Critical Analysis of ChatGPT 4 Omni in USMLE Disciplines, Clinical Clerkships, and Clinical Skills.

BACKGROUND: Recent studies, including those by the National Board of Medical Examiners (NBME), have highlighted the remarkable capabilities of recent large language models (LLMs) such as ChatGPT in passing the United States Medical Licensing Examination (USMLE). However, there is a gap in detailed analysis of these models' performance in specific medical content areas, thus limiting an assessment of their potential utility for medical education. OBJECTIVE: To assess and compare the accuracy of successive ChatGPT versions (GPT-3.5, GPT-4, and GPT-4 Omni) in USMLE disciplines, clinical clerkships, and the clinical skills of diagnostics and management. METHODS: This study used 750 clinical vignette-based multiple-choice questions (MCQs) to characterize the performance of successive ChatGPT versions [ChatGPT 3.5 (GPT-3.5), ChatGPT 4 (GPT-4), and ChatGPT 4 Omni (GPT-4o)] across USMLE disciplines, clinical clerkships, and in clinical skills (diagnostics and management). Accuracy was assessed using a standardized protocol, with statistical analyses conducted to compare the models' performances. RESULTS: GPT-4o achieved the highest accuracy across 750 MCQs at 90.4%, outperforming GPT-4 and GPT-3.5, which scored 81.1% and 60.0% respectively. GPT-4o's highest performances were in social sciences (95.5%), behavioral and neuroscience (94.2%), and pharmacology (93.2%). In clinical skills, GPT-4o's diagnostic accuracy was 92.7% and management accuracy 88.8%, significantly higher than its predecessors. Notably, both GPT-4o and GPT-4 significantly outperformed the medical student average accuracy of 59.3% (95% CI: 58.3-60.3). CONCLUSIONS: ChatGPT 4 Omni's performance in USMLE preclinical content areas as well as clinical skills indicates substantial improvements over its predecessors, suggesting significant potential for the use of this technology as an educational aid for medical students. These findings underscore the necessity of careful consideration of LLMs' integration into medical education, emphasizing the importance of structured curricula to guide their appropriate use and the need for ongoing critical analyses to ensure their reliability and effectiveness.

Endoscope-assisted supraorbital approach for excision of tuberculum sella meningioma: Technical nuances.

Background: Tuberculum sellae meningiomas (TSMs) are benign dural-based lesions of the anterior cranial fossa, which mainly present with impaired visual acuity/field deficits secondary to compression of the optic apparatus. Surgical management is recommended as the optimal strategy for large compressive TSMs, with goals of safe maximal resection, optic nerve decompression, and potential vision restoration. The philosophy of adapting keyhole approaches for such resections is commonly highlighted; however, it comes with notable criticism of encountering major blind spots during surgical resection and limited anatomical exposure. Adding angled endoscopes enhances the expanded panoramic view of the skull base and provides a synergistic modality to microsurgery for maximizing total resection and navigating the blind spots. Case Description: This video case presentation aims to highlight the technical nuances of endoscope-assisted microscopic supraorbital craniotomy for TSM resection invading bilateral optic canals in a 66-year-old female presenting with progressive right eye vision loss (OD Hand motion). The video emphasizes traditional skull-base surgical principles of TSM resection through the optics of a keyhole approach augmented by endoscopic tumor removal. Gross total resection was achieved, the patient's vision improved to 20/25, and she was discharged home on postoperative day 2. Conclusion: The endoscope-assisted supraorbital craniotomy offers a safe surgical corridor for TSM, using a limited craniotomy with minimal brain retraction in appropriately selected individuals, particularly with larger tumors with greater lateral extension and above the planum.

Three-Level Concavity Apical Pediculectomy During Intraoperative Neuromonitoring Loss: Following the Checklist Resulted in an Ambulatory Patient.

Adolescent idiopathic scoliosis is the most common form of scoliosis, with severe cases leading to a decline in patients with worsening angulation of deformity. Technical nuances of spinal flexibility and cord type based on the extent of the deformity may impact operating safety and outcome, with risks including neurological loss during and after surgical intervention. Here we present a case of posterior osteotomy and correction of a patient with adolescent idiopathic scoliosis with a T2 - L3 fusion in which transcranial motor evoked potentials (TcMEPs) and somatosensory evoked potentials (SSEPs) were lost intraoperatively, thus requiring application of operative consensus guidelines for the loss of neuromonitoring data. Particularly, the discussion focuses on the decision-making process that resulted in the complete recovery of TcMEPs and SSEPs post-operatively.

Evaluating academic productivity and match outcomes in neurosurgery residents from medical schools without a neurosurgery residency program: a 2016-2022 bibliometric analysis.

OBJECTIVE: Transition of the United States Medical Licensing Examination Step 1 to a pass/fail structure has focused attention on medical student research in residency application. Previous studies have explored how various factors affect the neurosurgery match success, but none have focused on applicants from schools without a neurosurgery residency program. METHODS: The authors compiled a list of neurosurgery residents matched from 2016 to 2022 from schools lacking a neurosurgery program. They gathered demographic and bibliometric data, focusing on academic productivity before residency. The distinction between the top 40 and non-top 40 programs used the 5-year institutional h-index (ih[5]-index) of departments. RESULTS: Between 2016 and 2022, the gross number of students entering neurosurgery from schools without a home program rose from 15 to 26 in 2021, declining to 23 in 2022. The range of matched applicants per school was 0 to 10. The median number of publications per resident increased from 2 in 2016 to 5 in 2022 (p < 0.001). The lowest and highest numbers of publications by applicants were 0 and 40, respectively, with 22.5% reporting no publications. The lowest and highest h-indices by applicants were 0 and 11, respectively, with nearly one-third (31.2%) possessing an h-index of 0. Applicants from schools lacking a neurosurgery residency program who matched into top 40 programs had a publication range of 0-11, with a higher median of 3 compared with those who did not (median 2, range 0-8). While no significant differences were found in publication numbers (p = 0.084), a difference in h-index was observed (p = 0.024) between the two groups. Publications significantly correlated with the h-index, with each additional publication increasing the h-index by 0.19 (p < 0.001, adjusted R2 = 0.3348). CONCLUSIONS: Median publication counts have increased in this cohort, but they do not distinguish top 40 program matches. Conversely, the h-index, correlating with publication quantity and journal impact factor, does.

Senior Mentorship and Scholarly Success: Assessing Influences on Successful Neurosurgery Residency Applicant's H-Index.

BACKGROUND: Research productivity is on the rise as neurosurgical residency positions become increasingly competitive. We explored the relationship between neurosurgical residency applicant's senior author's research productivity and matching into a neurosurgery residency program. METHODS: A retrospective analysis of bibliometric data for applicants who matched into neurosurgery in 2022-2023 and their senior authors was conducted using Scopus. RESULTS: Logistic regression revealed a significant association between h-index values and top 40 match outcomes (P = 0.038). The maximum h-index of senior authors significantly predicted matches at top 40 programs (P = 0.003). Affiliation with a top 40 medical school increased both applicant and senior author h-indices (P = 0.05, P < 0.001 respectively). Linear regression of the maximum h-index of senior authors in preresidency publications explained 42% of this variability (P < 0.001). A multiple linear regression model incorporating this with publication number elucidated 69% of the variance in interns' h-index. Authorship data categorized as first, second, and third author positions showed 1847 first author, 1417 second author, and 118 third author publications over 2-years. Applicants at top 40 residency programs had more first and second author publications compared to those from nontop 40 programs (P = 0.0158, P = 0.0275). CONCLUSIONS: There is a strong correlation between a neurosurgical applicant's academic output and that of their senior authors. The number of publications and the maximum h-index of senior authors significantly predict applicant h-indices. We also demonstrated that there is a significant difference in the academic productivity of applicants and senior authors of applicants who successfully match into a top 40 i(h)5 rated neurosurgical residency.

Supraorbital keyhole approaches in the first 3 years of practice: outcomes and lessons learned. Patient series.

BACKGROUND: Supraorbital keyhole approaches (SKAs) have garnered criticism for a limited surgical exposure, restrictive surgical freedom, blind spots, and the learning curve. This retrospective study of patients who underwent SKA aims to explore the outcomes, technical nuances, and the learning curve reflected in a single surgeon's experience in the initial 3 years of practice. OBSERVATIONS: A total of 20 SKA operations were performed in 19 patients. Gross- or near-total resection was achieved in 14 of 17 tumor cases. The mean blood loss was 80.5 mL, the mean duration of surgery was 5 hours, and the median stay was 3 days. Endoscopic augmentation was used in 11 cases in which additional tumor removal occurred in 8 of the 11 cases. There were no cases of cerebrospinal fluid leakage or wound infection. A 30-day readmission and typical narcotics after discharge were seen in one patient each. When comparing two halves of a neurosurgery practice over 3 years, the duration of surgery was significantly longer in the later year, which is likely due to operating on a larger tumor size as the years progressed. No cases required static retractors or conversion to larger craniotomies. LESSONS: Careful case selection and respecting the learning curve allows the safe incorporation of SKA in the early stages of neurosurgical practice.