A critical incident may be defined as a life-threatening crisis that requires rescue or emergency care. These incidents evoke strong emotional responses from health care workers. Some of the responses produced are normal and some are pathological stress and grief reactions. The Critical Incident Stress Debriefing process (CISD) is a model designed to mitigate the impact of such incidents on health care workers, to facilitate their return to routine functioning, and to prevent pathological responses to the trauma that is an inherent aspect of their profession. CISD is relied upon by hospital and emergency rescue professionals throughout the United States. The process was observed at St. Joseph's Hospital and Medical Center/Barrow Neurological Institute in Phoenix. This article examines the development of CISD and explores its implementation at St. Joseph's. Interviews conducted with health care workers who participated in the debriefing process following critical incident deaths are excerpted. Implications for death educators/counselors are discussed.

Strengthening EMS preparedness in response to suspected or confirmed HID cases may not only improve patient outcomes, but also worker and community safety.

OBJECTIVE In this article, the authors describe the impact of the COVID-19 virtual match cycle and discuss approaches to optimize future cycles through applicant and neurosurgical education leadership insights. METHODS Anonymous surveys of neurosurgery program leaders (program directors and program chairs), program administrators (PAs), and 2020–2021 neurosurgery residency match applicants were distributed by the SNS, in conjunction with the Association of Resident Administrators in Neurological Surgery and AANS Young Neurosurgeons Committee. RESULTS Responses were received from 77 (67.0%) of 115 PAs, 119 (51.7%) of 230 program leaders, and 124 (44.3%) of 280 applicants representing geographically diverse regions. During the virtual application cycle relative to the previous year, programs received more Electronic Residency Application Service applications (mean 314.8 vs 285.3, p < 0.0001) and conducted more applicant interviews (mean 45.2 vs 39.9, p = 0.0003). More than 50% of applicants applied to > 80 programs; 60.3% received ≤ 20 interview invitations, and 9% received > 40 invitations. Overall, 65% of applicants completed ≤ 20 interviews, whereas 34.7% completed > 20 interviews. Program leaders described one 4-week home subinternship (93.3%) and two 4-week external subinternships (68.9%) as optimal neurosurgical exposure; 62.8% of program leaders found the standardized letter of recommendation template to be somewhat (47.5%) or significantly (15.3%) helpful. Applicants, PAs, and program leaders all strongly preferred a hybrid model of in-person and virtual interview options for future application cycles over all in-person or all virtual options. Ninety-three percent of applicants reported matching within their top 10–ranked programs, and 52.9% of programs matched residents within the same decile ranking as in previous years. CONCLUSIONS Optimizing a national strategy for the neurosurgery application process that prioritizes equity and reduces costs, while ensuring adequate exposure for applicants to gain educational opportunities and evaluate programs, is critical to maintain a successful training system.

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