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Background The COVID-19 pandemic has led to substantial changes in the delivery of healthcare and medical education. Little is known about how the pandemic has altered medical students' perceptions in regard to career choice. Methods The authors developed and implemented a multi-center survey that evaluated medical students' career choice before and during the coronavirus pandemic. The survey was distributed to all levels of medical students (MS) at nine medical schools across the country from November 2020 to January 2021. The study was deemed exempt by the Institutional Review Board at the host institution, Sidney Kimmel Medical College at Thomas Jefferson University, and all participating sites. Results 1431 students completed the survey. The COVID pandemic was cited as a reason for a changed interest in specialty by 193 (13.5%) students. The most common reason for specialty change was the students’ clinical experience, followed by a desire to be on the front lines, and personal/family health concerns. There was a significant association between career change and degree of interest among students interested in emergency medicine (EM) as their future specialty before the COVID pandemic as well as during the COVID pandemic. Living with an immunocompromised individual had a significant association with a reduction of interest in EM. There was a significant association between EM rotation completion and how interested students were in EM as their future specialty before the COVID pandemic and during the COVID pandemic. Among EM interested students whose specialty interest was changed by the COVID pandemic, 34 (41.5%) became less favorable to EM, 28 (34.2%) stayed the same, and 20 (24.4%) students became more favorable to EM. Conclusions The impact of COVID-19 on medical students’ career choice is a complicated matter that involves both personal and professional factors. It appears that there is a trend towards less interest in the field of EM with multifactorial influences, some of which are related to the COVID-19 pandemic.

Introduction:In 2014, the residency program adopted a new chief resident model. Multiple other programs had adopted a similar style of having all final-year residents have a “chief” role. Chief residents are meant to be leaders in the residency, have a direct influence on the program, and serve as liaisons with other department chiefs.Method:Prior to 2014, the program had three chief residents a year: one Admin, one Academic, and one Recruitment. They were chosen using a vote amongst residents/faculty, with the ultimate decision made by the residency leadership. Many other residents were interested, and often qualified, but were ultimately not chosen. In 2014, the all-chief model was adopted. Each PGY-3 would have a responsibility. The goal was to give each a leadership opportunity, and a tangible product as they transition to fellowships or new jobs. The residents were allowed to pick their position, with some influence by residency leadership. Residents were encouraged to create new roles which aligned with their personal interests or career goals. Examples included Medical Director Chief, U/S chief, PEM chief and Wellness Chief.Results:Some residents thrived when given responsibility, while others did not. Some could not manage more responsibility: there was a clear disparity in the effort. At the start of this, all residents’ total shifts/month decreased equally. This created some controversy when the workload was not equal. The alteration of details, requirements, and expectations occurred every year in an attempt to correct the failures.Conclusion:Ultimately, the all-chief model was a failure. The program reverted to a traditional chief model, allowing only those the residency leadership felt could manage chief responsibilities to have a role. Those not doing a chief role were given additional shifts and those with less added work were given only a partial shift reduction.

Introduction:The COVID-19 pandemic hit Kentucky in March of 2020. While around the world the pandemic had already reared its head and strained international hospital systems at their core, Kentucky hospitals remained wholly underprepared. University of Kentucky Hospital is a relatively resource rich hospital. However, utilization of these resources was severely misplaced and inefficiently distributed. This led to unnecessarily large upfront costs in an attempt to prepare for large volumes of patients that never actually came, as well as risk stratifying patients in a costly and unproductive way.Method:We reviewed the initial response to the COVID-19 pandemic from the University of Kentucky as well as specifically within the emergency department. This included all system-wide preparations as well as emergency medicine-specific COVID-19 protocols regarding risk stratification of patients, testing, and delivering results.Results:Initially the number of patients that would need to be hospitalized with COVID-19 as well as how to risk stratify or treat them was completely unknown. This led to multiple large issues within University of Kentucky's response to the pandemic. A 400-bed field hospital was constructed out of University of Kentucky’s football field and subsequently deconstructed two months later before ever being used, costing the hospital $6.7 million dollars. Lack of tests and knowledge about the disease in combination with over ordering labs and CT scans in an attempt to risk stratify. There was no reliable way to obtain COVID-19 testing or deliver the results and this led to increased non-sick patients presenting to the ED just for information.Conclusion:The COVID-19 pandemic highlighted many shortcomings of our hospital system and its preparedness for a pandemic or mass disaster. The silver lining of these failures was the implementation of system wide improvements in throughput and preparation within our emergency department.

Introduction:The transition to residency is a challenging time in the medical trainee’s career. In addition to learning and implementing knowledge specific to emergency medicine, logistics and system nuances can initially impede a learner’s ability to begin the process of mastering their profession. In an attempt to ameliorate this transition to residency an orientation was created to introduce concepts of local ultrasound documentation, resuscitation protocols, EMR navigation, and procedural kits.Method:Interns were given a pre-workshop survey on comfort level (1-5 Likert) of ultrasound documentation, resuscitation protocols, EMR navigation, and procedural kits. They rotated through four workshop stations in small groups. The first was an ultrasound workshop showcasing our commonly used ultrasound and how we capture images and videos into our medical system for review. The next was institution specific protocols for medical and trauma resuscitation using simulation. Third was a workshop on how to navigate our electronic medical record with simple overviews of documentation and order entry. Lastly, they went through arterial and central line kits to familiarize themselves with the contents. A post-workshop survey was given.Results:Comfort with ultrasound documentation pre-workshop mean was 4.0 with a post-workshop mean of 4.45 (p=0.068). Comfort with resuscitation pre-workshop mean of 2.91 increased to 3.91 (p=0.008). Electronic medical record documentation comfort rose from a mean of 3.5 to 4.27 (p=0.007). Comfort navigating procedural kits increased to a mean of 4.09 from 3 (p=0.002).Conclusion:There was a statistically significant increase in comfort level with ultrasound documentation, resuscitation protocols, EMR navigation, and procedural kits after completion of the workshops. Only ultrasound documentation had a p value less than 0.05. It can be reasonably deduced that focusing on institutionally specific aspects of workflow can help interns expedite their education by familiarizing them with these nuances prior to their first shift.