Keith, Joshua J.

Abstract: A 49-year-old short-board goofy-stance competitive surfer presented with a 3-month history of bilateral, left foot pain associated with tender soft tissue plantar nodules. Magnetic resonance imaging of the left foot revealed foci of fibrotic tissue within the subcutaneous tissue adjacent to the first and fifth metatarsophalangeal joints compatible with surfers' knots . The patient underwent conservative treatment with oral ibuprofen as needed before competitions, topical diclofenac gel, wide toe box shoes, and use of a double-thick traction pad on his surfboard to alleviate the friction between the metatarsophalangeal joints of his left foot and the surfboard. He reported improvement of symptoms and full return to surfing at 8-month follow-up. We present a case of surfers' knots overlying the left first and fifth metatarsophalangeal joints of a male competitive surfer and highlight recommendations for successful conservative treatment options for symptomatic athletes.

OBJECTIVE The COVID-19 pandemic led to many changes across medical organizations and graduate medical education programs nationwide including the rapid implementation of telemedicine as a modality for delivering health care. The purpose of this study was to investigate the telemedicine experiences of residents and fellows with their self-reported level of preparedness, impact on their education including precepting, skill development, and patient-physician relationships, and perceptions of telehealth platforms and curricula in the future. METHODS A total of 365 Mayo Clinic residents and fellows across three sites (Florida, Arizona, and Minnesota) were identified as trainees who conducted at least one telemedicine encounter from January 1, 2020 to June 30, 2020 and were sent an electronic survey by e-mail. RESULTS There was a total of 103 completed surveys across various specialties with 58.3% female respondents, 63.1% residents, 35.0% fellows and 77.7% of respondents who attended medical school in the United States. Most trainees reported having very little to no exposure to telemedicine in their medical careers before the pandemic. The majority were satisfied with their first telemedicine encounter and found precepting comparable to in-person visits. The trainees in this study had a favorable view with 98.1% believing telemedicine will play a more prevalent role in the future and most agreed this should be included in medical school and residency training. CONCLUSION Our survey found that after the implementation of telemedicine during the COVID-19 pandemic, the experiences of trainees at a multi-site academic center were overall positive. More research is needed on the perceptions of skill development (physical exam and history taking) during a telemedicine encounter and outlining an optimal telemedicine curriculum that can improve confidence in trainees.