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Learning Objective: We sought to describe the effects of COVID-19 on UME within EM. Background(s): The COVID-19 pandemic has affected multiple aspects of Undergraduate Medical Education (UME) beyond infection and illness. Many universities, medical schools, and hospitals instituted policy changes around educational gatherings and clinical participation. State-issued travel restrictions impacted both rotations and altered the Match process. Objective(s): We sought to describe the effects of COVID-19 on UME within EM. Method(s): CORD chartered a COVID-19 Task Force comprised of 18 selected educators to explore the pandemic's impact on EM. A Modified Delphi process was used to develop multiple survey instruments. This process included a literature search for validated questions and internal piloting with iterative changes. After IRB approval, the UME survey was distributed to members of CORD during the 2021 Academic Assembly. Using SPSS v26, a descriptive analysis was performed. Result(s): Sixty-three individuals responded to the UME survey, with 27 (42.9%) program directors (PDs), 19 (30.2%) assistant/associate PDs, 5 (7.9%) core faculty, 5 (7.9%) clerkship directors, 4 (6.3%) residents/fellows and 3 others (vice chair of education, educational researcher, unknown). Most respondents were white (84.1%) and approximately half identified as women (50.8%). Table 1 provides means and standard deviations for statements displayed from most to least important. Conclusion(s): The positive financial impact on medical students was described as the greatest benefit of the pandemic. Virtual technology was varied in its impact: positive for conferences and interviewing but negative as a surrogate for clinical rotations or the ability for students to evaluate residency program culture. The top challenge facing UME was the removal of students from clinical rotations. This may impact residency programs, requiring them to remediate those skills. A limitation of this geographically broad cohort was the number of respondents.
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Learning Objectives: We sought to describe the effects of COVID-19 on UME within EM. Background(s): The COVID-19 pandemic has affected multiple aspects of Undergraduate Medical Education (UME) beyond infection and illness. Many universities, medical schools, and hospitals instituted policy changes around educational gatherings and clinical participation. State-issued travel restrictions impacted both rotations and altered the Match process. Objective(s): We sought to describe the effects of COVID-19 on UME within EM. Method(s): CORD chartered a COVID-19 Task Force comprised of 18 selected educators to explore the pandemic's impact on EM. A Modified Delphi process was used to develop multiple survey instruments. This process included a literature search for validated questions and internal piloting with iterative changes. After IRB approval, the UME survey was distributed to members of CORD during the 2021 Academic Assembly. Using SPSS v26, a descriptive analysis was performed. Result(s): Sixty-three individuals responded to the UME survey, with 27 (42.9%) program directors (PDs), 19 (30.2%) assistant/associate PDs, 5 (7.9%) core faculty, 5 (7.9%) clerkship directors, 4 (6.3%) residents/fellows and 3 others (vice chair of education, educational researcher, unknown). Most respondents were white (84.1%) and approximately half identified as women (50.8%). Table 1 provides means and standard deviations for statements displayed from most to least important. Conclusion(s): The positive financial impact on medical students was described as the greatest benefit of the pandemic. Virtual technology was varied in its impact: positive for conferences and interviewing but negative as a surrogate for clinical rotations or the ability for students to evaluate residency program culture. The top challenge facing UME was the removal of students from clinical rotations. This may impact residency programs, requiring them to remediate those skills. A limitation of this geographically broad cohort was the number of respondents.
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Learning Objective: To characterize the challenges and benefits that the COVID-19 pandemic has provided to academic EM faculty. Background(s): The COVID-19 pandemic has presented unpredicted challenges to EM education. The speed of the pandemic and extraordinary clinical burden prevented a coordinated educational response at all levels, including that of faculty development. While COVID-19 research is prolific and ongoing, EM faculty educational impact is yet to be fully explored. Objective(s): To characterize the challenges and benefits that the COVID-19 pandemic has provided to academic EM faculty. Method(s): CORD chartered a COVID-19 Task Force of 18 selected educators to explore the pandemic's impact on EM. A Modified Delphi process was used to develop multiple survey instruments. This process included a literature search for validated questions and internal piloting with iterative changes. After IRB approval, the faculty survey was distributed to members of CORD during the 2021 Academic Assembly. Using SPSS v26, a descriptive analysis was performed. Result(s): Forty-one individuals responded to the survey concerning faculty. Eighteen (43.9%) respondents were program directors, 14 (34.1%) were assistant/associate program directors, four (9.8%) were core faculty, four (9.8%) were clerkship directors, and one individual (2.4%) was involved with faculty development and research. Most respondents were white (87.8%) and women (61%). Table 1 demonstrates the faculty responses for the benefits and challenges of COVID-19 to education. Table 2 notes the impact on the faculty themselves. Conclusion(s): While the educational response to the pandemic was felt by faculty to be positive in the utilization of virtual platforms, faculty felt less engaged and less connected. Personally, faculty reported benefitting from numerous sources of human support, including familial, professional, and public. Despite this support, faculty reported the pandemic left them stressed, distressed, and burned out. A limitation of this geographically broad cohort was the number of respondents.
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Context: Despite being widely used with older adults in the community, there is limited literature on using the de Jong Gierveld Loneliness Scale with older adults living in long-term care (LTC). Objective: The purpose of this article is to discuss the considerations of using this scale with older adults in LTC. Method: Our team consisted of older person and family partners, a clinician, and academic researchers working together in all stages of research using the Loneliness scale to conduct individual interviews with 20 older adults in LTC in Vancouver, Canada, as part of a study exploring the experience of loneliness during the COVID-19 pandemic. Team reflection was embedded in the research process, with reflection data consisting of data transcripts, field notes, and regular team meeting notes. Thematic analysis was employed to identify lessons learned and implications. Findings: Participants had various challenges responding to the scale. Our analysis identified five themes: a) diverse meanings of loneliness, b) multi-faceted factors of loneliness, c) technical challenges, d) social desirability, and e) situational experience. We also offer five recommendations to consider when using this scale with older adults in LTC. Limitations: We used this scale with a small sample of older adults in LTC, which is a more time and labour-intensive population. Data on marital status and educational background was not collected but might help in understanding considerations for using the scale with older adults in LTC. Implications: We offer practical recommendations for using the scale with older adults in LTC, especially how qualitative open-ended questions can complement the scale by providing useful insights into context and complex experiences. © 2022 The Author(s).
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Objectives: In 2017, mifepristone became available for first trimester medical abortion (FTMA) in Canada. Shortly after, regulations permitted pharmacies to dispense mifepristone to patients, facilitating telemedicine provision. Our objective was to explore the barriers to providing FTMA using telemedicine in Canada in 2019. Methods: We conducted a cross-sectional, national, self-administered, anonymized survey of physicians and nurse practitioners who provided abortion care in Canada in 2019. Online invitations were sent through professional health organizations using a modified Dillman technique to optimize recruitment. Questions elicited provider demographics and perceived barriers to offering telemedicine FTMA. We used R software for descriptive statistics. Results: Four hundred sixty-five clinicians were included for analyses, of which 388 reported providing FTMA. Among those, 44.0% reported using telemedicine (for consultations, while often obtaining testing) for FTMA. British Columbia respondents reported the highest proportion of telemedicine use at 63.8%;the lowest was in Québec (10.7%). The majority of FTMA respondents (77.7%) reported barriers to telemedicine. The most common barriers were inability to confirm gestational age with ultrasound (43.0%), and lack of provincial fee code to pay practitioners (30.2%), timely access to serum hCG testing (24.6%), and nearby emergency services (23.3%). Few reported facility regulations (8.9%) and provincial regulations (4.9%) as barriers to providing telemedicine-based care;provincial regulation barriers were most common in Québec (16.1%). Conclusions: Less than half of respondents reported providing some abortion care via telemedicine and the majority perceived barriers. Low-test medical abortion protocols developed during COVID-19 have the potential to overcome some barriers. Keywords: telemedicine;abortion, induced;surveys and questionnaires;Canada;delivery of health care;mifepristone
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Objectives: Evaluate peripartum outcomes following COVID-19 vaccination during pregnancy. Methods: Ontario population-based retrospective cohort between December 14, 2020 and September 30, 2021 using linkage of provincial birth registry and COVID-19 immunization databases. Poisson regression was used to generate risk ratios (RR) and 95% confidence intervals (CI), adjusted for temporal, socio-demographic, and clinical factors using propensity scores. Obstetric (postpartum hemorrhage, chorioamnionitis, cesarean birth) and newborn (NICU admission and 5-minute Apgar<7) outcomes were compared for those who received ≥1 dose of COVID-19 vaccine during pregnancy with 2 unexposed groups—Group 1: individuals vaccinated postpartum, Group 2: never vaccinated. Results: Among 97 590 individuals, 22 660 (23%) received ≥1 dose of vaccine during pregnancy (64% received dose 1 in 3rd trimester). Compared with those vaccinated postpartum, we found no increased risks of postpartum hemorrhage (aRR 0.91, 95% CI 0.82–1.02);chorioamnionitis (aRR 0.92, 95% CI 0.70–1.21);or cesarean (aRR 0.92, 95% CI 0.89–0.95) following COVID-19 vaccination, nor any increased risk of NICU admission or 5-minute Apgar <7. All findings were similar when compared with individuals who did not receive COVID-19 vaccination at any point. We did not observe any difference according to vaccine product, number of doses received during pregnancy, or trimester of dose 1. Conclusions: As of late 2021, there is limited evidence from comparative studies in large populations on outcomes following COVID-19 vaccination during pregnancy. Our study of births up to September 30, 2021 did not identify any increased adverse peripartum outcomes associated with later pregnancy COVID-19 vaccination. Once more individuals vaccinated earlier in pregnancy deliver, we will report on other important obstetric and perinatal outcomes. Keywords: COVID-19 vaccine;pregnancy;epidemiology
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Learning Objectives: Our objectives were to create and introduce a virtual simulation curriculum that could easily be replicated using limited resources. We also aimed to assess medical students' perception of sim scenarios during the COVID-19 pandemic. : Background: The Coronavirus Disease 19 (COVID-19) pandemic brought significant disruption to medical student training in our emergency medicine clerkship. Students at our institution experienced limited in-person clinical rotations and transitioned to all-virtual didactics. In-person simulation training (sim) was one of these didactic sessions that had to be completely reimagined. In doing this, we wanted to maintain prior objectives of sim as well as use on-hand resources and create a low-fidelity model. Educational Objectives: Our objectives were to create and introduce a virtual sim curriculum that could easily be replicated using limited resources. We also aimed to assess medical students' perception of sim scenarios during the COVID-19 pandemic. Curricular Design: Students participated via a web conferencing application (WebEx), with one faculty member facilitating and another in the sim room with a low-fidelity sim mannikin. A laptop with webcam was used to show the sim room, including a monitor streaming vital signs via a low-cost application. Cases were developed from existing free open-access curriculum, with an emphasis on quick recognition of the sick patient and need to stabilize the patient as well as communicate with consultants. The curriculum was assessed via an optional, anonymous survey of students. Impact: Our pilot sim curriculum is designed to be easily adaptable for UME and GME sites without many resources;it requires little prep time for faculty and free or low-cost applications and materials. Student response to the pilot virtual simulation was overwhelmingly positive (Table 1), with 67 of 93 (72%) of students responding to an anonymous optional survey. Additionally, 87% of respondents felt the virtual setting was as effective or more effective compared to in-person simulation. Future iterations will include improved audiovisual effects and further development of student roles.
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Purpose/Objective(s): The COVID-19 pandemic posed challenges in resource allocation and breast cancer (BC) treatment decisions. Our study aims to understand changes in practice patterns of United States radiation oncologists (RO) treating BC during the COVID-19 pandemic. Materials/Methods: An IRB-approved 58-question survey with 6 clinical scenarios was distributed between July 17 and November 8, 2020 to ASTRO directory members. The cases included 1) Low-grade ductal carcinoma in situ (DCIS), 2) Low-risk BC treated with lumpectomy, 3) Low-risk BC treated with mastectomy with reconstruction 4) BC treated with neoadjuvant chemotherapy and mastectomy with reconstruction 5) BC treated with mastectomy and adjuvant chemotherapy but without reconstruction 6) Metastatic BC with enlarging breast mass. RO were surveyed about treatment recommendations if cases were seen pre-pandemic (PP) and hypothetically during the peak of pandemic (DTPP). Chi-square and McNemar-Bowker tests were used to examine the significance of changes. Results: A total of 285 respondents from 48 states completed the survey and reported treating at least one patient with BC in the past 12 months. 45% primarily practice in university affiliated hospitals and 43% in private practice. 22% reported treating ≥ 1 COVID-positive BC patients. Moderate hypofractionation (2.31 - 3 Gy per fraction) in the PMRT and immediate reconstruction setting was recommended by 0.7% PP compared to 10.5% DTPP. In the low-risk PMRT setting, recommendation of no further treatment increased from 13% PP to 20% DTPP. Further, 56% changed their DCIS recommendations if the patient was seen DTPP. For low-risk BC, whole breast RT was preferred by 83.5% PP compared to 46.7% DTPP, and 35.1% recommended delay of RT DTPP compared to 0.4% PP (P < 0.05). Increase in ultra-hypofractionation (> 5 Gy per fraction) was significant for low-risk BC after lumpectomy as 0.4% reported its use PP compared to 3.8% DTPP. In addition, utilization of brachytherapy as PBI modality decreased from 23.9% to 17% among respondents PP and DTPP respectively. The Florence fractionation schedule for PBI was recommended by 46.2% for early-stage BC and by 51.7% for DCIS DTPP compared to 20% and 34.4% PP. Finally, 68.1% reported the use of 10-25 fractions PP for the palliative scenario. However, of those who would change their recommendation (48.8%), 62.8% reported recommendation of ≤ 5 fractions DTPP. Additional subset analysis by geographic region and practice type were notable for variable changes in treatment recommendations, and will be presented. Conclusion: This large survey of Breast RO clinical decision making demonstrates significant differences in recommendations and rapid adoption of unique fractionation. While likely reflective of intent to optimize resource allocations during the pandemic, maintenance of new practice patterns remains subject to future investigation.
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Objectives: Canada was positioned to transition to telemedicine abortion care during the COVID-19 pandemic because REMs-like mifepristone restrictions were removed previously. We sought to characterize the impact of the pandemic response on Canadian clinical practice and abortion care access from the provider perspective. Methods: This was a sequential mixed methods study conducted between July 2020 and January 2021. A national sample of abortion providers completed a survey containing an open-ended question about the impact of the pandemic response. We took an inductive thematic approach to analysis that informed a second, primarily quantitative, survey. Results: The first survey was completed by 307 participants and the second by 78. Overall, 85% were physicians, 6% were nurse practitioners, and the remainder were pharmacists or administrators. Our thematic analysis identified 3 topics: access to abortion care, which was usually maintained despite pandemic-related challenges (eg difficulty obtaining tests, reduced operating time, limited referral pathways, new costs);change of practice to low- and no-touch medication abortion care;and provider perceptions of the patient experience, including shifting demand, good telemedicine acceptability, and increased rural access. The second survey showed uptake of telemedicine medication abortion among 89% of participants outside the province of Québec, where uptake was 33%. Pandemic-related restrictions did not delay care according to 76% of participants. Conclusions: The pandemic led to a robust transition to telemedicine abortion care in most of Canada, facilitated by prior removal of mifepristone restrictions and consideration of abortion as essential. Our findings could inform innovation in medication abortion service delivery in the US setting.
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The COVID-19 pandemic has affected profoundly all parties and health-care delivery. Most hospitalized patients find that separation from loved ones takes a toll on them and the safety measures instituted come at a huge cost to their physical and emotional well-being. Family members are distressed and traumatized because they are unable to support or advocate for their loved ones and feel disconnected from the health-care team. Health-care professionals (HCPs) experience psychological and moral distress because the absence of families negatively affects their ability to provide quality, compassionate, and timely care. As a result, there have been calls for revisions of policies and procedures to reprioritize patient- and family-centered care (PFCC). Building upon their experience as frontline HCPs, health-care team leaders, and patients and family members who are also frontline HCPs, the interprofessional team (psychologists, psychiatrists, hospitalists, nurses, and specialists) of co-authors reviewed the literature and developed collegial consensus on a roadmap for PFCC during the pandemic that includes guiding principles along with associated best practices and implementation strategies for their operationalization. The guiding principles focus on providing safe yet compassionate and ethical PFCC;balancing community health and the mitigation of viral transmission with appreciating family members as essential partners in care;fostering communication between patients and their families;and promoting interactions and decision-making among HCPs, patients, and families. We hope this roadmap facilitates the transformation of the health-care culture during the pandemic to one that is truly patient and family centered. (PsycInfo Database Record (c) 2021 APA, all rights reserved) © 2021 American Psychological Association
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The reduced availability of commercial swabs and transport media for testing and administrative demands for increased testing capacity during the coronavirus disease 2019 (COVID-19) public health emergency has seriously challenged national laboratory testing programs, forcing many to use nontraditional collection devices, often without typical analytical assessment of their suitability in testing. Five common transport media (four commercial and one in-house) were evaluated for their suitability in the collection of nasopharyngeal swab specimens for subsequent molecular detection of severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2). Results suggest that these transport media provide dependable temporal stability of the SARS-CoV-2 virus without significant analytical interference of molecular assays. These findings are not only important for addressing critical laboratory supply chain shortages of transport media in the current COVID-19 health crisis but also for future pandemic planning, when again supplies of commercially available transport media might be depleted.