ABSTRACT
The recent global pandemic revealed just how unprepared faculty and doctoral students at many U.S. colleges and universities were to teach online. In this study, we investigate the extent to which current and recently graduated doctoral students are prepared to teach online, how they are rewarded for those online teaching skills, and how they could be more effectively prepared. To answer these questions, we surveyed the beliefs of doctoral students and recently graduated faculty members from a Midwestern private university and a Southeastern state university regarding online teaching preparedness compared with those of faculty, department chairs, and deans. We also used data from a summer teaching pilot program to explore best practices for improving doctoral students' preparation to teach online. Findings suggest that educating doctoral students to teach in a virtual world can increase students' confidence and ability to teach in this mode and can be cost effective if offered across disciplines. However, while doctoral students believe that online competency is important in hiring and tenure decisions, deans and department chairs do not necessarily agree, and few schools provide meaningful preparation for online teaching to their doctoral students.
ABSTRACT
Study Objectives: We aimed to quantify the impact of the SARS-CoV-2 pandemic on emergency department (ED) volumes and patient presentations, and to evaluate changes in community mortality for the purpose of characterizing new patterns of emergency care utilization. Methods: This is an observational cross-sectional study using electronic health records for ED visits in an integrated, multi-hospital system with academic and community practices across four states for visits between March 17 to April 21, 2019, and February 9 to April 21, 2020. We compared quantity and proportion of common and critical chief complaints and diagnoses, triage assessments, trauma activations, throughput, disposition, and hospital lengths-of-stay for selected diagnoses, and out-of-hospital deaths. Academic and community hospitals were evaluated separately and in combination for an overall picture of emergency department utilization. Results: Compared to both the preceding four weeks (n=37,670), and the prior year (n=35,037), ED visits from March 17 to April 21, 2020 (n=18,646) decreased 49% and 53.2% respectively. The total numbers of patients diagnosed with myocardial infarctions (STEMI and Non-STEMI), stroke, appendicitis and cholecystitis all decreased by a similar percentage. While there were fewer visits for mental health (n=1104 in preceding weeks, n=1032 for year-prior, n=752 during pandemic), they made up a larger proportion of ED visits - 2.9% for both baselines and 4% during period of interest (p<.001 for both). Compared to both baselines, the percentages of traumas were similar;however, the absolute number of red (n= 35 during COVID;n=72, p<.001 peri-COVID;n=67, p=.002 pre-COVID) and yellow (p=.002 peri-COVID;p=.004 pre-COVID) declined overall, driven by a drop at academic centers by nearly 60% for red traumas and 50% for yellow. Mortality was considered a surrogate for delayed/deferred emergency care. Southern Minnesota Regional Medical Examiner’s Office data showed an increase in natural deaths during the COVID period (n=250) versus pre-COVID (n=204) baseline (p=.037). Out-of-hospital mortality for natural (non-COVID-related) and non-natural deaths increased from 73 pre-COVID to 128 during the COVID period (p<.001). The significant increase in out-of-hospital mortality drives the overall mortality increase. There was an increase in deaths, driven by out-of-hospital mortality. Conclusion: Fewer patients presenting with acute and time-sensitive diagnoses suggests that patients are deferring care, this may be further supported by an increase in out-of-hospital mortality as well as a lower number of patients presenting with complaints and diagnoses that would be expected to remain stable for a given population during the periods studied. Understanding which patients are deferring care and why will allow us to develop outreach strategies and ensure that those in need of rapid assessment and treatment will continue to seek it, preventing downstream morbidity and mortality.