Implication StatementThe peer review process is a critical step in producing sound scientific literature, traditionally conducted by professionals well-established in their field. It is uncommon for students, even at the graduate level, to contribute. Faculty created a novel course in which 18 medical students (nine per year) delivered peer reviews to the Canadian Medical Education Journal (CMEJ). The positive feedback and competency gained is described in the students’ Letter to the Editor. While this course was initially created to benefit students, it has also helped to address a known deficit in peer reviewers.

Background In 2020, COVID-19 spread across the world and brought the world to a halt, causing the shutdown of nearly everything in order to prevent its spread. The NFL, like most of the world, faced shutdowns leaving athletes unable to train in some of the most advanced facilities with many of the best trainers in the world. Through a previous study, COVID-19 Return to Sport Injury Prevalence Analysis, it was determined that there was increased injury prevalence during the 2020 season likely due to decreased physiological adaptations within athletes bodies that resulted from facility shutdowns. Understanding injury epidemiology is vital in the prevention of injuries and the development of return-to-play protocols. Objective: The objective of this study is to perform a follow up study to COVID-19 Return to Sport Injury Prevalence Analysis in order to to examine the longitudinal effects of the COVID-19 pandemic on injury epidemiology. This study will examine if there was a recovery to baseline or lingering effects from the COVID-19 pandemic-induced spike in injuries. Methods Injury tallies collected from the 17-week-long 2020 NFL regular season, played after COVID-19 restrictions, were compared with the injury tallies collected from the 18-week-long NFL regular seasons (2021, 2022), in order to determine if there was a change in injury prevalence. An unpaired t-test was conducted to compare the mean injuries per team per week between each of the 2020, 2021, and 2022 regular seasons. Results The 2022 and 2021 NFL regular seasons produced lower numbers of total injuries than the 2020 NFL regular season that was impacted by COVID-19. The comparison of the mean number of injuries per team per week of the 2020 season compared with the 2021 regular season was statistically significant (P=.03). The comparison of the 2020 and 2022 regular seasons was also statistically significant (P=.02). Conclusions The results of this follow-up study and our previous study show that extended training interruptions have the ability to induce detraining and lead to increased injuries. Additionally, the results of this study show that retraining can occur and lead to injury protective factors. This is the first large scale opportunity to demonstrate the effects of these principles and how they are important to understanding injury epidemiology.

Every summer, exertional heat illness in athletes becomes the center of attention among coaches, athletic trainers, and physicians across the United States. This topic has recently received increased attention as seven football players died from exertional heat illness between July 2020 and August 2021[1] . Health professionals believe that sport-related heat illnesses can be prevented through following published sports guidelines, protocols for weather monitoring and water breaks, and using appropriate conditioning during practice sessions. This topic has become such an issue that several states and local governing bodies have enacted legislation and policy for exertional heat illness education and training for coaches, players, and parents[2,3,32] . Every year there are coaches and programs that abstain from following guidelines, disregard weather conditions, and force extreme conditioning, referred to as “irrational intensity”[4] . This blatant disregard for player safety can lead to severe cases of exertional heat illness and even death. The COVID-19 pandemic has had an impact on athletics for nearly two years. When looking at the scope of athletics this upcoming summer, it is reasonable to say that we may be heading towards a return to more typical summer activities. As COVID-19 restrictions loosen, there will likely be an increase in sports participation this summer compared to the summers of 2020 and 2021. Therefore, it is of the utmost importance that the sporting community is educated on a preventable illness that plagues athletes during hot weather seasons. Through education, accountability, enacting protocols, and following guidelines set by health professionals[5-7] , we can help prevent these needless cases of severe heat illness and death.

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BACKGROUND In 2020, COVID-19 spread across the world and brought the world to a halt, causing the shutdown of nearly everything in order to prevent its spread. The NFL experienced the same effects of the shutdowns leaving athletes unable to train in some of the most advanced facilities with many of the best trainers in the world. Through a previous study, COVID-19 Return to Sport Injury Prevalence Analysis, it was determined that there was increased injury prevalence during the 2020 season likely due to decreased physiological adaptations within athletes bodies that resulted from facility shutdowns. Understanding injury epidemiology is vital in the prevention of injuries and the development of return-to-play protocols. OBJECTIVE The objective of this study is to perform a follow up study to COVID-19 Return to Sport Injury Prevalence Analysis in order to to examine the longitudinal effects of the COVID-19 pandemic on injury epidemiology. This study will examine if there was a recovery to baseline or lingering effects from the COVID-19 pandemic-induced spike in injuries. METHODS Injury tallies collected from the 17-week-long 2020 NFL regular season, played after COVID-19 restrictions, were compared with the injury tallies collected from the 18-week-long NFL regular seasons (2021, 2022), in order to determine if there was a change in injury prevalence. An unpaired t-test was conducted to compare the mean injuries per team per week between each of the 2020, 2021, and 2022 regular seasons. RESULTS The 2022 and 2021 NFL regular seasons produced lower numbers of total injuries than the 2020 NFL regular season that was impacted by COVID-19. The comparison of the mean number of injuries per team per week of the 2020 season compared with the 2021 regular season was statistically significant (P=.03). The comparison of the 2020 and 2022 regular seasons was also statistically significant (P=.02). CONCLUSIONS The results of this follow-up study and our previous study show that extended training interruptions have the ability to induce detraining and lead to increased injuries. Additionally, the results of this study show that retraining can occur and lead to injury protective factors. This is the first large scale opportunity to demonstrate the effects of these principles and how they are important to understanding injury epidemiology.