Grounded in reality: artificial intelligence in medical education.

Background: In a recent survey, medical students expressed eagerness to acquire competencies in the use of artificial intelligence (AI) in medicine. It is time that undergraduate medical education takes the lead in helping students develop these competencies. We propose a solution that integrates competency-driven AI instruction in medical school curriculum. Methods: We applied constructivist and backwards design principles to design online learning assignments simulating the real-world work done in the healthcare industry. Our innovative approach assumed no technical background for students, yet addressed the need for training clinicians to be ready to practice in the new digital patient care environment. This modular 4-week AI course was implemented in 2019, integrating AI with evidence-based medicine, pathology, pharmacology, tele-monitoring, quality improvement, value-based care, and patient safety. Results: This educational innovation was tested in 2 cohorts of fourth year medical students who demonstrated an improvement in knowledge with an average quiz score of 97% and in skills with an average application assignment score of 89%. Weekly reflections revealed how students learned to transition from theory to practice of AI and how these concepts might apply to their upcoming residency training programs and future medical practice. Conclusions: We present an innovative product that achieves the objective of competency-based education of students regarding the role of AI in medicine. This course can be integrated in the preclinical years with a focus on foundational knowledge, vocabulary, and concepts, and in clinical years with a focus on application of core knowledge to real-world scenarios.

Marvellous moths! pollen deposition rate of bramble (Rubus futicosus L. agg.) is greater at night than day.

Widespread concerns about declines of wild pollinating insects has attracted considerable research interest, largely directed towards identifying key nectar sources and assessing the contribution of pollinators towards ecosystem services. However, previous work has almost exclusively focussed on bees and other diurnal invertebrate taxa. This study aimed to assess the relative contribution of diurnal and nocturnal insects to the pollination of bramble (Rubus fruticosus agg.), a common and widespread species aggregate across Europe, which has been identified as a key source of pollen and nectar for diurnal pollinators. Bramble flower visitation rates by diurnal and nocturnal insects were quantified by analysing over 380,000 interval photographs taken over a 3-day period across 10 sites. A pollinator exclusion experiment was also undertaken to assess the importance of diurnal and nocturnal insects for pollination by analysing pollen deposition on 480 bramble stigmas of nocturnally exposed, diurnally exposed and unvisited control flowers across all sites. Flower visitation was significantly higher during the day, comprising 83% of all visits made by a range of taxa. Nocturnal visitation was almost exclusively by moths. Crucially, pollen deposition rates of bramble were significantly higher during the night compared with the day. No relationship was detected between pollen counts and flower visitation rates, suggesting that moths are more efficient pollinators of bramble compared with diurnal insects. Overall, this work provides further evidence of the value of bramble as a resource for pollinators and demonstrates that moths likely play an important role in bramble pollination.

Rare case of intrahepatic splenosis masquerading as malignancy.

A 54-year-old man presented with abdominal pain and a history of post-traumatic splenectomy 33 years prior, imaging revealed an incidental hepatic mass.

Effects of Artificial Light at Night (ALAN) on European Hedgehog Activity at Supplementary Feeding Stations.

: Artificial light at night (ALAN) can have negative consequences for a wide range of taxa. However, the effects on nocturnal mammals other than bats are poorly understood. A citizen science camera trapping experiment was therefore used to assess the effect of ALAN on the activity of European hedgehogs (Erinaceus europaeus) at supplementary feeding stations in UK gardens. A crossover design was implemented at 33 gardens with two treatments-artificial light and darkness-each of which lasted for one week. The order of treatment depended on the existing lighting regime at the feeding station: dark treatments were applied first at dark feeding stations, whereas light treatments were used first where the station was already illuminated. Although temporal changes in activity patterns in response to the treatments were noted in some individuals, the direction of the effects was not consistent. Similarly, there was no overall impact of ALAN on the presence or feeding activities of hedgehogs in gardens where supplementary feeding stations were present. These findings are somewhat reassuring insofar as they demonstrate no net negative effect on a species thought to be in decline, in scenarios where the animals are already habituated to supplementary feeding. However, further research is needed to examine long-term effects and the effects of lighting on hedgehog prey, reproductive success and predation risk.

Looking Beyond the Physician Educator: the Evolving Roles of Instructional Designers in Medical Education.

PURPOSE: To explore how instructional designers (IDs) view their work and give insight to organizations intending to hire for this role. METHOD: In 2018, a 28-question survey was utilized to examine the role of instructional designers in medical education and their contributions as educational professionals. The survey was sent to members of the DR-ED listserv, the Instructional Designer listserv through AAMC, relevant EDUCAUSE listservs, and via Twitter in April 2018. Quantitative and qualitative results were analyzed. The target population was determined as those who self-identify as working in instructional design in medical education, understanding that titles of IDs may vary widely in academic medicine. RESULTS: Participants in this study (72) were self-identified as 45 (63%) females and 23 (32%) males. Among the degrees held by participants, 33 (46%) hold a terminal degree, 37 (51%) a master's degree, and 2 (3%) a bachelor's degree. Seven (9%) of institutions employ one ID and 27 (36%) employ two to five IDs, and 19 (25%) of the participants did not know how many instructional designers were employed by their organization. Participants reported that 22 (40%) specialize in more than one type of work such as database development, classroom technology, faculty development, and assessment/evaluation. CONCLUSION: There is a wide variety of work environments for IDs in academic medicine; these range from large academic research institutions to consultant companies. A significant portion of IDs advise faculty on pedagogy and teaching best practices and develop professional development training. Job titles for IDs are also varied, representative of a wide range of influence within academic medicine organizations. ID expertise that was considered most commonly needed in academic medicine includes familiarity with learning management systems, multimedia literacy, and pedagogy.

How to integrate CAMBRA into private practice.

The traditional dentistry approach treated the disease with a limited surgical strategy aimed at removing carious lesions on teeth. Today, the dental profession is refocusing its efforts to include risk assessment with evidence-based diagnosis while also treating the biofilm component of the disease. While there is compelling science to support CAMBRA, there are fewer articles with practical direction regarding how to integrate CAMBRA diagnostics and treatment into clinical practice, which this article addresses.

Caries management by risk assessment: implementation guidelines.

ACT This consensus statement supports implementation of caries management by risk assessment in clinical practice by using the following principles: modification of the oral flora, patient education, remineralization, and minimal operative intervention. The statement includes a list of supporters.

Dental fraud: an introduction.

A manager of a dental benefits program defines fraud and abuse in the dental context. Such practices may cost as much as four billion dollars annually and have a damaging effect on the trust the profession places in the profession and on the way dentists relate to each other.

Practical protocols for the prevention of dental disease in community settings for people with special needs: the protocols.

People with special needs have more dental disease and more missing teeth than the general population. They also have reduced access to oral health diagnostic, preventive, interceptive and treatment services. If services are available, they can be complicated and costly. It is critical to prevent dental diseases in these individuals. This article presents a set of practical protocols for preventing dental disease in people with special needs. These protocols are designed to be used in community settings outside of a dental office.

Chlorhexidine and xylitol gum in caries prevention.

This paper presents the current best evidence on the respective and comparative outcomes of chlorhexidine and xylitol and extrapolates these data to individuals with special needs. It analyzes the probable mechanisms of action for both chlorhexidine and xylitol then reviews individual products and discusses the anticipated effectiveness of these products in individuals with special needs.

Risk assessment and epidemiology of dental caries: review of the literature.

The epidemiology of dental caries in the pediatric population demonstrates that caries is no longer pandemic in the US population. The incidence is confined to a subset of the total population of our children. The disease is also increasingly isolated to specific teeth and tooth morphology types in both the pediatric and the mixed dentitions, with pits and fissures being the predominate diseased sites. This sequestration of the disease into specific populations, individuals and tooth sites mandates a risk assessment strategy. In the past, universal preventive strategies were appropriate because of the extensive penetration of caries in the population. Our health care system does not have adequate resources to treat the entire population when a substantial portion of the population is not at risk for this disease process. Validated risk assessment strategies may prove adjunctive for the practicing dentist. Certainly knowledge of the known risk factors will assist the practitioner in performing risk assessment within their patient populations. This paper presents a review of the known risk factors for dental caries in child and adolescent populations.

Patterns of oral care in a Washington State dental service population.

BACKGROUND: The authors compare patterns of oral health care reported by the Washington Dental Service, or WDS, Seattle, in 1993 and 1999 to assess changes in patient populations, practice characteristics, procedures and treatment costs in the state. METHODS: Data were obtained from dental benefits claims from a population of about 1.25 million people. Variables of interest included patient age and other demographic information, character of dental practice, dental procedures and treatment costs that combined WDS payment and patient copayment. RESULTS: The results showed high agreement (97 percent) between the database and randomly surveyed patient records. For both 1993 and 1999, general dental offices were responsible for more than 80 percent of patient care. Single crowns (21 percent), restorative services (15 percent) and dental prophylaxis (13 percent) made up about half of the costs of dental care. Broad categories of service were similar in 1993 and 1999, and anticipated major declines in restorative procedures related to caries were not apparent. The mix of services varied considerably by patient age and between generalists and specialists in both years. CONCLUSIONS: Patterns of oral health care among this insured patient population largely remained unchanged from 1993 to 1999, with some shifts in specific procedures and specialty care. During this period, dentists saw more patients and performed fewer treatments per patient, while total treatment costs per patient increased. CLINICAL IMPLICATIONS: Patterns of oral health care in the United States are projected to undergo major changes linked to improved oral health, declining trends in caries and periodontal diseases, scientific advances in treatment approaches and a patient population that is living longer. Changes in care patterns during this six-year period may reflect patient and provider preferences, as well as the influence of reimbursement policies. Dental benefits databases can serve as a critical resource for monitoring such changes.