Impact of COVID-19 on emergency medicine resident procedure performance.

Background: As a result of the COVID-19 pandemic, patterns of patient presentations and medical education have changed, potentially resulting in fewer and different types of patient encounters. Procedural proficiency is a cornerstone of emergency medicine (EM) training, and residents must meet Accreditation Council for Graduate Medical Education (ACGME) requirements to graduate. It is feared there may have been a pandemic-induced decrease in opportunities for residents to perform procedures. This study investigates the change in procedures performed by EM residents during the initial year of the pandemic. Methods: This study utilized a multicenter retrospective design. Across three EM residency programs, logs of 14 ACGME-required procedures performed by residents were reviewed. For each procedure, counts were compared prepandemic year (March 2019 to February 2020) to during pandemic year (March 2020 to February 2021). Procedures were further grouped into 4-month periods: March to June, July to October, and November to February. Results: A total of 113 EM resident physicians were included in this study. Procedures performed by EM residents tended to decrease during the COVID-19 pandemic. There were statistically significant decreases in number of annual cricothyrotomies (2.4 vs. 0.9, p < 0.001) and pediatric trauma resuscitations (5.7 vs. 3.9, p = 0.024). Comparing the first 4-month periods of each year, there were significant decreases in cardiac pacing (6.3 vs. 5.4, p = 0.038), chest tubes (2.2 vs. 1.0, p < 0.001), cricothyrotomies (0.6 vs. 0.1, p = 0.001), intubations (8.2 vs. 4.4, p = 0.002), and pericardiocenteses (1.7 vs. 0.2, p < 0.001). Conclusions: The COVID-19 pandemic has led to a decrease in the number of procedures performed per EM resident in many of the domains required by the ACGME. Although only some procedures had statically significant decreases, it remains to be seen if this will lead to decreased resident procedural competency. Further research may be required in this area to determine any such effect.

Focused Ultrasound for Pediatric Diseases.

Focused ultrasound (FUS) is a noninvasive therapeutic technology with multiple pediatric clinical applications. The ability of focused ultrasound to target tissues deep in the body without exposing children to the morbidities associated with conventional surgery, interventional procedures, or radiation offers significant advantages. In 2021, there are 10 clinical pediatric focused ultrasound studies evaluating various musculoskeletal, oncologic, neurologic, and vascular diseases of which 8 are actively recruiting and 2 are completed. Pediatric musculoskeletal applications of FUS include treatment of osteoid osteoma and bone metastases using thermal ablation and high-intensity FUS. Pediatric oncologic applications of FUS include treatment of soft tissue tumors including desmoid tumors, malignant sarcomas, and neuroblastoma with high-intensity FUS ablation alone, or in combination with targeted chemotherapy delivery. Pediatric neurologic applications include treatment of benign tumors such as hypothalamic hamartomas with thermal ablation and malignant diffuse intrinsic pontine glioma with low-intensity FUS for blood brain barrier opening and targeted drug delivery. Additionally, low-intensity FUS can be used to treat seizures. Pediatric vascular applications of FUS include treatment of arteriovenous malformations and twin-twin transfusion syndrome using ablation and vascular occlusion. FUS treatment appears safe and efficacious in pediatric populations across many subspecialties. Although there are 7 Food and Drug Administration-approved indications for adult applications of FUS, the first Food and Drug Administration approval for pediatric patients with osteoid osteoma was obtained in 2020. This review summarizes the preclinical and clinical research on focused ultrasound of potential benefit to pediatric populations.

Self-Perceived Independent Living Skills and Self-Determination as a Method of Evaluating a Residential Program in Young Adults With Autism Spectrum Disorder.

Prior research shows that employment programs for individuals with autism spectrum disorder (ASD) fail to address ASD as a heterogeneous disorder and focus on specific ASD traits associated with difficulty in obtaining and maintaining employment. This study provides descriptive evidence that self-perceptions of self-determination improve in young adults with ASD who participate in a residential program that promotes Wehmeyer and Schalock's essential characteristics of self-determined behavior: behavioral autonomy, self-regulated behavior, acting in a psychologically empowered manner, and self-realization. Qualitative surveys were administered to 60 participants (17-28 years old) on perceptions of self-determination, confidence in independent living skills, and program effectiveness regarding case management and sustainable employment. One-sided t-tests using pre- and post-program responses were assessed. Post- versus pre-program means were significantly higher in participants feeling confident to live alone (p = 0.0059). Findings suggest that programs adopting self-determined behavior may be more effective in increasing self-confidence for individuals with ASD. However, these findings warrant long-term analysis to assess the continuity of program success and sustained employment.

Creating a Pipeline for Minority Physicians: Medical-Student-Led Programming.

Medical School Outreach Programming provides value to medical schools and the community by: (1) fulfilling medical school accreditation requirements, (2) creating pipelines to promote diversity in future healthcare professionals, and (3) providing medical students with opportunities for extracurricular community-level engagement. An Outreach Program initiated at a U.S. community-based medical school provides a medical student-led model with primary goals of improving college candidacy and healthcare career representation for underserved and under-represented minorities in the United States. The Outreach Program also promotes the personal growth and education of medical students.