The COVID-19 pandemic has dramatically and rapidly changed the status quo for nearly every aspect of medical education, including resident and fellow recruitment.¹ Several organizations, including the Association of American Medical Colleges and the Canadian Resident Matching Service, have issued statements encouraging or mandating virtual-only interview processes for the upcoming recruitment season.^2–4 Further, institutions have placed restrictions on visiting student clinical rotations.⁵ Traditionally, visiting student rotations have functioned as “audition rotations,” whereby applicants and residency programs can assess mutual compatibility.⁶ The loss of these opportunities limits applicants' ability to experience

The COVID-19 pandemic has caused major disruptions in medical education. Most medical schools abruptly converted teaching to virtual classrooms and halted or dramatically reduced in-person clinical experiences. In light of these changes hindering medical students from completing required rotations, the Coalition for Physician Accountability issued guidance in May for the 2020–2021 residency application cycle.¹ In addition to discouraging most away rotations and delaying release of applications through the Electronic Residency Application Service, the coalition recommended all residency programs perform virtual instead of on-site applicant interviews this cycle.

We commend these decisions to prioritize faculty, resident, and applicant safety

ABSTRACT

Background

The resident selection process involves the analysis of multiple data points, including letters of reference (LORs), which are inherently subjective in nature.

Objective

We assessed the frequency with which LORs use quantitative terms to describe applicants and to assess whether the use of these terms reflects the ranking of trainees in the final selection process.

Methods

A descriptive study analyzing LORs submitted by Canadian medical graduate applicants to the University of Ottawa General Surgery Program in 2019 was completed. We collected demographic information about applicants and referees and recorded the use of preidentified quantitative descriptors (eg, best, above average). A 10% audit of the data was performed. Descriptive statistics were used to analyze the demographics of our letters as well as the frequency of use of the quantitative descriptors.

Results

Three hundred forty-three LORs for 114 applicants were analyzed. Eighty-five percent (291 of 343) of LORs used quantitative descriptors. Eighty-four percent (95 of 113) of applicants were described as above average, and 45% (51 of 113) were described as the “best” by at least 1 letter. The candidates described as the “best” ranked anywhere from second to 108th in our ranking system.

Conclusions

Most LORs use quantitative descriptors. These terms are generally positive, and while the use does discriminate between different applicants, it was not helpful in the context of ranking applicants in our file review process.

ABSTRACT

Background

Dental caries are the most common chronic condition of childhood and have significant medical, psychological, and financial consequences. The American Academy of Pediatrics (AAP) recommends primary care physicians apply fluoride varnish (FV) every 3 to 6 months from tooth emergence through age 5.

Objective

Through a resident-led quality improvement (QI) project, we aimed to provide FV to 50% of patients ages 1 through 5 who did not have a dental visit in the preceding 6 months or receive FV elsewhere in the past month.

Methods

From May 2017 through April 2018, we conducted 7 monthly plan-do-study-act cycles to improve our primary outcome measure (FV application), secondary outcome measure (percentage of patients who had routine dental care), and process measure (percentage of dental referrals). Balancing measures included time taken away from other clinical priorities and reimbursement rates.

Results

Fluoride varnish application improved from 3.6% to 44% with a 54% peak. The percentage of patients under 6 who had seen a dentist in the past 6 months increased from 30% to 47%. The percentage of dental referrals increased from 17% to 33%.

Conclusions

Application of FV is a quick, cost-effective way for primary care providers to improve dental health. This resident-led QI project increased rates of FV application, dental referrals, and dental visits while meeting ACGME guidelines for experiential learning in QI. By adapting to state-specific guidelines and workflows of each clinic, this QI project could be nationally reproduced to improve adherence to AAP and United States Preventive Services Task Force guidelines.

ABSTRACT

Background

The I-PASS framework is increasingly being adopted for patient handoffs after a recent study reported a decrease in medical errors and preventable adverse events. A key component of the I-PASS handoff included assignment of illness severity.

Objective

We evaluated whether illness severity categories can identify patients at higher risk of overnight clinical deterioration as defined by activation of the rapid response team (RRT).

Methods

The I-PASS handoff documentation created by internal medicine residents and patient charts with overnight RRT activations from April 2016 through March 2017 were reviewed retrospectively. The RRT activations, illness severity categories, vital signs prior to resident handoff, and patient outcomes were evaluated.

Results

Of the 28 235 written patient handoffs reviewed, 1.3% were categorized as star (sickest patients at risk for higher level of care), 18.8% as watcher (unsure of illness trajectory), and 79.9% as stable (improving clinical status). Of the 98 RRT activations meeting the inclusion criteria, 5.1% were labeled as star, 35.7% as watcher, and 59.2% as stable. Patients listed as watcher had an odds ratio of 2.6 (95% confidence interval 1.7–3.9), and patients listed as star had an odds ratio of 5.2 (95% confidence interval 2.1–13.1) of an overnight RRT activation compared with patients listed as stable. The overall in-hospital mortality of patients with an overnight RRT was 29.6%.

Conclusions

The illness severity component of the I-PASS handoff can identify patients at higher risk of overnight clinical deterioration and has the potential to help the overnight residents prioritize patient care.