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Introduction The COVID-19 pandemic presented unpredicted challenges to Emergency Medicine (EM) education. The rapid onset of the pandemic created clinical, operational, administrative, and home-life challenges for virtually every member of the medical education community, demanding an educational and professional response at all levels including undergraduate medical education (UME), graduate medical education (GME), and faculty. The Council of Residency Directors in Emergency Medicine (CORD) COVID-19 Educational Impact Task Force was established in 2021 to examine these effects and the response of the EM educational community. Methods The Task Force utilized consensus methodology to develop the survey instruments, which were revised using a modified Delphi process. Both open- and closed-answer questions were included in the survey, which was initially distributed electronically to attendees of the 2021 Virtual Academic Assembly. Results were analyzed quantitatively and qualitatively. Results Sixty-three individuals responded to the first part of the survey (which addressed issues related to UME and GME) and 41 individuals responded to the second part of the survey (which addressed faculty and wellness). The pandemic's influence on EM education was viewed in both a positive and negative light. The transition to virtual platforms had various impacts, including innovation and engagement via technology. Remote technology improved participation in didactics and allowed individuals to more easily participate in departmental meetings. However, this also led to a decreased sense of connection with peers and colleagues resulting in a mixed picture for overall engagement and effectiveness. The Task Force has developed a list of recommendations for best practices for EM programs and for EM organizations. Conclusion The survey results articulated the educational benefits and challenges faced by EM educators during the COVID-19 pandemic. Through the challenging times of the pandemic, many institutional and program-based innovations were developed and implemented to address the new educational environment. These approaches will provide invaluable educational tools for future training. This will also prepare the EM academic community to respond to future educational disruptions.

Learning Objectives: We sought to describe the effects of COVID-19 on UME within EM.Background: The COVID-19 pandemic has affected multiple aspects of Undergraduate Medical Education (UME) beyond infection and illness. Many universities, medical schools, and hospitals instituted policy changes around educational gatherings and clinical participation. State-issued travel restrictions impacted both rotations and altered the Match process.Objectives: We sought to describe the effects of COVID-19 on UME within EM.Methods: CORD chartered a COVID-19 Task Force comprised of 18 selected educators to explore the pandemic’s impact on EM. A Modified Delphi process was used to develop multiple survey instruments. This process included a literature search for validated questions and internal piloting with iterative changes. After IRB approval, the UME survey was distributed to members of CORD during the 2021 Academic Assembly. Using SPSS v26, a descriptive analysis was performed.Results: Sixty-three individuals responded to the UME survey, with 27 (42.9%) program directors (PDs), 19 (30.2%) assistant/associate PDs, 5 (7.9%) core faculty, 5 (7.9%) clerkship directors, 4 (6.3%) residents/fellows and 3 others (vice chair of education, educational researcher, unknown). Most respondents were white (84.1%) and approximately half identified as women (50.8%). Table 1 provides means and standard deviations for statements displayed from most to least important.Conclusions: The positive financial impact on medical students was described as the greatest benefit of the pandemic. Virtual technology was varied in its impact: positive for conferences and interviewing but negative as a surrogate for clinical rotations or the ability for students to evaluate residency program culture. The top challenge facing UME was the removal of students from clinical rotations. This may impact residency programs, requiring them to remediate those skills. A limitation of this geographically broad cohort was the number of respondents.

Learning Objective: To characterize the challenges and benefits that the COVID-19 pandemic has provided to academic EM faculty.Background: The COVID-19 pandemic has presented unpredicted challenges to EM education. The speed of the pandemic and extraordinary clinical burden prevented a coordinated educational response at all levels, including that of faculty development. While COVID-19 research is prolific and ongoing, EM faculty educational impact is yet to be fully explored.Objectives: To characterize the challenges and benefits that the COVID-19 pandemic has provided to academic EM faculty.Methods: CORD chartered a COVID-19 Task Force of 18 selected educators to explore the pandemic’s impact on EM. A Modified Delphi process was used to develop multiple survey instruments. This process included a literature search for validated questions and internal piloting with iterative changes. After IRB approval, the faculty survey was distributed to members of CORD during the 2021 Academic Assembly. Using SPSS v26, a descriptive analysis was performed.Results: Forty-one individuals responded to the survey concerning faculty. Eighteen (43.9%) respondents were program directors, 14 (34.1%) were assistant/associate program directors, four (9.8%) were core faculty, four (9.8%) were clerkship directors, and one individual (2.4%) was involved with faculty development and research. Most respondents were white (87.8%) and women (61%). Table 1 demonstrates the faculty responses for the benefits and challenges of COVID-19 to education. Table 2 notes the impact on the faculty themselves.Conclusions: While the educational response to the pandemic was felt by faculty to be positive in the utilization of virtual platforms, faculty felt less engaged and less connected. Personally, faculty reported benefitting from numerous sources of human support, including familial, professional, and public. Despite this support, faculty reported the pandemic left them stressed, distressed, and burned out. A limitation of this geographically broad cohort was the number of respondents.

Learning Objectives: The objective of this innovation is to provide virtual reality as an alternative method for learners in emergency medicine to build procedural competence. We will also be looking at feasibility of VR for education and participant satisfaction.As part of a wider virtual reality curriculum, we are developing and assessing the feasibility of using virtual reality as an alternative method for learners to build competence in procedural skills. This innovation is being tested and implemented with medical students rotating through on their 4th year emergency medicine elective. The study’s plan is to look at how practicing procedures with virtual reality compares to more traditional hands-on simulation techniques. Medical students were given a lecture on how to do a surgical chest tube. Then, depending on the month, students were either assigned to practice with virtual reality programs or with simulation task trainers. The following week students were assessed on their ability to walk through and perform a surgical chest tube based on clinical skills evaluation that is already used for emergency medicine residents at VCUhealth. The goal of this innovation is to allow for more easily accessible ways to practice procedures through deliberate practice and allow residents to build experience and competence in procedures in emergency medicine. This has the potential to be especially beneficial in high acuity, low frequency procedures.

Mineralization in the Earth's crust can be regarded as a singular process resulting in large amounts of mass accumulation and element enrichment over short time or space scales. The elemental concentrations modeled by fractals and multifractals show self-similarity and scale-invariant properties. We take the view that fluid-pressure variations in response to earthquakes or fault rupture are primarily responsible for changes in solubility and trigger transient physical and chemical variations in ore-forming fluids that enhance the mineralization process. Based on this general concept, we investigated mineral precipitation processes driven by rapid fluid pressure reductions by coupling mineralization to a cellular automaton model to reveal the nonlinear mechanism of the orogenic gold mineralization process using simulation. In the model, fluid pressure can increase to the rock failure condition, which was set as lithostatic pressure at a depth of 10 km (270 MPa), due to either porosity reduction or dehydration reactions. Rapid drops in pressure resulting from fault rupture or local hydrofracture may induce repeated gold precipitation. The geochemical patterns generated by the model evolve from depletion to enrichment patterns, and from spatially random to spatially clustered structures quantified by multifractal models and geostatistics. Results show how metal elements self-organize to form high metal concentration patterns displaying self-similarity and scale-invariance. These transitions are attributed to the growth and coalescence of sub-networks with different fluid pressures up to the percolation threshold, resulting in a wide range of fluid pressure reductions and gold precipitation in the form of clusters. The results suggest that cyclic evolution of fluid pressure and its effects on gold precipitation systems can effectively mimic the repeated mineralization superposition process, and generate complex geochemical patterns characterized by a multifractal model. The nonlinear behavior exhibits scale-invariance and self-organized critical threshold, where mineral phase separations result from fluid pressure reductions associated with fault failure.

This is a novel case report of a 44-year-old woman who presented to the emergency department with epigastric pain wrapping around to her back. She had no risk factors for cardiac disease, but her initial electrocardiogram (ECG) showed a Wellens syndrome pattern and she was taken urgently to the catheterization lab. After a negative catheterization, she underwent cardiac magnetic resonance imaging, which was positive for Takotsubo cardiomyopathy (TC). Ultimately, abdominal computed tomography revealed that she had cholecystitis, which likely was the cause of her TC and ECG changes.