Digital Ink and Surgical Dreams: Perceptions of Artificial Intelligence-Generated Essays in Residency Applications.

INTRODUCTION: Large language models like Chat Generative Pre-Trained Transformer (ChatGPT) are increasingly used in academic writing. Faculty may consider use of artificial intelligence (AI)-generated responses a form of cheating. We sought to determine whether general surgery residency faculty could detect AI versus human-written responses to a text prompt; hypothesizing that faculty would not be able to reliably differentiate AI versus human-written responses. METHODS: Ten essays were generated using a text prompt, "Tell us in 1-2 paragraphs why you are considering the University of Rochester for General Surgery residency" (Current trainees: n = 5, ChatGPT: n = 5). Ten blinded faculty reviewers rated essays (ten-point Likert scale) on the following criteria: desire to interview, relevance to the general surgery residency, overall impression, and AI- or human-generated; with scores and identification error rates compared between the groups. RESULTS: There were no differences between groups for %total points (ChatGPT 66.0 ± 13.5%, human 70.0 ± 23.0%, P = 0.508) or identification error rates (ChatGPT 40.0 ± 35.0%, human 20.0 ± 30.0%, P = 0.175). Except for one, all essays were identified incorrectly by at least two reviewers. Essays identified as human-generated received higher overall impression scores (area under the curve: 0.82 ± 0.04, P < 0.01). CONCLUSIONS: Whether use of AI tools for academic purposes should constitute academic dishonesty is controversial. We demonstrate that human and AI-generated essays are similar in quality, but there is bias against presumed AI-generated essays. Faculty are not able to reliably differentiate human from AI-generated essays, thus bias may be misdirected. AI-tools are becoming ubiquitous and their use is not easily detected. Faculty must expect these tools to play increasing roles in medical education.

Physician Communication Coaching: How Psychologists can Elevate Skills and Support Resident Education, Professionalism, and Well-being.

Many factors influence resident physician communication, including rigorous training demands that can contribute to professionalism issues or burnout. The University of Rochester Physician Communication Coaching program launched for attendings in 2011, and expanded to residency programs within 11 clinical departments of our institution. In this model, psychologists serve as coaches, drawing on their expertise in communication skills, behavior change, and wellness promotion. These coaches conduct real-time observation of patient encounters, coding communication with an expanded Cambridge-Calgary Patient-Centered Observational Checklist. Residents receive a written report with individualized feedback. From 2013 to 2020, 279 residents were coached. Since 2018, residents have been formally surveyed for feedback (n = 70 surveys completed; 61% response rate), with 97% rating the experience Very Helpful or Helpful. Of the 70 completed surveys, 54 (77%) included qualitative feedback that has also been positive. Due to the feasibility and growing demand for communication coaching from other residency and fellowship programs, in 2018 two authors (SM and LD-R) developed a 2-year, part-time program to train communication coaches.

Dementia spousal caregivers and past transgressions: Measuring and understanding forgiveness experiences.

The transition from "wife" to "caregiver" for a cognitively impaired husband can be an overwhelming experience. Communication patterns change and small conflicts can grow, at times bringing angry feelings and new burdens. Engagement with forgiveness processes may benefit wives by lowering resentment over past tensions, restoring trust, and enhancing the overall caregiving experience. This study examined the utility of the Enright Forgiveness Inventory (EFI) within a sample of caregiving wives. Our intent was to better understand this population's experience with forgiveness when other contextual factors were likely to influence this process. Forgiveness scores on the EFI were positively related to the cognitive status of the care recipient, a particularly important finding for clinical intervention, and inversely related to marital distress and state anxiety.

Hospital to home: a geriatric educational program on effective discharge planning.

There has been increased attention on the needs of the burgeoning older adult population, with focus on the limited education and training experiences available in geriatric care. Older adults transitioning between levels of care often require increased attention, and the American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has encouraged greater training opportunities be provided to better understand the needs of this population. The Hospital to Home Program is one model of geriatric training emphasizing many of the AGS recommendations. Through qualitative analyses of 51 internal medicine residents' reflections, the authors report how this educational program is meeting the above need and share how Hospital to Home is enhancing residents' skills in creating a safe discharge for geriatric patients and their families.

The role of self-perceived age in older adults considering adjuvant chemotherapy.

INTRODUCTION: Aging-related concerns can increase the risk of treatment toxicities among older adults considering adjuvant chemotherapy. We previously demonstrated that older adults with cancer who reported feeling older than their chronological age (i.e., self-perceived age) were more likely to have aging-related concerns identified during a geriatric assessment. We explored how decisions about adjuvant chemotherapy vary with or are related to older adults' self-perceived age. MATERIALS AND METHODS: We conducted a secondary analysis of a multi-phased feasibility pilot using semi-structured interviews that were conducted to explore the patient decision-making process for adjuvant chemotherapy. Interviews incorporated questions about chronological and perceived age as factors for decision-making. Patient eligibility for the study included (1) age ≥ 70 years and older, (2) a diagnosis of breast, colon, or lung cancer and considering adjuvant chemotherapy, and (3) able to read size 18 font in English. Interview data were analyzed using constant comparative method. RESULTS: Twenty-one patients were enrolled. The mean chronological age was 78 years (range 71-91). The average perceived age of patients was 57 years (range 21-80). Eleven patients chose to receive treatment while ten patients did not. Aging-related themes illustrated that self-perceived age plays an important role when patients make decisions about adjuvant chemotherapy. More specifically, patients who reported their self-perceived age as younger than their chronological age also reported better perceived health status and chose to receive adjuvant chemotherapy. DISCUSSION: Patients' experiences of aging and self-perceived age may have different implications for decision-making.

A physician communication coaching program: Developing a supportive culture of feedback to sustain and reinvigorate faculty physicians.

INTRODUCTION: Physician-patient communication involves complex skills that affect quality, outcome, and satisfaction for patients, families, and health care teams. Yet, institutional, regulatory, and scientific demands compete for physicians' attention. A framework is needed to support physicians continued development of communication skills: Coaching is 1 such evidence-based practice, and we assessed the feasibility of implementing such a program. METHOD: Participants were 12 physicians, representing high and low scorers on the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey. We added items to capture empathy and family experience to the Calgary-Cambridge Observation Guide for the Medical Interview. Coaches observed communication associated with patient satisfaction and quality measures: introductions (I), asking about concerns (C), and check for understanding (U), or ICU. Participants received a report describing their communication behaviors, emphasizing strengths, and identifying areas for improvement. RESULTS: Scores on the ICU significantly discriminated between low and high HCAHPS scorers, physicians from surgical and cognitive specialties, men and women. We collected anonymous feedback regarding the value of this training; participants recommended expanding the program. DISCUSSION: Based on physician endorsement, experienced coaches are expanding the coaching program to physicians throughout our institution. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

We Orient Residents to Surgical Life: Why Not Their Families Too?

Surgical education requires more than time and commitment; it is a period of a professional development that relies on one's resilience and fortitude. While training programs makes substantial efforts to onboard learners and prepare them for the experiences to come, most are likely underutilizing one of the greatest resources available to learners: their personal communities. Every intern who enters residency brings with them the emotional bonds and benefits of family, friends, and/or other community members who may or may not understand the nature of surgical training and the professional journey ahead. In an effort to support our own learners and increase the awareness of resources available to them, we hosted an orientation for interns' friends and families. The programming allowed for residents and their personal supports to better understand residency culture, meet educational leadership, and discuss the experiences of more senior residents, faculty and their families over time. Additionally, some education was provided regarding the signs and symptoms of burnout and depression; our aim was to help residents' communities feel better able to recognize and respond to such symptoms. The preliminary feedback regarding the program is strong, encouraging its continued implementation.

Psychological Issues in Medically Underserved Patients.

The US population has a subset of those that are underserved who are in need of primary care and also suffer from mental health disorders. In this article, categories of underserved populations are described. Each section defines the population being presented, identifies the mental health problems each is likely to encounter, explores the barriers that prevent access to care, and identifies potential methods to minimize such barriers. The ways in which psychiatric issues vary in underserved settings compared with the general population are differentiated. Recommendations are offered for primary care physicians to support improved recognition and management of psychosocial stressors and psychiatric illness among the underserved.

Reducing hospital readmission through team-based primary care: A 7-week pilot study integrating behavioral health and pharmacy.

INTRODUCTION: A team-based service delivery model was applied to provide patients with biopsychosocial care following hospital discharge to reduce hospital readmission. Most previous interventions focused on transitions of care occurred in the inpatient setting with attention to predischarge strategies. These interventions have not considered psychosocial stressors, and few have explored management in primary care settings. METHOD: A 7-week team-based service delivery model was implemented in a family medicine practice emphasizing a biopsychosocial approach. A physician, psychologist, pharmacist, care managers, and interdisciplinary trainees worked with 17 patients following hospital discharge. This comprehensive evaluation assessed patients' mood, cognitive abilities, and self-management of health behaviors. Modifications were made to improve ease of access to outpatient care and to improve patient understanding of the therapeutic plan. This pilot study was conducted to determine the utility of the model. RESULTS: Of 17 patients, 15 individuals avoided readmission at 30- and 90-day intervals. Other substantial benefits were noted, including reduced polypharmacy, engagement in specialty care, and reduction of environmental stressors to improve access to care. The clinic in which this was implemented is currently making efforts to maintain this model of care based on observed success. DISCUSSION: Although this work only represents a small sample, results are encouraging. This model can be replicated in other primary care settings with specialty clinicians on site. Specifically, approaches that promote a team-based delivery in a primary care setting may support improved patient outcomes and reduced overall systems' costs. Recommendations for research in a clinical setting are also offered. (PsycINFO Database Record

Simulation-based learning: From theory to practice.

Comments on the article, ""Stimulating Reflective Practice Using Collaborative Reflective Training in Breaking Bad News Simulations," by Kim, Hernandez, Lavery, and Denmark (see record 2016-18380-001). Kim et al. are applauded for engaging and supporting the development of simulation-based education, and for their efforts to create an interprofessional learning environment. However, we hope further work on alternate methods of debriefing leverage the already inherent activation of learners that builds on previous experience, fosters reflection and builds skills. What is needed is the transference of learning theories into our educational research efforts that measure the effectiveness, validation, and reliability of behavior based performance change. The majority of breaking bad news (BBN) curricula limit program evaluations to reports of learner satisfaction, confidence and self-efficacy, rather than determining the successful translation of effective and humanistic interpersonal skills into long-term clinical practice (Rosenbaum et al., 2004). Research is needed to investigate how educational programs affect provider-patient-family interaction, and ultimately patient and family understanding, to better inform our teaching BBN skills. (PsycINFO Database Record