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.

Emergency delivery and perimortem C-section.

The emergency department is a suboptimal location for delivery, and the greater prevalence of complicated presentations and emergency deliveries results in higher morbidity and mortality. Any woman greater than 20 weeks' gestation in labor is considered medically unstable and should be triaged quickly. Fetal viability occurs after 24 to 26 weeks' gestation. Placenta previa and abruption should be considered in a woman in labor with ongoing bleeding, and ultrasound evaluation should be performed emergently. Continuous fetal monitoring is the best method to assess for heart rate variations, accelerations, or decelerations. After the fetus crowns, a finger sweep can exclude the presence of a cord prolapse or nuchal cord. Set up a safety net by notifying appropriate specialists when a complicated delivery is suspected. In shoulder dystocia, generous episiotomy, drainage of the bladder, McRobert's maneuver, and suprapubic pressure may all help disengage the anterior shoulder. With a cord prolapse, the mother is instructed not to push, and the presenting part is elevated off of the cord. Perimortum cesarean delivery is performed with gestational age greater than 24 to 26 weeks. The supine position can lead to aortocaval compression. Perimortum cesarean delivery should be performed within 4 minutes of maternal cardiopulmonary arrest.