Analysis of ChatGPT Responses to Ophthalmic Cases: Can ChatGPT Think like an Ophthalmologist?

Objective: Large language models such as ChatGPT have demonstrated significant potential in question-answering within ophthalmology, but there is a paucity of literature evaluating its ability to generate clinical assessments and discussions. The objectives of this study were to (1) assess the accuracy of assessment and plans generated by ChatGPT and (2) evaluate ophthalmologists' abilities to distinguish between responses generated by clinicians versus ChatGPT. Design: Cross-sectional mixed-methods study. Subjects: Sixteen ophthalmologists from a single academic center, of which 10 were board-eligible and 6 were board-certified, were recruited to participate in this study. Methods: Prompt engineering was used to ensure ChatGPT output discussions in the style of the ophthalmologist author of the Medical College of Wisconsin Ophthalmic Case Studies. Cases where ChatGPT accurately identified the primary diagnoses were included and then paired. Masked human-generated and ChatGPT-generated discussions were sent to participating ophthalmologists to identify the author of the discussions. Response confidence was assessed using a 5-point Likert scale score, and subjective feedback was manually reviewed. Main Outcome Measures: Accuracy of ophthalmologist identification of discussion author, as well as subjective perceptions of human-generated versus ChatGPT-generated discussions. Results: Overall, ChatGPT correctly identified the primary diagnosis in 15 of 17 (88.2%) cases. Two cases were excluded from the paired comparison due to hallucinations or fabrications of nonuser-provided data. Ophthalmologists correctly identified the author in 77.9% ± 26.6% of the 13 included cases, with a mean Likert scale confidence rating of 3.6 ± 1.0. No significant differences in performance or confidence were found between board-certified and board-eligible ophthalmologists. Subjectively, ophthalmologists found that discussions written by ChatGPT tended to have more generic responses, irrelevant information, hallucinated more frequently, and had distinct syntactic patterns (all P < 0.01). Conclusions: Large language models have the potential to synthesize clinical data and generate ophthalmic discussions. While these findings have exciting implications for artificial intelligence-assisted health care delivery, more rigorous real-world evaluation of these models is necessary before clinical deployment. Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Você está pensando, refletindo, analisando o que você vê e o que você faz o tempo todo: percepção de residentes de Medicina de Família e Comunidade sobre vídeo feedback / You are thinking, reflecting, analysing what you see and what you do all the time: perception of General Practice trainees about video feedback / Estás pensando, reflexionando, analizando lo que ves y lo que haces todo el tiempo: percepción de los residentes de Medicina Familiar y Comunitaria sobre vídeo feedback

Introdução: A comunicação é reconhecida como uma habilidade central por vários órgãos reguladores internacionais da educação médica. O ensino específico de habilidades de comunicação é fundamental para melhorar a comunicação dos médicos. As técnicas experienciais mostraram superioridade em comparação com os modelos tradicionais. A utilização de consultas reais ajuda os estudantes a visualizar melhor as suas competências de entrevista e a refletir sobre elas. Com os avanços da tecnologia, o uso de consultas médicas gravadas em vídeo tornou-se a abordagem padrão para o ensino da comunicação. No entanto, a eficácia dessa técnica depende do envolvimento ativo dos estudantes. As suas contribuições e comentários dos pares sobre a consulta gravada são essenciais para a aprendizagem. Contudo, a perspectiva do estudante sobre a utilidade dessa abordagem educativa recebeu pouca atenção. Objetivos: Compreender a percepção da aprendizagem dos residentes de medicina de família e comunidade resultante da atividade de vídeo feedback na sua formação profissional. Métodos: Estudo exploratório, qualitativo, realizado com residentes do primeiro ano de medicina de família e comunidade de um programa de residência estabelecido em São Paulo, Brasil. Os participantes foram entrevistados após as sessões educativas, que foram analisadas por meio de análise temática reflexiva. Resultados: A autopercepção de sua prática, o aprendizado de habilidades de comunicação e os ganhos afetivos foram identificados pelos participantes como pontos de aprendizado derivados da atividade de vídeo feedback. Além disso, sobre o aprendizado de habilidades específicas de comunicação, eles mencionaram comunicação não-verbal e verbal, conexões entre teoria e prática, estrutura de consulta e oportunidades para cristalizar conhecimentos. Os ganhos afetivos incluíram sentir-se parte de um grupo, melhora da autoestima, superação de inseguranças, percepção de consultas mais efetivas, reforço do gosto pelo trabalho e reconhecer a necessidade de mais aprendizado. Conclusões: Os ganhos de aprendizagem identificados em nosso estudo levaram a uma experiência de humanidade compartilhada, que permite aos participantes serem mais efetivos técnica e afetivamente com seus pacientes. Além disso, identificamos que a atividade educativa de vídeo feedback pode ser utilizada para outros possíveis fins educacionais além do ensino da comunicação.

Introduction: Communication is recognized as a central skill by various international medical education regulatory bodies. Specific teaching on communication skills is important to enhance doctors' communication. Experiential techniques appear to be superior compared to traditional models. Real-life consultation helps trainees visualize their interview skills and reflect on them. Upgraded by technology, the use of video-recorded medical visits became the standard approach for communication teaching. However, the effectiveness pf this technique relies on trainees' active involvement. Their inputs and peer feedback on the recorded consultation are essential to learning. Despite its importance, their perspective on the usefulness of video feedback in medical education has received limited attention. Objective: To understand the perception of learning among general practice trainees as a result of the video feedback activity in their vocational training. Methods: An exploratory, qualitative study, conducted with first-year general practice trainees from an established training program in São Paulo, Brazil. Participants were interviewed after educational session, which were analyzed using reflexive thematic analysis. Results: Self-perception of their practice, communication skills learning, and affective gains were identified by participants as learning points derived from the video feedback activity. Furthermore, for specific communication skills learning, they mentioned nonverbal and verbal communication, theory and practice connections, consultation structure and opportunities for crystallizing knowledge. Affective gains included feeling part of a group, improving self-esteem, overcoming insecurities, perception of more effective consultations, reinforcing fondness for their work, and need for more learning. Conclusions: The learning gains identified in our study led to an experience of common humanity, which allowed participants to be more technically and affectively effective with their patients. Also, we identified that the video feedback educational activity can be used for other possible educational purposes, beyond the teaching of communication.

Introducción: La comunicación es reconocida como una habilidad fundamental por varios organismos reguladores internacionales de educación médica. La enseñanza específica de habilidades de comunicación es importante para mejorar la comunicación de los médicos. Las técnicas experienciales parecen ser superiores a los modelos tradicionales. El uso de consultas reales ayuda a los estudiantes a visualizar y reflexionar mejor sobre sus habilidades de entrevista. Actualizado por la tecnología, el uso de consultas médicas grabadas en video se ha convertido en el enfoque estándar para la enseñanza de la comunicación. Sin embargo, para que la técnica funcione, la participación de los estudiantes es crucial. Sus contribuciones y comentarios de los compañeros sobre la consulta grabada son esenciales para el aprendizaje. Sin embargo, la perspectiva de los estudiantes sobre la utilidad de este enfoque educativo ha recibido poca atención. Objetivos: Comprender la percepción del aprendizaje por parte de los residentes de medicina de familia y comunitaria como resultado de la actividad de vídeo feedback en su formación profesional. Métodos: Estudio cualitativo exploratorio realizado con residentes de primer año de medicina familiar y comunitaria de un programa de residencia establecido en São Paulo, Brasil. Los participantes fueron entrevistados después de una sesión educativa, que fueron analizados mediante análisis temático reflexivo. Resultados: La autopercepción de su práctica, el aprendizaje de habilidades comunicativas y las ganancias afectivas fueron identificadas por los participantes como puntos de aprendizaje derivados de la actividad de vídeo feedback. Además, sobre el aprendizaje de habilidades comunicativas específicas, mencionaron la comunicación verbal y no verbal, las conexiones entre la teoría y la práctica, la estructura de consulta y las oportunidades para cristalizar conocimientos. En cuanto a las ganancias afectivas, relataron sentirse parte de un grupo, mejora de la autoestima, superación de las inseguridades, percepción de consultas más efectivas, refuerzo del gusto por el trabajo y necesidad de más aprendizaje. Conclusión: Los logros de aprendizaje identificados en nuestro estudio llevaron a una experiencia de humanidad compartida, que permite a los participantes ser técnica y afectivamente más efectivos con sus pacientes. Además, identificamos que la actividad educativa de vídeo feedback puede ser utilizada para otros posibles fines educativos, además de la enseñanza de la comunicación.

Aprendizagem baseada em projeto e a formação médica: relato de experiência introduzindo questões para o debate interprofissional / Project-based learning and medical education: experience report introducing issues for interprofessional debate / El aprendizaje basado en proyecto y la formación médica: informe de experiencia que introduce cuestiones para el debate interprofesional

A aprendizagem baseada em projeto orientada pelos fundamentos da educação interprofissional é um modelo que pode contribuir para a formação de relacionamentos interpessoais, criatividade, empatia e colaboração na educação médica, por meio de uma colaboração mútua com profissionais de saúde da rede. Muito se fala da efetividade desse método no campo do ensino e aprendizagem médica, mas há a necessidade de incluir a importância do desenvolvimento de habilidades interprofissionais, com equipes colaborativas, em ações extensionistas, diante das necessidades locais no contexto da atenção primária, pensando na melhoria dos resultados de saúde. O objetivo deste trabalho é apresentar um relato de experiência de aprendizagem baseada em projeto de estudantes de Medicina no contexto da Estratégia Saúde da Família. Participaram deste trabalho estudantes do Módulo Integração Ensino, Serviço e Comunidade da Faculdade de Medicina da Universidade Federal dos Vales do Jequitinhonha e Mucuri que executaram, em colaboração com uma equipe interprofissional o projeto sobre a saúde do homem. Como resultado da análise qualitativa do feedback entre os integrantes, observaram-se mudanças no comportamento dos estudantes, com melhorias na comunicação, empatia e nas relações interpessoais, por meio do trabalho colaborativo com a equipe interprofissional. Esta experiência poderá ser adaptada para implementar o ensino e aprendizagem no projeto pedagógico orientado pela educação interprofissional na atenção primária.

Project-based learning guided by the fundamentals of interprofessional education is a model that can contribute to the formation of interpersonal relationships, creativity, empathy and collaboration within medical education, through mutual collaboration with health professionals in the health network. Much has been said about the effectiveness of this method in medical teaching and learning, but there is a need to include the importance of developing interprofessional skills, with collaborative teams, within extension actions, in view of local needs in the context of primary care, thinking about the improved health outcomes. The objective of this work was to present a report of a project-based learning experience of medical students in Family Health Strategy. Students from the Teaching, Service and Community Integration Module of the Faculty of Medicine of Universidade Federal dos Vales do Jequitinhonha e Mucuri participated in this work, executing in collaboration with an interprofessional team a project about men's health. As a result of the qualitative analysis of the feedback among the members, changes in student behavior were observed with improvements in communication, empathy and interpersonal relationships through collaborative work with the interprofessional team. This experience can be adapted to implement teaching and learning in the pedagogical project guided by interprofessional education in primary care.

El aprendizaje basado en proyectos y guiado por los fundamentos de la educación interprofesional es un modelo que puede contribuir a la formación de relaciones interpersonales, creatividad, empatía y colaboración dentro de la educación médica, a través de la colaboración mutua con los profesionales de la salud en la red de salud. Mucho se habla de la efectividad de este método dentro de la enseñanza y el aprendizaje médico, pero es necesario incluir la importancia del desarrollo de habilidades interprofesionales, con equipos colaborativos, dentro de las acciones de extensión, frente a las necesidades locales en el contexto de la atención primaria, pensando sobre los mejores resultados de salud. El objetivo de este trabajo es presentar un informe de experiencia de aprendizaje basado en proyectos de estudiantes de medicina en la Estrategia de Salud Familiar. Participaron en este trabajo estudiantes del Módulo Integración Enseñanza, Servicio y Comunidad de la Facultad de Medicina de la Universidade Federal dos Vales do Jequitinhonha e Mucuri que ejecutaron en colaboración con un equipo interprofesional el proyecto sobre la salud del hombre. Como resultado del análisis cualitativo de la retroalimentación entre los integrantes, se observaron cambios en el comportamiento de los estudiantes con mejoras en la comunicación, la empatía y las relaciones interpersonales a través del trabajo colaborativo con el equipo interprofesional. Esta experiencia puede adaptarse para implementar la enseñanza y el aprendizaje en el proyecto pedagógico guiado por la educación interprofesional en atención primaria.

Medical faculty's perception of students' mental health: a qualitative survey study / Percepción de los profesores de medicina sobre la salud mental de los estudiantes: un estudio cualitativo / Percepção dos docentes de medicina sobre a saúde mental dos estudantes: um estudo qualitativo

This study sought to explore the perspective of medical faculty on the mental health of their students. This qualitative study based on a focus group is part of a longitudinal research that studied the mental health of Brazilian students. One group was conducted with faculty employed at a medical school. Topics discussed covered the concept of mental health and medical education. Six professors participated in one group. The mental health of medical students is a construct that encompasses emotional aspects, ability to solve problems and multiple facets of a human being, according to the participants. Artistic practices, moments of socialization and leisure were perceived as stimulating students' good mental health. Excessive demands generate competitiveness and the teacher's expectation of the student's good performance based on their own experience can harm the student's mental health. Participants also highlighted that a pedagogical reformulation that makes sense for the student's learning process is necessary to update traditional curricula. Medical students' mental health is influenced by experiences and exchanges during the medical school, mainly between professor and student, understood as necessary and inherent to the process of becoming physician. The findings of this study show the need for curriculum changes in the medical education process and updating teacher training for good practices that reinforce good mental health.

Este estudio buscó explorar la perspectiva de los profesores de medicina sobre la salud mental de sus estudiantes. Este estudio cualitativo basado en un grupo focal es parte de una investigación longitudinal que estudió la salud mental de estudiantes brasileños. Un grupo se llevó a cabo con profesores empleados en una escuela de medicina. Los temas tratados abarcaron el concepto de salud mental y educación médica. Seis docentes participaron en un grupo. La salud mental de los estudiantes de medicina es un constructo que abarca aspectos emocionales, capacidad de resolución de problemas y múltiples facetas del ser humano, según los participantes. Las prácticas artísticas, los momentos de socialización y el ocio fueron percibidos como estimulantes de la buena salud mental de los estudiantes. Las exigencias excesivas generan competitividad y la expectativa del docente sobre el buen desempeño del estudiante basándose en su propia experiencia puede perjudicar la salud mental del estudiante. Los participantes también resaltaron que es necesaria una reformulación pedagógica que tenga sentido para el proceso de aprendizaje del estudiante para actualizar los currículos tradicionales. La salud mental de los estudiantes de medicina está influenciada por las experiencias y los intercambios durante la carrera de medicina, principalmente entre profesor y estudiante, entendidos como necesarios e inherentes al proceso de convertirse en médico. Los hallazgos de este estudio muestran la necesidad de cambios curriculares en el proceso de formación médica y de actualización de la formación docente hacia buenas prácticas que refuercen la buena salud mental.

Este estudo buscou explorar a perspectiva dos docentes de medicina sobre a saúde mental de seus alunos. Este estudo qualitativo baseado em grupo focal faz parte de uma pesquisa longitudinal que estudou a saúde mental de estudantes brasileiros. Um grupo foi conduzido com professores empregados em uma faculdade de medicina. Os temas discutidos abrangeram o conceito de saúde mental e educação médica. Seis professores participaram de um grupo. A saúde mental dos estudantes de medicina é um construto que engloba aspectos emocionais, capacidade de resolução de problemas e múltiplas facetas do ser humano, segundo os participantes. As práticas artísticas, os momentos de socialização e de lazer foram percebidos como estimuladores da boa saúde mental dos estudantes. Exigências excessivas geram competitividade e a expectativa do professor pelo bom desempenho do aluno com base na própria experiência pode prejudicar a saúde mental do aluno. Os participantes destacaram também que é necessária uma reformulação pedagógica que faça sentido para o processo de aprendizagem do aluno para atualizar os currículos tradicionais. A saúde mental dos estudantes de medicina é influenciada pelas experiências e trocas durante o curso de medicina, principalmente entre professor e aluno, entendidas como necessárias e inerentes ao processo de tornar-se médico. Os achados deste estudo mostram a necessidade de mudanças curriculares no processo de formação médica e de atualização da formação docente para boas práticas que reforcem a boa saúde mental.

Enhancing Learning in Medical Biochemistry by Teaching Based on VARK Learning Style for Medical Students.

Purpose: Learners, including medical students, naturally have different learning style preferences. Teachers need to use a variety of teaching materials to help learners understand the content. However, previous studies have not reported the effects of learning in medical biochemistry by teaching based on the VARK learning style. This study aims to investigate the learning style preferences, the effects of learning in medical biochemistry by teaching based on the VARK learning style, and the relationship between type and number of VARK learning styles and medical biochemistry achievement in medical students. Methods: We investigated a total of 92 first-year medical students at Walailak University. The VARK questionnaire was used to identify the learning style preference of medical students. All students took a pretest before beginning each online lecture. After completing each lecture, all students received additional teaching materials according to their learning style to use in reviewing the lessons. All students took a posttest for each lecture after reviewing the lesson. Results: The results showed that the medical students preferred a multimodal learning style (70.65%) more than a unimodal learning style (29.35%). The medical students preferred four learning styles (VARK) more than two and three learning styles. All learning styles had a mean difference score (posttest score minus pretest score) above 27.00 (33.75%). There were no significant differences in mean difference scores among the different learning styles. In addition, there were no significant differences in mean difference scores between the single style preference, two style preferences, three style preferences, and four style preferences. Conclusion: Teaching based on the VARK learning style could enhance medical students' learning in medical biochemistry. The difference in learning style and the difference in the number of learning styles (single, two, three, and four style preferences) were not significantly related to medical students' learning achievement in medical biochemistry.

Student Performance and Perceptions of Flipped Classrooms and Small Group Discussions as Teaching Tools in Practical Anatomy.

Introduction A quasi-experimental study was conducted to assess students' attitudes toward the flipped practical classroom and evaluate its effectiveness in teaching practical anatomy. Methods Two survey questionnaires were developed: the first assessed students' attitudes toward flipped practical classrooms, while the second focused on the obstacles and difficulties students might encounter in this learning environment. Results We found that students rated flipped learning significantly higher compared to other teaching methods, particularly in terms of the quality of learning materials, enhancement of learning skills, engagement and understanding of anatomy topics, and problem-solving abilities. The highest mean examination grades were observed for the pretest flipped modality, followed by the pretest small group discussion (mean scores: 82.72 vs. 54.46, F = 43.2, P = 0.004). Conclusions Students hold positive attitudes toward flipped classrooms and small group discussions compared to traditional classes.

Medical student perceptions of gender and pain: a systematic review of the literature.

BACKGROUND: Gender bias exists in healthcare and affects how pain is assessed and managed. This bias affects patient outcomes and their trust in healthcare professionals. We also know that future clinicians develop their attitudes early in training. Medical school is therefore an opportunity to shape the values of future doctors and to combat systemic gender bias in healthcare. This systematic review aims to explore medical student perceptions of the relationship between patients' gender and their pain, so that recommendations can be made for developing medical education. METHODS: Embase, MEDLINE, PsychINFO, LILACS, Global Index Medicus, PakMediNet and ERIC were searched for articles relating to medical student perceptions of gender and pain, with no geographical or language limitations. Quality was assessed using the Medical Education Research Study Quality Index and the Critical Appraisal Skills Programme checklist. RESULTS: Nine publications were identified, two qualitative and seven quantitative. All studies had methodological limitations. Many different study designs were used, although most involved simulated patients. All studies referred to gender as binary. Multiple studies found that women's pain is more likely to be underestimated by medical students and that the patient's gender drives different approaches during clinical history taking, examination and management in these simulated situations. Only one study found no effect of patients' gender on students' perception of their pain. CONCLUSIONS: Whilst there is a paucity of high-quality studies in this area, patients' gender was found to affect how their pain is perceived by medical students. No studies explored where students' attitudes towards gender and pain arise from, and few involved 'real life situations'. We propose that further work into medical student perceptions in 'real situations' is needed. This will help to inform how undergraduate medical education can be developed to tackle gender bias, and ultimately improve outcomes for patients.

Efficacy of medical education combined with extended care on adherence to inhaled glucocorticoids and clinical effects in patients with bronchial asthma.

OBJECTIVE: To observe the clinical efficacy of medical education combined with extended care in patients with bronchial asthma and its effect on adherence to inhaled glucocorticoids. METHODS: Ninety-eight patients with bronchial asthma were divided into the control group and the experimental group, n = 49, by utilizing the random number table method. The control group was given routine education and care as well as routine out-of-hospital instructions, and the experimental group was given medical education and extended care based on the control group. Asthma disease knowledge mastery, asthma control, quality of life, medication adherence and lung function were compared between both groups, and the number of asthma attacks and re-hospitalizations were recorded. RESULTS: The experimental group performed higher scores of health knowledge, asthma control test and quality of life, rate of complete adherence, forced expiratory volume in one second (FEV1), peak expiratory flow rate, and FEV1/forced vital capacity. The number of asthma attacks and the times of re-hospitalizations were lower in the experimental group (all P < 0.05). CONCLUSION: Medical education combined with extended care can improve bronchial asthma patients' mastery of asthma disease knowledge, effectively control patients' conditions, enhance patients' quality of life and lung function, increase patients' adherence to inhaled glucocorticoids, and reduce the recurrence of bronchial asthma patients.

"Lives and times": The case for qualitative longitudinal research in anatomical sciences education.

Qualitative longitudinal research (QLR) focuses on changes in perceptions, interpretations, or practices through time. Despite longstanding traditions in social science, QLR has only recently appeared in anatomical sciences education (ASE). While some existing methodology papers guide researchers, they take a narrow view of QLR and lack specificity for ASE. This discursive article aims to (1) describe what QLR is and its benefits, its philosophies, methodologies and methods, considerations, and quality indicators, and (2) critically discuss examples of QLR in ASE. Underpinned by relativist ontology and subjectivist epistemology, time can be understood as fluid/subjective or fixed/objective. QLR is a flexible, creative, and exploratory methodology, often associated with other methodologies. Sampling is typically purposive, with repeated and recursive data collection methods, and complex three-strand analyses (themes, cases, and time), enabling cross-sectional and longitudinal analyses. QLR involves ethical, relationship, analytical, dissemination, and funding considerations. Key quality indicators relate to qualitative research as well as temporal aspects. Most of the nine ASE papers reviewed explored changes in anatomy learners, but few labeled their methodology as QLR. Just under half described their sampling as purposive, most employed pre-planned and standardized repeated interviews, analyzed their data cross-sectionally, and utilized qualitative data analysis software. Most cited the confirmability and transferability of their studies, but few cited credibility and dependability elements. Study timeframes and tempos were generally clear, but details of longitudinal retention/attrition were often lacking, and longitudinal data analysis was not often conducted. We therefore provide recommendations for the conduct of QLR in ASE.

Efficacy of large language models and their potential in Obstetrics and Gynecology education.

Objective: The performance of large language models (LLMs) and their potential utility in obstetric and gynecological education are topics of ongoing debate. This study aimed to contribute to this discussion by examining the recent advancements in LLM technology and their transformative potential in artificial intelligence. Methods: This study assessed the performance of generative pre-trained transformer (GPT)-3.5 and -4 in understanding clinical information, as well as its potential implications for obstetric and gynecological education. Obstetrics and gynecology residents at three hospitals underwent an annual promotional examination, from which 116 of the 170 questions over 4 years (2020-2023) were analyzed, excluding 54 questions with images. The scores achieved by GPT-3.5, -4, and the 100 residents were compared. Results: The average scores across all 4 years for GPT-3.5 and -4 were 38.79 (standard deviation [SD], 5.65) and 79.31 (SD, 3.67), respectively. For groups R1, R2, and R3, the cumulative annual average scores were 79.12 (SD, 9.00), 80.95 (SD, 5.86), and 83.60 (SD, 6.82), respectively. No statistically significant differences were observed between the scores of GPT-4.0 and those of the residents. When analyzing questions specific to obstetrics, the average scores for GPT-3.5 and -4.0 were 33.44 (SD, 10.18) and 90.22 (SD, 7.68), respectively. Conclusion: GPT-4 demonstrated exceptional performance in obstetrics, different types of data interpretation, and problem solving, showcasing the potential utility of LLMs in these areas. However, acknowledging the constraints of LLMs is crucial and their utilization should augment human expertise and discernment.

The effectiveness of Balint groups at improving empathy in medical and nursing education: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Empathy is crucial for patient health. The Balint group is a commonly used method for empathy training. However, the impact of Balint groups on empathy remains unclear. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess the impact of Balint groups on empathy training among medical and nursing students, as well as doctors and nurses. METHODS: This review involved searching multiple databases for relevant articles. Rigorous eligibility criteria were applied during the screening of titles and abstracts, and during the selection of records. Following a full-text eligibility evaluation, two reviewers independently extracted data from the final selection of studies, and a meta-analysis was conducted. The standardized mean difference (SMD) was calculated to assess the systematic outcomes. RESULTS: A total of 11 studies were included in this systematic review and meta-analysis. Participants in Balint groups demonstrated a significant increase in empathy than those in the control group (SMD = 1.46, 95% confidence interval [CI] 0.86-2.06; p < 0.001). Studies conducted in China (SMD = 2.13, 95% CI 1.27-2.99; p < 0.001) revealed a greater impact of Balint groups on empathy than those conducted in France (SMD = 0.24, 95% CI 0.12-0.37; p < 0.001). The impact of Balint groups was significantly greater among physicians (SMD = 2.50, 95% CI 1.79-3.21; p < 0.001) and nurses (SMD = 2.88, 95% CI 1.34-4.43; p < 0.001) compared to medical students (SMD = 0.71, 95% CI = 0.35-1.06; p < 0.001). Participants who attended ten or more sessions (SMD = 2.37, 95% CI 1.35-3.39; p < 0.001) demonstrated better outcomes compared to those who attended fewer than ten sessions (SMD = 0.79, 95% CI 0.30-1.29; p < 0.01). CONCLUSION: Balint groups are effective for empathy training among doctors, nurses, and medical students. Future research should incorporate patient-led measurements to evaluate empathy and ascertain the long-term impact of Balint groups on empathy training. TRIAL REGISTRATION: PROSPERO registration number CRD42023488247.

Impact of Virtual Navigation on the Education and Access of Patients with Cancer: A National Mixed Methods Investigation.

Introduction: Despite growing evidence of efficacy, oncology patient navigation is not ubiquitously offered. Navigation may reduce barriers to cancer care, yet geographic location may limit patient access. To overcome geographical barriers and increase patient education in oncology, our medical center developed a virtual navigation program. Objective: To examine the efficacy of the Virtual Navigation Program designed to increase patient access and education across local and national contexts. Methods: In this mixed-methods study, a total of 105 individuals completed an online survey administered nationally to oncology patients who used the navigation program. Clinical and demographic data were collected. Nonparametric tests were used for group comparisons (Wilcoxon Signed-Ranks test). Results: Virtual navigation increased access as the majority of patients utilized the Virtual Navigation Program beyond the local area; 42% of patients were local; 58% were patients located across the US. 55 (52%) were female; 25% were non-White. Pancreatic cancer was the largest tumor type: 51 (49%). Patients agreed the virtual cancer education helped them make critical health choices (mean 4.89 SD = 84); understand their diagnosis (mean 4.44 SD = .77); were able to make informed decisions (mean 4.43 SD = .83), and empowered to manage their cancer care (mean 4.58 SD = .82). Post navigation, the user experience survey revealed significant increases in a subset of patients' cancer knowledge (P < 0.001), access to quality cancer education (P = 0.045), decision-making in cancer care (P < 0.05), and coordinated cancer care (P = 0.03). Conclusion: This study explores a unique role that virtual navigation may play in helping accommodate healthcare for many cancer patients in underserved areas. The use of innovative aspects of research and education in virtual navigation may be successful in promoting patient empowerment in the cancer continuum. Internet-strategies are needed to inform sustainable patient navigation in low-resource contexts.

Teaching Medical Students to Communicate Risks Like Military Intelligence Analysts.

Communication about health often involves descriptions of risk: the probability or likelihood of an unfavorable outcome. Communicating risk helps individuals make choices about their own health by building understanding of potential outcomes and providing context for the importance of procedures, health interventions, and lifestyle choices. However, medical education in the United States does not provide future physicians with adequate statistical literacy to communicate risk effectively and rarely encourages them to practice communicating risk in pre-clinical years. Risk communication in military intelligence, a field with formalized risk language and training, offers a unique perspective into potential improvements for medical risk communication. With backgrounds in the military, public health, communication, surgery, and medical education, the authors offer the following recommendations to improve risk communication for medical students. (1) Encourage the use of numerical absolute risk when communicating among health practitioners to avoid varied interpretations of what different risk descriptors ("uncommon," "likely," or "low") might mean; (2) build efficient, teachable skills in use of patient-facing risk communication tools like comparative probabilities and visual aids; and (3) practice estimating risk through role-play of risk communication between medical students and standardized patients. By improving risk communication in medical education, future doctors will be better equipped to build trust through open communication and improve the health of the patients and the communities for whom they care.

Students' Perspectives of Competency-based Medical Education in Undergraduate Psychiatry Clinical Training: A Qualitative Evaluation.

Background: Undergraduate (UG) medical students are one of the stakeholders and ultimate beneficiaries of the competency-based medical education (CBME) curriculum introduced in 2019 by the National Medical Commission (NMC). There is a dearth of literature on student perspectives on CBME Psychiatry clinical posting in India. Methods: Second professional students who attended the psychiatry clinical posting were invited to participate in the qualitative study. They were asked to give perspectives about the training during clinical posting based on a semi-structured questionnaire. Results: Written feedback forms were obtained from 44 students. Data were analyzed using thematic analysis. Results showed the perceived impact of posting (change in knowledge, skills, and attitude), barriers to learning (student factors, patient factors, interaction factors, structural factors), and feedback on training during clinical posting (structural factors, practice over theory). Conclusion: UG students perceived improvement in their knowledge, attitude, and clinical skills during their posting in Psychiatry. They reported several barriers to learning at variouslevels. Their feedback to improve the posting focused on demonstrating skills using patients rather than theory classes.

Association Between Teaching Clinic Structure and the Readiness of Ophthalmology Residents to Enter Independent Practice.

OBJECTIVE: Our objective is to determine if the structure of Graduate Medical Education teaching clinics is associated with how well ophthalmology residents are prepared to meet the workload demands of independent clinical practice. DESIGN: Resident preparedness to enter independent practice was measured by the Readiness Index. Part of the Department of Veterans Affairs' new Workload-based Resident Academic Performance measures (WRAP), resident readiness is computed from electronic health records for residents by clinic and service-date. The index compares resident productivity net of supervision and adjusted for care quality to the average productivity of non-supervising ophthalmologists. Readiness comprises a Workload component (ratio of resident gross productivity to the average productivity of non-supervising ophthalmologists) and Supervision component (ratio of resident net of supervision to gross productivity). Teaching clinic factors include resident postgraduate-year level, resident-to-physician staff ratios, patient care complexity, and program size. Covariates include time into the academic year, facility quality ranking and complexity rating, and attending physician productivity rate. SETTING: Study setting is 109 ophthalmology outpatient clinics from the United States Department of Veterans Affairs and its 1,300 annual ophthalmology resident positions rotating on 84,600 ophthalmology clinic-days during academic years from July 1, 2015, through June 30, 2019. PARTICIPANTS: An average 2.6 residents at a second-year or higher saw 25.0 patients requiring 93.6 relative value units (RVUs) of workload. RESULTS: Senior ophthalmology residents from clinics with higher resident-to-physician ratios had greater practice readiness than their counterparts primarily from having greater progressive autonomy from supervision. Residents from larger programs treating more complex patients had only slightly greater practice readiness than their counterparts primarily from having greater workload productivity. CONCLUSIONS: The readiness of ophthalmology residents to enter independent practice is associated with their academic level and resident-to-physician staff ratios, and to a lesser extent care complexity and program size.

"It changed my whole entire thinking": Identifying narrative elements in medical affidavit writing for asylum seekers.

The medical affidavit is critically significant for asylum seekers. Studies have shown that asylum seekers applying with a medical affidavit (versus without a medical affidavit) have double the success rate. There are many training resources for clinician-evaluators on the interviewing process, but little instruction exists on the affidavit writing process. Our objective was to identify the most common narrative elements in medical affidavits of successful (versus unsuccessful) asylum seekers to provide further writing guidance for clinician-evaluators. We hypothesized that these elements, when thoughtfully employed, help clinician-evaluators best represent their clients in the US immigration system. We focused on the most vulnerable applicants: those applying after the one-year deadline. Using grounded theory, we coded 23 affidavits filed after the one-year deadline for narrative elements. We identified seven narrative elements more common in medical affidavits of asylum seekers who filed after the one-year deadline and were successful: (1) Recommending specific clinical interventions; (2) Quoting elevated diction by the client; (3) Using headlines; including anecdotes that describe (4) The client forming human connections, (5) Archetypal female characters, (6) Love stories, or (7) Moments of realization.

Factors associated with failure of intraosseous access in prehospital trauma treatment by military medical personnel.

INTRODUCTION: Intraosseous devices have become an alternative to peripheral intravenous (PIV) access. Despite the established success of intraosseous devices in laboratory and simulator studies, there is a lack of data regarding their real-world utilisation in prehospital settings. Therefore, this study aims to evaluate the success rates of intraosseous access in a prehospital military context and identify factors associated with failure. METHODS: Using the Israel Defense Forces (IDF) Trauma Registry, we retrospectively collected data from 2010 to 2023. The primary outcome was the first pass success rate of intraosseous access, and logistic regression models were applied to identify variables associated with first pass failure. RESULTS: The study included 172 trauma patients who underwent attempted intraosseous access with 46.5% cases which were classified as military events. The median age was 22 years, and 17.3% were paediatric patients. First pass success was achieved in 67.4% of cases, with a cumulative success rate of 80.8% after multiple attempts. Moreover, significant differences were noted when examining the success rate of the three intraosseous devices used by the IDF teams, with the highest success rate being documented for the NIO Adult versus the EZ-IO or the BIG (81.4%; 76.7%; 62.4%). However, logistic regression analysis revealed that the number of PIV access attempts was the only variable significantly associated with decreased odds of achieving first pass intraosseous access. CONCLUSION: These findings suggest that intraosseous devices are a viable alternative for establishing vascular access in prehospital military settings. However, success rates were slightly lower than previous reports, potentially due to the severity of injuries in the study cohort. Our analyses revealed a higher number of PIV access attempts correlated with reduced first pass intraosseous success, possibly stemming from caregiver proficiency in obtaining vascular access. Further research is needed to explore additional factors affecting intraosseous access success rates.

Internal Medicine Residents' Confidence and Preferences in Hospital Medicine Competencies: A Multi-Site Study.

BACKGROUND: Hospital medicine (HM) is an important career option for internal medicine (IM) residency graduates. Limited data exist regarding preferences and educational gaps in HM competencies among IM residents. OBJECTIVE: To assess resident confidence and desire for additional instruction in HM competencies across a broad spectrum of residents. DESIGN: A multi-center survey-based assessment of IM resident confidence and desire for additional instruction in published HM competencies. PARTICIPANTS: PGY-1 through PGY-4 residents from eight US IM residency programs, including academic medical center (AMC) and community-based programs (CBPs). MAIN MEASURES: Resident confidence and desire for more teaching in HM competency domains including procedures, point-of-care ultrasound (POCUS), system-level competencies, clinical skills, patient-level competencies, palliative care, and care transitions. KEY RESULTS: We received survey responses from 272 of 594 (46%) residents. More than half of respondents envisioned a future HM position. Results demonstrated lower than expected confidence for all HM competencies surveyed. Confidence was lowest (30-36% confident) for procedures, POCUS, and system-level competencies, and highest (65-78%) in care transitions, patient-level competencies, and palliative care. Desire for more instruction was highest in the same competency domains rated with the lowest confidence. Junior residents (PGY-1 and PGY-2) reported significantly lower confidence levels than senior residents (PGY-3 and PGY-4) across all domains except patient-level competencies. Junior residents expressed a significantly higher desire than senior residents for more teaching in all domains. There were no significant differences in confidence or desire for more instruction between trainees who envision a future HM position versus those who do not. Residents from AMCs expressed significantly higher confidence than those from CBPs in POCUS, clinical skill, patient-level, palliative care, and care transitions, while residents from CBPs reported significantly higher confidence in procedures. CONCLUSIONS: Our data can inform targeted inpatient competencies and educational curricula for IM residents in the USA.

The Use of Silicone Simulators for Bile Duct Anastomosis Education in Medical Conferences for the Purpose of Improving the Canadian Medical Education Directives for Specialists (CanMEDS) Competencies.

This technical report explores the potential of including silicone bile duct simulators for the purpose of completing a bile duct anastomosis (BDA) in medical conferences. The purpose is to target the need for exposure to more surgical skills and to contribute to the Canadian Medical Education Directives for Specialists (CanMEDS) requirements, as per the Royal College of Physicians and Surgeons of Canada.  Data collection was completed at the 2023 Canadian Conference for the Advancement of Surgical Education (C-CASE) in Montreal, Canada. For several years, the quality improvement feedback received at the end of these conferences suggested a few areas of improvement, one of which was related to the concept of return on investment (ROI). The participants spend a considerable amount of funds to travel to the conferences but feel that the only measurable gains are at a research capacity and thus only relate to two CanMEDS competencies. By leveraging C-CASE, the aim is to enhance students' educational experience during events they already intend to attend. Initially, students participated in a five-part simulation workshop and engaged in a think-aloud protocol (TAO). From there, nine participants were recruited for a focus group to further understand the perceived educational value and feedback on both the simulators and the conference structure.