Using ChatGPT in the Development of Clinical Reasoning Cases: A Qualitative Study.

Background There has been an explosion of commentary and discussion about the ethics and utility of using artificial intelligence in medicine, and its practical use in medical education is still being debated. Through qualitative research methods, this study aims to highlight the advantages and pitfalls of using ChatGPT in the development of clinical reasoning cases for medical student education. Methods Five highly experienced faculty in medical education were provided instructions to create unique clinical reasoning cases for three different chief concerns using ChatGPT 3.0. Faculty were then asked to reflect on and review the created cases. Finally, a focus group was conducted to further analyze and describe their experiences with the new technology. Results Overall, faculty found the use of ChatGPT in the development of clinical reasoning cases easy to use but difficult to get to certain objectives and largely incapable of being creative enough to create complexity for student use without heavy editing. The created cases did provide a helpful starting point and were extremely efficient; however, faculty did experience some medical inaccuracies and fact fabrication. Conclusion There is value to using ChatGPT to develop curricular content, especially for clinical reasoning cases, but it needs to be comprehensively reviewed and verified. To efficiently and effectively utilize the tool, educators will need to develop a framework that can be easily translatable into simple prompts that ChatGPT can understand. Future work will need to strongly consider the risks of recirculating biases and misinformation.

Learning in the Pandemic: Medical Students' Perceived Effects of COVID-19 on Their Clinical Experiences and Career Choices During the Internal Medicine Clerkship.

Introduction: The COVID-19 pandemic forced changes to undergraduate medical education with its impact still not fully understood. This is the first US study to assess the pandemic's perceived impact on medical education after return to in-person clerkships. Materials and Methods: We conducted a survey of third-year medical students completing their medicine clerkship during the 2020-2021 and 2021-2022 academic years (AY). Survey questions assessed students' attitudes on perceived risk of COVID-19 infection, impact on clinical encounters, and students' specialty interests. Results: Of 312 students enrolled, 283 (90.71%) completed the survey. Concern for COVID-19 infection was highest in the second rotation (3.98 [95% CI 3.64, 4.31]) of the 2020-2021 AY and the third rotation of the 2021-2022 AY (3.41 [95% CI 3.06, 3.76]), corresponding to the surges of COVID-19 cases and subsequent variants. Conversely, as incidence increased, students reported a greater perceived impact on histories, physicals, and time spent with patients with no differences in patient rapport or specialty interests. Discussion: Although concern for infection was initially high, it decreased after the introduction of the COVID-19 vaccine despite increasing incidence nationally and then peaked again during the Omicron surge. The degree of concern did not exceed initial levels, despite unprecedentedly high disease prevalence. Higher infection rates correlated with greater perceived impact on clinical experiences. Our study underscores the importance of vaccination, highlights learners' concerns and resilience throughout the pandemic, and should be considered in balancing student exposure with maintaining clinical opportunities. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01589-8.

A Case of Cerebellar Hippocampal and Basal Nuclei Transient Edema With Restricted Diffusion Syndrome With Poor Clinical Outcome.

Cerebellar hippocampal and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome is a specific pattern of restricted diffusion in the hippocampi and cerebellum identified on brain imaging by clinicians in patients who present with altered mental status in the context of substance intoxication. These patients developed obstructive hydrocephalus a couple of days into their hospitalization that required therapy with osmotic agents and/or surgical interventions (i.e., drains and decompressive craniectomy). In prior cases published, many of the patients had good recovery. The case we present is of a woman who presented after polysubstance use and was found to have brain imaging findings supportive of CHANTER syndrome. Although she was treated with aggressive osmotic therapy and surgical interventions, she ultimately developed irreversible brain damage leading to an overall poor prognosis for recovery. Our case suggests variability in the progression of the syndrome and demonstrates the need for further studies to examine whether the substance of use and the patient's chronic medical conditions may contribute to the degree of recovery.

Association between alanine aminotransferase within the normal range and all-cause and cause-specific mortality: A nationwide cohort study.

BACKGROUND AND AIM: We sought to determine the association between alanine aminotransferase (ALT) in the normal range and mortality in the absence of liver dysfunction to better understand ALT's clinical significance beyond liver injury and inflammation. METHODS: A cohort of 2,708 male and 3,461 female adults aged 20-75 years without liver dysfunction (ALT<30 in males & <19 in females, negative viral serologies, negative ultrasound-based steatosis, no excess alcohol consumption) from the National Health and Nutrition Examination Survey (NHANES)-III (1988-1994) were linked to the National Death Index through December 31, 2015. Serum ALT levels were categorized into sex-specific quartiles (Females: <9, 9-11, 11-14, ≥14 IU/L, Male: <12, 12-15, 15-20, ≥20 U/L). The primary outcome was all-cause mortality. Hazard ratios (HRs) were estimated, adjusting for covariates and accounting for the complex survey design. RESULTS: Relative to males in the lowest quartile (Q1), males in the highest quartile (Q4) had 44% decreased risk of all-cause mortality (aHR [95% CI]: 0.56 [0.42, 0.74]). Females in Q4 had 45% decreased risk of all-cause mortality (aHR [95% CI]: 0.55 [0.40, 0.77]). Males with BMI <25 kg/m2 in Q4 had significantly lower risk of all-cause mortality than Q1; however, this association did not exist in males with BMI ≥25 (BMI<25: 0.36 [0.20, 0.64], BMI≥25: 0.77 [0.49, 1.22]). Risk of all-cause mortality was lower in males ≥50 years than in males<50 (age≥50: 0.55 [0.39, 0.77], age<50: 0.81 [0.39, 1.69]). These age- and BMI-related differences were not seen in females. CONCLUSION: ALT within the normal range was inversely associated with all-cause mortality in U.S. adults.

Spontaneous tumor lysis syndrome in T-cell malignancy: two case reports.

Tumor lysis syndrome (TLS) refers to a constellation of metabolic abnormalities that result from release of intracellular solutes (potassium, phosphate, and nucleic acid metabolites) from rapidly dying tumor cells. While TLS most commonly occurs following chemotherapy, spontaneous TLS can rarely occur in rapidly dividing liquid or solid malignancies. Here, we report the cases of two patients who presented with non-specific symptoms and were found to have spontaneous TLS. Work-up in both cases led to a diagnosis of T-cell malignancy (i.e., acute lymphoblastic leukemia and angioimmunoblastic lymphoma). Given that spontaneous TLS can be the first manifestation of an underlying malignancy, all physicians should be familiar with this oncologic emergency. Early recognition and prompt management can be lifesaving for patients with an otherwise curable malignancy.

Age-related prevalence of cardiac valvular abnormalities warranting infectious endocarditis prophylaxis.

The goal of our study was to determine the prevalence of older patients with cardiac valvular abnormalities warranting endocarditis prophylaxis. We performed a retrospective analysis of 1,000 randomly selected echocardiograms (inpatients and outpatients) from our tertiary care institution. We found that the prevalence of valvular abnormalities increased significantly with age, and that 50% of patients > or =60 years of age warranted endocarditis prophylaxis using current guidelines. With the aging population of the United States and the negative consequences of widespread antibiotic prophylaxis, further investigation is needed to identify patients who are truly at risk for infectious endocarditis.