Background Ensuring high-quality patient-centered care for critically ill coronavirus disease 2019 (COVID-19) patients presents unprecedented challenges. Many patients become critically ill unexpectedly and have not previously discussed their health-care wishes. Clinicians lack experience with this illness and therefore struggle to predict patient outcomes. Measures Critical care medicine (CCM) providers were surveyed about the effectiveness and efficiency of a pilot intervention. Intervention Proactive palliative care rounding with CCM providers on COVID-19 intensive care units. Outcomes Fifty-four percent of CCM providers responded to the survey (21/39). CCM providers rated the intervention highly across all domains. CCM providers frequently identified that early palliative involvement was critical to providing families with information and support when separated from their loved ones. Conclusions/Lessons Learned This pilot study found that proactive rounding improves critical care provider assessments of quality of care for patients and families and allows CCM providers to focus their efforts on managing complex physiology and surges.

Background Traumatic duodenal injury is a rare, potentially devastating condition with challenging management decisions. Contemporary literature on operative management of duodenal injury is lacking. The purpose of this study is to assess optimal management strategies based on outcomes of patients with traumatic duodenal injury at a single trauma center. Methods A retrospective study of patients with traumatic duodenal injury from 2013-2020 at a level 1 trauma center was performed. Patient demographics, grade of injury as noted on CT scan or intraoperatively, surgical procedure(s) performed, and resultant outcomes were extracted. Results After excluding one patient due to death on arrival, 23 patients met inclusion criteria. Injuries consisted of grade 1 (n = 7), grade 2 (n = 2), grade 3 (n = 12), and grade 5 (n = 2); there were no grade 4 injuries. Patients were predominantly male (83%) with a median age of 30 years old. Nineteen patients (82%) underwent surgery. Four of nine patients (44%) with grade 1/2 injuries had hematomas and were managed non-operatively. The remaining five patients (56%) with grade 1/2 injuries underwent operation, which included primary repair (n = 3), duodenal exclusion (n = 1), and periduodenal drainage (n = 1). Of 12 patients with grade 3 injury, 6 underwent primary repair and 6 underwent resection. Three patients who underwent primary repair and one who underwent resection developed a duodenal leak. All patients with grade 5 injury (n = 2) underwent pancreaticoduodenectomy. Conclusion Grade 1 and 2 duodenal hematomas can be managed non-operatively, while lacerations require operative repair. Outcomes may be better following resection in patients with grade 3 injury.

Phenomenon: The American medical student perspective on the coronavirus pandemic, particularly in terms of its effects on medical education and future curricular approach, is valuable. This study seeks to provide future physicians with a voice to share their personal experience with distance learning and suggestions for medical education reform in the era of COVID-19. Approach: A virtual focus group of medical students was conducted on April 30, 2020. Each student was asked to broadly and candidly reflect on their personal experiences relative to the COVID-19 pandemic, and to specifically expound upon how their personal growth and medical education has been impacted. Consent was obtained. Data was coded by key ideas and themes. The content of the discussion was analyzed. Findings: Seven third-year medical students attending a United States traditional school of medicine consented to participate. All participants provided extensive responses to the question. The focus group lasted for 2 hours. The group expounded upon five self-initiated themes: guilt, anxiety, self-awareness, volunteerism, and autonomy. Analysis of these themes from the context of medical student wellness and the future of medical curricula led to the conclusion that three general concepts should be emphasized in reforming medical education. Insights: The coronavirus pandemic has uniquely affected medical students. Their perspectives can inform medical education reform relative to curricular design and student wellness. Key concepts to consider include prioritizing routine virtual delivery of content through innovative technology, encouraging increased student autonomy and self-directed learning through less prescriptive schedules, and emphasizing reflection training and sharing.