Background Travel costs and application fees make in-person residency interviews expensive, compounding existing financial burdens on medical students. We hypothesized virtual interviews (VI) would be associated with decreased costs for applicants compared to in-person interviews (IPI) but at the expense of gathering information with which to assess the program. Objective To survey senior medical students and postgraduate year (PGY)-1 residents regarding their financial burden and program perception during virtual versus in-person interviews. Methods The authors conducted a single center, multispecialty study comparing costs of IPI vs VI from 2020-2021. Fourth-year medical students and PGY-1 residents completed one-time surveys regarding interview costs and program perception. The authors compared responses between IPI and VI groups. Potential debt accrual was calculated for 3- and 7-year residencies. Results Two hundred fifty-two (of 884, 29%) surveys were completed comprising 75 of 169 (44%) IPI and 177 of 715 (25%) VI respondents. The VI group had significantly lower interview costs compared to the IPI group (median $1,000 [$469-$2,050 IQR] $784-$1,216 99% CI vs $3,200 [$1,700-$5,500 IQR] $2,404-$3,996 99% CI, P<.001). The VI group scored lower for feeling the interview process was an accurate representation of the residency program (3.3 [0.5] vs 4.1 [0.7], P<.001). Assuming interview costs were completely loan-funded, the IPI group will have accumulated potential total loan amounts $2,334 higher than the VI group at 2% interest and $2,620 at 6% interest. These differences were magnified for a 7-year residency. Conclusions Virtual interviews save applicants thousands of dollars at the expense of their perception of the residency program.
Enhanced recovery after surgery (ERAS) and perioperative surgical home (PSH) initiatives are widely utilized to improve quality of patient care. Despite their established benefits, implementation still has significant barriers. We developed a survey for perioperative clinicians to gather information on perception and knowledge of ERAS/PSH programs to guide future expansion of these programs at our institution. The survey included questions about familiarity with ERAS/PSH and perceived value, perceived barriers to protocol implementation, preferred learning methods and prioritization of various ERAS/PSH protocol elements into care delivery and provider education. Faculty surgeons and anesthesiologists, in addition to advanced practice nurses and postgraduate physician trainees in the Departments of Surgery and Anesthesiology were asked to complete the survey. Overall survey participation was 25% (223/888). About half of survey respondents had provided care to a patient on an ERAS/PSH protocol, and a majority felt at least somewhat knowledgeable about ERAS/PSH protocols. Perception of the value of ERAS/PSH was positive. Participants were enthusiastic about on-going learning, with multimodal pain management being the topic of most interest and learning by direct participation in care of protocol patients being the favored educational approach. A significant majority of participants felt that upcoming health providers should receive formal ERAS/PSH education as part of their training. Based on our survey results, we plan to explore teaching methods that successfully engage learners of all levels of clinical expertise and also overcome the major barriers to gaining knowledge about ERAS/PSH identified by study participants, most notably lack of time for busy clinicians.
Background: Long periods of time with opened, uncovered sterile case carts and high rates of operating room (OR) traffic are correlated with contamination risk. We studied the length of time the case cart was open before incision and compared room traffic frequency before and after surgical incision. Methods: Thirty-three orthopaedic implant cases were observed at three hospitals over an 8-week period. Observation began at the opening of the implant case cart and concluded when the final dressing was placed. The length of time the sterile case cart was open before the patient was in the room and before an incision was made was recorded. Traffic was counted any time a surgical door opened and stratified on a per-hour basis. The traffic rate was counted before and after incision. Results: The average length that the case cart was open prior to the patient being in the room was 43.2 (±29.7) mins, (range, 0-153). On average the case cart was open 91.5 (±31.2) mins, (range, 45-189) prior to the incision. The room traffic was significantly greater during preincision period (45.0±12.8), than during postincision period (26.6±12.8) (P<0.0001). The average number of people in the operating room was 6.9 (±2.7). Conclusions: Room traffic during orthopaedic implant cases is high, with more than one door opening every 2 min. The highest frequencies of traffic occurred before incision but after case carts were opened. Case carts usually were opened more than 1 hr before incision for orthopaedic implant cases.
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