RESUMEN
Sparse data exist on sex-related differences in extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest (rCA). We explored the role of sex on the utilization and outcomes of ECPR for rCA by retrospective analysis of the Extracorporeal Life Support Organization (ELSO) International Registry. The primary outcome was in-hospital mortality. Exploratory outcomes were discharge disposition and occurrence of any specific extracorporeal membrane oxygenation (ECMO) complications. From 1992 to 2020, a total of 7,460 adults with ECPR were identified: 30.5% women; 69.5% men; 55.9% Whites, 23.7% Asians, 8.9% Blacks, and 3.8% Hispanics. Women's age was 50.4 ± 16.9 years (mean ± standard deviation) and men's 54.7 ± 14.1 (p < 0.001). Ischemic heart disease occurred in 14.6% women vs. 18.5% men (p < 0.001). Overall, 28.5% survived at discharge, 30% women vs. 27.8% men (p = 0.138). In the adjusted analysis, sex was not associated with in-hospital mortality (odds ratio [OR] = 0.93 [confidence interval {CI} = 0.80-1.08]; p = 0.374). Female sex was associated with decreased odds of neurologic, cardiovascular, and renal complications. Despite being younger and having fewer complications during ECMO, women had in-hospital mortality similar to men. Whether these findings are driven by biologic factors or disparities in health care warrants further investigation.
RESUMEN
PROBLEM: Transition to residency (TTR) courses help alleviate medical students' concerns about preparing for residency; however, existing TTR courses are often limited to teaching clinical or procedural skills without addressing the nonclinical skills necessary for transitioning to practice. This report describes the use of design thinking (DT) to develop a learner-centered TTR course at the State University of New York Downstate Health Sciences University. APPROACH: DT consists of 5 steps: discovery, interpretation, ideation, experimentation, and evolution. The first 3 steps were used for needs assessments and course design. During the discovery step, empathetic, semistructured interviews of interns, program directors, and graduating medical students were conducted to identify concerns about starting residency. During the interpretation step, thematic analysis of interviews was performed to identify areas of concerning attitudes and deficient skills and to inform content. In the ideation step, a 2-week curriculum was designed, including didactic lectures, small group discussions and workshops, simulation, and procedure labs, to address the defined content areas. OUTCOMES: During the fourth step, implementation, a 2-week pilot elective course of the designed curriculum was conducted in spring 2021 with 6 students. Participant feedback from 2 students collected 6 months into internship found the procedures and simulated clinical skills cases high yield, appropriate, relevant to intern practice, and valuable. The course size in spring 2022 increased to 19 students, and the curriculum was refined based on the feedback of the previous pilot course (from 2 students and 4 faculty members) and from a precourse student survey (5 students). NEXT STEPS: The last step of DT, evolution, included determining larger-scale feasibility while maintaining learner-centeredness and conducting a programmatic evaluation. The iterative, adaptable approach of DT is suitable for TTR design and is generalizable. Other institutions can adapt the DT approach to develop their own institutional TTR programs.