This piece is one of a series of Ģ����Ƶ Medical Education pieces for 2021-2022. Learn more about the Medical Education Team and get updates here!��

COVID-19 changed the MATCH. What’s next?

COVID-19 drastically affected medical education and residency application for 2020-2021. Students were not allowed to attend in-person clinical rotation for part of the year, and students were limited on their away rotation, which serves as a pseudo-audition to get into the program. Notably, Step 2 Clinical Skills was indefinitely canceled. In addition, interviews for rotations went all virtual.����

With these changes behind us, and yet more to come, the Ģ����Ƶ Medical Education Team reviewed the recommendations and changes for the 2021-2022 residency applications for each speciality. We looked at recommendations for virtual interviews, away rotations,�� interview caps, and other unique recommendations. We have a compiled .����

Virtual Interview Recommendations

On August 24, 2021, the Coalition of Physician Accountability (CPA) recommended for the 2021-22 Recruitment Cycle, noting the risk of the delta variant. In addition, nearly every specialty organization or association recommended virtual interviews. The American Orthopaedic Association was the only one that deferred to individual programs, but this was before the CPA recommendations. There were a few specialties that we did not find a statement regarding virtual interviews.

Away Rotation Recommendations

For�� away rotations, the Coalition for Physician Accountability (CPA) gave to limit approved away rotations in any specialty to one per learner, per speciality. CPA gave an exception if additional rotations are needed to complete graduation or accreditation requirements. Most specialties abided by the recommendations.�� A few specialties also included the exception if the home medical school institution does not have their respective specialty program in that home institution. The American Orthopaedic Association distinctly discouraged limitations on away rotations, but noted it should abide by the medical school’s guidelines.��

Limits on applications and acceptances by specialty

Some specialties have recommendations for the max number of program applications an applicant sends, or the number of interview acceptances. In 2020-2021, Emergency Medicine capped the number of interview acceptances to 17. This year, Ophthalmology capped the number of interview acceptances to 18. Psychiatry recommends that applicants don’t accept more than 15 interview acceptances.��

Signalling requirements

Some specialties have required signalling for applications. Signalling is a way to let a residency program know that you are very interested in their program. There is a limited number of signals an applicant can give. Otolaryngology used signaling (limit of 5) in their 2020-2021 and showed applicants were in the programs that they signal compared to the programs they did not signal. This year, Dermatology will use signaling (limit of 3), and Internal Medicine and General Surgery will use signaling (limit of 5).

Specialty-specific quirks

There are some unique resident applications quirks based on the specialty. Plastic Surgery and Ophthalmology have an early interview and match system, taken care of by the . Dermatology, Internal Medicine, and General Surgery will have a .��

Looking ahead to the 2021-2022 MATCH

Medical students awaiting the 2021-2022 MATCH may be apprehensive after watching last year as expectations and options for the MATCH changed in real time response to the global pandemic. We hope these pointers help ease the MATCH anxiety as much as possible! Remember you can always .��

Keep an eye out for future Medical Education Team updates and follow our work here!��

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This post is a series of mental health pieces from the Ģ����Ƶ WSL Committee.

It is no surprise that medical students have high rates of . Undertreatment of such mental conditions increases the risk of suicide. Physicians face an alarmingly high rate of suicides per year that is . The issue of high physician suicide rates and increasing prevalence of mental health disorders in the medical community have been called a public health crisis by experts such as

We know mental health topics of burnout, anxiety, depression and suicide have been hot topics in the medical community. Now with the COVID-19 Pandemic, we are faced with even more obstacles and struggles.

Impact of the COVID pandemic on medical students

In March 2020, graduating medical students just found out where they would be going for residency. Third year medical students were looking forward to completing their USMLE Step 2 CK and CS examinations and moving onto electives. Second year medical students were taking their Step 1 exams and looking forward to transitioning into clinical rotations. First years were looking forward to celebrating the end of year one.

When the COVID pandemic hit, it disrupted the entire world. For medical students this meant rapid changes to the medical school curriculum, decreased student activities, removal of students from clinical rotations. Everything hit the pause button, but time kept moving on. Graduating medical students still were expected to begin residency in July. Upcoming fourth years needed to finish taking board exams and begin preparation for residency applications in the fall. Second and third years still needed to get clinic hours and experience while taking shelf exams.

Students had to adapt quickly to utilizing virtual platforms for classroom learning and examinations. Students had to limit clinical exposure to help decrease the spread of COVID-19 and conserve PPE for essential hospital staff. Students were faced with cancellations and delays of USMLE examinations. International students were faced with new ECFMG certification changes. All of these changes were on top of other challenges the pandemic brought upon such as isolation, no travelling, and wearing masks.

Strategies to maintaining well-being during the pandemic

It is natural to experience more anxiety and stress during these times. It is now more important than ever to address issues of mental health of medical students. Our society needs competent physicians ready to enter the workforce while we fight this pandemic. Here are some strategies you and your peers can use to maintain well-being during these challenging times:

1. Maintain a routine. ​Whether you are at home doing virtual classes or able to get back into the clinic, it is important to maintain a daily routine. Wake up at the same time. Make a daily schedule. Take breaks. Maintain as much normalcy as you can in your day to day schedule.
2. Stay connected with family and friends. ​We may be physically distanced, but we can still stay connected with family and friends via social media, video chatting and phone calls. If you are able to see people in person, make sure you wear a mask and keep each other safe. Humans are social beings, so find creative ways to connect with each other.
3. Take care of yourself. Stay active. ​You’ve heard it over and over again…eat healthy and exercise. But now more than ever, it is important to fuel your body with healthy foods and stay active throughout the day. Go for a walk, do some yoga, follow an at home workout plan. Take extra time for self-care. Journal, meditate, play with your dog. Whatever allows you to unplug and relax.
4. Reach out for help. ​Do not hesitate to reach out to school counselors, online therapists, or even peers. You are not alone in this battle. Address signs and symptoms of burnout, depression and anxiety early on.
5. Prioritize and pace yourself. ​Make a list of important tasks and deadlines. Tackle the main priorities first and then address the extra stuff when you have time. Do not compare yourself to what others are doing. Everyone works at a different pace and everyone copes differently in times of stress.

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This post is one of a series of mental health pieces from the .

Approximately in the United States of America identify as Black. That is about 13.2% of the total population which is comprised of African American, as well as African and Caribbean immigrants. As such, there are major differences in the rates of treatment, diagnosis, and access to care among this group of people. The detrimental psycho-physiological impacts of these differences can be attributed to historical, infrastructural, and socioeconomic adversity which has ultimately led to (AA/B) community.��

AA/B people are more frequently diagnosed with than their white counterparts. Given that the criteria for diagnosis can be subjective, it is important to understand how culture impacts the perception and stigmatization of certain symptoms. The AA/B community are also less likely to be offered psychotherapy and are more likely to be incarcerated due to mental illness in .

In addition to the adversity constantly faced by this community, the current pandemic has compounded the disparity as it has presented a new reality for many. With high restrictions and mandates in place, Americans have been forced to quickly adjust mentally, physically, and emotionally to a world many have not seen before. Social distancing has created an environment where it is easy to slip into isolation and with the lack of physical interaction, individuals may find themselves exhibiting depressive symptoms, feeling increased anxiety levels, or finding it difficult to manage their mood. In addition to the aforementioned changes, education systems have switched to remote learning and thus students are studying without the support of classmates, faculty, or the usual extra curricular activities that serve as buffers for stress. The lack of job security may also contribute to the increase of societal stressors. The new reality from COVID-19 is ushering in a mental health crisis.

Marginalized groups, in particular, may perceive the pandemic as even more triggering or traumatic. Given the current social climate of this country with the recent wave of publicized murders and calls for revolution, it is important to understand how racial discrimination may increase the allostatic load of the minority population. Allostatic load is defined as the wear and tear on the body due to increased exposure to stress. Many have been affected by the pandemic physically, economically, and emotionally, however, minorities may be more susceptible to poor health outcomes due to the additive effects of race-related stressors.

Studies show that ethnic minority groups are more vulnerable to the . Seeing that there is a positive relationship between , it is important to understand and identify these linkages in order to combat stressors. Furthermore, the lack of access and poor utilization of mental health resources only perpetuates the issue at hand.

The utilization of mental health interventions such as self-care is paramount during these unprecedented times. In literature, self-care is a coping mechanism defined as a human regulatory function necessary to maintain mental, emotional, and physical well being. Although coping mechanisms vary from person to person, social interaction through phone or video calls play a key role in better health outcomes. Utilizing healthy coping mechanisms such as yoga, cooking, walking, or even setting boundaries may aid individuals struggling to manage stress. Avoiding social isolation, while maintaining physical distancing mandates, during this time may prove beneficial for overall physiological and psychological health. Furthermore, incorporating cultural practices that encourage social relationships, self-reflection, or forms of spirituality may be effective on the individual level.

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On August 10, 2020, Ģ����Ƶ joined Physicians for Human Rights and a number of other health and human rights organizations to call on the National Governors Association to enact and enforce state-level guidance on healthcare workforce protections during the Coronavirus pandemic.

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Recommended standards are derived from the 2009 California OSHA Aerosol Transmissible Disease Standards, which include clear standards for social distancing; face masks; hand sanitizing, washing, and gloves; regular workplace disinfection; increased ventilation; and notification of infections, among other key provisions. Our letter to the National Governors Association also calls for protection from discrimination, intimidation, or dismissal of health workers for speaking out in the face of dangerous conditions.

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This letter is intentional in its scope of targeting the National Governors Association. It goes beyond calling on individual healthcare facilities for protections, but also allows for more specific state-level regulation than would be possible on the national level. The American Hospital Association provides guidance and recommendations related to worker protections [], but does not have the capacity or the power to enact regulations in this sphere. Likewise, the Occupational Safety and Health Administration (OSHA) provides national guidance and advisory recommendations for healthcare work protections, but its only actual standard related to this issue “requires employers to provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm” [].

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In this context, with a dearth of adequately clear and enforceable protections for healthcare workers working on the frontlines of the pandemic, healthcare workers are at increased risk of reporting a positive test for COVID-19 [].

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As we continue to create and reinforce a national dialogue that frames healthcare workers as heroes [], we must fulfill our obligation to protect their efforts to fulfill their professional obligations. State-level protections are the most effective, clear-cut way of doing just that. That’s why Ģ����Ƶ joined our colleagues in calling for regulations to protect healthcare professionals and trainees in their efforts to care for our nation’s vulnerable. It’s the right, morally sound, and just way forward.

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Read the full text .

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This post is a series of mental health pieces from the Ģ����Ƶ WSL Committee

Much has been written about the potential negative effects of the COVID-19 pandemic and mental health. Many have felt isolation to a greater extent than ever before in their lives. Anxiety exists about various issues from the safety of loved ones to financial security. This deficit of mental wellness, like most societal problems, likely will disproportionately affect those who have the fewest resources to protect their well-being and advocate for themselves. One population fits this description particularly well—prisoners.

Mental health in prisons has been a concern long before COVID-19—, such as schizophrenia, bipolar disorder or major depressive disorder. This means there are an estimated 383,200 inmates with a severe psychiatric disorder in the U.S., over ten times as many as people who are housed in state mental hospitals. is the leading cause of death in jails. Prisoners suffer from an abysmal lack of medical support, with over who received psychiatric medications at admission not receiving continued pharmacotherapy in prison. This practice alone sets prisoners up for worse mental health consequences from COVID-19, but another major factor is at play as well. Prisons are very susceptible to virus outbreaks. from Johns Hopkins Bloomberg School of Public Health analyzed public data and found that the COVID-19 case rate was 5.5 times higher for prisoners than the general U.S. population. Their death rate was three times higher than the general population.

Little hard data exists about a worsening mental health crisis in prisons due to COVID-19. However, what we do know is discouraging. Early indicate deteriorating mental wellness among prisoners with and without preexisting conditions, along with heightened anxiety in prison staff. along with the suspension of prison visits and recreational activities have taken place, any and all of which could predict poor mental health outcomes. Patients in dire need of hospitalization have also become stuck in jails due to in order to limit COVID-19 spread. The national watchdog group Solitary Watch has reported in the use of solitary confinement due to the pandemic to physically distance prisoners. This strategy is in opposition to the fact that solitary confinement has been shown to be to the extent that it is considered “cruel, inhuman or degrading treatment or punishment” under international law.

The dehumanizing experience of incarceration surely cannot be fully understood without having experienced it first-hand. However, considering that many Americans have recently realized the effects of social distancing on our own mental health, we may be closer to a form of understanding than ever before. This means that now may be an ideal time to reflect on this issue. Social relationships, recreational activities, a safe environment, and access to therapists are useful, if not necessary, for maintaining mental health. It is reprehensible to deny these vital resources. As this is fundamentally a health issue, healthcare workers have a responsibility to advocate for changes to the system. Visit the website where you can click “Take Action” to submit your statement to your representatives in support of prioritizing prisoner protections in upcoming COVID-19 legislation.

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