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Introduction: Virtual interviews (VI) are now a permanent part of pediatric emergency medicine (PEM) recruitment, especially given the cost and equity advantages. Yet inability to visit programs in person can impact decision-making, leading applicants to apply to more programs. Moreover, the cost advantages of VI may encourage applicants to apply to programs farther away than they might otherwise have been willing or able to travel. This could create unnecessary strain on programs. We conducted this study to determine whether PEM fellowship applicants would apply to a larger number of programs and in different geographic patterns with VI (2020 and 2021) as compared to in-person interviews (2018 and 2019). Methods: We conducted an anonymous national survey of all PEM fellows comparing two cohorts: current fellows who interviewed inperson (applied in 2018/2019) and fellows who underwent VIs in 2020/ 2021 (current fellows and those recently matched in 2021). The study took place in March–April 2022. Questions focused on geographic considerations during interviews and the match. We used descriptive statistics, chi-square and t-tests for analysis. Results: Overall response rate was 42% (231/550); 32% (n = 74) interviewed in person and 68% (n = 157) virtually. Fellows applied to a median of 4/6 geographic regions (interquartile range 2, 5). Most applied for fellowship both in the same region as residency (216, 93%) and outside (192, 83%). Only the Pacific region saw a statistically significant increase in applicants during VI (59.9% vs 43.2%, P = 0.02). There was no statistical difference in the number of programs applied to during in-person vs VI (mean difference (95% confidence interval 0.72, −2.8 – 4.2). A majority matched in their preferred state both during VI (60.4%) and in-person interviews (65.7%). The difference was not statistically significant (P = 0.45). Conclusion: While more PEM fellowship applicants applied outside the geographic area where their residency was and to the Pacific region, there was no overall increase in the number of programs or geographic areas PEM applicants applied to during VI as compared to in-person interview seasons. As this was the first two years of VI, ongoing data collection will further identify trends and the impactof VI. [ABSTRACT FROM AUTHOR]

The article focuses on disparities for women in pediatrics and emergency medicine in the U.S. Topics discussed include proposed actions toward resolving gender disparities in academic medicine, the gender distribution of physicians in the medical subspecialties and the rate of change of women in leadership positions.

PURPOSE: Components of trainee applications may introduce bias based on race or gender. Behavior-based interviews (BBIs) rely on structured questions to elicit applicants' past experiences to predict future behavior. Our objective was to implement BBIs in one fellowship program and compare applicant assessment by race and gender when using a standardized assessment tool versus a BB1-based tool. METHODS: In 2019 and 2020, we developed BBIs and BBI-specific assessments; 6 of 15 faculty were trained in this interview method. Applicants completed 6 interviews with either a BBI or unstructured format. All faculty completed a standardized assessment on applicants. BBI faculty also completed a BBI-specific assessment. Normalized average scores were cal-culated and used to rank applicants into quartiles. Race was categorized into White, underrepresented minorities (URMs: Black and Hispanics), and non-URMs (all others). Faculty and applicants were surveyed about BBIs. RESULTS: Seventy-five applicants were interviewed. Significant differences were found in standardized assessment scores (White 1.01 +/- 0.09, non-URM 1.02 +/- 0.08, URM .94 +/-0.07; P = .02) and quartiles by race (P = .05), but not for BBI scores (White 0.98 +/- 0.09, non-URM 1.03 +/- 0.09, URM 1.02 +/- 0.1; P = .18) or quartiles by race (P = .17). There were no significant differences in score or quartile by gender for either tool. The majority of faculty and applicant survey respondents commented positively about BBIs. CONCLUSION: BBIS were successfully implemented and generally reviewed positively by faculty and applicants. BBIs reduced racial differences in applicant assessments. Applicant assessment may benefit from structured tools to mitigate potential biases. [ABSTRACT FROM AUTHOR]

Background: Burnout is a common phenomenon among health care providers known to adversely affect their mental health and clinical acumen. As mindfulness has been shown to diminish burnout with large-scale interventions, our aim was to assess whether smaller, on-shift activities aimed at increasing mindfulness could decrease burnout among staff in a pediatric emergency department (PED). Methods: Prior to the implementation of a series of mindfulness-based activities, a diverse cohort of PED staff including nurses, physicians, nurse practitioners, technicians, and administrative personnel completed electronic preintervention surveys about their demographics, personal mindfulness engagement, and individual baseline burnout level using the Maslach Burnout Inventory (MBI). Trained nurses and physicians served as champions who coordinated on-shift mindfulness activities, and burnout levels were subsequently reassessed using a postintervention survey. Findings: Among 83 eligible staff, 75 completed the preintervention and 69 completed the postintervention survey. For the MBI, the majority of staff had moderate to high burnout levels at baseline. Few staff engaged in personal mindfulness activities outside of work. Although 82% of staff participated in the on-shift interventions, no significant differences were found in scores before and after the intervention for emotional exhaustion (20.1 vs. 20, p =.93), depersonalization (7.6 vs. 7.3, p =.97), and personal accomplishment (36.1 vs. 34.8, p =.11). Conclusion/Application to Practice: While mindfulness effectively combats burnout, few PED providers regularly practice mindfulness activities. Brief, on-shift mindfulness activities were insufficient to significantly reduce burnout levels. Hospital leadership should consider dedicating resources to more intensive mindfulness activities to combat amplified burnout levels among emergency department staff. [ABSTRACT FROM AUTHOR]

Objectives: Unrecognized dislodgement of an endotracheal tube (ETT) during the transport of an intubated patient can have life-threatening consequences. Standard methods to monitor these patients, such as pulse oximetry and physical examination, are both subject to inaccuracies with patient movement and ambient noise. Capnography provides a continuous and objective measure of ventilation that can alert a provider immediately to an airway problem. The objective of this study was to determine through simulation if capnography decreases time to correction of dislodged ETTs during the transport of intubated patients, in comparison to standard monitoring. Methods: Paramedics and paramedic students were randomized as to whether or not they had capnography available to them in addition to standard monitoring during a simulated scenario. In the scenario, subjects monitored an intubated baby who subsequently experiences a dislodgement of the ETT during interfacility transport. Time to correction of the ETT dislodgement was the primary outcome. The secondary outcome was correction of dislodgement prior to decline in pulse oximetry. Results: Fifty-three subjects were enrolled in the study, with complete data on 50 subjects. Median time to correction of ETT dislodgement was 2.02 minutes (95% confidence interval [CI] = 1.22 to 4.12 minutes) for the capnography group versus 4.00 minutes (95% CI = 3.35 to 5.50 minutes) in the standard monitoring group (p = 0.05). Forty-eight percent of subjects using capnography corrected the ETT dislodgement prior to decline in pulse oximetry compared with 12% of controls (p = 0.01). There were no differences in time to correction of dislodgement based on years of experience, perceived comfort, reported adequacy of teaching, or past use of capnography. Conclusions: The addition of capnography to standard monitoring significantly improves recognition of ETT dislodgement and reduces the time to correction of dislodged ETTs by prehospital providers in a simulated pediatric transport setting. [ABSTRACT FROM AUTHOR]