Impact of the first COVID-19 surge on the outcomes of diverticulitis.

Introduction: During the first surge of the COVID-19 pandemic, healthcare utilization changed. We sought to examine the impact of the first COVID-19 surge on the outcomes of patients whose elective surgeries for diverticulitis were postponed and those who underwent urgent surgery during the surge. Materials and methods: This was a retrospective study from a single tertiary center in the Northeast of the US. Patients whose elective surgeries were delayed, or who underwent urgent surgery for diverticulitis during the first COVID-19 surge (3/16/2020 to 8/1/2020) were included. A cohort from 2019 was used for comparison. Variables were compared between groups including: procedure, death, length of stay, disposition, stoma rate, technique for surgery, and leak rate. Results: Forty-five patients were included in the COVID-19 group and 44 patients in the 2019 group. Twenty-seven patients had elective surgeries delayed during the COVID-19 surge. Ten (37%) required more urgent surgery, 80% with complicated disease. Six (22%) were admitted to the hospital and 13 (48%) required additional antibiotics. Eight (30%) patients postponed their surgeries indefinitely and 7 (26%) had surgery once permitted. There were no observed differences between the two groups in the rate of complicated disease, leaks, technique for surgery or stoma rate. Conclusions: During the first COVID-19 surge, over 1/3 of patients whose elective diverticulitis surgeries were postponed required urgent surgery, a majority of whom had complicated disease. There were no apparent differences in outcomes when compared to a pre-pandemic cohort, highlighting the importance of a triage system with the ability to escalate surgery in a timely manner.

(En)trust me: Validating an assessment rubric for documenting clinical encounters during a surgery clerkship clinical skills exam.

BACKGROUND: The AAMC developed 13 Core Entrustable Professional Activities (EPAs) for graduating medical students. EPA 5 is: Document a clinical encounter in the patient record. Our goal was to develop an assessment rubric and gather evidence to support its validity in measuring progress towards entrustability. METHODS: A rubric was developed for EPA 5. During the 2017 surgery clerkship, 57 students wrote a note for each of two standardized patient (SP) encounters. These notes were prospectively collected and assessed by two physician raters. Messick's validity framework was used to gather validity data. RESULTS: Inter-rater reliability with two raters was excellent, ICC = 0.86 (ICC 95%, confidence interval (CI) 0.80-0.90) for overall note score. Correlation between note items and SP checklists ranged 0.39-0.46 (p < 0.05) and between note items and clinical evaluations 0.28-0.39 (p < 0.05). CONCLUSIONS: There is initial reliability evidence supporting the use of our rubric for assessing progress towards entrustability of EPA 5.