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Background: Training in clinical ultrasound has become highly relevant for working as an otorhinolaryngologist. While there is a high demand for standardized and certified training courses, until recently, there was no possibility to attend web-based and exclusively virtual head and neck ultrasound courses certified by the Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM; German Society for Ultrasound in Medicine)., Objective: The aim of this study was to provide a qualitative and semi-quantitative analysis of the first purely virtual DEGUM-certified head and neck ultrasound courses., Materials and Methods: In 2021, three purely web-based DEGUM-certified head and neck ultrasound courses were carried out and then qualitatively analyzed using questionnaires including an examination., Results: The purely virtual implementation of head and neck ultrasound courses proved to be a viable alternative to the conventional course format, with a high level of acceptance among the participants. The lack of practice among the participants remains a relevant criticism., Conclusion: A more dominant role of web-based and remote ultrasound training is likely and should be considered as an alternative depending on existing conditions. Nevertheless, acquisition of practical sonographic skills remains a major hurdle if courses are purely digital., (© 2024. The Author(s).)

Introduction: The 2022 Presidential Address for the Association for Academic Surgery was focused on better understanding the personal and professional challenges faced by surgeons during the COVID-19 pandemic., Methods: As part of this work, we embarked on a listening tour, inviting surgeons from all over the country to tell us their stories. This led to forming a panel of five selected participants based on how their stories crosscut many of the most prevalent themes during those conversations. Here, we present thematic excerpts of the 2022 presidential panel, intending to capture that moment and challenge surgeons to contribute to an ever-evolving movement that pushes us to unpack some of our greatest areas of discomfort., Results: We found that, in many ways, the COVID-19 pandemic brought into focus what many surgeons from marginalized groups have historically struggled with. Dominant themes from these conversations included the role of surgery in informing identity, the tensions between personal and professional identity, the consequences of maintaining medicine as an apolitical space, and reflections on initiatives to address inequities. Panelists also reflected on the hope that these conversations are part of a movement that leads to sustained change rather than a passing moment., Conclusions: The primary goal of this work was to center voices and experiences in a way that challenges us to become comfortable with topics that often cause discomfort, validate experiences, and foster a community that allows us to rethink what and whom we value in surgery. We hope this work serves as a guide to having these conversations in other institutions., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This essay argues that emerging forms of translational work in the field of medical humanities offer valuable methods for engaging with communities outside of academic settings. The first section of the essay provides a synthetic overview of definitions and critical engagements with the concept of 'translation' in the context of medical humanities, a field that, in the wake of the COVID pandemic, can serve as an exemplar for other fields of the humanities. The second section explains the 'data/narrative' divide in medicine and health to demonstrate the need for new translational methodologies that can address this nexus of concern, particularly in collaboration with constituencies outside of academic settings. The third section maps out the sites and infrastructures where digital medical humanities is poised to make significant translational interventions. The final section of the essay considers data privacy and health ecology as conceptual frameworks that are necessary for bridging the data/narrative divide. Examples are drawn from the 'Translational Humanities for Public Health' website, which aggregates projects worldwide to demonstrate these emerging methodologies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The presence of calling in medicine has been shown to be related to a preponderance of positive outcomes among medical students. However, only a few studies examined the antecedents of calling. Of this group, little is known about how a calling emerges and develops in a crisis situation. This study examines the processes underlying the emergence and development of calling when confronted with COVID-19., Methods: Semi-structured interviews were conducted with medical students (N = 28) from China from February to March 2020. Medical students reported their experiences about the emergence of calling, its antecedents, and its outcomes in the context of the COVID-19 pandemic. Interviews were transcribed and analyzed using a thematic analysis approach., Results: Four main themes were identified: (1) the definition of calling, (2) the trajectories of calling development, (3) the factors leading to the emergence of calling, and (4) the outcomes of the emergence of calling. Medical students conceptualized calling as both self- and other-oriented regarding serving the common good. Three calling paths were revealed: significantly enhanced, growing out of nothing, and remaining unchanged. Work sense-making and identity formation interact to facilitate the emergence of calling. The emergence of a calling affects career and study-related outcomes., Discussion: Our findings advance the concept of how the calling of medical students emerges and develops in response to life events through work sense-making and identity formation. Academic institutions and medical educators could leverage these events to facilitate calling discernment among medical students., (© 2023. The Author(s).)

Persistent manifestations of COVID-19, known as «long COVID» or post-COVID-19 condition (RA02, CIM-11), affect many infected individuals, with a 24-month prevalence depending on the studies context (18 % in a recent Swiss study). The diversity of clinical presentation, the sometimes complex diagnostic methods, and the multidisciplinary management highlight the importance of a holistic approach, with practical advice for assessing work capacity in the outpatient setting. This article offers an update and synthesis of current knowledge concerning post-COVID-19 condition with practical recommendations for primary care medicine, illustrated by real clinical situations., Competing Interests: Les auteurs remercient le Pr Jacques Cornuz pour sa contribution et la relecture de cet article.

Background: Loss of cognitive and executive functions is a problem that affects people of all ages. That is why it is important to perform exercises for memory training and prevent early cognitive deterioration. The aim of this work was to compare the cognitive performance of the participants after an intervention by using two mnemonic techniques to exercise memory functions (paired-associate learning and method of loci)., Methods: A longitudinal study was conducted with 21 healthy participants aged 18 to 55 years over a 2-month period. To assess the impact of this proposal, the NEUROPSI brief battery cognitive assessment test was applied before and after the intervention. In each session, a previous cognitive training was carried out using the paired-associate learning technique, to later perform a task based on the loci method, all from a smart device-based application. The accuracy response and reaction times were automatically collected in the app., Results: After the intervention, a statistically significant improvement was obtained in the neuropsychological assessment (NEUROPSI neuropsychological battery) reflected by the Wilcoxon paired signed-rank test (P < .05)., Conclusion: The task based on the method of loci also reflected the well-known age-related effects common to memory assessment tasks. Episodic memory training using the method of loci can be successfully implemented using a smart device app. A stage-based methodological design allows to acquire mnemic skills gradually, obtaining a significant cognitive improvement in a short period of time., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Purpose: This study determined whether initiation of pharmacologic treatment was delayed for newly diagnosed osteoporosis patients during the COVID-19 pandemic., Methods: 1,189 patients ≥50 years with newly diagnosed osteoporosis using dual-energy x-ray absorptiometry (DXA) screening at a single academic institution were included. Patients with previous osteoporosis were excluded. Patients diagnosed between March 1, 2018-January 31, 2020 (pre-pandemic cohort, n = 576) were compared to those diagnosed between March 1, 2020-January 31, 2022 (pandemic cohort, n = 613). Age, sex, race, ethnicity, ordering providers (primary vs specialty), and pharmacological agents were evaluated. Primary outcomes included proportion of patients prescribed therapy within 3 and 6-months of diagnosis, and mean time from diagnosis to treatment initiation., Results: The pre-pandemic cohort had more White patients (74.3 vs 68.4%, p = .02) and no differences between remaining demographic variables. Only 40.5% of newly diagnosed patients initiated pharmacologic therapy within 6 months. Patients treated at 3-months (31.8 vs 35.4%, p = 0.19) and 6-months (37.8 vs 42.9, p = 0.08) were comparable between cohorts (47.2 vs 50.2% p = 0.30). Mean time from diagnosis to treatment initiation was similar (46 vs 45 days, p = 0.72). There were no treatment differences based on gender, race, or ethnicity or between ordering providers (65.1 vs 57.4% primary care, p = 0.08). Bisphosphonates were most often prescribed in both cohorts (89% vs 82.1%)., Conclusions: This is the first study assessing COVID-19's impact on pharmacologic treatment of newly diagnosed osteoporosis. 40.5% of newly diagnosed patients were treated pharmacologically within six months of diagnosis, and the pandemic did not significantly affect treatment rates., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 White et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Trust in medicine is often conceived of on an individual level, with respect to how people rely on particular clinicians or institutions. Yet as discussions of trust during the Covid-19 pandemic highlighted, trust decisions are not always as individual or interpersonal as this conception suggests. Rather, individual instances of trusting behavior are related to social trust, which is conceived as a willingness to be vulnerable to people in general, based on a sense of shared norms. In this essay, I propose that individual and social trust are connected to each other in what can be termed a "climate of trust." I explain how masking trends during the pandemic facilitated a "climate of distrust," and I consider the role that clinicians might play in transforming climates of distrust into climates of trust., (© 2023 The Hastings Center.)

The COVID-19 pandemic has necessitated the development of reliable diagnostic methods for accurately detecting the novel coronavirus and its variants. Deep learning (DL) techniques have shown promising potential as screening tools for COVID-19 detection. In this study, we explore the realistic development of DL-driven COVID-19 detection methods and focus on the fully automatic framework using available resources, which can effectively investigate various coronavirus variants through modalities. We conducted an exploration and comparison of several diagnostic techniques that are widely used and globally validated for the detection of COVID-19. Furthermore, we explore review-based studies that provide detailed information on synergistic medicine combinations for the treatment of COVID-19. We recommend DL methods that effectively reduce time, cost, and complexity, providing valuable guidance for utilizing available synergistic combinations in clinical and research settings. This study also highlights the implication of innovative diagnostic technical and instrumental strategies, exploring public datasets, and investigating synergistic medicines using optimised DL rules. By summarizing these findings, we aim to assist future researchers in their endeavours by providing a comprehensive overview of the implication of DL techniques in COVID-19 detection and treatment. Integrating DL methods with various diagnostic approaches holds great promise in improving the accuracy and efficiency of COVID-19 diagnostics, thus contributing to effective control and management of the ongoing pandemic., Competing Interests: Declaration of competing interest There is no conflict of interest in the present work., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: COVID-19 is a multi-organ disease with a broad spectrum of manifestations. Many affected individuals have major difficulties in resuming their previous daily routine or occupation as a result of the disease. Currently, no causal therapeutic approaches are available for the treatment of post-COVID disease. Due to the wide range of possible symptoms, an interprofessional and integrated treatment should be used, while rehabilitation and interventions should be based on the objective findings as well as on the patient's goals. Fatigue and cognitive impairment are among the most common symptoms, which can limit both occupational participation and coping with everyday life. Fatigue management is a central component of rehabilitation. The workload should be increased very slowly; indications of post-exertional malaise must be given special consideration. Due to the fluctuating course of the disease, a periodic reevaluation and adjustment of the workload may be necessary., Competing Interests: Es bestehen keine Interessenskonflikte., (© 2023 Aerzteverlag medinfo AG.)

Background: Leaders in academic health sciences centres (AHCs) must navigate multiple roles as an inherent component of their positions. Changing accountabilities, varying expectations, differing leadership capabilities required of multiple leadership roles can be exacerbated by health system disruption, such as during the COVID-19 pandemic. We need improved models that support leaders in navigating the complexity of multiple leadership roles., Method: This integrative conceptual review sought to examine leadership and followership constructs and how they intersect with current leadership practices in AHCs. The goal was to develop a refined model of healthcare leadership development. The authors used iterative cycles of divergent and convergent thinking to explore and synthesise various literature and existing leadership frameworks. The authors used simulated personas and stories to test the model and, finally, the approach sought feedback from knowledge users (including healthcare leaders, medical educators and leadership developers) to offer refinements., Results: After five rounds of discussion and reformulation, the authors arrived at a refined model: the LEADS+ Developmental Model. The model describes four nested stages, organising progressive capabilities, as an individual toggles between followership and leadership. During the consultation stage, feedback from 29 out of 65 recruited knowledge users (44.6% response rate) was acquired. More than a quarter of respondents served as a senior leader in a healthcare network or national society (27.5%, n = 8). Consulted knowledge users were invited to indicate their endorsement for the refined model using a 10-point scale (10 = highest level of endorsement). There was a high level of endorsement: 7.93 (SD 1.7) out of 10., Conclusion: The LEADS+ Developmental Model may help foster development of academic health centre leaders. In addition to clarifying the synergistic dynamic between leadership and followership, this model describes the paradigms adopted by leaders within health systems throughout their development journey., (© 2023 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Aim: Although the number of global studies on ECMO, which is an important support system in the treatment of COVID-19 related respiratory failure, has increased in recent months, there is still no bibliometric study on the use of ECMO in COVID-19 in the literature. The aim of this study is to analyze the scientific articles on the use of ECMO in COVID-19 by statistical and bibliometric methods., Method: Articles published between 2019-2022 about the use of ECMO in COVID-19 were obtained from the Web of Science (WoS) database and analyzed using statistical and bibliometric methods. Spearman correlation coefficient was used for correlation studies. Network visualization maps were used to identify effe analysis and trending topics., Results: A total of 1197 publications were found. 758 (63.3%) of these publications were articles. The top 3 contributing countries to the literature were USA (257, 33.9%), Germany (102, 13.4%) and Japan (87, 11.5%). The top 3 most active institutions were League of European Research Universities (90), Harvard University (50), and Udice French Research Universities (39). The top 3 journals with the highest count of publications were ASAIO Journal ( n = 36), Frontiers in Medicine (22), and Perfusion-UK ( n = 20). According to the average count of citations per article, the most influential journals were JAMA (1319), Intensive Care Medicine (327), and Lancet (95.7), respectively. We have shared a summary of 758 articles in this comprehensive bibliometric study on the use of ECMO in COVID-19., Conclusion: It can be said that the use of ECMO in COVID-19 has been the trending topic recently and most of the studies are from countries in the ELSO Awards of Excellence list which indicates that the follow-up of ECMO in certain centers and teams can also be influencing the publications. This article can be a useful resource for clinicians, scientists, and students concerning global output for ECMO use in COVID-19.

The Sine Cosine Algorithm (SCA) is an outstanding optimizer that is appreciably used to dissolve complicated real-world problems. Nevertheless, this algorithm lacks sufficient population diversification and a sufficient balance between exploration and exploitation. So, effective techniques are required to tackle the SCA's fundamental shortcomings. Accordingly, the present paper suggests an improved version of SCA called Hierarchical Multi-Leadership SCA (HMLSCA) which uses an effective hierarchical multi-leadership search mechanism to lead the search process on multiple paths. The efficiency of the HMLSCA has been appraised and compared with a set of famous metaheuristic algorithms to dissolve the classical eighteen benchmark functions and thirty CEC 2017 test suites. The results demonstrate that the HMLSCA outperforms all compared algorithms and that the proposed algorithm provided a promising efficiency. Moreover, the HMLSCA was applied to handle the medicine data classification by optimizing the support vector machine's (SVM) parameters and feature weighting in eight datasets. The experiential outcomes verify the productivity of the HMLSCA with the highest classification accuracy and a gain scoring 1.00 Friedman mean rank versus the other evaluated metaheuristic algorithms. Furthermore, the proposed algorithm was used to diagnose COVID-19, in which it attained the topmost accuracy of 98% in diagnosing the infection on the COVID-19 dataset, which proves the performance of the proposed search strategy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Simulation-based learning has been a valuable integrated part of simulation curricula. Simulation modalities include high-fidelity simulation (HFS), clinical skills (SK), standardized patients (SP), hybrid and combined simulation. HFS and SK are usually taught face-to-face and require specialized equipment. In response to the COVID-19 pandemic and lockdowns, efforts to develop distributed screen-based high-fidelity simulation accelerated to provide enhanced remote learning. The authors set out to develop cost-effective, high fidelity, user-friendly software to assist medical students in developing cardiac auscultation skills and clinical reasoning. Physical manikins are expensive, where costs range from $23,000-$250,000 each. The following applications: Heart Auscultation Trainer (HAT), Lung Auscultation Trainer (LAT), and a distributed screen-based high-fidelity simulator (DSB-HFS) comprise a comprehensive medical education software package developed and implemented at the University of South Dakota Sanford School of Medicine (USD SSOM). The HAT application was specifically evaluated in this project., Methods: HAT and LAT were developed for Macintosh, Windows, and Linux operating systems. Both applications feature an on-screen human torso on which users can auscultate heart and lung sounds. Users can select from 52 heart and 15 lung conditions, built-in lessons, a testing mode, and sonograms. DSB-HFS is a network of applications distributed over the internet. Learners can view a patient avatar, perform basic physical exam, review vital signs, and order treatments. An instructor can change avatar parameters in accordance to administered treatments. Information exchange between the instructor and learners occur via a cloud-based connection. Effectiveness, simplicity, and cross-platform usability of HAT was assessed via survey. DSB-HFS has been developed, tested, and piloted. As of December 2022, DSB-HFS was under next phase of development., Results: The 11-question survey was distributed to medical students with an 81.4% response rate. More than half of respondents used HAT at least once per week. Most respondents agreed that: installation was relatively easy, the Graphic User Interface was easy to use, built-in lessons were somewhat useful, and he/she would recommend HAT to other students. Narrative feedback was collected to improve future iterations of HAT. No data were collected regarding LAT or the DSB-HFS simulator., Conclusion: The suite of applications was found to be effectively implemented and was a cost-saving addition to a remote software package available to medical students at the USD SSOM. HAT was perceived by first-time users to be an easy to use and effective learning tool. User-generated feedback will be implemented to improve applications. Limitations to this project include a lack of quantitative data., (Copyright© South Dakota State Medical Association.)

Objectives: This study aimed to investigate how people's health-seeking behaviors evolve in the COVID-19 pandemic by community and medical service category., Study Design: This is a longitudinal study using mobility data from 19 million mobile devices of visits to all types of health facility locations for all US states., Methods: We examine the variations in weekly in-person medical visits across county, neighborhood, and specialty levels. Different regression models are used for each level to investigate factors that influence the disparities in medical visits. County-level analysis explores associations between county medical visit patterns, political orientation, and COVID-19 infection rate. Neighborhood-level analysis focuses on neighborhood socio-economic compositions as potential determinants of medical visit levels. Specialty-level analysis compares the evolution of visit disruptions in different specialties., Results: A more left-leaning political orientation and a higher local infection rate were associated with larger decreases in in-person medical visits, and these associations became stronger, moving from the initial period of stay-at-home orders into the post-lockdown period. Initial reactions were strongest for seniors and those of high socio-economic status, but this reversed in post-lockdown period where socio-economically disadvantaged communities stabilized at a lower level of medical visits. Neighborhoods with more female and young people exhibited larger decreases in in-person medical visits throughout the initial and post-lockdown periods. The evolution of disruptions diverges across medical specialties, from only short-term disruption in specialties such as dentistry to increasing disruption, as in cardiology., Conclusions: Given distinct patterns in visit between communities, medical service categories, and between different periods in the pandemic, policy makers, and providers should concentrate on monitoring patients in disrupted specialties who overlap with the at-risk contexts and socio-economic factors in future health emergencies., (Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Virtual reference services have become a staple in many libraries, but these services reached a new level of importance when in-person reference shut down in response to COVID-19. This descriptive study aims to discover how health sciences librarians utilized virtual reference services in response to the pandemic. A survey was developed and distributed to health sciences librarians. The survey addressed the status of virtual reference services before and during the COVID-19 pandemic as well as any changes that are seen as libraries reopen. Virtual reference shifted heavily to video conferencing during the pandemic both for librarians at home and those remaining onsite.

The Stare decisis of Medicine is the Scientific Method and the Stare decisis of the Scientific Method is Debate over any knowledge claim involving the patient. COVID-19 has threatened the orthodoxy of the Scientific Method with a new orthodoxy - Medicine as political purpose. Among the many examples involve origins, immunity and lockdowns. In each of these the patient-as-judge may declare a mistrial. Only Medicine can restore trust through the legal doctrine of Completeness., (Copyright© South Dakota State Medical Association.)

These S1 guidelines are an updated and expanded version of the S1 guidelines on long COVID differential diagnostic and management strategies. They summarize the state of knowledge on postviral conditions like long/post COVID at the time of writing. Due to the dynamic nature of knowledge development, they are intended to be "living guidelines". The focus is on practical applicability at the level of primary care, which is understood to be the appropriate place for initial access and for primary care and treatment. The guidelines provide recommendations on the course of treatment, differential diagnostics of the most common symptoms that can result from infections like with SARS-CoV-2, treatment options, patient management and care, reintegration and rehabilitation. The guidelines have been developed through an interdisciplinary and interprofessional process and provide recommendations on interfaces and possibilities for collaboration., (© 2023. The Author(s).)

Introduction: The medical specialisation model in Spain is carried out in the context of specialised health training, through the residency programme. The aim of the study is to analyse, by an anonymous survey, the opinion on three aspects among final-year residents in Endocrinology and Nutrition (E&N): self-assessment of the knowledge acquired, working prospects, care and training consequences arising from the pandemic COVID-19., Materials and Methods: Cross-sectional observational study using a voluntary and anonymous online survey, shared among final-year national interns in the last year of the E&N programme, carried out between June-July 2021., Results: 51 responses were obtained, 66% of the fourth-year residents. Overall perception of their knowledge was 7.8 out of 10. Most external rotations were in thyroid and nutrition areas. A total of 96.1% residents, carried out some activity associated with COVID-19, with a training deterioration of 6.9 out of 10. 88.2% cancelled their rotations and 74.5% extended their working schedule. The average negative emotional impact was 7.3 out of 10. 80.4% would like to continue in their training hospital, remaining 45.1%. 56.7% have an employment contract of less than 6 months, most of them practising Endocrinology., Conclusion: The perception of the knowledge acquired during the training period is a "B". Residents consider that the pandemic has led to a worsening of their training, generating a negative emotional impact. Employment outlook after completing the residency can be summarised as: temporality, practice of Endocrinology and interhospital mobility., (Copyright © 2022 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)

Core Surgical Training (CST) is a 2-year UK training programme, designed to provide junior doctors interested in surgery with formal training and to introduce them to various surgical specialties. The selection process is divided into two stages. In the portfolio stage, applicants submit a score based on a published self-assessment guidance. Only candidates whose scores remain higher than the cut-off after verification will proceed to the interview stage. Finally, jobs are allocated according to the overall performance of both stages. Despite the rising number of applicants, the number of job vacancies remains largely similar. Hence, the intensity of competition has increased over the past few years. The competitive ratio increased from 2.8:1 in 2019 to 4.6:1 in 2021. Hence, several changes have been implemented in the CST application process, with the aim to combat this trend. The recurring changes in the CST application process have sparked considerable discussions among applicants. The effect of the changes on the current and prospective applicants is yet to be explored. This letter aims to highlight the changes and discuss the potential impacts. The CST application from 2020 to 2022 has been compared to identify the changes implemented throughout the years. Specific changes have been highlighted. The impact of changes in the CST application process on applicants has been divided into 'pros' and 'cons' sections. Recently, many specialties have shifted from portfolio-based assessment to Multiple Specialty Recruitment Assessments. In contrast, CST application preserves its emphasis on holistic assessment and academic excellence. However, the application process could be further refined for more impartial recruitment. This would ultimately help alleviate the challenging situation of staff shortage, increase the number of specialist doctors, reduce waiting time for elective surgeries and most importantly, provide better care for our patients in the NHS., (© The Author(s) 2022. Published by Oxford University Press on behalf of Postgraduate Medical Journal. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The COVID-19 pandemic disrupted students' opportunities for away rotations (ARs). Schools and specialty organizations innovated by supplementing in-person ARs (ipARs) with virtual ARs (vARs). We sought to determine how ipAR and vAR completion varied by intended specialty among 2021 graduates., Design: Using de-identified Association of American Medical Colleges 2021 Graduation Questionnaire (GQ) data, we examined AR completion by specialty and community-based school attendance (among other variables) in univariate analysis and multivariable logistic regression models., Setting: Students graduating from MD-degree granting U.S. medical schools were invited to complete the 2021 GQ, administered electronically on a confidential basis., Participants: Our study included data for 15,451 GQ respondents (74% of all 2021 graduates)., Results: Among GQ respondents, 18% (2,787/15,451) completed ARs: 8% (1,279/15,451) ipAR only, 8% (1,218/15,451) vAR only, and 2% (290/15,541) both. In univariate analysis, specialty and community-based school attendance (each p < 0.001), among other variables, were associated with ipAR and with vAR. In multivariable logistic regression, surgical specialties associated with greater odds of AR completion (vs. general surgery reference) included neurological surgery (ipAR: adjusted odds ratio [AOR]=1.9, 95% confidence interval [CI]=1.1-3.3; vAR AOR=3.1, 95% CI=1.9-4.9), ophthalmology (ipAR: AOR=2.3, 95% CI=1.6-3.3; vAR: AOR=2.5, 95% CI=1.7-3.7), orthopedic surgery (ipAR: AOR=2.5, 95% CI=1.8-3.4; vAR: AOR=12.4, 95%CI=9,2-16.5), otolaryngology (ipAR: AOR=1.8, 95% CI=1.2-2.8; vAR: AOR=4,8, 95% CI=3.4-6.9), plastic surgery (ipAR: AOR=2.1, 95% CI=1.2-3.5; vAR: AOR=13.9, 95% CI=9.3-20.7) and urology (ipAR: AOR=2,1, 95% CI=1.4-3.2; vAR: AOR=11.9, 95% CI=8.4-16.8). Community-based medical school attendance was also associated with greater odds of ipAR (AOR=4.6, 95% CI=3.1-6.7) and vAR (AOR=1.8, 95% CI=1.4-2.3)., Conclusions: The prevalence of AR completion was low. Differences we observed by specialty and medical school type aligned well with recommended circumstances for ipARs for the class of 2021. Substantial specialty-specific differences in vAR completion suggest that various surgical specialties were among the early innovators in this regard., Competing Interests: Declaration of Competing Interest All authors are employed by the Association of American Medical Colleges (AAMC), which administers the AAMC Graduation Questionnaire. The AAMC is a member of the Coalition for Physician Accountability, which issued recommendations to medical education institutions regarding away rotations for the 2020-2021 academic year., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Craft specialties such as surgery endured widespread disruption to postgraduate education and training during the pandemic. Despite the expansive literature on rapid adaptations and innovations, generalisability of these descriptions is limited by scarce use of theory-driven methods. In this research, we explored UK surgical trainees' (n = 46) and consultant surgeons' (trainers, n = 25) perceptions of how learning in clinical environments changed during a time of extreme uncertainty (2020/2021). Our ultimate goal was to identify new ideas that could shape post-pandemic surgical training. We conducted semi-structured virtual interviews with participants from a range of working/training environments across thirteen Health Boards in Scotland. Initial analysis of interview transcripts was inductive. Dynamic capabilities theory (how effectively an organisation uses its resources to respond to environmental changes) and its micro-foundations (sensing, seizing, reconfiguring) were used for subsequent theory-driven analysis. Findings demonstrate that surgical training responded dynamically and adapted to external and internal environmental uncertainty. Sensing threats and opportunities in the clinical environment prompted trainers' institutions to seize new ways of working. Learners gained from reconfigured training opportunities (e.g., splitting operative cases between trainees), pan-surgical working (e.g., broader surgical exposure), redeployment (e.g., to medical specialties), collaborative working (working with new colleagues and in new ways) and supervision (shifting to online supervision). Our data foreground the human resource and structural reconfigurations, and technological innovations that effectively maintained surgical training during the pandemic, albeit in different ways. These adaptations and innovations could provide the foundations for enhancing surgical education and training in the post-pandemic era., (© 2022. The Author(s).)

We introduce a new logic, called Temporal Cohort Logic (TCL), for cohort specification and discovery in clinical and population health research. TCL is created to fill a conceptual gap in formalizing temporal reasoning in biomedicine, in a similar role that temporal logics play for computer science and its applications. We provide formal syntax and semantics for TCL and illustrate the various logical constructs using examples related to human health. Relationships and distinctions with existing temporal logical frameworks are discussed. Applications in electronic health record (EHR) and in neurophysiological data resource are provided. Our approach differs from existing temporal logics, in that we explicitly capture Allen's interval algebra as modal operators in a language of temporal logic (rather than addressing it in the semantic structure). This has two major implications. First, it provides a formal logical framework for reasoning about time in biomedicine, allowing general (i.e., higher-levels of abstraction) investigation into the properties of this approach (such as proof systems, completeness, expressiveness, and decidability) independent of a specific query language or a database system. Second, it puts our approach in the context of logical developments in computer science, allowing potential translation of existing results into the setting of TCL and its variants or subsystems so as to illuminate opportunities and computational challenges involved in temporal reasoning for biomedicine., (©2022 AMIA - All rights reserved.)

Objective: To identify which Veteran populations are routinely accessing video-based care., Data Sources and Study Setting: National, secondary administrative data from electronic health records at the Veterans Health Administration (VHA), 2019-2021., Study Design: This retrospective cohort analysis identified patient characteristics associated with the odds of using any video care; and then, among those with a previous video visit, the annual rate of video care utilization. Video care use was reported overall and stratified into care type (e.g., primary, mental health, and specialty video care) between March 10, 2020 and February 28, 2021., Data Collection: Veterans active in VA health care (>1 outpatient visit between March 11, 2019 and March 10, 2020) were included in this study., Principal Findings: Among 5,389,129 Veterans in this evaluation, approximately 27.4% of Veterans had at least one video visit. We found differences in video care utilization by type of video care: 14.7% of Veterans had at least one primary care video visit, 10.6% a mental health video visit, and 5.9% a specialty care video visit. Veterans with a history of housing instability had a higher overall rate of video care driven by their higher usage of video for mental health care compared with Veterans in stable housing. American Indian/Alaska Native Veterans had reduced odds of video visits, yet similar rates of video care when compared to White Veterans. Low-income Veterans had lower odds of using primary video care yet slightly elevated rates of primary video care among those with at least one video visit when compared to Veterans enrolled at VA without special considerations., Conclusions: Variation in video care utilization patterns by type of care identified Veteran populations that might require greater resources and support to initiate and sustain video care use. Our data support service specific outreach to homeless and American Indian/Alaska Native Veterans., (© 2022 Health Research and Educational Trust. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Phenomenon: The 2020-2021 residency application cycle was subject to major alterations following the COVID-19 global pandemic. This study determined the online presence of US-based residency training programs during this time period., Approach: An official list of accredited US residency programs for 24 medical specialties was obtained through the Electronic Residency Application Service Programs' online presence and was evaluated for website ownership in addition to Twitter, Instagram, and Facebook account ownership. Date of social media account foundation and virtual opportunities offered were recorded. Doximity Residency Navigator for 2020-2021 was used to determine program rank, and programs were stratified by location using Association of American Medical Colleges regions. Program rank and geographic location were used to determine potential trends in online presence. This study was performed during the residency application cycle from September 2, 2020, to November 29, 2020, during which applications were submitted and the interview cycle began., Findings: Fifty-seven percent of the 4,562 programs had a presence on social media. One-third of all accounts were created after March 1, 2020, and most (58%) were residency program-associated. A total of 1,315 programs offered virtual open houses through Twitter (829), Instagram (792), and Facebook (295). First-quartile programs had significantly more social media accounts per program on average (1.8) than those in subsequent quartiles, and Western region programs had significantly more accounts per program on average (1.3) than the Central (1.0), Northeastern (1.0), and Southern (1.1) regions., Insights: US residency programs created social media accounts and online opportunities for applicants following March 1, 2020. Online interactions may serve as substitutes at a time when in-person interaction is not possible. Future studies may examine the influence and impact of virtual interactions.Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2022.2047050.

Rationale, Aims, and Objectives: The disciplinary profile and the quality of production of knowledge on Corona pandemic is studied. This scientific field is called 'Medical Corona Science'., Methods: Criteria of analytical philosophy of science and science studies are systematically applied., Results: It is shown that mainly auxiliary medical disciplines such as virology and epidemiology but not clinical disciplines provide Corona knowledge. We see a laboratory-centered, technology- and data-driven science, largely ignoring clinical issues. Therefore we call these approaches "Medical Corona Science" (MCS). We see the need to adapt to features of a 'post-normal science', a 'mode 2 science' and of 'Integration and Implementation Science', especially as clinical knowledge must be integrated. There is also a severe lack of theoretical considerations that could help to frame the pandemic as a complex dynamic system., Conclusions: We suggest a deeper meta-scientific discussion of the epistemic value of MCS and propose the application of tools from systems science., (© 2022 John Wiley & Sons Ltd.)

A relationship was found between the COVID-19 pandemic and depression among older adults and between depressed mood and increased use of antidepressant medication among older adults during the pandemic. With the aim of broadening the understanding of these relationships, the study examined whether COVID-19 perceived susceptibility mediates the relationship between psychosocial resources (optimism and perceived social support) and depressive symptoms and medication use. Participants included 383 older adults ( M = 71.75, SD = 6.77) reporting on socio-demographics, health characteristics, depression, optimism, social support, and COVID-19 perceived susceptibility. Medication use was retrieved from participants medical files. Lower optimism, lower social support, and higher COVID-19 perceived susceptibility were associated with greater depression, related with higher medication use. The findings emphasize the buffering effect of psychosocial resources on the adverse effects of depression affecting older adults during the COVID-19 pandemic, and consequently, the increased use of medication in this population. Practitioners should focus interventions on enhancing optimism and expanding social support among older adults. Moreover, interventions focused on alleviating depression among older adults should aim at improving perceptions of perceived susceptibility in the older population.

As a scientific community we assumed that exome sequencing will elucidate the basis of most heritable diseases. However, it turned out it was not the case; therefore, attention has been increasingly focused on the non-coding sequences that encompass 98% of the genome and may play an important regulatory function. The first WGS-based datasets have already been released including underrepresented populations. Although many databases contain pooled data from several cohorts, recently the importance of local databases has been highlighted. Genomic databases are not only collecting data but may also contribute to better diagnostics and therapies. They may find applications in population studies, rare diseases, oncology, pharmacogenetics, and infectious and inflammatory diseases. Further data may be analysed with Al technologies and in the context of other omics data. To exemplify their utility, we put a highlight on the Polish genome database and its practical application.

The Network University Medicine (NUM) consists of 36 university clinics in Germany. It was set up to coordinate COVID-19 university medicine research activities on a national level. This required, among other things, common infrastructures for the collection, storage, and use of medical research data. These infrastructures were not available in the required form when the NUM started in April 2020. Medical research data are extremely heterogeneous and reach far beyond "real world data" from patient care. There was no "one size fits all" solution, so NUM built five infrastructures for different types of data, different ways of obtaining data, and different data origination settings. To prevent the creation of new data silos, all five infrastructures operate based on FAIR principles (findable, accessible, interoperable, reusable). In addition, NUM is implementing an overarching governance framework to manage the evolution of these five infrastructures. The article describes the current state of development and possible perspectives with a strong focus on technical and organizational aspects., (© 2023. The Author(s).)

Background: Owing to the prevalence of the coronavirus disease (COVID-19), coping with clinical issues at the individual level has become important to the healthcare system. Accordingly, precise initiation of treatment after a hospital visit is required for expedited processes and effective diagnoses of outpatients. To achieve this, artificial intelligence in medical natural language processing (NLP), such as a healthcare chatbot or a clinical decision support system, can be suitable tools for an advanced clinical system. Furthermore, support for decisions on the medical specialty from the initial visit can be helpful., Materials and Methods: In this study, we propose a medical specialty prediction model from patient-side medical question text based on pre-trained bidirectional encoder representations from transformers (BERT). The dataset comprised pairs of medical question texts and labeled specialties scraped from a website for the medical question-and-answer service. The model was fine-tuned for predicting the required medical specialty labels among 27 labels from medical question texts. To demonstrate the feasibility, we conducted experiments on a real-world dataset and elaborately evaluated the predictive performance compared with four deep learning NLP models through cross-validation and test set evaluation., Results: The proposed model showed improved performance compared with competitive models in terms of overall specialties. In addition, we demonstrate the usefulness of the proposed model by performing case studies for visualization applications., Conclusion: The proposed model can benefit hospital patient management and reasonable recommendations for specialties for patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

When the COVID-19 pandemic struck and China reported the first case to the World Health Organization in December 2019, there was no evidence-based treatment to combat it. With the catastrophic situation that followed, materialised by a considerable number of deaths, researchers, doctors, traditional healers, and governments of all nations committed themselves to find therapeutic solutions, including preventive and curative. There are effective treatments offered both by modern medicine and traditional medicine for COVID-19 today. However, other therapeutic proposals have not been approved due to the lack of effectiveness and scientific rigour during their development process. Proponents of modern medicine prefer biomedical therapies while in some countries, traditional treatments are used regularly because of their availability, affordability and satisfaction they bring to the population. In this paper, we propose a transactional medicine approach where the interaction between traditional and modern medicine produces a change. With this approach, the promoters of traditional medicine and those of modern medicine will be able to acquire knowledge through the experience produced by their encounters. Transactional medicine aims to be a model for decolonising medicine and recognising the value of both traditional and modern medicine in the fight against COVID-19 and other global emerging pathogens.

We herein report the outcomes of rehabilitation intervention for a patient in his 80s with chronic obstructive pulmonary disease on prolonged mechanical ventilation after COVID-19 infection. The patient was forced to be long-term bedridden due to respirator dependence, showing notable muscle weakness and needing full assistance for all of his activities of daily living (ADL). We implemented rehabilitation for the purposes of withdrawal from mechanical ventilation and improvement of his physical function. We provided a combination program of range of motion exercise, resistance training, and gradual mobilization, such as sitting on the edge of the bed, moving between the bed and wheelchair, sitting on the wheelchair, standing and walking. After rehabilitation for 24 days, the patient was withdrawn from mechanical ventilation, his muscle strength recovered to a level of 4 (Good) on manual muscle testing (MMT) and he became able to walk using a walker. A follow-up survey one year later confirmed that he performed ADL without assistance and returned to work.

Background: Journal impact factor (IF) is the leading method of scholarly assessment in today's research world, influencing where scholars submit their research and where funders distribute their resources. COVID-19, one of the most serious health crises, resulted in an unprecedented surge of publications across all areas of knowledge. An important question is whether COVID-19 affected the gold standard of scholarly assessment., Objective: In this paper, we aimed to comprehensively compare the productivity trends of COVID-19 and non-COVID-19 literature as well as track their evolution and scholarly impact across 3 consecutive calendar years., Methods: We took as an example 6 high-impact medical journals (Annals of Internal Medicine [Annals], The British Medical Journal [The BMJ], Journal of the American Medical Association [JAMA], The Lancet, Nature Medicine [NatMed], and The New England Journal of Medicine [NEJM]) and searched the literature using the Web of Science database for manuscripts published between January 1, 2019, and December 31, 2021. To assess the effect of COVID-19 and non-COVID-19 literature in their scholarly impact, we calculated their annual IFs and percentage changes. Thereafter, we estimated the citation probability of COVID-19 and non-COVID-19 publications along with their rates of publication and citation by journal., Results: A significant increase in IF change for manuscripts including COVID-19 published from 2019 to 2020 (P=.002; Annals: 283%; The BMJ: 199%; JAMA: 208%; The Lancet: 392%; NatMed: 111%; and NEJM: 196%) and to 2021 (P=.007; Annals: 41%; The BMJ: 90%; JAMA: 6%; The Lancet: 22%; NatMed: 53%; and NEJM: 72%) was seen, against non-COVID-19 ones. The likelihood of highly cited publications was significantly increased in COVID-19 manuscripts between 2019 and 2021 (Annals: z=3.4, P<.001; The BMJ: z=4.0, P<.001; JAMA: z=3.8, P<.001; The Lancet: z=3.5, P<.001; NatMed: z=5.2, P<.001; and NEJM: z=4.7, P<.001). The publication and citation rates of COVID-19 publications followed a positive trajectory, as opposed to non-COVID-19. The citation rate for COVID-19 publications peaked by the second quarter of 2020 while that of the publication rate approximately a year later., Conclusions: The rapid surge of COVID-19 publications emphasized the capacity of scientific communities to respond against a global health emergency, yet inflated IFs create ambiguity as benchmark tools for assessing scholarly impact. The immediate implication is a loss in value of and trust in journal IFs as metrics of research and scientific rigor perceived by academia and society. Loss of confidence toward procedures employed by highly reputable publishers may incentivize authors to exploit the publication process by monopolizing their research on COVID-19 and encourage them to publish in journals of predatory behavior., (©Orestis Delardas, Panagiotis Giannos. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 21.12.2022.)

Aim: To explore whether physiotherapy use is increased after hospitalization with COVID-19 with or without respiratory support vs. other respiratory tract infections (RTI)., Methods: In all Norwegian residents aged 18-80 years who were hospitalized with COVID-19 (N = 5,344) or other RTI (N = 82,235) between July 1st 2017 and August 1st 2021, we used a pre-post study design to explore the weekly individual average physiotherapy use in community care from 12 weeks prior to hospital admission, to 36 weeks (9 months) after hospital discharge for individuals who received and who did not receive respiratory support., Results: Prior to the hospital stay, COVID-19 patients and patients with other RTI had ~ 40-60 physiotherapist consultations per 1000 inpatients per week. COVID-19 patients on respiratory support had a higher increase in physiotherapy use after discharge than persons with other RTI on respiratory support (an additional 27.3 (95% confidence interval = 10.2 to 44.4) consultations per 1000 for men, and 41.8 (13.7 to 69.9) per 1000 for women)). The increase in physiotherapy use lasted for 6 months for men, and 9 months for women. COVID-19 inpatients without respiratory support had a similar up-to-9-months-change post-discharge physiotherapy use as inpatients with other RTI without respiratory support (-0.2 (-0.7 to 0.2) for men, and 0.09 (-6.4 to 6.6) for women)., Conclusion: The need for physiotherapy was increased for up to 9 months after having COVID-19 requiring respiratory support vs. other RTI requiring respiratory support. No difference between diseases was seen for individuals who were hospitalized but not on respiratory support., (© 2022. The Author(s).)

Competing Interests: Dr. Kho received funding from the Canadian Institutes of Health Research; she disclosed that she holds a Canada Research Chair in Critical Care Rehabilitation and Knowledge Translation and that she is leading an international randomized controlled trial of in-bed cycling in critically ill patients, and Restorative Therapies loaned her three in-bed cycle ergometers for this research. Dr. Rewa has disclosed that she does not have any potential conflicts of interest.

This article aims to theorise the human experiences of time during the lockdown (in the first phase of the pandemic) and the COVID-19 pandemic through the verbo-visual exposition of graphic medicine that combines the medium of comics and healthcare. The event of the pandemic has not only bifurcated our perception of time in terms of a 'before' and an 'after' but also complicated our awareness and experience of time. Put differently, an epochal transformation caused by pandemics has shifted our temporal experience from the calendar/clock time to a queer time situated outside of formal time-related constructions. The pandemic also implies a dismantling and rearranging of the fundamental structures of time within which human beings interacted with the world. Such a discontinuity in the linear trajectory of chronological time engenders an epistemic and ontological reconfiguration of the very sense of time itself. Through a phenomenological close reading of various sequential comics, single panelled images and graphic medical narratives, this article investigates how visual narratives in the form of comics communicate the passage of time. Categorically speaking, pandemic graphic narratives on time draw attention to stagnation, repetition, acceleration, loss of referentiality and the queerness (strangeness) of pandemic time. The article argues that a shift in the perception of time precipitates an altered spatio-temporal awareness that informs postpandemic discourses and power structures., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

This study explored how speech-language pathologists (SLPs) in Jordan perceived and implemented telepractice at the beginning of the COVID-19 pandemic, from April to June 2020. Eighty-five SLPs who provided telepractice and 57 SLPs, who did not, completed an online survey sharing their perceptions related to the delivery and barriers of telepractice. The results showed a significant increase of telepractice use in response to the pandemic. However, the SLPs identified several barriers to telepractice, including environmental distractions at the client's end, limited computer knowledge, technological issues, internet connectivity problems, and platform availability. There was general agreement among the SLPs regarding the need for professional training and governmental guidelines to regulate the use of telepractice. The study's findings demonstrate how SLPs in Jordan adapted to the sudden shift toward telepractice, and identify potential implementation obstacles, which could assist in establishing telepractice as a reliable model for speech-language therapy services in the future.

Objectives: The impact of a coronavirus disease (COVID-19)-specific professional development programme on the well-being of obstetrics and gynaecology (O&G) doctors in training (DiT) working during the pandemic., Design: A mixed-method evaluation of a single group pre-post test design study., Setting: Melbourne, Australia between September 2020 and April 2021., Participants: 55 O&G DiT working across four healthcare sites of a major tertiary hospital in Victoria, Australia, were included in the programme., Interventions: The delivery of a codesigned peer-to-peer programme, which identified and addressed the well-being goals of O&G DiT. Seven interactive workshops were run alongside the implementation of a number of participant-led wellness initiatives., Main Outcome Measures: Repeated-measures analysis of WHO Well-being Index (WHO-5) and Copenhagen Burnout Innovatory (CBI) scores across three time points during the programme. Multilevel generalised linear mixed-effects models with random intercept were fit to the data, both in the entire population (intention-to-treat) and restricted to those who attended the workshop ('per-protocol' analysis). Participatory experiences and programme learning were captured using the Most Significant Change (MSC) technique, which included inductive thematic analysis., Results: We demonstrated an overall 31.9% improvement in well-being scores (p=0.006). The MSC evaluation captured a shift in workplace culture as a result of the programme, with improvement across the domains of connection, caring, communication, confidence and cooperation., Conclusions: We have successfully used a mixed-method approach to contextualise a productive programme to improve the well-being of COVID-19 front-line healthcare workers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored., (Copyright © 2022 by the American Academy of Pediatrics.)

Background and Objectives: Due to COVID-19, residency programs could not conduct in-person interviews during the 2020-2021 match and were forced to implement a virtual format. We conducted a nationwide survey of US senior medical students to evaluate their perception of the virtual interview process and to solicit their recommendations for future virtual interview best practices., Methods: This study was administered to US fourth-year medical students currently participating in the residency match using Survey Monkey during March 2021. Students were contacted through their respective student affairs deans. Surveys solicited demographic information, 26 4-point Likert-scale questions, and four free-response questions., Results: A total of 357 surveys were completed. Most respondents stated that they could confidently represent themselves to the program (71.7%) using a virtual platform. However, only 11.6% stated that they could confidently assess a program's facility using a virtual platform. Although most respondents (58.26%) found that virtual meet and greets helped them better assess their fit for the program, less than half (46%) confidently believed they could assess their fit into the program after the conclusion of the virtual interview. Regarding potential disparities introduced by virtual interviews, 40.6% believed that the virtual interviews introduce greater inequalities into the match process. Two-thirds of respondents (239, 66.95%), believed that there should be a limit on the number of interview offers an applicant can accept, with the maximum number of interviews per specialty capped at 25.7 (10-150). Finally, just over two-thirds (69.47%), claimed they could confidently prepare their rank-order list at the conclusion of the interview., Conclusions: Most respondents found virtual interviews financially beneficial, however difficulty in assessing fit was a challenge. Best practice recommendations from the respondents include shorter interviews, more engaging resident-led social hours without faculty present, and preinterview packages to include video representations of the program facilities.

Virtual health and secure messaging gained newfound relevance in medicine during the coronavirus disease (COVID)-19 pandemic. For a military trainee health care clinic located on Joint Base San Antonio, the McWethy Troop Medical Clinic (TMC), implementation of virtual health and secure messaging services meant decreased risk of COVID-19 exposure for trainees and clinical staff. Through ongoing utilization, these services also made impacts to reduce loss of instruction time and improve access to care for the McWethy TMC trainee population. In defining the challenges, successes, and future implications for virtual health and secure messaging at the McWethy TMC, key lessons emerge for other military trainee clinics. The key concepts explored in this article are virtual health and secure messaging., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.)