Impact of Virtual Interviews on Pulmonary and Critical Care Fellowship Match: An Analysis of National Data.

Background: Internal Medicine residents have historically expressed hesitancy in pursuing a career in pulmonary and critical care medicine (PCCM). However, recent studies have demonstrated newfound competitiveness. The coronavirus disease (COVID-19) global outbreak prompted the implementation of a virtual interviewing model for PCCM fellowship match. The effect of this new paradigm on PCCM match results has not been studied previously. Objective: With the shift to virtual interviewing, we aim to determine how this new method of interviewing may influence the selection of candidates for fellowship training programs. Methods: We acquired data of 4,333 applicants ranking PCCM for the years 2017-2021 from the National Resident Matching Program and the Electronic Residency Application Service websites for the years 2017-2021. Chi-square (χ2) analysis of the applicants' demographics and the percentage of applicants matching at their first choice versus those who matched at lower than their third-choice program before and after the implementation of virtual interviews season was performed. Results: The matching probability for the U.S. Doctors of Osteopathic Medicine significantly increased after the implementation of virtual interviews compared with the years 2017-2020 (χ2 = 8.569; P = 0.003). The matching probability remained unchanged for U.S. Doctors of Medicine (χ2 = 2.448; P = 0.118). Overall, an applicant's probability of matching at their first choice has significantly decreased after the virtual interview format (χ2 = 4.14; P = 0.04). Conversely, the probability of matching at a program that is lower than the third choice has significantly increased (χ2 = 11.039; P < 0.001). Conclusion: Our study provides evidence regarding the effect of the virtual interview format on PCCM match results. Strikingly, applicants are more likely to match at lower-ranked programs in their rank list after the implementation of the virtual interview process. These results can be helpful for both programs and applicants, to guide their future expectations and decisions while going through the interview process.

Examining the differential of digital ischaemia and review of paraneoplastic ischaemia.

There is a broad differential diagnosis of digital ischaemia that includes commonly encountered conditions of vascular or thromboembolic nature as well as less commonly seen such as those of vasculitic or rheumatological origin. A less frequently encountered pathology is digital ischaemia associated with malignancy. This paraneoplastic process is rare and infrequently described in the literature, though it has been observed in various solid and haematological malignancies. Here, we describe a patient case with an atypical presentation of digital ischaemia and present a brief review on prior reports of digital ischaemia related to cancer.

Diffuse pulmonary calcification in allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is a condition that most often occurs in patients with asthma or cystic fibrosis. The diagnosis is usually confirmed by the combination of clinical, radiographic, and immunologic criteria as there is not individual test to establish the diagnosis. We describe the case of a 64-year-old male with a prior medical history of moderate persistent asthma who presented with worsening cough and was found to have IgE positive for Aspergillus fumigatus with findings of diffuse bilateral pulmonary calcifications on HRCT.