Purpose First‐year medical students (M1s) at the Icahn School of Medicine at Mount Sinai begin their year with Structures course, which opens their medical education, covering gross anatomy, embryology, and histology. Second‐year medical students (M2s) serve as teaching assistants (TAs) for this course and their responsibilities include leading comprehensive review sessions prior to each set of exams. Historically, such reviews have taken place in small‐group classrooms, with groups of 10‐18 M1s rotating through a series of rooms, each hosting a rapid‐fire review of a specific topic, conducted by several TAs. In 2020, the virtual setting imposed by COVID‐19 restrictions demanded creativity to rethink the format of these review sessions, leading to the implementation of a large‐group, interactive format, with all M1s in the same remote video session, covering material at a slower pace. We here examine the effectiveness of this large‐group, interactive format. Methods: The first two review sessions of Structures 2020 mimicked the traditional style, with groups of M1s rotating through a series of 20‐minute Zoom sessions led by M2s TAs. For the last two review sessions, all students remained in one 3‐hour Zoom session, and TAs covered certain material at certain times, with more or less time allotted depending on the difficulty and amount of material. TAs also incorporated more interactivity with real time quizzes on high‐yield topics and direct practical questions through the review. We surveyed M1s regarding which format they preferred and also solicited qualitative feedback from M1s and TAs throughout Structures. Results: 55% of M1s preferred the large‐group format, with 23% preferring the traditional format and 23% expressing no preference. Many TAs also expressed preferences for the large‐group format. Qualitative feedback from M1s indicated that they appreciated the interactivity with quizzes and practical questions. Conclusion: In the remote environment, most students preferred a large‐group, interactive format over the small‐group rotation format. Main advantages observed were: 1) time flexibility: complex components of the session addressing challenging topics were covered more extensively and in‐depth; 2) In the large group, all M1s experience the session equally, including the answers to all questions from their classmates. Such interactivity is not compatible with the small group format and can be challenging in its compressed timeframe. 3) optimization of M2 TAs workforce: in the large session TAs are assigned with a section of the review and lead the review of their only once, for a short period of time, while in the small group format, TAs are required to repeat the review of their topic multiple times. The effectiveness of this format may have implications once in‐person instruction resumes; for example, review sessions could be conducted in a lecture hall, in an in‐person setting, or virtually, in a hybrid learning system, to facilitate the advantages of the large‐group interactive format.

Background: Intracranial chondrosarcomas are slowly growing malignant cartilaginous tumors that are especially rare in adolescents. Case Description: A 19-year-old woman with no medical history presented with symptoms of intermittent facial twitching and progressive generalized weakness for 6 months. The patient’s physical examination was unremarkable. Imaging revealed a large bifrontal mass arising from the falx cerebri, with significant compression of both cerebral hemispheres and downward displacement of the corpus callosum. The patient underwent a bifrontal craniotomy for gross total resection of tumor. Neuropathologic examination revealed a bland cartilaginous lesion most consistent with low-grade chondrosarcoma. Her postoperative course was uneventful, and she was discharged to home on postoperative day 3. Conclusion: This is an unusual case of an extra-axial, non-skull base, low-grade chondrosarcoma presenting as facial spasm in an adolescent patient.

ObjectivesExtended high‐frequency (EHF) audiometry elicits pure‐tone thresholds at frequencies above 8 kHz, which are not included in routine clinical testing. This study explores the utility of EHF audiometry in patients with various audiologic symptoms despite normal‐hearing thresholds at ≤8 kHz.MethodsA retrospective review was performed of all patients receiving conventional (250–8 kHz) and EHF (9–20 kHz) audiometry at a tertiary otological referral center between April 2021 and August 2022. Only patients with audiologic symptoms and pure‐tone thresholds ≤25 dB HL at ≤8 kHz bilaterally on routine testing were included in subsequent analysis. EHF‐PTA was defined for each ear as an average of the air conduction thresholds at 9.0, 10.0, 11.2, 12.5, 14.0, 16.0, 18.0, and 20.0 kHz.ResultsOf the 50 patients who received EHF testing, 40 had audiologic symptoms and normal conventional audiograms at ≤8 kHz. Twenty‐five of the 40 (62.5%) were found to have hearing loss in the highest frequencies. Patients with EHF hearing loss (EHF‐HL) were more likely to report subjective hearing loss. Age was significantly greater in those with EHF‐HL compared with those without EHF‐HL, and age was positively correlated with the degree of EHF‐HL.ConclusionEHF testing correlates with audiologic symptoms in patients with normal testing at ≤8 kHz and may be considered when standard audiometry is normal. Additional data are warranted to create an evidenced‐based, clinical algorithm for EHF audiometry that can guide treatment, direct mitigation strategies, and potentially identify those at higher risk of hearing loss over time.Level of Evidence4 Laryngoscope, 2023