faculty displayed strong consensus regarding the competitiveness of applicants via SLOEs, adding further support to the use of SLOEs for selection and advising. Two models predicted consensus competitiveness rankings with a high degree of accuracy.

Problem representation and diagnostic accuracy during an OSCE.

PURPOSE: The National Academy of Medicine has called for "identifying opportunities to improve the diagnostic process". We studied the association between problem representation and diagnostic accuracy during an objective structured clinical exam (OSCE). MATERIALS AND METHODS: We conducted a non-randomized controlled trial during a ten-case OSCE. We measured whether a summary statement prompt increased the likelihood that the student listed the correct diagnosis and whether better summary statements were correlated with diagnostic accuracy. RESULTS: 114 students provided 1135 responses. The non-prompted control group yielded 631 responses, listing the correct diagnosis first 73% of the time and within the top three slots 85% of the time. The intervention group exposed to the prompt yielded 453 responses listing the correct diagnosis first 72% of the time (P = 0.617) and within the top three slots 84% of the time (P = 0.760). Summary statements were scored on a 0, 0.5, or 1 rubric. When grouped according to summary statement score, students listed the correct diagnosis first 74%, 70%, and 72% of the time respectively (P = 0.666). The correct diagnosis was included within the top three slots 88%, 82%, and 83% of the time (P = 0.238). CONCLUSIONS: Prompting students to form a summary statement did not improve diagnostic accuracy. Better summary statements were not correlated with diagnostic accuracy.

End-of-Life Care: A Multimodal and Comprehensive Curriculum for Graduating Medical Students Utilizing Experiential Learning Opportunities.

Introduction: End-of-life (EOL) care is an essential skill for most physicians and health care providers, yet there continues to be an educational gap in medical education literature for these skills. The Johns Hopkins School of Medicine developed the Transition to Residency, Internship, and Preparation for Life Events (TRIPLE) curriculum with the primary goal of preparing graduating medical students for life after medical school. Methods: The EOL module was one of many within the TRIPLE curriculum and consisted of two half-day sessions that targeted EOL care, death, dying, and communication skills. The first half-day session focused on a standardized patient encounter where learners initiated and completed an EOL care goals conversation around a living will. The second half-day session focused on death and dying. It included didactic sessions on organ donation, autopsy/death certificates, a simulation-based learning session on ending a resuscitation, and a standardized patient encounter where learners disclosed the death of a loved one. End-of-day and end-of-course evaluations were collected via anonymous online surveys. Results: In 2019, 120 students and 26 instructors participated in TRIPLE. Students rated the EOL module overall as 4.6 of 5 (SD = 0.6) and rated instructors overall as 4.6 of 5 (SD = 0.6). Discussion: By implementing a thorough and diverse curriculum with a variety of modalities and targeted skills, learners may be better prepared to care for patients dealing with EOL care issues. Further, the generalization of these skills may assist learners in a variety of other aspects of patient and family care.

High-Risk Chief Complaints III: Abdomen and Extremities.

Abdominal and extremity complaints are common in the emergency department (ED) and, because of their frequency, clinical vigilance is vital in order not to miss the timely diagnosis of occult or delayed emergencies. Such emergencies, if not timely managed, are sources of significant patient morbidity and mortality and may expose ED physicians to possible litigation. Each patient complaint yields to a nuanced approach in diagnostics and therapeutics that can lead physicians toward the ruling in or out of the correct high-risk diagnosis. This article discusses the approach and risk management of this high-risk subset of abdominal and extremity diagnoses.

Emergency department management of non-ST-segment elevation myocardial infarction

Chest pain is the second most common complaint in emergency departments, with 6.4 million visits annually in the United States. A quarter of these patients will be diagnosed with acute coronary syndromes, but among those, nearly half will have nondiagnostic electrocardiograms. Non­ST-segment elevation myocardial infarction (NSTEMI) is twice as common as ST-segment elevation myocardial infarction (STEMI), and lack of clarity surrounding the best management of this condition can contribute to adverse outcomes. In this review, current national management guidelines for NSTEMI are summarized as they pertain to the ED, and the evidence base supporting them is considered. Issues surrounding special patient populations are addressed, and new diagnostic and therapeutic modalities are discussed.

Trauma to the globe and orbit.

Trauma to the eye represents approximately 3% of all emergency department visits in the United States. Rapid assessment and examination following trauma to the eye is crucial. A thorough knowledge of potential injuries is imperative to ensure rapid diagnosis, to prevent further damage to the eye, and to preserve visual capacity. This article describes the aspects of the eye examination that merit special attention in the case of trauma. It then discusses the eye injuries most likely to be seen in the emergency department and their appropriate treatment.