As paradigms of clinical care delivery have been significantly impacted by the novel coronavirus disease-2019 pandemic, so has the structure, delivery, and future of medical education. Both undergraduate and graduate medical education have seen disruptions ranging from fully virtual delivery of educational content and limited clinical care for medical students to increased clinical demands with redeployment for residents and fellows. Adherence to social distancing has led to the adoption and implementation of already available technologies in medical education, including video conferencing softwares and social media platforms. Efficient and effective use of these technologies requires an understanding not only of these platforms and their features but also of their inherent limitations. During a time of uncertainty and increased clinical demands, the approach to medical education must be thoughtful with attention to wellness of both the educator and learner. In this review, we discuss the influence of the pandemic on the existing medical education landscape, outline existing and proposed adaptations to social distancing, and describe challenges that lie ahead.

The prevalence of initial treatment failure is high (22%) in patients with SBP and doubles the 30-day mortality risk, supporting recommendations to retap all patients with SBP.

Introduction:Methadone is an effective medication for treating pain and has unique characteristics that require specialized knowledge to prescribe safely. Palliative care providers use methadone for analgesia in patients with a wide range of prognoses, goals of care, and comorbid conditions. New consensus guidelines for methadone use released in 2019 by the American Academy of Hospice and Palliative Medicine provide guidance for safe use in patients who have potentially life-limiting illnesses. A needs assessment of palliative care fellows and faculty at our institution highlighted lack of knowledge and confidence with regard to prescribing methadone. Methods: We created a virtual, flipped classroom, interactive learning module intended for palliative care fellows and practicing clinicians that emphasized updated practice recommendations. Participants took a pretest, reviewed an article and lecture, and completed practice cases prior to an interactive session conducted via videoconference. Following the session, participants completed a posttest to assess knowledge and confidence regarding the learning objectives. Results: A total of 28 clinicians at the fellow and faculty/staff levels completed the intervention during two sessions in 2020. Self-reported confidence in all educational objectives improved following the intervention. Participants demonstrated improved skill in calculating methadone doses, converting between modes of drug administration, and identifying safety guidelines during and after the intervention. Discussion: Following the intervention, participants reported improved confidence and demonstrated improved skills in prescribing methadone for pain. Additional benefits of this training model include ease of implementation, engaging format, and time and resource efficiency given its virtual format.

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tall doctor I had never met before came into the exam room, did not introduce himself, silently performed an ultrasound, and said ''there is no pregnancy in the uterus.'' When I put my face into my hands he said, ''I'll get the nurse'' and left. After years of trying and failing to have a baby, through residency, fellowship, and as an attending, this was the farthest I had ever made it. That morning I had been pregnant enough to vomit in the trash can under my office desk and scroll through maternity jeans online before rounds.I took a cab home and gathered the things I had squirreled away in the closet, a tiny blue polka dot dress, a children's book about a mouse in winter. I went to the hallway and shoved them down the trash chute.I was in the third year of my internal medicine residency training the first time I remember someone trying to teach me a way to respond to patients' emotions. I rolled my eyes along with everybody else. This is ridiculous, I remember thinking. I don't need to memorize a bunch of corny phrases to say to patients having a hard time. The attending drew the word NURSE in big letters on the white board and led us through the acronym. Name the emotion, he encouraged us. Express Understanding! Respect what you admire in the patient! Support! Explore! He made us practice sentences on each other from a photocopy: ''You seem frustrated.'' ''I can't imagine what it's like to hear this news.'' As a resident, my plan for dealing with hard situations was to use authentic emotions and respond like a human. My co-residents and rotation evaluations assured me that I was good with people.My skepticism about the need to teach empathy started to crumble when I became the patient and craved a bare minimum of understanding. I spent early mornings and covert lunch breaks at the fertility clinic. The waiting room walls were covered in giant photographs of flowers in fertile bloom as if they would wear off on us. Orchestral versions of pop songs played calmly over the speakers. Struggling to have a baby in your mid-30s as a physician is an unoriginal story. The clinic reflected this, full of