Purpose: The COVID-19 pandemic precipitated an entirely virtual 2020-2021 residency application cycle. As many specialties plan to continue virtual interviews, it is essential to evaluate what aspects worked well and what can be improved. Methods: From April to June 2021, authors surveyed participants of the 2020-2021 Match about their experiences with the virtual application cycle. Survey items asked about benefits and drawbacks of virtual interviews, the utility of social media, and thoughts regarding preference signaling mechanisms and application/interview limits. Results: Participants (n=158) represented 24 states and applied to 31 specialties. The majority (73.1%) were satisfied with their experience during the 2020-2021 Match. Applicants found Twitter (78.4%) and Instagram (69.1%) to be the most helpful social media platforms. Almost all applicants (98.1%) believed that the virtual setting increased financial access to interviews. The majority (68.6%) indicated that residency programs should continue to provide virtual interviews. However, most applicants (73.9%) felt that the virtual setting allowed more students to hoard interviews. Many (66.1%) also felt their medical school did not provide adequate electronic equipment for conducting virtual interviews. While many applicants (56.9%) did not support a cap on the number of applications one can submit, most supported a limit on the number of interviews one can attend (62.7%) as well as a mechanism to signal genuine interest in a program (59.7%). Conclusions: Our study highlights that, across geography and specialty, many applicants would like virtual interviews to continue and offers insight into how medical schools and residency programs can best support applicants in the virtual environment. The virtual setting also provides an opportunity to evaluate mechanisms to address the congestion from the increasingly high number of applications residency programs receive, with most applicants supporting interview caps and preference signaling.

Boerhaave’s syndrome or spontaneous perforation of the oesophagus is a life-threatening condition that carries high mortality. Delayed diagnosis has a mortality rate of 20%–50%. While surgical intervention has been the mainstay of treatment, advancements in endoscopy and oesophageal stenting have allowed for alternative management. Our case involves a 33-year-old man with self-induced emesis and DKA. After 10 days in the ICU, he developed a large right pleural effusion, which was treated with chest tube placement. Upper GI study confirmed delayed Boerhaave’s syndrome. A self-expanding stent was inserted followed by percutaneous endoscopic gastrostomy (PEG) for decompression and jejunal extension for nutrition. He developed empyema and underwent right thoracotomy for washout and lung decortication. Stent was exchanged once due to recurrent leak following migration and removed after 40 days. Endoscopic stent placement with PEG with jejunal extension followed by thoracotomy is a viable alternative to primary repair of delayed oesophageal perforation.

Cholecystogastric and cholecystocolonic fistulae are rare sequelae of longstanding cholelithiasis and can complicate surgical management. Our case involves a male patient in his early 40s with a history of chronic cholelithiasis who presented to the emergency department with severe abdominal pain. Findings on imaging were consistent with acute calculous cholecystitis. During laparoscopic cholecystectomy, the presence of both cholecystogastric and cholecystocolonic fistulae was discovered. Fistula resection with cholecystectomy in a one-step approach using indocyanine green (ICG) angiography was performed. The patient improved and was discharged 3 days later. Laparoscopic management complemented by ICG angiography is a viable surgical approach in patients with cholecystogastric and cholecystocolonic fistulae.

No abstract