Deciphering a Changing Match Environment in Emergency Medicine and Identifying Residency Program Needs.

INTRODUCTION: The Match in emergency medicine (EM) is historically competitive for applicants; however, the 2022 residency Match had a large number of unfilled positions. We sought to characterize the impact of and response to the Match on programs and determine programs' needs for successful recruitment strategies. METHODS: We conducted a web-based survey of EM residency program leadership during March-April 2022. Program characteristics were generated from publicly available data, and descriptive statistics were generated. We analyzed free-text responses thematically. RESULTS: There were 133/277 (48%) categorical EM residency programs that responded. Of those, 53.8% (70/130) reported a negative impression of their Match results; 17.7% (23/130) positive; and the remainder neutral (28.5%; 37/130). Three- and four-year programs did not differ in their risk of unfilled status. Hybrid programs had a higher likelihood of going unfilled (odds ratio [OR] 4.52, confidence interval [CI] 1.7-12.04) vs community (OR 1.62, CI 0.68-3.86) or university programs (0.16, 0.0-0.49). Unfilled programs were geographically concentrated. The quality of applicants was perceived the same as previous years and did not differ between filled and unfilled programs. Respondents worried the expansion of EM residency positions and perceptions of the EM job market were major factors influencing the Match. They expressed interest in introducing changes to the interview process, including caps on applications and interviews, as well as a need for more structural support for programs and the specialty. CONCLUSION: This survey identifies impacts of the changed match environment on a broad range of programs and identifies specific needs. Future work should be directed toward a deeper understanding of the factors contributing to changes in the specialty and the development of evidence-based interventions.

Maintenance of Skill Proficiency for Emergency Skills With and Without Adjuncts Despite the Use of Level C Personal Protective Equipment.

Objective To determine the impact of Level C personal protective equipment (PPE) on the time to perform intravenous (IV) cannulation and endotracheal intubation, both with and without the use of adjuncts. Methods This prospective, case-control study of emergency medicine resident physicians was designed to assess the time taken by each subject to perform endotracheal intubation using both direct laryngoscopy (DL) and video laryngoscopy (VL), as well as peripheral IV cannulation both with and without ultrasound guidance and with and without PPE. Results While median times were higher using VL as compared to DL, there was no significant difference between intubation with either DL or VL in subjects with and without Level C PPE. Similarly, no significant difference in time was found for intravenous cannulation in the PPE and no-PPE groups, both with and without ultrasound guidance. Conclusions Existing skill proficiency was maintained despite wearing PPE and there was no advantage with the addition of adjuncts such as video-assisted laryngoscopy and ultrasound-guided intravenous cannulation. A safe and cost-effective strategy might be to conduct basic, just-in-time PPE training to enhance familiarity with donning, doffing, and mobility, and couple this with the use of personnel who have maximal proficiency in the relevant emergency skill, instead of more expensive, continuous, skills-focused PPE training.