Virtual Recruitment Effects on Matched Residents in Family Medicine: Experiences From Central Pennsylvania.

Background and Objectives: As a result of the COVID-19 pandemic, interviews during the 2021 US residency match were conducted virtually, a practice again recommended and repeated by many programs in 2022. The impact of virtual interviews on recruitment and match outcomes has recently been of interest, with results showing the virtual format to be mostly well received by applicants due to cost, travel, and scheduling benefits. Few studies have looked at pre/posttransition comparisons of applicant geographic and demographic data. We compared objective match outcomes between in-person and virtual interviews across three residency programs. Methods: We conducted a retrospective cross-sectional analysis of National Residency Matching Program data between 2015-2022 across three family medicine residency programs. Primary outcomes were fill rate, average rank position, distance from program, and percentage of underrepresented in medicine demographic status for matched applicants. We compared aggregate in-person data (2015-2019) to aggregate virtual data (2020-2022) for each program using χ2, Fisher Exact test, or 2-tailed t tests to 95% confidence. Results: Saint Joseph Hospital in Reading, Pennsylvania, a 3-year community-based university affiliated program, had significantly more unfilled positions during virtual recruitment (P=.0058). Mount Nittany Medical Center in State College, Pennsylvania, a 3-year community based university-affiliated program, had a significant difference in distance of matched residents' current address (P=.048). Virtual interviews were not associated with significant differences in average position on rank list, average distance from permanent address zip code, or percentage of underrepresented in medicine (URiM) demographic status for matched applicants. Conclusions: The impact of virtual interviewing on unfilled positions and geographic data is likely site specific and generally small, as some programs had significant structural changes. Further research is needed to confirm the generalizability of these results and explore future comparisons of demographic and geographic characteristics of matched applicants pre/posttransition to the virtual format.

Effects of Early COVID-19 Restrictions on Resident Well-being and Burnout.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has contributed to burnout among residents, a population already at increased risk for heightened stress and work-related fatigue. Residency programs were also forced to alter schedules and educational objectives. We assessed how social distancing restrictions (specifically self-isolation) enacted early in the COVID-19 pandemic affected family medicine (FM) resident well-being and burnout. Our FM department created a 2-week reserve rotation as a response to the need to socially distance and protect the residents. We explored how the reserve rotations impacted their experiences. METHODS: A purposive sample of FM residents were recruited in May and June of 2020. Qualitative interviews explored well-being and burnout, changes in education and provision of patient care, and overall adaptation to the pandemic. We employed interpretative phenomenology to analyze the interviews. RESULTS: We interviewed six out of 24 residents before saturation was reached. Qualitative analysis revealed themes related to positive and negative consequences of the pandemic, including uncertainty/fear of the unknown, schedule/life changes, communication, and adapting to a new routine. CONCLUSIONS: The COVID-19 pandemic placed an additional burden on residents, a group already at increased risk for burnout. While uncertainty and disruptions in work and home life were significant stressors, this cohort demonstrated adaptability and resilience that was facilitated by peer support and effective communication. These factors, along with the reserve rotation with decreased clinical responsibilities, led to an improved sense of well-being and decreased feelings of burnout.

Mock Trial as a Learning Tool in a Family Medicine Residency.

BACKGROUND AND OBJECTIVES: Mock trials have been used to teach medical learners about malpractice litigation, ethics, legal concepts, and evidence-based practice. Although 5.2% of family physicians are sued for malpractice annually, there is no formal requirement nor curriculum for educating our residents about malpractice, and mock trial has not been reported as an education modality in a family medicine residency. We developed a mock trial experience to educate family medicine residents about malpractice litigation and evaluated the resident experience over 3 years. METHODS: This is a retrospective, single-site study evaluating resident experience in our mock trials. We assessed perceived value using a 5-point Likert scale; and we assessed knowledge with free-text answers to both open and closed questions. We used descriptive statistics to describe data. RESULTS: Residents found the mock trial effective and engaging, giving the experience an overall evaluation of 4.9/5±0.3; 86.4% identified the importance of documentation as a learning outcome; 72.7% of residents identified negligence as necessary to justify a lawsuit, but they demonstrated limited mastery of the four elements of negligence, with 45.5% correctly listing harm, 40.9% causation, 13.6% breach of duty, and 0% duty owed. CONCLUSIONS: Mock trial is an enjoyable and effective tool to engage residents and provide a general understanding of malpractice litigation. It is less effective in conveying nuanced details of negligence. It may also be effective in teaching practice management techniques.

Population Structure, Diversity and Reproductive Mode of the Grape Phylloxera (Daktulosphaira vitifoliae) across Its Native Range.

Grape Phylloxera, Daktulosphaira vitifoliae, is a gall-forming insect that feeds on the leaves and roots of many Vitis species. The roots of the cultivated V. vinifera cultivars and hybrids are highly susceptible to grape phylloxera feeding damage. The native range of this insect covers most of North America, and it is particularly abundant in the eastern and central United States. Phylloxera was introduced from North America to almost all grape-growing regions across five of the temperate zone continents. It devastated vineyards in each of these regions causing large-scale disruptions to grape growers, wine makers and national economies. In order to understand the population diversity of grape phylloxera in its native range, more than 500 samples from 19 States and 34 samples from the introduced range (northern California, Europe and South America) were genotyped with 32 simple sequence repeat markers. STRUCTURE, a model based clustering method identified five populations within these samples. The five populations were confirmed by a neighbor-joining tree and principal coordinate analysis (PCoA). These populations were distinguished by their Vitis species hosts and their geographic locations. Samples collected from California, Europe and South America traced back to phylloxera sampled in the northeastern United States on V. riparia, with some influence from phylloxera collected along the Atlantic Coast and Central Plains on V. vulpina. Reproductive statistics conclusively confirmed that sexual reproduction is common in the native range and is combined with cyclical parthenogenesis. Native grape phylloxera populations were identified to be under Hardy-Weinberg equilibrium. The identification of admixed samples between many of these populations indicates that shared environments facilitate sexual reproduction between different host associated populations to create new genotypes of phylloxera. This study also found that assortative mating might occur across the sympatric range of the V. vulpina west and V. cinerea populations.

History of Parvovirus B19 infection is associated with a DNA methylation signature in childhood acute lymphoblastic leukemia.

Acute lymphoblastic leukemia (ALL) likely has a multistep etiology, with initial genetic aberrations occurring early in life. An abnormal immune response to common infections has emerged as a plausible candidate for triggering the proliferation of pre-leukemic clones and the fixation of secondary genetic mutations and epigenetic alterations. We investigated whether evidence of infection with a specific common myelotropic childhood virus, parvovirus B19 (PVB19), relates to patterns of gene promoter DNA methylation in ALL patients. We serologically tested bone marrow samples at diagnosis of B-cell ALL for PVB19 infection and DNA methylation using a high-throughput bead array and found that 4.2% and 36.7% of samples were seroreactive to PVB19 IgM and IgG, respectively. Leukemia samples were grouped by DNA methylation pattern. Controlling for age and immunophenotype, unsupervised modeling confirmed that the DNA methylation pattern was associated with history of PVB19 (assessed by IgG, p = 0.02), but not recent infection (assessed by IgM). Replication assays on single genes were consistent with the association. The data indicate that a common viral illness may drive specific DNA methylation patterns in susceptible B-precursor cells, contributing to the leukemogenic potential of such cells. Infections may impact childhood leukemia by altering DNA methylation patterns and specific key genes in susceptible cells; these changes may be retained even after the clearance of infection.