Health Care Disparities and Access to Video Visits Before and After the COVID-19 Pandemic: Findings from a Patient Survey in Primary Care.

Background:In 2020, the Centers for Medicare & Medicaid Services reimbursement structure was relaxed to aid in the rapid adoption nationally of telemedicine during the COVID-19 pandemic. Due to limited access to internet service, cellular phone data, and appropriate devices, many patients may be excluded from telemedicine services.Methods:In this study, we present the findings of a survey of patients at an urban primary care clinic regarding their access to the tools needed for telemedicine before and after the COVID-19 pandemic. Patients provided information about their access to internet services, phone and data plans, and their perceived access to and interest in telemedicine. The survey was conducted in 2019 and then again in September of 2020 after expansion of telemedicine services.Results:In 2019, 168 patients were surveyed; and in 2020, 99 patients participated. In both surveys, 30% of respondents had limited phone data, no data, or no phone at all. In 2019, the patient responses showed a statistically significant difference in phone plan types between patients with different insurance plans (p < 0.10), with a higher proportion (39%) of patients with Medicaid or Medicaid waiver having a prepaid phone or no phone at all compared with patients with commercial insurance (26%). The overall awareness rate increased from 17% to 43% in the 2020 survey.Conclusions:This survey illustrated that not all patients had access to devices, cellular data, and internet service, which are all needed to conduct telemedicine. In this survey, patients with Medicaid or Medicaid waiver insurance were less likely to have these tools than those with a commercial payor. Finally, patients' access to these telemedicine tools correlated with their interest in using telemedicine visits. Providing equitable telemedicine care requires attention to and mitigation strategies for these gaps in access.

Can Life Experiences Predict Readiness for Residency? A Family Medicine Residency's Analysis.

BACKGROUND: Program directors for Family Medicine residencies must navigate an increasingly complex recruitment landscape. With increasing United States allopathic and osteopathic graduates and continued high volumes of international graduates, the ability to identify application characteristics that predict quality residents both for filtering applications for interview offers and ranking is vital. Our study concentrates on the predictive value of reported life experiences including volunteerism, work experiences, prior career, research experience, and participation in medical student organizations including student leadership. METHODS: Through a retrospective cohort study, we extracted the described life experiences from resident application materials. We then obtained initial clinical performance data on the Family Medicine inpatient service during the first six months of residency to determine readiness for residency. This analysis occurred in 2020 and included all matriculants in the graduating classes of 2013 through 2020 for a single residency. Of 110 matriculating residents, data were available for 97(88%). RESULTS: Applicants with a history of a prior career demonstrated improved overall readiness for residency with competency domain-specific advantages in Interpersonal and Communication Skills and Systems-Based Practice. In contrast, applicants reporting participation in research performed below peers in all competency domains. Applicant reports on volunteerism, work experience, academic productivity and student involvement did not correlate with initial clinical performance. CONCLUSIONS: Residency directors should recognize applicants with prior careers as likely having strong communications and systems-based practice skills. All other examined experiences should be evaluated within the context of broader applicant assessments including research experience which overall has a potential negative correlation to clinical readiness.

One Institution's evaluation of family medicine residency applicant data for academic predictors of success.

BACKGROUND: Family Medicine residencies are navigating recruitment in a changing environment. The consolidation of accreditation for allopathic and osteopathic programs, the high volume of applicants, and the forthcoming transition of the United States Medical Licensing Exam (USMLE) Step 1 to pass/fail reporting all contribute. This retrospective cohort study evaluated which components of a student's academic history best predict readiness for residency. METHODS: In 2020, we analyzed applicant data and initial residency data for program graduates at a single residency program between 2013 and 2020. This included undergraduate education characteristics, medical school academic performance, medical school academic problems (including professionalism), STEP exams, location of medical school, and assessments during the first 6 months of residency. Of 110 matriculating residents, assessment data was available for 97 (88%). RESULTS: Pre-matriculation USMLE data had a positive correlation with initial American Board of Family Medicine (ABFM) in-training exams. Pre-matriculation exam data did not have a positive correlation with resident assessment across any of the six Accreditation Council for Graduate Medical Education (ACGME) competency domains. A defined cohort of residents with a history of academic struggles during medical school or failure on a USMLE exam performed statistically similarly to residents with no such history on assessments across the six ACGME competency domains. CONCLUSIONS: Applicants with a history of academic problems perform similarly in the clinical environment to those without. While a positive correlation between pre-matriculation exams and the ABFM in-training exam was found, this did not extend to clinical assessments across the ACGME competency domains.

Idiopathic omental infarction: managed conservatively.

We report a case of a 49-year-old woman who presented with acutely worsening episodic abdominal pain. Workup was negative but CT of the abdomen showed right upper quadrant omental fat stranding, suggestive of fat necrosis or infarct. Treatment for the patient was largely supportive with pain management and fluid resuscitation.

A rare case of thyroid storm.

Thyroid storm is a rare and life-threatening state of thyroid hormone excess. Rapid recognition of thyroid storm is key to decreasing the morbidity and mortality of this condition. Clinical manifestations of thyroid storm include unexplained weight loss, hyperactivity and irritability. The most common causes of thyrotoxicosis are Graves' disease, toxic multinodular goitre and toxic adenoma. We present a rare case of thyroid storm induced by dual nivolumab and ipilimumab immunotherapy in a patient receiving treatment for advanced melanoma. In this case, our patient was admitted for thyroid storm 1 month after initiating treatment with nivolumab and ipilimumab immunotherapy. The patient was treated with ß-blockers, antithyroid medications and systemic steroids resulting in an improvement in thyroid function testing and symptoms.