The graduate school guide: How to prepare for the qualifying exam and assemble a thesis/graduate committee.

Qualifying exams and thesis committees are crucial components of a PhD candidate's journey. However, many candidates have trouble navigating these milestones and knowing what to expect. This article provides advice on meeting the requirements of the qualifying exam, understanding its format and components, choosing effective preparation strategies, retaking the qualifying exam, if necessary, and selecting a thesis committee, all while maintaining one's mental health. This comprehensive guide addresses components of the graduate school process that are often neglected.

Clinical breast exam contribution to breast cancer diagnosis in BRCA mutation carriers vs. average to intermediate risk women.

PURPOSE: The contribution of clinical breast exam (CBE) to breast cancer diagnosis in average risk women undergoing regular screening mammography is minimal. To evaluate the role of CBE in high-risk women, we compared BC diagnosis by CBE in BRCA mutation carriers undergoing regular BC surveillance to average to intermediate risk women undergoing regular breast cancer screening. METHODS: A retrospective chart review of all consecutive screening visits of BRCA mutation carriers (January 2012-October 2022) and average to intermediate risk women (November 2016-December 2022) was completed. Women with histologically confirmed BC diagnosis were included. Additional CBE yield for BC diagnosis, defined as the percentage of all BC cases detected by CBE alone, was assessed in both groups. RESULTS: Overall, 12,997 CBEs were performed in 1,328 BRCA mutation carriers in whom 134 BCs were diagnosed. In 7,949 average to intermediate risk women who underwent 15,518 CBEs, 87 BCs were diagnosed. CBE contributed to BC diagnosis in 3 (2%) BRCA mutation carriers and 3 (4%) non-carriers. In both groups, over 4,000 CBEs were needed in order to diagnose one cancer. In all 3 BRCA mutation carriers BC was palpated during the surveillance round that did not include MRI. In the average to intermediate risk group, 2 of 3 cancers diagnosed following CBE findings were in a different location from the palpable finding. CONCLUSIONS: The contribution of CBE to BC diagnosis is marginal for all women including BRCA mutation carriers. In BRCA mutation carriers, CBE appears redundant during the MRI surveillance round.

Performance of continuous controlled attenuation parameter and liver stiffness measurement by the novel SmartExam in metabolic dysfunction-associated steatotic liver disease.

BACKGROUND & AIMS: FibroScan® Expert 630 and FibroScan® Mini+430 are novel vibration-controlled transient elastography devices equipped with the same SmartExam software, which allows continuous measurement of controlled attenuation parameter (CAP) during the entire examination. This study aims to compare the CAP variabilities and the quantification for liver fibrosis and steatosis between the conventional FibroScan and the SmartExam-equipped machines in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS: This retrospective study included 118 patients with biopsy-proven MASLD who underwent liver biopsy at two tertiary centres between 2021 and 2023. Liver stiffness and steatosis measurements were performed using both FibroScan machines and M and XL probes for each individual. Liver histology was used as the reference standard for liver fibrosis and steatosis staging. RESULTS: Standard deviations of continuous CAP (cCAP) were significantly lower than those of CAP for all probes (p < .0001). CAP variability was significantly associated with body mass index (p < .01), probe selection (p < .001) as well as the random effect of centre. Only the effect of probe selection (p < .001) was significantly associated with cCAP variability. No significant difference was found in the performance of staging liver fibrosis and steatosis between two types of machines at the same cut-offs. CONCLUSIONS: The SmartExam-based VCTE reduces the variability of CAP measurement and achieves a similar accuracy as the FibroScan 502 device for the estimation of both hepatic steatosis and fibrosis. Future studies should determine if cCAP is a better tool to monitor changes in steatosis than the original CAP.

Multidisciplinary approach to evaluation of rectovaginal fistulas.

Thorough evaluation of a rectovaginal fistula is essential to optimize surgical repair. The underlying cause should be addressed and treated, which can affect the timing and the approach to repair. It is imperative to be well prepared because the highest chance of successful closure occurs during the initial repair attempt. Our objective was to demonstrate how multidisciplinary colorectal surgery and urogynecology teams use specific methods during the examination under anesthesia to evaluate a complex rectovaginal fistula and to optimize the surgical approach to repair. Anesthesia may be provided with monitored anesthesia care and a posterior perineal block. This pain control allows for a wide range of techniques to evaluate the fistula using anoscopy, fistula probe, hydrogen peroxide, and sigmoidoscopy. In addition, the teams show how curettage and subsequent seton placement can encourage closure by secondary intention and decrease the risk of abscess formation, respectively.

Topical Lidocaine for Pessary Removal and Reinsertion Pain Reduction: A Randomized Clinical Trial.

BACKGROUND: Vaginal pessaries are an inexpensive non-surgical treatment for pelvic organ prolapse and stress urinary incontinence. Pessary maintenance includes periodic removal, cleaning, and reinsertion, which can be painful. Lidocaine-prilocaine cream has been shown to significantly reduce pain during pessary maintenance exams. In some practices, Lidocaine HCl 2% jelly may be more readily available and serve as an alternative to lidocaine-prilocaine cream. However, the effect of Lidocaine HCl 2% jelly use during pessary maintenance exams has not been tested. OBJECTIVE: To estimate the effect of Lidocaine HCl 2% jelly versus lubricating jelly on pain at the time of office pessary removal and reinsertion. STUDY DESIGN: This study is a single-blind, randomized clinical trial among patients presenting to a urogynecology office at a tertiary care center. Participants were randomized to the application of 5cc of Lidocaine HCl 2% jelly or a water-based lubricating jelly five minutes before pessary removal. Visual analog scale pain scores were collected from the participants at baseline, at pessary removal, and at pessary reinsertion. The primary outcome was the visual analog scale pain score at the time of pessary removal. A sample size of 33 per group (n=66) was planned to estimate an absolute mean difference in visual analog pain scale of 2.05 cm at the time of pessary removal. RESULTS: Between September 2022 and June 2023, 192 women were screened, and 66 were enrolled. Thirty-three participants were randomized into the lubricating jelly group and 33 participants were randomized into the Lidocaine HCl 2% jelly group. The two groups were similar in baseline characteristics. Most participants were postmenopausal, using vaginal estrogen, wearing a 70 mm ring pessary with support for pelvic organ prolapse, and reported being very satisfied with the pessary. Other pessaries worn included ring without support, incontinence rings with and without support, Gellhorn, and donut. The pessary sizes ranged from 51 mm to 96 mm. There was no significant difference in pessary type and size between groups. Visual analog scale pain scores at pessary removal were low in both groups: 3.23±3.00 cm in the lubricating group and 2.66±2.77 cm in the lidocaine group. After adjusting for baseline pain, there was no significant difference in pain at pessary removal between the lidocaine jelly and the lubricating jelly groups (mean difference=-0.56 cm, 95% CI: -1.97 to 0.85; p=0.44). Despite no significant difference in visual analog scale pain scores, 71.2% of participants reported a desire for numbing jelly at future pessary examinations. CONCLUSION: Pain during pessary removal and reinsertion is low. Compared to lubricating jelly, lidocaine jelly did not further reduce pain during pessary examinations.

Beyond lectures and practical courses: Teaching pharmacology using imaginative pedagogical tools.

Pharmacology has broadened its scope considerably in recent decades. Initially, it was of interest to chemists, doctors and pharmacists. In recent years, however, it has been incorporated into the teaching of biologists, molecular biologists, biotechnologists, chemical engineers and many health professionals, among others. Traditional teaching methods, such as lectures or laboratory work, have been superseded by the use of new pedagogical approaches to enable a better conceptualization and understanding of the discipline. In this article, we present several new methods that have been used in Spanish universities. Firstly, we describe a teaching network that has allowed the sharing of pedagogical innovations in Spanish universities. A European experience to improve prescribing safety is described in detail. The use of popular films and medical TV series in biomedical students shows how these audiovisual resources can be helpful in teaching pharmacology. The use of virtual worlds is detailed to introduce this new approach to teaching. The increasingly important area of the social aspects of pharmacology is also considered in two sections, one devoted to social pharmacology and the other to the use of learning based on social services to improve understanding of this important area. Finally, the use of Objective Structured Clinical Evaluation in pharmacology allows to know how this approach can help to better evaluate clinical pharmacology students. In conclusion, this article allows to know new pedagogical methods resources used in some Spanish universities that may help to improve the teaching of pharmacology.

How does artificial intelligence master urological board examinations? A comparative analysis of different Large Language Models' accuracy and reliability in the 2022 In-Service Assessment of the European Board of Urology.

PURPOSE: This study is a comparative analysis of three Large Language Models (LLMs) evaluating their rate of correct answers (RoCA) and the reliability of generated answers on a set of urological knowledge-based questions spanning different levels of complexity. METHODS: ChatGPT-3.5, ChatGPT-4, and Bing AI underwent two testing rounds, with a 48-h gap in between, using the 100 multiple-choice questions from the 2022 European Board of Urology (EBU) In-Service Assessment (ISA). For conflicting responses, an additional consensus round was conducted to establish conclusive answers. RoCA was compared across various question complexities. Ten weeks after the consensus round, a subsequent testing round was conducted to assess potential knowledge gain and improvement in RoCA, respectively. RESULTS: Over three testing rounds, ChatGPT-3.5 achieved RoCa scores of 58%, 62%, and 59%. In contrast, ChatGPT-4 achieved RoCA scores of 63%, 77%, and 77%, while Bing AI yielded scores of 81%, 73%, and 77%, respectively. Agreement rates between rounds 1 and 2 were 84% (κ = 0.67, p < 0.001) for ChatGPT-3.5, 74% (κ = 0.40, p < 0.001) for ChatGPT-4, and 76% (κ = 0.33, p < 0.001) for BING AI. In the consensus round, ChatGPT-4 and Bing AI significantly outperformed ChatGPT-3.5 (77% and 77% vs. 59%, both p = 0.010). All LLMs demonstrated decreasing RoCA scores with increasing question complexity (p < 0.001). In the fourth round, no significant improvement in RoCA was observed across all three LLMs. CONCLUSIONS: The performance of the tested LLMs in addressing urological specialist inquiries warrants further refinement. Moreover, the deficiency in response reliability contributes to existing challenges related to their current utility for educational purposes.

American Board of Surgery In-Training Exam Performance Predicted by Question Bank Use While Unassociated With Other Learning Strategies.

INTRODUCTION: There is no consensus regarding optimal curricula to teach cognitive elements of general surgery. The American Board of Surgery In-Training Exam (ABSITE) aims to measure trainees' progress in attaining this knowledge. Resources like question banks (QBs), Surgical Council on Resident Education (SCORE) curriculum, and didactic conferences have mixed findings related to ABSITE performance and are often evaluated in isolation. This study characterized relationships between multiple learning methods and ABSITE performance to elucidate the relative educational value of learning strategies. METHODS: Use and score of QB, SCORE use, didactic conference attendance, and ABSITE percentile score were collected at an academic general surgery residency program from 2017 to 2022. QB data were available in the years 2017-2018 and 2021-2022 during institutional subscription to the same platform. Given differences in risk of qualifying exam failure, groups of ≤30th and >30th percentile were analyzed. Linear quantile mixed regressions and generalized linear mixed models determined factors associated with ABSITE performance. RESULTS: Linear quantile mixed regressions revealed a relationship between ABSITE performance and QB questions completed (1.5 percentile per 100 questions, P < 0.001) and QB score (1.2 percentile per 1% score, P < 0.001), but not with SCORE use and didactic attendance. Performers >30th percentile had a significantly higher QB score. CONCLUSIONS: Use and score of QB had a significant relationship with ABSITE performance, while SCORE use and didactic attendance did not. Performers >30th percentile completed a median 1094 QB questions annually with a score of 65%. Results emphasize success of QB use as an active learning strategy, while passive learning methods warrant further evaluation.

GPT-4 passes the bar exam.

In this paper, we experimentally evaluate the zero-shot performance of GPT-4 against prior generations of GPT on the entire uniform bar examination (UBE), including not only the multiple-choice multistate bar examination (MBE), but also the open-ended multistate essay exam (MEE) and multistate performance test (MPT) components. On the MBE, GPT-4 significantly outperforms both human test-takers and prior models, demonstrating a 26% increase over ChatGPT and beating humans in five of seven subject areas. On the MEE and MPT, which have not previously been evaluated by scholars, GPT-4 scores an average of 4.2/6.0 when compared with much lower scores for ChatGPT. Graded across the UBE components, in the manner in which a human test-taker would be, GPT-4 scores approximately 297 points, significantly in excess of the passing threshold for all UBE jurisdictions. These findings document not just the rapid and remarkable advance of large language model performance generally, but also the potential for such models to support the delivery of legal services in society. This article is part of the theme issue 'A complexity science approach to law and governance'.

Artificial intelligence large language model scores highly on focused practice designation in metabolic and bariatric surgery board practice questions.

BACKGROUND: Artificial intelligence models such as ChatGPT (Open AI) have performed well on the exams of various medical and surgical fields. It is not yet known how ChatGPT performs on similar metabolic and bariatric surgery (MBS) questions. OBJECTIVE: Assess the performance of ChatGPT on Focused Practice Designation in Metabolic and Bariatric Surgery board-style questions. SETTING: United States. METHODS: Questions obtained from the largest commercially available bank of FPD-MBS practice questions were entered into ChatGPT-4, as is, without prior training. We assessed the overall percentage correct as well as the percentage correct within each of the five American Board of Surgery (ABS) question categories. One-way ANOVA was used to determine if the frequency of correct answers differed between categories. RESULTS: Out of 255 questions, ChatGPT-4 correctly answered 189 (74.1%). Between the five question categories there was no difference between the frequency of correct answers (p = 0.22). It did not matter if questions were entered individually or in groups of up to 10. CONCLUSION: Without prior training, ChatGPT-4 scored highly when evaluated on the largest practice question bank for the FPD-MBS exam.

Digital Rectal Exams Are Infrequently Performed Prior to Anorectal Manometry.

BACKGROUND: Digital rectal examination should be performed prior to anorectal manometry; however, real-world data is lacking. AIMS: Characterize real world rates of digital rectal and their sensitivity for detecting dyssynergia compared to anorectal manometry and balloon expulsion test. METHODS: A retrospective single-center study was conducted to examine all patients who underwent anorectal manometry for chronic constipation between 2021 and 2022 at one tertiary center with motility expertise. Primary outcomes consisted of the rate of digital rectal exam prior to anorectal manometry; and secondary outcomes included the sensitivity of digital rectal exam for dyssynergic defecation. RESULTS: Only 42.3% of 142 patients had digital rectal examinations prior to anorectal manometry. Overall sensitivity for detecting dyssynergic defecation was 46.4%, but significantly higher for gastroenterology providers (p = .004), and highest for gastroenterology attendings (82.6%). CONCLUSIONS: Digital rectal examination is infrequently performed when indicated for chronic constipation. Sensitivity for detecting dyssynergic defecation may be impacted by discipline and level of training.

Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT): optometric exam improves access and utilization of eye care services.

PURPOSE: To describe the benefits of optometric evaluation for detection of vision-affecting conditions in the context of community-based eye health screenings and identify factors associated with having a recent dilated eye exam. METHODS: Enrolled participants were age 40 and older, living independently in affordable housing developments in New York City. Eye health screening failure and criteria for seeing the on-site study optometrist were defined as visual acuity 20/40 or worse in either eye, intraocular pressure 23-29 mmHg, or an unreadable fundus image. The optometrist conducted a manifest refraction using loose lenses and used a portable slit lamp and ophthalmoscope to perform a non-dilated anterior and posterior segment ocular health evaluation. Demographics, social determinants of health, eye health screening results, and rates of suspected ophthalmic conditions were recorded. To determine factors associated with having a recent dilated eye exam, which was the main outcome for this statistical analysis, a stepwise multivariate logistic regression was performed. RESULTS: A total of 708 participants were screened, 308 attended the optometric exam; mean age 70.7 ± 11.7 [standard deviation (SD)] years. Among this subgroup, 70.1% identified as female, 54.9% self-identified as African American, 39% as Hispanic/Latino, and 26.6% Dominican ethnicity; 78.2% (241/308) had not undergone a dilated eye exam within the last year, 71.4% reported they did not have an eye care provider. Stepwise multivariate logistic regression analysis indicated that participants who self-reported having cataracts (odds ratio (OR) 2.15; 95% confidence interval (CI) 1.03-4.47; p = 0.041), self-reported having glaucoma/glaucoma suspect (OR 5.60; 95% CI 2.02-15.43; p = 0.001), or spoke Spanish as their primary language (OR 3.25; 95% CI 1.48-7.11; p = 0.003) had higher odds of having a recent dilated eye exam. CONCLUSIONS: This community-based screening initiative demonstrated the effectiveness of optometric exams in detecting vision-affecting conditions and identified factors associated with having a recent dilated eye exam. Optometrists play a vital role in increasing access to eye care for high-risk, underserved populations. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04271709).

Digital Rectal Exam in Prostate Cancer Screening and Elevated PSA Work-up-Is there a role anymore?

PURPOSE OF REVIEW: Prostate cancer (PCa) screening tools, particularly digital rectal examination (DRE), are under scrutiny. This review assesses the utility of DRE in PCa screening. RECENT FINDINGS: Recent studies reaffirm the DRE's sensitivity and specificity, a higher PCa detection rate with PSA in conjunction with DRE, and a slightly elevated risk of clinically significant PCa (CSPC) in those with elevated PSA and suspicious DRE. Studies confirm high accuracy of MRI in identifying CSPC, with ongoing research exploring its screening potential. DRE alone lacks accuracy for PCa screening, often resulting in missed diagnoses and unnecessary biopsies. Its supplementary use with PSA marginally increases detection rates of identifying a small percentage of CSPC, but the benefit remains questionable. Emerging evidence suggests MRI has the potential as a superior screening tool compared to DRE, although direct comparative studies are lacking. Overall, the DRE has a limited role in current PCa screening.

Transesophageal echocardiographic acquisition of the venous excess ultrasound exam-a case series and technical description.

PURPOSE: Obtaining an objective, reproducible, and accurate assessment of volume status is one of the more difficult tasks in the perioperative arena. Since its advent in 2020, the Venous Excess Ultrasound (VExUS) score has gained popularity in the minimally invasive assessment of venous congestion. The VExUS exam has been well described as an additional series of images (hepatic vein, portal vein, and intrarenal vein) obtained with a phased-array probe during a transthoracic echocardiogram. Nevertheless, there are no descriptions of comprehensive VExUS exams performed using transesophageal echocardiography (TEE)-a modality that is routinely employed in patients undergoing cardiac surgery. CLINICAL FEATURES: We describe techniques to acquire and interpret a comprehensive TEE-supported VexUS exam, which may be used to optimize the perioperative care of cardiac surgical patients. CONCLUSION: Given the risks of fluid overload in critically ill cardiac surgery patients, TEE-supported VExUS examination may be a way to reduce morbidity in this population.

RéSUMé: OBJECTIF: L'obtention d'une évaluation objective, reproductible et précise du statut volémique est l'une des tâches les plus difficiles dans l'arène périopératoire. Depuis son introduction en 2020, le score VExUS (pour Venous Excess Ultrasound, soit échographie de l'excès veineux) a gagné en popularité dans l'évaluation minimalement invasive de la congestion veineuse. L'examen échographique VExUS a été bien décrit en tant que série supplémentaire d'images (veine hépatique, veine porte et veine intrarénale) obtenues à l'aide d'une sonde type « phased-array ¼ lors d'un échocardiogramme transthoracique. Néanmoins, il n'existe aucune description d'examens VExUS complets réalisés à l'aide d'une sonde d'ETO (échocardiographie transœsophagienne), une modalité couramment utilisée chez les patient·es bénéficiant d'une chirurgie cardiaque. CARACTéRISTIQUES CLINIQUES: Nous décrivons des techniques permettant d'acquérir et d'interpréter un examen VexUS complet par ETO, qui peut être utilisé pour optimiser les soins périopératoires de la patientèle en chirurgie cardiaque. CONCLUSION: Compte tenu des risques de surcharge hydrique chez la patientèle gravement malade en chirurgie cardiaque, l'examen VExUS basé sur l'ETO peut être un moyen de réduire la morbidité dans cette population.

Implementation of a clinical breast exam and referral program in a rural district of Pakistan.

BACKGROUND: The role of clinical breast examination (CBE) for early detection of breast cancer is extremely important in lower-middle-income countries (LMICs) where access to breast imaging is limited. Our study aimed to describe the outcomes of a community outreach breast education, home CBE and referral program for early recognition of breast abnormalities and improvement of breast cancer awareness in a rural district of Pakistan. METHODS: Eight health care workers (HCW) and a gynecologist were educated on basic breast cancer knowledge and trained to create breast cancer awareness and conduct CBE in the community. They were then deployed in the Dadu district of Pakistan where they carried out home visits to perform CBE in the community. Breast cancer awareness was assessed in the community using a standardized questionnaire and standard educational intervention was performed. Clinically detectable breast lesions were identified during home CBE and women were referred to the study gynecologist to confirm the presence of clinical abnormalities. Those confirmed to have clinical abnormalities were referred for imaging. Follow-up home visits were carried out to assess reasons for non-compliance in patients who did not follow-through with the gynecologist appointment or prescribed imaging and re-enforce the need for follow-up. RESULTS: Basic breast cancer knowledge of HCWs and study gynecologist improved post-intervention. HCWs conducted home CBE in 8757 women. Of these, 149 were warranted a CBE by a physician (to avoid missing an abnormality), while 20 were found to have a definitive lump by HCWs, all were referred to the study gynecologist (CBE checkpoint). Only 50% (10/20) of those with a suspected lump complied with the referral to the gynecologist, where 90% concordance was found between their CBEs. Follow-up home visits were conducted in 119/169 non-compliant patients. Major reasons for non-compliance were a lack of understanding of the risks and financial constraints. A significant improvement was observed in the community's breast cancer knowledge at the follow-up visits using the standardized post-test. CONCLUSIONS: Basic and focused education of HCWs can increase their knowledge and dispel myths. Hand-on structured training can enable HCWs to perform CBE. Community awareness is essential for patient compliance and for early-detection, diagnosis, and treatment.

Assessing ChatGPT's Mastery of Bloom's Taxonomy Using Psychosomatic Medicine Exam Questions: Mixed-Methods Study.

BACKGROUND: Large language models such as GPT-4 (Generative Pre-trained Transformer 4) are being increasingly used in medicine and medical education. However, these models are prone to "hallucinations" (ie, outputs that seem convincing while being factually incorrect). It is currently unknown how these errors by large language models relate to the different cognitive levels defined in Bloom's taxonomy. OBJECTIVE: This study aims to explore how GPT-4 performs in terms of Bloom's taxonomy using psychosomatic medicine exam questions. METHODS: We used a large data set of psychosomatic medicine multiple-choice questions (N=307) with real-world results derived from medical school exams. GPT-4 answered the multiple-choice questions using 2 distinct prompt versions: detailed and short. The answers were analyzed using a quantitative approach and a qualitative approach. Focusing on incorrectly answered questions, we categorized reasoning errors according to the hierarchical framework of Bloom's taxonomy. RESULTS: GPT-4's performance in answering exam questions yielded a high success rate: 93% (284/307) for the detailed prompt and 91% (278/307) for the short prompt. Questions answered correctly by GPT-4 had a statistically significant higher difficulty than questions answered incorrectly (P=.002 for the detailed prompt and P<.001 for the short prompt). Independent of the prompt, GPT-4's lowest exam performance was 78.9% (15/19), thereby always surpassing the "pass" threshold. Our qualitative analysis of incorrect answers, based on Bloom's taxonomy, showed that errors were primarily in the "remember" (29/68) and "understand" (23/68) cognitive levels; specific issues arose in recalling details, understanding conceptual relationships, and adhering to standardized guidelines. CONCLUSIONS: GPT-4 demonstrated a remarkable success rate when confronted with psychosomatic medicine multiple-choice exam questions, aligning with previous findings. When evaluated through Bloom's taxonomy, our data revealed that GPT-4 occasionally ignored specific facts (remember), provided illogical reasoning (understand), or failed to apply concepts to a new situation (apply). These errors, which were confidently presented, could be attributed to inherent model biases and the tendency to generate outputs that maximize likelihood.

The effect of exam retakes on future exam performance in a large classroom setting.

Assessing student mastery is often done by using exams. Inevitably, some students will complete remediation, which may include exam retakes. This method provides students an additional opportunity to take an exam that assesses the same objectives as the original exam, while using different questions. Although this form of remediation increases exam scores, it is also possible that students who prepare for an exam retake adversely affect preparation for an upcoming exam. Therefore, the purpose of this study was to determine whether studying for and taking an exam retake affected preparation for the next exam. We hypothesized that students who completed an exam retake would have lower than expected scores on their next exam. This study utilized data collected over five semesters from 467 students enrolled in a 200-level introductory human physiology class; 159 students (34.0%) completed at least one exam retake. Students who retook an exam increased their original exam score by 6.1% (SD 13.9). These findings suggest that retaking an exam leads to better outcomes, which could be explained by students improving their study habits or test-taking skills, which would help them perform better on future exams.NEW & NOTEWORTHY Exam retakes provide students with an additional opportunity to demonstrate mastery of learning objectives. However, this preparation might adversely affect performance on subsequent exams. This study suggests that students who choose to prepare for and take an exam retake not only improve their original exam score but show a larger improvement on subsequent exam performance than those students who did not take an exam retake.

Using artificial intelligence platforms to support student learning in physiology.

The advent of artificial intelligence (AI)-powered language models presents new opportunities and challenges in education. By teaching students how to craft prompts that elicit insightful responses, faculty can scaffold activities where AI acts as a supplemental resource to amplify critical thinking and support student learning. Ongoing dialogue and iteration focused on ethical usage norms can achieve the right balance between emerging technology and foundational skills development. With care and intention, AI-assisted study tactics offer students personalized support while adhering to academic standards. While AI-powered tools provide many positive opportunities, students and faculty need to learn about and use them responsibly and ethically, not as replacements for required thinking and effort. Before implementing these AI tools for studying biology, there are several key things to discuss with students. This article outlines several ways that students can employ these tools to support better learning along with a set of guidelines for all to be wary of when implementing these in an academic setting.NEW & NOTEWORTHY Utilizing of artificial intelligence tools offers a promising new technology to support student learning. This article outlines several ways that students can employ these tools to support better learning along with a set of guidelines for all to be wary of when implementing these in an academic setting.

Comparative analysis of Physician Assistant/Associate National Certifying Examination (PANCE) performance trends: pre and during COVID-19 era.

BACKGROUND: COVID-19 significantly impacted physician assistant/associate (PA) education programs. Most programs transitioned didactic and clinical education from in-person to remote, and clinical training opportunities diminished. Graduates of accredited PA programs take the Physician Assistant National Certifying Examination (PANCE), a five-hour exam with 300 multiple-choice questions, and must attain or exceed the scaled passing score of 350 (range: 200-800). We examined first-time examinees' trends in PANCE scores and passing rates three years prior to the pandemic and three years during. METHODS: We analyzed data (N = 59,459) from the National Commission on Certification of Physician Assistants. The two primary outcomes were PANCE scores and pass rates. The main exposure was the timeframe: three years pre-pandemic (2017-2019) and three years during the pandemic (2020-2022). The 2017-2018 scores were equated to the new passing standard implemented in 2019. Covariates included age, gender, years the PA program has been accredited, program region, and rural-urban setting. Analyses consisted of descriptive, bivariate, and multivariate statistics. RESULTS: The mean PANCE score and pass rate during the six-year study period were 463 and 93%, respectively. In unadjusted analyses comparing each year individually, mean PANCE score was highest in 2020 and lowest in 2022 than in all other years except for 2017. When comparing each pandemic year to the pooled three pre-pandemic years and adjusting for test-taker and PA program covariates, examinees scored significantly higher in 2020; there was no difference in 2021, and they scored lower in 2022. When controlling for covariates, examinees had 1.24 higher odds of failing in 2022 compared to the pooled pre-pandemic period. CONCLUSION: Findings suggest that PANCE scores and pass rates were impacted during the third year of the pandemic. PANCE assesses if examinees have the essential clinical knowledge to enter the PA profession. It is crucial to determine whether the pandemic affected PANCE scores and pass rates to ensure PAs provide safe and high-quality patient care.

Effect of a multimodal training on the ability of medical students to administer the MMSE: a comparative study.

BACKGROUNDS: The Mini-Mental State Examination (MMSE) is the main screening and follow-up test for neurocognitive disorders. In France, it is often administered by medical students. Conditions allowing to administer the MMSE are strict but not well known by students, leading to mistakes in scoring. Our objectives were to assess the effect of a multimodal training on medical students' ability to administer the MMSE and to describe their previous training. METHODS: 75 medical students between the 4th and 6th year of study were included. Previous MMSE training was assessed by a standardized questionnaire. The teaching material used for our training was the article validating MMSE in French, a video explaining the steps on how to administer the MMSE test, and MMSE's scoring exercises. The ability to administer the MMSE was assessed by a Standardized practical exam (SPE). Students were self-selected and then assigned in two groups, one benefiting from all the training before SPE, and the other receiving only the article before SPE. RESULTS: 41 students were included in the training group and 34 in the control group. There was no difference between groups regarding previous training. 71% of the students had already administered a MMSE test and only 17% had received specific training. Students considered their previous training as insufficient in most cases. The overall score and scores of each subpart of the SPE were significantly higher in the training group than in the control group (overall score: median [IQR]: 71 [62-78] vs. 52 [41-57], p < 0.001). The rate of students able to complete the MMSE was higher in the training group compared to the control (85% vs. 44%, p < 0.001). Quality of the training and its usefulness were judged to be good or very good by all participants. CONCLUSIONS: A multimodal training improves the ability of medical students to administer the MMSE.