Student mental health concerns can manifest in several forms. Medical students juggling a multitude of trials (i.e., intense academic rigor, financial debt, sleep deprivation, lack of control, continual exposure to sickness and death, and training mistreatment) can help explain the higher prevalence of psychological disorders within this population. Furthermore, these mental health difficulties are not static; certain challenges move into the forefront as students face key transition points in schooling. Primary examples include the entry year of medical school, the shift from preclinical curriculum to clinical training, and the final moments prior to beginning residency. Given the existing mental health trends among medical students at baseline, it can be concluded that the COVID-19 pandemic has exacerbated the stress, anxiety, and depression associated with medical education. Solutions do indeed exist to address the moral injury medical students face, from expanded crisis management training and implementation of peer support networks to destigmatization of and improved access to professional mental health resources. It is up to the curators of the medical education system to make these solutions the new status quo.

The literature outlining the overall psychiatric effects of dialysis procedures in patients with chronic kidney disease (CKD) is sparse.The aim of this study was to investigate the subsequent development of substance use disorders in dialysis-dependent ESRD/CKD stage 5 patients.A retrospective cohort analysis was conducted using TriNetX database.Using validated ICD-10 codes, cohort 1 identified those with ESRD or CKD stage 5 who are dependent on renal dialysis, while the control group cohort 2 identified patients with ESRD or CKD stage 5 who are not receiving renal dialysis.After propensitymatching for demographics and related comorbidities, we analyzed the incidence of subsequent substance abuse disorders and clinical outcomes 30 days, 90 days, 1 year, and 5 years thereafter.Values were presented as adjusted Risk Ratios (aRR) with 95% CI.At 30 days, increased risk was observed for opioid abuse or dependence (aRR [95% CI])=(1.25[1.01,1.54])and nicotine dependence (1.16[1.08,1.24]).At 90 days, greater risk for opioid abuse or dependence (1.46[1.26,1.69]),cannabis abuse or dependence (1.35[1.15,1.58]),and nicotine dependence (1.40[1.33,1.48]).The 1-year time frame demonstrated increased risk for alcohol abuse or dependence (1.17[1.10,1.23]),opioid abuse or dependence (1.47[1.33,1.62]),cannabis abuse or dependence (1.58[1.42,1.76]),and nicotine dependence (1.42[1.37,1.48]).Within 5 years, increased risk were observed for alcohol abuse or dependence (1.28[1.22,1.33]),opioid abuse or dependence (1.70[1.59,1.82]),cannabis abuse or dependence (1.84[1.74,2.04]),sedative-hypnotic-anxiolytic abuse (1 .31[1.14, 1.50]) or dependence and nicotine dependence (1.43[1.39,1.47]).The risk for substance use disorder development consistently increased as the time of observation was extended from 1 month to 5 years on maintenance dialysis in CKD patients.These results prove the need for increased awareness and provision of resources for this population.

As the pandemic made it unsafe for providers and patients to meet in person, the US government implemented key temporary telehealth waivers in March 2020 that expanded Medicare telehealth coverage dramatically. Some of the most significant changes included the removal of location restrictions so that patients and providers could engage in telehealth from their homes, full provider reimbursement for telehealth visits, coverage for more medical specialties and types of practitioners such as occupational and physical therapists, and the allowance of telehealth prescription of controlled substances. The waivers will end when the government removes the federal status of a public health emergency, which is expected to occur in 2023. Nearly 64 million Medicare patients are at risk of losing most modalities of telehealth access. We present current legislation that could combat this "telehealth cliff" and defend the position that Medicare telehealth access should remain permanently expanded.