Applicant Perspectives of Virtual General Surgery Residency Interviews.

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic prompted drastic changes to residency recruitment. The majority of general surgery residency interviews for the 2020-2021 interview cycle were restructured into a virtual format. The goal of this study is to evaluate general surgery residency applicants' perception of virtual interviews. METHODS: A secure, anonymous, web-based survey was developed, tested, and distributed via email to all candidates who applied to the University of California Irvine general surgery residency program for Match 2021. RESULTS: 1239 general surgery applicants were invited after Match Day 2021 to take the survey, and 167 (13.5%) completed the survey and were included in the final analysis. Applicants received and accepted a median of 10 (Interquartile range [IQR], 5-18) and 9 (IQR, 5-15) interviews. Using a Likert scale, candidates revealed they were most satisfied with introduction and program overview (72.5%) and interactions with faculty (70.6%). Applicants were dissatisfied with pre-interview socials (66.9%) and hospital tours (66.2%). When evaluating programs, they had the most difficulty discerning program culture and resident autonomy. Most applicants (54%) were satisfied with the virtual format and 52% believed that virtual format should continue. DISCUSSION: The majority of applicants were satisfied with virtual interviews and could foresee the format continuing in the future.

Dawn of a New Normal: Resident and Faculty Attitudes in Adopting Virtual Conferences and Education.

BACKGROUND: The COVID-19 pandemic has dramatically changed education in medical residencies with the need to transition to a virtual format. The objective of this study is to assess the adoption of a virtual format for grand rounds, M&M, and education of the surgical department. METHOD: A 25 question online survey was developed using Qualtrics and distributed to faculty and resident physicians in the Department of Surgery from March to April 2021. RESULTS: Fifty four out of 79 potential respondents (68%) completed the survey. Twenty-seven out of 54 (50%) respondents stated they were more likely to be participating in another activity most of the time or always. During to in-person conferences, 20/54 (37%) of participants reported being more distracted by other activities. Forty-two out of 54 (78%) participants strongly agree that virtual conferences are more flexible with their schedule and saves them travel time. All of the faculty want conferences to continue virtually (with or without an in-person component) citing virtual conferences are more flexible with their schedule and saves travel time. However, 4/26 (15%) of residents responded not wanting to continue virtual education citing work distractions and not truly having protected time. CONCLUSION: As the Coronavirus 2019 (COVID-19) pandemic is continuing with new variants, the virtual education and conference format is necessary. There is overwhelming support from both residents and faculty in favor of the virtual conference format due to flexibility, ease, and convenience. However, care must be taken to make sure that resident education time is truly protected.

Improved outcomes over time for adult COVID-19 patients with acute respiratory distress syndrome or acute respiratory failure.

BACKGROUND: COVID-19's pulmonary manifestations are broad, ranging from pneumonia with no supplemental oxygen requirements to acute respiratory distress syndrome (ARDS) with acute respiratory failure (ARF). In response, new oxygenation strategies and therapeutics have been developed, but their large-scale effects on outcomes in severe COVID-19 patients remain unknown. Therefore, we aimed to examine the trends in mortality, mechanical ventilation, and cost over the first six months of the pandemic for adult COVID-19 patients in the US who developed ARDS or ARF. METHODS AND FINDINGS: The Vizient Clinical Data Base, a national database comprised of administrative, clinical, and financial data from academic medical centers, was queried for patients ≥ 18-years-old with COVID-19 and either ARDS or ARF admitted between 3/2020-8/2020. Demographics, mechanical ventilation, length of stay, total cost, mortality, and discharge status were collected. Mann-Kendall tests were used to assess for significant monotonic trends in total cost, mechanical ventilation, and mortality over time. Chi-square tests were used to compare mortality rates between March-May and June-August. 110,223 adult patients with COVID-19 ARDS or ARF were identified. Mean length of stay was 12.1±13.3 days and mean total cost was $35,991±32,496. Mechanical ventilation rates were 34.1% and in-hospital mortality was 22.5%. Mean cost trended downward over time (p = 0.02) from $55,275 (March) to $18,211 (August). Mechanical ventilation rates trended down (p<0.01) from 53.8% (March) to 20.3% (August). Overall mortality rates also decreased (p<0.01) from 28.4% (March) to 13.7% (August). Mortality rates in mechanically ventilated patients were similar over time (p = 0.45), but mortality in patients not requiring mechanical ventilation decreased from March-May compared to June-July (13.5% vs 4.6%, p<0.01). CONCLUSIONS: This study describes the outcomes of a large cohort with COVID-19 ARDS or ARF and the subsequent decrease in cost, mechanical ventilation, and mortality over the first 6 months of the pandemic in the US.