To describe the characteristics of hospitalized children with severe acute respiratory syndrome coronavirus 2 in New York City metropolitan area. PATIENTS AND METHODS:This was a multicenter, retrospective cohort study at 4 hospitals comprising 82 hospitalized children (0-21 years) who tested positive for severe acute respiratory syndrome coronavirus 2 after symptoms and risk screening between March 1 and May 10, 2020. We subdivided patients on the basis of their admission to acute or critical care units and by age groups. Further subanalyses were performed between patients requiring respiratory support or no respiratory support. RESULTS: Twenty-three (28%) patients required critical care. Twenty-nine (35%) patients requiring respiratory support, with 9% needing mechanical ventilation, and 1 required extracorporeal support. All patients survived to discharge. Children with any comorbidity were more likely to require critical care (70% vs 37%, P 5 .008), with obesity as the most common risk factor for critical care (63% vs 28%, P 5 .02). Children with asthma were more likely to receive respiratory support (28% vs 8%, P 5 .02), with no difference in need for critical care (P 5 .26). Children admitted to critical care had higher rates of renal dysfunction at presentation (43% vs 10%, P 5 .002). CONCLUSIONS:Children with comorbidities (obesity and asthma in particular) were at increased risk for critical care admission and/or need for respiratory support. Children with renal dysfunction at presentation were more likely to require critical care.

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The COVID-19 pandemic caused by the SARS-CoV-2 virus presents new diagnostic challenges including differentiating COVID-19 infection from other diagnostic entities. Both COVID-19 infection and acute endocarditis may present with hypoxic respiratory failure, fever, and elevated inflammatory biomarkers. The task of distinguishing the two is complicated by the complexities of interpreting SARS-CoV-2 RT-PCR test results. The RT-PCR test may be negative early in the disease course 1-3 and may remain positive long after the initial infection due to viral clearance delay. 4,5 Here, we present two cases of left-sided endocarditis, which were both initially attributed to COVID-19 infection, and only correctly diagnosed after echocardiography was performed.

Twenty-seven pediatric residents were assessed for knowledge, attitudes, and behaviors regarding rights of immigrant families. A program documenting immigrant rights was reinforced in the clinic with posters and individual consultations on immigrant children's needs. This brief program was effective in instructing residents on health and nutritional services for immigrant patients.

The COVID-19 pandemic has dramatically disrupted the educational experience of medical trainees. However, a detailed characterization of exactly how trainees’ clinical experiences have been affected is lacking. Here, we profile residents’ inpatient clinical experiences across the four training hospitals of NYU’s Internal Medicine Residency Program during the pandemic’s first wave. We mined ICD-10 principal diagnosis codes attributed to residents from February 1, 2020, to May 31, 2020. We translated these codes into discrete medical content areas using a newly developed “crosswalk tool.” Residents’ clinical exposure was enriched in infectious diseases (ID) and cardiovascular disease content at baseline. During the pandemic’s surge, ID became the dominant content area. Exposure to other content was dramatically reduced, with clinical diversity repopulating only toward the end of the study period. Such characterization can be leveraged to provide effective practice habits feedback, guide didactic and self-directed learning, and potentially predict competency-based outcomes for trainees in the COVID era.

ProblemInternal medicine training programs operate under the assumption that the 3-year residency training period is sufficient for trainees to achieve the depth and breadth of clinical experience necessary for independent practice; however, the medical conditions to which residents are exposed in clinical practice are not easily measured. As a result, residents' clinical educational experiences are poorly understood.

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Background Experiential learning through patient care is fundamental to graduate medical education. Despite this, the actual content to which trainees are exposed in clinical practice is difficult to quantify and is poorly characterized. There remains an unmet need to define precisely how residents’ patient care activities inform their educational experience.  Methods Using a recently-described crosswalk tool, we mapped principal ICD-10 discharge diagnosis codes to American Board of Internal Medicine (ABIM) content at four training hospitals of a single Internal Medicine (IM) Residency Program over one academic year to characterize and compare residents’ clinical educational experiences. Frequencies of broad content categories and more specific condition categories were compared across sites to profile residents’ aggregate inpatient clinical experiences and drive curricular change. Results There were 18,604 discharges from inpatient resident teams during the study period. The crosswalk captured > 95% of discharges at each site. Infectious Disease (ranging 17.4 to 39.5% of total discharges) and Cardiovascular Disease (15.8 to 38.2%) represented the most common content categories at each site. Several content areas (Allergy/Immunology, Dermatology, Obstetrics/Gynecology, Ophthalmology, Otolaryngology/Dental Medicine) were notably underrepresented (≤ 1% at each site). There were significant differences in the frequencies of conditions within most content categories, suggesting that residents experience distinct site-specific clinical content during their inpatient training. Conclusions There were substantial differences in the clinical content experienced by our residents across hospital sites, prompting several important programmatic and curricular changes to enrich our residents’ hospital-based educational experiences.