The Carbon Footprint and Cost of Virtual Residency Interviews.

Background: The shift from in-person to virtual residency interviews may impact greenhouse gas emissions (GHGE) and costs but the direction and amount of this change is not yet clear. Objective: To estimate GHGE and financial impacts of virtual interviews among applicants and programs. Methods: In 2020-2021 we sent a postinterview survey to 1429 applicants from 7 residency programs and 1 clinical psychology program at 1 institution. The survey collected origin of travel and transit type if in-person interviews had been held and excluded responses if the applicant would not have participated in an in-person interview, or if travel type or original city was missing. We used the International Civil Aviation Organization calculator to estimate flight-related GHGE in metric tons of carbon dioxide equivalent (MTCO2e) and Google Maps to estimate ground travel, with a standard CO2e per mile. Flight, hotel, and airport taxi costs were estimated using Expedia.com, Hotels.com, Uber, and Lyft. We aggregated these data and calculated median and interquartile ranges (IQRs) for applicant GHGE and cost savings, and assumed no cost or GHGE from virtual interviews. We used Wilcoxon signed rank sum tests to compare in-person 2019-2020 and virtual 2020-2021 GME program interview budgets. Results: The survey response rate was 565, or 40% of applicants; 543 remained after the exclusion criteria were applied. Reduction in applicant travel due to virtual interviews led to median estimated GHGE savings of 0.47 (IQR 0.30-0.61) MTCO2e and $490 (IQR $392-$544) per applicant, per interview. Programs savings ranged from $7,615 to $33,670 for the interview season. Conclusions: Virtual interviews in 8 GME programs were associated with lower estimated GHGE and costs, for applicants and programs, compared with in-person interviews.

Effectiveness of Virtual Residency Interviews: Interviewer Perspectives.

BACKGROUND AND OBJECTIVES: Virtual residency interviews were widely utilized during the COVID-19 pandemic. Little is known about the effectiveness, advantages, barriers, and acceptability of virtual interviews, casting uncertainty about how interviews should be conducted after the pandemic. We conducted a survey of interviewers to inform future decisions. METHODS: We developed and implemented an online postinterview survey of interviewers representing seven residency programs and two clinical psychology programs at one midsized academic medical center. We analyzed results using descriptive statistics. RESULTS: Of 312 interviewers, 136 completed the survey (44% response rate). A majority rated virtual interviews as very or extremely effective in creating a comfortable setting (79%), answering interviewee questions (86%), establishing a sense of connection (59%), evaluating interviewee strengths (64%), and communicating program culture (51%). About half felt virtual interviews were not effective at all or only slightly effective for evaluating interviewee strengths via informal interactions (51%). A similar portion agreed or strongly agreed that virtual tours (44%) and social environment (50%) information were adequate. The most frequent advantages were time efficiency (81%), reduced carbon footprint (61%) and cost savings (56%). Frequent disadvantages included technological issues (21%) and caregiving duties (18%). Most interviewers (91%) thought some form of virtual interviews should be incorporated postpandemic. CONCLUSIONS: Interviewers found virtual interviews to be effective in most aspects, and identified more advantages than barriers. The vast majority preferred incorporation of virtual interviews in the future. Virtual tours and social activities were areas for improvement.

Virtual Residency Interviews: Applicant Perceptions Regarding Virtual Interview Effectiveness, Advantages, and Barriers.

Background: Studies of the virtual interview format are needed to inform medical residency program leaders as they plan for future virtual interview seasons. Objective: In the current study, completed in 2021, we sought to assess applicant perspectives of virtual interview effectiveness, advantages, and barriers, including factors that might impact equity and inclusion. Methods: Interviewees applying to 7 residency programs and 2 clinical psychology programs at an academic medical center in the Pacific Northwest completed a post-interview survey. Results: A total of 565 of 1429 interviewees (40%) completed the survey. A vast majority (83%-96%) agreed virtual interviews were effective in each measured domain, except for learning institutional culture (352 of 565, 62%). Many also found information regarding social/living environments inadequate. Participants selected advantages to virtual interviews more frequently than disadvantages. Commonly selected advantages included cost savings, time efficiency, reduced burden of travel, and reduced carbon footprint. Disadvantages included time zone differences, access to an appropriate interview setting, and reliable access to internet. The majority of interviewees (84%, 456 of 542) desired to keep a component of virtual interviews in the future. There were no significant disparities in results based on gender, rural/suburban/urban location, race, or underrepresented minority status. Conclusions: Virtual interviews were perceived as effective, more advantageous than burdensome, and widely acceptable, with no disparities in these findings by included demographic characteristics.

MRI of prolapsed polypoid adenomyoma: Expanding the differential diagnosis for the broccoli sign.

We report a 44 year old previously healthy premenopausal woman who presented with a three month history of vaginal bleeding and a 5 cm vaginal mass obscuring the cervix on physical examination. Ultrasound evaluation was non diagnostic. Pelvic MRI demonstrated a 6 cm soft tissue mass in the vagina prolapsed from the uterine cavity with a visible connecting stalk, which is termed the broccoli sign. The initial radiological differential diagnosis included prolapsed uterine malignancy or leiomyoma. Surgical pathology revealed a polypoid adenomyoma. We conclude polypoid adenomyoma should be included in the differential diagnosis for prolapsed uterine tumor demonstrating the broccoli sign.

Conservative treatment of placenta accreta.

Prolonged retained placenta causing a delayed postpartum hemorrhage is a relatively common occurrence. However, there is a dearth of medical literature describing fertility-preserving treatments when standard therapy fails. We present two cases in which protracted retained placenta due to placenta accreta was successfully treated by hysteroscopic resection. Two nulliparous women had spontaneous vaginal deliveries requiring manual placental extraction. Both experienced delayed postpartum hemorrhage and underwent suction curettage with ultrasound guidance. Both patients were found to have persistent products of conception with imaging consistent with placenta accreta. Both patients failed expectant management and subsequently underwent hysteroscopic resection with complete resolution of their symptoms. We conclude that hysteroscopic resection is a conservative therapeutic option for placenta accreta in stable patients.