An Asynchronous Curriculum: Learner Perspectives on Incorporating Asynchronous Learning Into In-Person and Virtual Emergency Residency Didactics.

Background  Didactic education in emergency medicine (EM) residencies has been impacted both by the advent of asynchronous learning and by the shift toward virtual, web-based conference education due to coronavirus disease 2019 (COVID-19). Studies have demonstrated the efficacy of asynchronous education, but few have explored resident opinions about how asynchronous and virtual modifications on conference impact their educational experience.  Objective This study aimed to evaluate resident perceptions of both asynchronous and virtual modifications to a historically in-person didactic curriculum. Methods This was a cross-sectional study of residents of a three-year EM program at a large academic center where a 20% asynchronous curriculum was implemented in January 2020. A questionnaire was administered online with questions assessing how residents perceived their didactic curriculum with regard to convenience, retention of information, work/life balance, enjoyability, and overall preference. Questions compared resident opinions of in-person vs. virtual learning, as well as how the substitution of one hour of asynchronous learning impacted residents' perception of their didactics. Responses were reported on a five-point Likert-type scale.  Results A total of 32 out of 48 residents (67%) completed the questionnaire. When virtual conference was compared to in-person conference, residents favored virtual conference with regard to convenience (78.1%), work-life balance (78.1%), and overall preference (68.8%). They favored in-person conference (40.6%) or felt that the modalities were equivalent (40.6%) with regard to retention of information and favored in-person conference with regard to enjoyability (53.1%). Residents felt that the addition of asynchronous learning to their curriculum increased subjective convenience, work-life balance, enjoyability, retention of information, and overall preference, regardless of whether synchronous conference was virtual or in-person. All 32 responding residents were interested in seeing the asynchronous curriculum continue. Conclusion EM residents value the addition of asynchronous learning to both in-person and virtual didactic curricula. Additionally, virtual conference was favored over in-person conference with regard to work/life balance, convenience, and overall preference. As social distancing restrictions continue to ease post-COVID-19 pandemic, EM residencies may consider adding or maintaining asynchronous or virtual components to their synchronous conference schedule as a means to support resident wellness.

Rapid sequence tandem intubation to navigate a subglottic obstruction.

Emergency airway management requires matching the appropriate intubation tools to anticipated obstacles. Video laryngoscopy and flexible endoscopy are often used for difficult airways. Here we describe a case where neither method alone was anticipated to be sufficient. A 53-year-old female with an obstructing lung mass required intubation for a mixed type 1 and 2 respiratory failure. Chest x-ray revealed a tortuous subglottic obstruction. The patient could not be temporized on maximized non-invasive airway support. These factors made tandem intubation, sequentially using video laryngoscopy and flexible endoscopic intubation, an appropriate intubation strategy. In this case report we describe the rationale and technique for a rapid sequence tandem intubation.

Searching for signals of evolutionary selection in 168 genes related to immune function.

Pathogens have played a substantial role in human evolution, with past infections shaping genetic variation at loci influencing immune function. We selected 168 genes known to be involved in the immune response, genotyped common single nucleotide polymorphisms across each gene in three population samples (CEPH Europeans from Utah, Han Chinese from Guangxi, and Yoruba Nigerians from Southwest Nigeria) and searched for evidence of selection based on four tests for non-neutral evolution: minor allele frequency (MAF), derived allele frequency (DAF), Fst versus heterozygosity and extended haplotype homozygosity (EHH). Six of the 168 genes show some evidence for non-neutral evolution in this initial screen, with two showing similar signals in independent data from the International HapMap Project. These analyses identify two loci involved in immune function that are candidates for having been subject to evolutionary selection, and highlight a number of analytical challenges in searching for selection in genome-wide polymorphism data.