Background Undergraduate medical education was severely impacted by the COVID-19 pandemic. As traditional clinical rotations were suspended, medical students quickly began alternative, novel educational experiences. Third-year medical students at an academic medical center were given the opportunity to join inpatient eConsult teams within the department of medicine. This study describes the development and implementation of this program as well as the experiences of student and faculty participants. Methods Student eConsult participation was rapidly developed and implemented within medical subspecialty teams in either infectious diseases (ID) or nephrology. Twelve third-year medical students and 15 subspecialty attendings participated in this program during an eight-week period from April 6 through May 29, 2020. Breadth of student clinical experience was assessed via review of clinical documentation and surveys. Participating students and attending physicians completed surveys to reflect upon their impressions of the program. Surveys were returned by nine students and eight faculty members. Survey responses were summarized with descriptive statistics. Results Over an eight-week period, student consultants wrote 126 notes on 100 patients; 74 of these patients (74%) were hospitalized with COVID-19. Student experiences were largely positive with most strongly agreeing that attendings promoted interactive and engaged learning (N = 8 of 8, 100%), that the experience helped to expand their knowledge about consultant roles (N = 6, 75%), and that they would participate in a remote eConsult program again if given the opportunity (N = 6, 75%). Faculty also were largely positive about the experience with most agreeing or strongly agreeing with the importance of teaching medical students about telehealth (N = 7 of 8, 88%) and eConsults (N = 6, 75%). In narrative responses, students and faculty agreed that teaching was a strength of the program whereas lack of in-person contact was a challenge. Conclusions Rapid development of an inpatient eConsult-based educational experience for third-year medical students was feasible and successful. Student-consultants saw a range of pathology including COVID-19 and related complications. Students were satisfied with the program. They were able to develop a strong relationship with attendings while learning about the role of a consultant. Faculty agreed with the importance of teaching students about telehealth and eConsults specifically.

Aim To identify factors associated with baseline prolonged corrected QT (QTc) and higher risk of QTc prolongation during follow‐up in patients with Rett syndrome (RTT). Method A retrospective review of patients receiving an electrocardiogram (ECG) between June 2012 and June 2018 was performed. Age, methyl‐CpG binding protein 2 gene (MECP2) mutation, RTT Severity Scale (RSSS) score, breathing abnormalities, seizure frequency, medications, and ECG parameters were collected. Prolonged QTc was defined as greater than or equal to 460ms. Comparisons at baseline and during follow‐up were made. Results In total, 129 unique patients (all female) had 349 ECGs. At baseline, 12 (9.3%) had a prolonged QTc (median 474ms, interquartile range 470–486ms) and were more likely to have moderate/severe breathing abnormalities (66.7% vs 24.8%; p=0.005) and take selective serotonin reuptake inhibitors (SSRIs) (41.7% vs 15.4%; p=0.04). There was no difference in age, RSSS score, seizures, or mutation. Twenty‐six developed prolonged QTc during a median follow‐up of 1 year 7 months (interquartile range 0–3y 6mo). QTc prolongation was associated with p.(Thr158Met) mutation versus the remaining six common mutations (hazard ratio 4.1, 95% confidence interval 1.4–12.0; p=0.01) but not with age, RSSS score, seizures, breathing abnormalities, or SSRIs. Interpretation Breathing abnormalities and SSRIs were associated with baseline QTc prolongation and those with p.(Thr158Met) mutation were more likely to develop prolonged QTc over time. Identification of patients with prolonged QTc warrants increased clinical monitoring. What this paper adds Breathing abnormalities and selective serotonin reuptake inhibitors are associated with prolonged baseline corrected QT (QTc). Development of QTc prolongation is associated with the p.(Thr158Met) mutation.

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17 Background: Cancer diagnosis, staging work up and treatment need to be done in a timely manner but are rarely emergencies. Cancer work up during a hospital admission is costly and can take away resources that are needed for more urgent patients. We aim to understand factors related to cancer work up in the hospital inpatient setting. Methods: Patients with a new diagnosis of colon cancer at a single academic institution in 2018 were identified using cancer registry. Patients were excluded if they had cancer other than carcinoma or if data on more than half of their work up was not available for review. A chart review was performed to obtain factors including their demographics, details on their cancer presentation, diagnostic and staging work up and treatment. Patients were considered to have had inpatient work up (Inpt_WU) if 50% or more of their cancer related diagnostic, staging and pre-treatment work up was conducted during a hospital admission, and included imaging, bloodwork, evaluation by consultants. Inpt_WU and non-Inpt_WU patients were compared. Logistic regression model was used calculate odds ratio (OR) and 95% confidence intervals (CI) to identify associations with Inpt_WU. Results: Data on 121 newly diagnosed colorectal cancer patients were analyzed. Inpt_WU occurred in 63 (52%) of the cohort. Inpt_WU and non-Inpt_WU patients required the same median number of work-up events [6, interquartile range (IQR) 5, 6]. Inpt_WU patients were more likely to initially present to the emergency department (ED: 91% vs 16%, p<0.001), have Medicaid insurance (40% vs 17%, p=0.018), be functionally dependent (30% vs 16%, p=0.091), have more defined symptoms (75% vs 45% p=0.001), and have greater cancer severity (metastatic disease 33% vs 17%, p=0.004). The median time between presentation and treatment initiation was markedly less for Inpt_WU compared to non-Inpt_WU [11 days (IQR 5, 24) vs 48 (IQR 37, 81), p<0.001]. The logistic model showed that ED presentation had over 40-fold higher odds of Inpt_WU (OR 41.2, 95% CI 12.1-177.4) after adjusting for comorbidities, insurance, functional status, symptoms, and cancer severity. Conclusions: The cancer diagnostic and pre-treatment work-up process was markedly expedited when done during hospital admission. Most cancers presenting to the ED as the initial location of presentation resulted in admission and cancer work up in the hospital. Further studies are needed to explore whether all of these patients necessitate inpatient admission, and whether healthcare systems can be modified to mimic the efficiency of in-hospital workup.

52 Background: Delays in colon cancer (CC) treatment can impact patient outcomes. Detailed examination into the patterns and reasons for delay in the diagnostic and pre-treatment work up are understudied, hindering the development of strategies to improve timeliness of care. Methods: CC patients diagnosed at an urban academic institution in 2018 were investigated. Chart review yielded presentation location, diagnostic-work up, treatment and patient characteristics. Time between presentation to the healthcare provider to treatment initiation of ≥ 60 days was considered a delay (Total_Delay). Total time further examined as 3 phases: presentation to diagnosis (PtoD), diagnosis to staging completion (DtoS), and staging completion to treatment (StoT). Delays for each phase was defined as ≥ 30 days. Total_Lt60d vs non-Total_Ge60d were compared. A logistic regression model was used to calculate odds ratio (OR) and 95% confidence intervals (CI) to identify associations with Total_Ge60d. Results: Among 121 CC patients, the median time and interquartile range (IQR) between presentation and treatment initiation was 29 (IQR 8, 53) days. Total_Delay occurred in 21% of patients. The median time between presentation and treatment and interquartile range (IQR) for Total_Delay was 106 (IQR 82, 162) and 16 (IQR 6, 39) for non-Total_Delay. Age, sex, race, and comorbidities were similar between Total_Delay and non-Total_Delay. Total_Delay patients were generally more functionally independent (92% vs 74%, p < .06), presented to locations other than the emergency department (64% vs 42%, p < .075) and were less likely to have hospital admission work-up (20% vs 60%, p < .001) compared to non-Total_Delay. The logistic model showed that Total_Delay is associated with non-hospital work-up (OR 8.3, 95% CI 1.9-45.3), adjusting for comorbidities, symptoms, functional status, cancer severity, and insurance. Delays similarly occurred in all three phases for Total_Delay patients; 48% had delay during PtoD, 60% during DtoS, and 48% during StoT. The most common reason for delay by phase was the following; in the PtoD phase, 5 of 11 (46%) was due to obtaining endoscopy, in DtoS and StoT, 6 of 15 (40%) and 5 of 11 (46%), respectively, was in getting outpatient specialty appointments. Delays due to patient factors (PtoD 18%, DtoS 27%, StoT 28%) were less frequent. Conclusions: Delays to treatment for CC are largely driven by health systems delays. Bundling of diagnostic evaluation and pre-treatment that mimics work-up during a hospital admission may overcome delays in cancer care.

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