The delivery of medical student education has changed rapidly during the coronavirus disease 2019 (COVID-19) pandemic. Students in their pre-clinical years have transitioned to online courses and examinations. Students in their clinical years are not permitted on clinical rotations, and face uncertainties in career exploration and the residency application process. Medical students in all stages of training are volunteering and helping their communities. The future presence of COVID-19 throughout the United States is unknown, and medical students are eager to return to their training. This paper outlines current challenges in medical student education and the various responses that have been adopted. We also discuss possible future directions for students through involvement in telemedicine, outpatient clinic visits, and non-respiratory inpatient care tasks as adequate personal protective equipment, COVID-19 testing, and resources become more widely available.

95% CI 1.63-4.16; p<0.001) were significant predictive factors of PSM. Conversely, hilar clamping, robotic versus open approach and PADUA score were significantly associated with PSM, but were not independent at multivariable analysis.CONCLUSIONS: The early oncological goal of PN is to achieve negative margins. In our multi-institutional report, CCI, laparoscopic approach, enucleoresection technique, lymphovascular invasion and tumor upstaging were independent predictors of PSM in patients treated with PN for localized RCC.

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INTRODUCTION AND OBJECTIVE: Laparoscopic Cryoablation (LC) is commonly indicated for anterior renal mass or those nearby vital structures. Reports describing early postoperative (postop) morbidity are rare. We used the National Surgical Quality Improvement Program (NSQIP) data in patients with renal mass to evaluate early postop complications related to LC and to determine the preoperative (preop) factors associated with any complication.METHODS: Using 2007-16 NSQIP, patients who received LC for renal mass were identified. Information on demographics, comorbidities, preop labs, operating time (OPTIME), length of stay (LOS), and postop complications 30 days were extracted. The presence of any of the extracted complications was used to create a variable for "any complication" and the presence of either superficial or deep surgical site infection (SSI), organ space SSI, or wound disruption was used to indicate "any wound occurrence." Univariate analysis described the proportions of patients with complications, and a multivariable logistic regression determined preop factors associated with any complication.RESULTS: A total of 250 patients with average age of 68 years (SD[11) were identified. Most were males (62%) and Caucasians (75%) while some were current smoker (18%), obese (47%), functionally dependent (4%), and had metastatic cancer (2%). Most common comorbidities were hypertension (76%) and diabetes (24%). Most had a preop hematocrit level <45% (88%). Mean LOS was 3.6 days (SD [4.8) and mean OPTIME was 141 minutes (SD[58). The proportions of patients with early postop mortality was 0.8%, any complication was 12%, and any wound occurrence was 0.8%. Most frequent complications were blood transfusion (4%), urinary tract infection (3%), return to OR (2%), unplanned intubation (1%) and cerebrovascular accident (1%). Of 128 patients with data on readmissions, 5% were readmitted.

scar assessment scale (PSAS) and observer scar assessment scale (OSAS).RESULTS: Mean operative time was 142.7AE16.3 and 97.60AE25.6 minutes in LESS and ML groups, respectively (P< 0.05). Mean estimated blood loss was 70.67AE43.67 and 56AE23.54 mL in both groups, respectively (P > 0.05). Mean VAS was 2.07AE0.26 and 2.27AE0.46 in both groups, respectively (P[ 0.07). Mean PSAS and OSAS was 6.53AE6.53 and 7.00AE0.93 vs 9.8AE2 and 9.73AE1.67 in both groups, respectively (P< 0.05). There were no intraoperative complications, conversions to open surgery, or to conventional laparoscopy in both groups. No additional port was used in LESS RN. There was no significant difference in the postoperative complications according to the Clavien-Dindo system nor in hospital stay in both groups.CONCLUSIONS: Both LESS RN and ML RN are valid options for treatment of renal neoplasms. They have comparable results in terms of blood loss, complication rate, VAS and hospital stay. However, LESS is associated with longer operative time and better cosmesis