Implementation of a Specialty Society‒Sponsored Wilderness Medicine Fellowship Match.

INTRODUCTION: Previously, wilderness medicine (WM) fellowships offered spots to applicants using an offer date. Due in part to increases in the number of WM fellowships and applicants, in 2021, the WM program directors (PDs) agreed to conduct the first WM fellowship match through the Wilderness Medical Society graduate medical education committee. This article outlines the process used and demonstrates its feasibility. METHODS: To create an independent matching process, a simulation was performed using imaginary programs and participants. Using the same algorithm utilized by the National Resident Matching Program, this process was completed manually and by computer to ensure accuracy. The PDs shared an email with the applicants they interviewed and submitted their names. Applicants registered for the match and generated a match list. The PDs then submitted a rank list of applicants they interviewed through a similar Google form. These lists were used to run the matching algorithm both manually and by computer. Any programs that did not "fill" or applicants who did not "match" were contacted to participate in a secondary match. Following the match, a survey was sent to PDs and participants for process improvement. RESULTS: The match filled 11 of 14 participating programs and 15 of 19 applicants. The results obtained via a computer algorithm were consistent with multiple human validations. The survey results were mostly positive, with 2 neutral responses and no negative responses. CONCLUSIONS: The inaugural WM fellowship match was successful in matching the majority of programs and participants and was well-received by both directors and applicants.

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Management of Tick-Borne Illness in the United States.

The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the prevention and management of tick-borne illness (TBI). Recommendations are graded based on quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. The guidelines include a brief review of the clinical presentation, epidemiology, prevention, and management of TBI in the United States, with a primary focus on interventions that are appropriate for resource-limited settings. Strong recommendations are provided for the use of DEET, picaridin, and permethrin; tick checks; washing and drying clothing at high temperatures; mechanical tick removal within 36 h of attachment; single-dose doxycycline for high-risk Lyme disease exposures versus "watchful waiting;" evacuation from backcountry settings for symptomatic tick exposures; and TBI education programs. Weak recommendations are provided for the use of light-colored clothing; insect repellents other than DEET, picaridin, and permethrin; and showering after exposure to tick habitat. Weak recommendations are also provided against passive methods of tick removal, including the use of systemic and local treatments. There was insufficient evidence to support the use of long-sleeved clothing and the avoidance of tick habitat such as long grasses and leaf litter. Although there was sound evidence supporting Lyme disease vaccination, a grade was not offered as the vaccine is not currently available for use in the United States.