Introducing AnatomyGPT: A customized artificial intelligence application for anatomical sciences education.

Artificial intelligence (AI) technologies are poised to become an increasingly important part of education in the anatomical sciences. OpenAI has also introduced generative pretrained transformers (GPTs), which are customizable versions of the standard ChatGPT application. There is little research that has explored the potential of GPTs to serve as intelligent tutoring systems for learning the anatomical sciences. The objective of this study was to describe the design and explore the performance of AnatomyGPT, a customized artificial intelligence application intended for anatomical sciences education. The AnatomyGPT application was configured with GPT Builder by uploading open-source textbooks as knowledge sources and by providing pedagogical instructions for how to interact with users. The performance of AnatomyGPT was compared with ChatGPT by evaluating the responses of both applications to prompts of the National Board of Medical Examiners (NBME) sample items with respect to accuracy, rationales, and citations. AnatomyGPT achieved high scores on the NBME sample items for Gross Anatomy, Embryology, Histology, and Neuroscience and scored comparably to ChatGPT. In addition, AnatomyGPT provided several citations in the responses that it generated, while ChatGPT provided none. Both GPTs provided rationales for all sample items. The customized AnatomyGPT application demonstrated preliminary potential as an intelligent tutoring system by generating responses with increased citations as compared with the standard ChatGPT application. The findings of this study suggest that instructors and students may wish to create their own custom GPTs for teaching and learning anatomy. Future research is needed to further develop and characterize the potential of GPTs for anatomy education.

Dental student perceptions of teamwork during a community-engaged interprofessional learning experience.

INTRODUCTION: Dental professionals have been strong advocates for interprofessional education (IPE). During PFF, students in diverse, interprofessional teams of four are assigned a local volunteer family during their first academic year. Teams conduct four home visits and implement a health improvement project focused on the family's health and well-being. The purpose of our analysis was to examine dental student perspectives on the use of teamwork skills during this unique interprofessional educational experience. METHODS AND MATERIALS: Dental student responses from 2017 to 2018 and 2018 to2019 were qualitatively analysed. Open coding by hand was used to identify keywords and themes. The themes and open codes were compared and contrasted by the researchers until a consensus was reached on themes. RESULTS: Researchers discerned three meta-themes: value, skills and time. Researchers also found eight sub-themes prevalent in responses: teamwork, adaptability, mutual support, trust, interprofessional communication, time, feedback, coordination and accountability. DISCUSSION: Our findings indicate dental students understood the importance of interprofessional teamwork and experiential learning within the context of PFF. Students communicated an understanding of how teamwork skills can impact team-oriented outcomes. Dental students seemed to value many teamwork skills that contributed to their interprofessional team's success and experiential learning experience. CONCLUSION: Engagement in a longitudinal experience that is patient-centred, requiring time outside of the classroom, is valued by dental students for its interprofessional collaborative competency development.

Identifying indicators during pregnancy for child maltreatment.

To measure the effect of a short interpregnancy interval (IPI), along with other indicators routinely asked during pregnancy on later report of child maltreatment. We hypothesized that an IPI of <18 months was associated with increased risk of child maltreatment. This study was a secondary analysis of a linked population-based dataset from 2005 to 2007 in Florida. Data were derived from three sources: Birth Certificates, Healthy Start Prenatal Risk Screens, and the HomeSafeNet Database. Primary predictor variables were IPI, and mothers' evaluations of the timing of the pregnancy and perceptions of harm. Logistic regression analyses were used to estimate the odds of child maltreatment, adjusting for demographic and other known risk factors for maltreatment. The final study sample consisted of 85,258 multipara women-infant dyads with credible IPIs and with completed Healthy Start Prenatal Risk Screens. Seventeen percent of children had a report of child maltreatment in the first 5 years of life. An IPI of less than 18 months was associated with 18 % higher odds of maltreatment compared to an IPI of greater than 18 months (95 % CI 1.13, 1.23). Mothers' perception of harm and desire to be pregnant at a later time were also significantly associated with higher odds of maltreatment report (AOR = 2.43 95 % CI = 2.17, 2.71 and AOR = 1.18 95 % CI 1.13, 1.24, respectively). Ascertaining short IPI and asking pregnant and peripartum women about their perception of harm and desire for a longer birth spacing can alert obstetricians, family practitioners and pediatricians to potential child maltreatment.

Adding Safety Rules to Surgeon-Authored Virtual Reality Training.

INTRODUCTION: The Toolkit for Illustration of Procedures in Surgery (TIPS) is an open source virtual reality (VR) laparoscopic simulation-based training environment with force feedback. The TIPS-author is a content creation interface that allows a surgeon educator (SE) to assemble new laparoscopic training modules. New technology enables safety rules to be specified by the SE, automatically tracks specified safety errors, and summarizes and communicates achievements and errors to the surgical trainee. METHODS: The TIPS-author combines and initializes building blocks of anatomy with their physical properties, as selected by the SE from a database. The SE can add any safety rule that can be tested in terms of location, proximity, separation, clip count, and force. Errors are then automatically monitored during simulation and recorded as visual snapshots for feedback to the trainee. The TIPS was field tested at 2 surgical conferences, one before and one after adding the error snapshot feature. RESULTS: Sixty-four respondents at 2 surgical conferences assessed the utility of TIPS on a Likert scale. While other ratings remained unchanged for an overall score of 5.24 of 7 (7 = very useful), the rating of the statement "The TIPS interface helps learners understand the force necessary to explore the anatomy" improved from 5.04 to 5.35 of 7 after the snapshot mechanism was added. CONCLUSIONS: The ratings indicate the viability of the TIPS open source SE-authored surgical training units with safety rules. Presenting SE-determined procedural missteps via the snapshot mechanism at the end of the training increases perceived utility.

Assessment of parental decision making in congenital heart disease, cardiomyopathy and heart transplantation: an observational study analysing decisional characteristics and preferences.

OBJECTIVE: We explore shared decision making (DM) in guardians of children with heart disease by assessing the desired weight of influence on DM and factors that may alter the relative weight of parent or medical team influence. METHODS: Guardians of patients <21 years and admitted >1 week in the paediatric cardiac intensive care unit (PCICU) were recruited. Twelve vignettes were designed including technical (antibiotic selection, intubation, peripherally inserted central catheter placement, ventricular assist device placement, heart transplant, organ rejection, heart rhythm abnormalities and resuscitation effort) and non-technical vignettes (cessation of life-sustaining therapies, depression treatment, obesity and palliative care referral). Participants responded to questions on DM characteristics and one question querying preference for relative weight of parent or medical team influence on DM. RESULTS: Of 209 participants approached, 183 were included. Most responded with equal desire of medical team and parental influence on DM in all vignettes (range 41.0%-66.7%). Technical scenarios formed one cluster based on DM characteristics, compared with non-technical scenarios. Factors that increase the relative weight of parental influence on DM include desired input and involvement in big-picture goals (OR 0.274, CI [0.217 to 0.346]; OR 0.794, CI [0.640 to 0.986]). Factors that increase the relative weight of medical team influence on DM include perception of medical expertise needed (OR 1.949 [1.630 to 2.330]), urgency (OR 1.373 [1.138 to 1.658]), benefit (OR 1.415 [1.172 to 1.710]), number of PCICU admissions (OR 1.134 [1.024 to 1.256]) and private insurance (OR 1.921 [1.144 to 3.226]). CONCLUSION: Although factors may alter the weight of influence on DM, most parents desire equal parental and medical team influence on DM.

Parents' knowledge of and opinions about healthcare laws and technology in primary care.

PURPOSE: Historically, parents have demonstrated poor understanding of adolescent healthcare laws. This study assessed US parents' current knowledge and opinions about technology facilitated physician-adolescent communication and applicable laws to enhance transition to adult health care. METHODS: A brief survey in two low-income academic paediatric clinics asked parents about their knowledge of health care and laws, and their opinions about technology facilitated contact between physicians and adolescents. RESULTS: Almost all parents (96.7%) have internet access at home, work or via a mobile device. Only 44.1% approved of having a physician directly contact their child about annual examinations, immunisations or to discuss issues of sexuality. Half (55.4%) were aware that adolescents could receive confidential sexuality information and treatment without parents' permission. Only one-third (32.2%) approved of a specific technology for direct communication. CONCLUSIONS: Parents are divided about direct physician-adolescent contact. Future plans to engage adolescents to understand their health will require parental education and involvement on the value of physician-adolescent communication.

Hospital homebound students and K-12 online schooling.

The flexibility afforded by online education may provide opportunities for learners with disability who require absence from traditional learning environments. This study sought to describe how a subset of learners with disability, those with hospital-homebound designation, perform in K-12 online classes, particularly as compared to non-hospital homebound counterparts. A cross-sectional analysis was performed of all Florida Virtual School course enrollments from August 1, 2012 to July 31, 2018. Researchers analyzed 2,534 course enrollments associated with K-12 students who, at the time of their course enrollment, had hospital-homebound designation, and a comparison group of 5,470,591 enrollments from K-12 students without hospital-homebound status. Data analysis showed three important outcomes. First, hospital-homebound designated student academic performance was equivalent to their non-hospital homebound counterparts. Second, however, hospital-homebound course enrollments were 26% more likely to result in a withdrawal prior to grade generation. Third, these withdrawals were potentially mitigated when H/H designated students were enrolled in five or more classes or in classes with five or more students. The results of this study provided evidence that when they can remain enrolled, hospital-homebound learners experience equivalent academic outcomes in online learning environments. These findings suggest that healthcare professionals should be made aware of the potentially equivalent outcomes for their patients. Moreover, virtual schools should seek to identify and create supports for these students.

Script Concordance Tests for Formative Clinical Reasoning and Problem-Solving Assessment in General Pediatrics.

Introduction: Script Concordance Tests (SCTs) are short clinical vignettes with proposed diagnoses, diagnostic studies, treatments, and management options for patient care scenarios. The SCTs included in this resource were incorporated into a required pediatric clerkship to facilitate formative student feedback and additional opportunities for precepting faculty to provide midclerkship feedback. Pediatric cases were specifically selected due to the scarcity of medical student experience with common pediatric clinical presentations. Methods: We developed eight themed SCTs comprising 72 individual test items focused on common topics in general pediatrics. Items were administered to a convenience sample of third-year medical students during their required pediatric clerkship between fall 2016 and spring 2020. To evaluate the SCTs, we conducted item analyses, as well as comparing student performance to summative assessments. Results: The mean aggregate percentage score across all SCTs was .84 (SD = .08). Student SCT performance was related to USMLE Step 2 Clinical Knowledge scores, clerkship grades, and NBME Pediatrics Shelf Exam scores. Discussion: These SCTs facilitated feedback to medical students in the clinical learning environment. Their current form provides a means of exploring student clinical reasoning and problem-solving and can be used at a single point or to measure longitudinally. When paired with structured subject- and competency-specific midclerkship student evaluation, SCTs helped facilitate timely feedback to students via immediate explanations of each question. SCTs can assist students in recognizing and reflecting on potential knowledge gaps.

Nonclinical use of online social networking sites: new and old challenges to medical professionalism.

The AMA Council on Ethical and Judicial Affairs (CEJA) has written a position paper on how social medical use challenges medical professionalism. The report offers persuasive ethical and practical guidelines for nonclinical internet use, specifically for social networking. This commentary provides a framework from which to apply these guidelines, but adds that there may be important situations in which physicians are not able to act in accordance. The guidelines call for professional reporting of questionable online portrayals or behaviors, but this commentary argues that this may be not only cumbersome to implement, but may violate aspects of constitutional rights. While online social networking may in many ways be a new application of old challenges, there may be other aspects that require novel approaches to medical professionalism.

Using Data Mining for the Early Identification of Struggling Learners in Physician Assistant Education.

PURPOSE: Despite the importance of early intervention and remediation, the relatively short duration of physician assistant education programs necessitates the importance of early identification of at-risk learners. This study sought to ascertain whether machine learning was more effective than logistic regression in predicting remediation status among students, using the limited set of data available before or immediately following the first semester of study as predictor variables and academic remediation as an outcome variable. METHODS: The analysis included one institution and student data from 177 graduates between 2017 and 2019. We employed one data mining model, random forest trees, and compared it to a traditional predictive analysis method, logistic regression. Due to the small sample size, we employed leave-one-out cross-validation and bootstrap aggregation. RESULTS: Data provided evidence that the random forest algorithm correctly identified individuals who would later experience academic intervention with a 63.3% positive predictive value, whereas logistic regression exhibited a positive predictive value of 16.6%. CONCLUSIONS: This single-institution study indicates that predictive modeling, employing machine learning, may be a more effective means than traditional statistical methods of identifying and providing assistance to learners who may experience academic challenges.

Design of a Situational Judgment Test for Preclinical Interprofessional Collaboration.

PROBLEM: There is an unmet need for economically feasible, valid, reliable, and contextually relevant assessments of interprofessional collaborative knowledge and skills, particularly at the early stages of health professions education. This study sought to develop and gather content and internal structure validity for an Interprofessional Situational Judgement Test (IPSJT), a tool for the measurement of students' interprofessional collaborative intentions during the early stages of their professional development. APPROACH: After engaging in an item development and refinement process (January-June 2018), an 18-question IPSJT was administered to 953 first-year students enrolled in 10 health professions degree programs at the University of Florida Health Science Center in October 2018. The IPSJT's performance was evaluated using item-level analyses, item difficulty, test-retest reliability, and exploratory factor analysis. OUTCOMES: Seven hundred thirty-seven (77.3%) students consented to the use of their data. Student IPSJT scores ranged from 0 to 69, averaging 42.68 (standard deviation = 12.28), with some statistically significant differences in student performance by health professions degree program. IPSJT item difficulties ranged from 0.13 to 0.92. Once one item with poor properties was excluded from analysis, the IPSJT demonstrated an overall reliability of 0.62. Students were more successful at identifying the least effective than the most effective responses. Test-retest reliability provided evidence of consistency (r = 0.50, P < .001) and similar item difficulty across administrations. An exploratory factor analysis indicated a 3-factor model with multiple cross-factor loadings. NEXT STEPS: This work represents the first step toward the development of a valid, reliable IPSJT for early learners. The emergent 3-factor model provides evidence that multiple competencies can be assessed in early learners via this tool. Additional research is necessary to build a more robust question bank, explore different scoring and response methods, and gather additional sources of validity evidence, including relations to other variables.

Using machine learning analysis to assist in differentiating between necrotizing enterocolitis and spontaneous intestinal perforation: A novel predictive analytic tool.

PURPOSE: Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are devastating diseases in preterm neonates, often requiring surgical treatment. Previous studies evaluated outcomes in peritoneal drain placement versus laparotomy, but the accuracy of the presumptive diagnosis remains unknown without bowel visualization. Predictive analytics provide the opportunity to determine the etiology of perforation and guide surgical decision making. The purpose of this investigation was to build and evaluate machine learning models to differentiate NEC and SIP. METHODS: Neonates who underwent drain placement or laparotomy NEC or SIP were identified and grouped definitively via bowel visualization. Patient characteristics were analyzed using machine learning methodologies, which were optimized through areas under the receiver operating characteristic curve (AUROC). The model was further evaluated using a validation cohort. RESULTS: 40 patients were identified. A random forest model achieved 98% AUROC while a ridge logistic regression model reached 92% AUROC in differentiating diseases. When applying the trained random forest model to the validation cohort, outcomes were correctly predicted. CONCLUSIONS: This study supports the feasibility of using a novel machine learning model to differentiate between NEC and SIP prior to any intended surgical interventions. LEVEL OF EVIDENCE: level II TYPE OF STUDY: Clinical Research Paper.

An analysis of healthcare providers' online ratings.

BACKGROUND: Many websites allow consumers to evaluate their healthcare experience yet scant data exist that explore the type and content of reviews. OBJECTIVE: To evaluate and describe online healthcare provider reviews. METHODS: We analysed 16,703 ratings on 6101 providers from four US cities. Ratings spanned five categories and an overall provider score. We also performed text analyses of narrative commentary (n = 15,952). RESULTS: Providers had a high mean score for each category (3.7-4.0 out of 5). Higher overall scores were associated with higher staff (adjusted odds ratio (aOR) 3.0, 95% CI 2.9-3.0, P < 0.01) and punctuality scores (aOR 2.1, 95% CI 2.05-2.15, P < 0.01). Review frequency was inversely associated with scores, (aOR 0.94, 95% CI 0.92-0.96, P < 0.01). Analyses of narrative commentaries revealed more positive than negative terms (P < 0.01). CONCLUSIONS: Online ratings were largely positive. Future research must discern how online surveys affect patient referrals, provider reputations and patients' perceptions of quality of care.

Teaching Students How to Improve Safety and Quality in Two Children's Hospitals: Building a Pediatric Clerkship Patient Safety and Quality Experience.

This report describes a novel method to enhance medical student understanding of systems-based practice and patient safety through experiential learning, assessing the perceived value of student-identified patient safety and systems vulnerabilities, and their proposed interventions at academic children's hospitals.

The intersection of online social networking with medical professionalism.

AIM: To measure the frequency and content of online social networking among medical students and residents. METHODS: Using the online network Facebook, we evaluated online profiles of all medical students (n = 501) and residents (n = 312) at the University of Florida, Gainesville. Objective measures included the existence of a profile, whether it was made private, and any personally identifiable information. Subjective outcomes included photographic content, affiliated social groups, and personal information not generally disclosed in a doctor-patient encounter. RESULTS: Social networking with Facebook is common among medical trainees, with 44.5% having an account. Medical students used it frequently (64.3%) and residents less frequently (12.8%, p < .0001). The majority of accounts (83.3%) listed at least 1 form of personally identifiable information, only a third (37.5%) were made private, and some accounts displayed potentially unprofessional material. There was a significant decline in utilization of Facebook as trainees approached medical or residency graduation (first year as referent, years 3 and 4, p < .05). DISCUSSION: While social networking in medical trainees is common in the current culture of emerging professionals, a majority of users allow anyone to view their profile. With a significant proportion having subjectively inappropriate content, ACGME competencies in professionalism must include instruction on the intersection of personal and professional identities.

Family-centered rounds and medical student education: a qualitative examination of students' perceptions.

BACKGROUND: Although current literature supports the benefits of family-centered rounds on medical education, few studies have explored students' perceptions of family-centered rounds. PURPOSE: The aim of this study was to provide a better and broader understanding of the effect of family-centered rounds on medical student education. METHODS: During the inpatient portion of the third-year pediatric clerkship at a southeastern United States 4-year medical school, students were exposed to family-centered and conference room work rounds and completed a post-hoc reflective open-ended questionnaire. The study was conducted from July to December 2007 and the inpatient experience was at one of two large academic medical centers. Using a constant comparative approach, the qualitative content of 45 of the 63 potential students' responses was analyzed. RESULTS: Family-centered rounds served as an opportunity for medical students to build their practice-based knowledge through direct and simultaneous interaction with the medical team, patients, and families. Family member communication, medical team communication, and increased exposure to patients allowed for unique learning opportunities such as augmentation of communication skills, practice with use of lay terms, legitimate peripheral participation, and humanizing cognitive understanding of diseases. Areas of concern noted by the students included space limitations, length of rounds, potential anxiety provoked in the patient, and faculty and resident comfort with teaching certain topics. CONCLUSIONS: Our qualitative analysis of medical student perceptions on family-centered rounds suggests that pediatric medical student education may benefit by improving knowledge and practice with communication and humanizing disease processes. However, perceived barriers, such as concerns about space or instructor comfort with teaching certain topics, existed. Further studies are warranted to gain a better understanding of the educational impact of conducting this type of rounds.

Pediatric residents' learning styles and temperaments and their relationships to standardized test scores.

BACKGROUND: Board certification is an important professional qualification and a prerequisite for credentialing, and the Accreditation Council for Graduate Medical Education (ACGME) assesses board certification rates as a component of residency program effectiveness. To date, research has shown that preresidency measures, including National Board of Medical Examiners scores, Alpha Omega Alpha Honor Medical Society membership, or medical school grades poorly predict postresidency board examination scores. However, learning styles and temperament have been identified as factors that 5 affect test-taking performance. The purpose of this study is to characterize the learning styles and temperaments of pediatric residents and to evaluate their relationships to yearly in-service and postresidency board examination scores. METHODS: This cross-sectional study analyzed the learning styles and temperaments of current and past pediatric residents by administration of 3 validated tools: the Kolb Learning Style Inventory, the Keirsey Temperament Sorter, and the Felder-Silverman Learning Style test. These results were compared with known, normative, general and medical population data and evaluated for correlation to in-service examination and postresidency board examination scores. RESULTS: The predominant learning style for pediatric residents was converging 44% (33 of 75 residents) and the predominant temperament was guardian 61% (34 of 56 residents). The learning style and temperament distribution of the residents was significantly different from published population data (P  =  .002 and .04, respectively). Learning styles, with one exception, were found to be unrelated to standardized test scores. CONCLUSIONS: The predominant learning style and temperament of pediatric residents is significantly different than that of the populations of general and medical trainees. However, learning styles and temperament do not predict outcomes on standardized in-service and board examinations in pediatric residents.

Revisiting Social Network Utilization by Physicians-in-Training.

OBJECTIVE: To measure and compare the frequency and content of online social networking among 2 cohorts of medical students and residents (2007 and 2009). METHODS: Using the online social networking application Facebook, we evaluated social networking profiles for 2 cohorts of medical students (n  =  528) and residents (n  =  712) at the University of Florida in Gainesville. Objective measures included existence of a profile, whether it was made private, and whether any personally identifiable information was included. Subjective outcomes included photographic content, affiliated social groups, and personal information not generally disclosed in a doctor-patient encounter. We compared our results to our previously published and reported data from 2007. RESULTS: Social networking continues to be common amongst physicians-in-training, with 39.8% of residents and 69.5% of medical students maintaining Facebook accounts. Residents' participation significantly increased (P < .01) when compared to the 2007 data. Individuals in the 2009 cohort had significantly more "friends" (P < .01), belonged to more "groups" (P < .01), and were more likely to limit public access to their profiles through the use of privacy settings (P < .01) than the individuals in the 2007 cohort. DISCUSSION: Online social networking application use by physicians-in-training remains common. While most now limit access to their profiles, personal profiles that still allow public access exhibited a few instances of unprofessional behavior. Concerns remain related to the discovery of content in violation of patient privacy and the expansive and impersonal networks of online "friends" who may view profiles.