The Unforeseen Costs of Medical Education.

OBJECTIVE: Financial burdens of medical education are a major barrier for many students. The goal of this study is to identify and quantify unforeseen costs associated with being a medical student. METHODS: Medical students at the University of Tennessee Health Science Center were surveyed on unforeseen financial costs. Qualitative data were collected. RESULTS: Students spent significant extra funds in professional development, social spending, living, and technology. CONCLUSION: Schools and students should consider all aspects of life to have a fruitful education and appropriately provide loan funding and financial education for both enough and thoughtful use of financial resources during medical education.

The digital readiness of future physicians: nurturing the post-pandemic medical education.

BACKGROUND: The COVID-19 pandemic has accelerated the integration of digital technologies in the healthcare sector. Telemedicine has notably emerged as a significant tool, offering a range of benefits. However, various barriers, such as healthcare professionals' insufficient technological skills and competencies, can hinder its effective implementation. Scholars have examined the readiness of future physicians, with some studies exploring their readiness before or during the COVID-19 crisis. There is, however, a noteable gap in the literature concerning the post-pandemic period. This study aims to identify gaps in current medical education programs by examining two primary aspects: (1) technical readiness (encompassing general and health-related digital competencies) and (2) behavioural readiness, which includes prior experiences and future intentions related to telemedicine education and implementation among medical students and residents. METHODS: A cross-sectional study was conducted using a web-based questionnaire administered to medical students and residents at a major Northern Italian university. The survey responses were analyzed to ascertain whether their distributions varied across demographic variables such as gender and level of education. RESULTS: The most commonly owned technologies were laptops and smartphones, with smartphones perceived as the easiest to use, while desktop computers presented more challenges. Approximately 38% of respondents expressed apprehension about applying digital health information in decision-making processes. There was a significant lack of both personal and academic experience, with only 16% of students and residents having used telemedicine in a university setting. Despite this, 83% of participants expressed a desire for training in telemedicine, and 81% were open to experimenting with it during their academic journey. Moreover, 76% of respondents expressed interest in incorporating telemedicine into their future clinical practice. CONCLUSIONS: This study highlights the need for medical students and residents to receive specific education in digital health and telemedicine. Introducing curricula and courses in this domain is critical to addressing the challenges of digital healthcare.

Corona Virus Disease (COVID-19): Lessons Learned Impact on the Education of Health Professionals.

The coronavirus disease (COVID-19) had a tremendous impact on the education of health professionals globally because of the lack of continuity in the medical education process. After it was declared a pandemic, stay-at-home orders forced students to learn virtually, to mitigate the spread of infection. While didactic courses transitioned easily to a virtual format, using platforms like Webex, Zoom, Google Classroom, etc. preclinical and clinical teaching suffered immensely. Patient care was halted for the safety of the patients, students and faculty, and staff involved. Uncertainty about clinical care and isolation during quarantine due to infections caused poor mental health among students. Most health professions innovated their teaching with simulations, role-play, educational videos, etc. but dental education suffered due to the need for psychomotor skill development. As the COVID-19 protocols evolved, and vaccinations became available, the teaching slowly transformed to Flipped Classrooms, Blended Learning, and Hybrid formats, and patient care was allowed with screening, triaging, and testing before scheduling for aerosol-causing procedures in dentistry. This new normal was accepted and silver linings in the pedagogies were appreciated by faculty and institutions alike as outcomes were analyzed. This chapter examines lessons learned on pandemic awareness, effective teaching pedagogies, and challenges of health professionals. An analysis of the lessons based on the framework of the Community of Inquiry is provided as guidelines to educate Gen Z for the future.

Promoting professionalism through humanities-based transformation.

INTRODUCTION: In the last two decades, academic medical centers in the United States have faced a new challenge, dealing with breaches of medical professionalism in their staff, house staff, and medical students. Medical education settings have largely directed their professionalism efforts toward responding reactively to negative outliers. DISCUSSION: This paper contends that the warrant of medical education mandates a transformative path forward. While negative behavior must be responded to meaningfully, so, too, must positive role models of professional behavior be publicly lauded for their consequential culture change in their institutions, and promoted as positive role models. Further, the promotion of medical professionalism must be part of this culture by proactively engaging all learners and health care providers with medical ethics and humanities-based knowledge, critical thinking skills, and role modeling. CONCLUSION: Professionalism programs should be vested with the authority to implement an affirmative educational program intended to nurture and promote medical professionalism in each medical student, resident, fellow, and attending and utilize methods to that end employing both virtue and care ethics.

Medical professionalism is the foundational concept grounded upon scientific- and humanities-based knowledge and skills, directed toward the promotion of patient benefit with the rejection of self-interest, delivered with excellence in comportment, and the adherence to a covenant of trust with society.Medical educators who solely emphasize the detection and punishment of negative outliers are missing essential elements in promoting medical professionalism.Medical professionalism should be comprehensively addressed through a systematic addressing of teaching fundamental knowledge, skills, and virtue, promote excellence in role modeling and mentorship, and the redress of those lacking insight in their professional conduct.

Teaching Artificial Intelligence to Medical Students.

Among the measures taken by UVVG to modernize the educational process is the pioneering undertaking regarding the introduction of a course on Artificial Intelligence in Medicine (AIM). Such an action has to face several challenges, at three levels, starting from its inclusion in the curricular vision of the university, its positioning in the didactic program as well as the content of the syllabus suitable for medical students. The first part presents the necessity and opportunity of introducing the course in the current context of the rapid growth of AIM applications. The second part refers to the concrete implementation of the introduction of the course in the curriculum, while the last and most developed part is dedicated to the preparation of the syllabus starting from the premises that the field is growing very fast and we should provide the basic knowledge to assure an easy understanding and a smooth assimilation of further developments.

Mixed Reality in Medical Education - Introduction of a Practical Course Module.

With increasing digitalization in healthcare, there is growing potential for the use of Mixed Reality (MR) in medicine. In response to this, we developed a course to provide students with hands-on experience in MR and familiarize them with the technology. Utilizing the HoloLens 2, we designed an application enabling multiple users to interact with virtual objects overlaid on the real world and shared across devices. We used 3D heart anatomy models to let students discuss cardiovascular diseases together. We conducted a preliminary evaluation of our prototype, involving ten participants. The first test indicated a positive reception of the course, with students expressing keen interest in MR. With this work we share our experience to contribute to the field of MR applications.

Futureproofing Medical Education Through Scenario Analysis: Instrumental Case Study.

Developments in technology and climate change, as well as other "megatrends" are having lasting impacts in society and healthcare. A scenario analysis was conducted to explore the impact of megatrends on medical education. Three scenarios were developed for the year 2035, showing varying levels of technological integration and environmental focus. Implications for an updated curricula focus on health inequalities, digital health, and globalization effects.

[The humanization of medical education: publications review].

The humanization of medical education is targeted at integration of humanitarian values and approaches into system of education of medical personnel to improve their professional and personal training. This process includes education in medical ethics, development of communication skills, stress management and implementation of humanitarian disciplines into the curriculum. The humanization contributes into formation of empathy, responsibility and professionalism in future physicians that helps to better understand and consider psychological, social and emotional needs of patients. The problems of including humanitarian sciences into medical education are associated with lack of systematic approach, adequate curricula and qualified lecturers. To optimize process, it is necessary to focus on education of ideals and beliefs, development of integrated curricula and enhancement of humanitarian component of education.

[The programs of additional legal education as necessary element of system of training of students of medical university].

The actual trends in training of health care professionals set before medical university task of actualization and diversification of training programs targeted to formation both professional and universal competencies to contribute to variable combination of different skills and habits in implementation of medical activities. The increasing needs of labor market in specialists capable to meet actual realities and associated with transformational transition from narrow specialization to different specific skills, inevitably results into increasing of importance for additional education programs as an element of continuing The following key features of various proposals for additional professional education programs were singled out. The major task of forming proposal of additional programs is seen by university through prism of possible increasing of income. And main contingent of students is formed by specialists improve their qualifications. The specificity of medical university is specialists training to implement medical practice. In this regard, additional law training programs are targeted to exclusively at persons mastering basic educational program for the first time. The competencies implemented are focused at extending and specifying training considering legal maintenance or new trends. Besides, applying value-based approach to formation of educational trajectory of student, university translates primary importance of autonomy of will of student choosing additional educational programs. Thus, learning program of additional education is carried out using basic training in law and considering necessary and sufficient factual component that meets the needs of modern labor market, permitting strengthen and expand available competencies for future professional activity of medical worker. The article analyzed results of studies of pedagogues and psychologists, specialists of philosophical direction, professional lecturers, and sociological studies. The methods applied were analysis and synthesis, formalization, generalization, document analysis. The main methods of data analysis were substantive (hermeneutical) analysis and discourse analysis.

[The integrated programs in medical education: modern trends and development prospects].

The article considers possibilities of forming integrated educational programs of personnel training. The integration supposes interdisciplinary approach and inclusion within curricula, besides medical subjects, disciplines from different fields of science. As practice demonstrates, this approach provides larger spectrum of professional knowledge, skills and competencies and contributes into better career guidance and subsequent employment of graduates.

Ethical issues and proposed solutions in conducting practical assessment of medical students involving patients.

Practical assessment involving patients plays a vital role in medical education, allowing students to demonstrate their clinical competencies. However, there are significant ethical concerns associated with these assessments that require careful consideration and resolution. The primary ethical concerns include violation of patient autonomy, lack of written informed consent, power dynamics, cultural differences, potential harm to patients, breach of privacy and confidentiality, discomfort to admitted patients, financial loss to patients, impact on other patients' care, and delays in workup/procedures. To address these concerns, measures such as respecting patient autonomy, obtaining written informed consent, ensuring patient safety, exploring alternative methods, providing reimbursement, resource planning, creating a supportive environment, developing cultural competency, putting in place a feedback system, prioritising patient care, and implementing ethical oversight and monitoring are recommended. The formulation of a guideline could be a crucial starting point, and it should be integrated into a broader ethical framework that encompasses education and training, ethical oversight, ongoing monitoring, and a culture that prioritises ethical conduct.

CLINICAL REASONING AND ARTIFICIAL INTELLIGENCE: CAN AI REALLY THINK?

Artificial intelligence (AI) in the form of ChatGPT has rapidly attracted attention from physicians and medical educators. While it holds great promise for more routine medical tasks, may broaden one's differential diagnosis, and may be able to assist in the evaluation of images, such as radiographs and electrocardiograms, the technology is largely based on advanced algorithms akin to pattern recognition. One of the key questions raised in concert with these advances is: What does the growth of artificial intelligence mean for medical education, particularly the development of critical thinking and clinical reasoning? In this commentary, we will explore the elements of cognitive theory that underlie the ways in which physicians are taught to reason through a diagnostic case and compare hypothetico-deductive reasoning, often employing illness scripts, with inductive reasoning, which is based on a deeper understanding of mechanisms of health and disease. Issues of cognitive bias and their impact on diagnostic error will be examined. The constructs of routine and adaptive expertise will also be delineated. The application of artificial intelligence to diagnostic problem solving, along with concerns about racial and gender bias, will be delineated. Using several case examples, we will demonstrate the limitations of this technology and its potential pitfalls and outline the direction medical education may need to take in the years to come.

Educational Utility of Clinical Vignettes Generated in Japanese by ChatGPT-4: Mixed Methods Study.

BACKGROUND: Evaluating the accuracy and educational utility of artificial intelligence-generated medical cases, especially those produced by large language models such as ChatGPT-4 (developed by OpenAI), is crucial yet underexplored. OBJECTIVE: This study aimed to assess the educational utility of ChatGPT-4-generated clinical vignettes and their applicability in educational settings. METHODS: Using a convergent mixed methods design, a web-based survey was conducted from January 8 to 28, 2024, to evaluate 18 medical cases generated by ChatGPT-4 in Japanese. In the survey, 6 main question items were used to evaluate the quality of the generated clinical vignettes and their educational utility, which are information quality, information accuracy, educational usefulness, clinical match, terminology accuracy (TA), and diagnosis difficulty. Feedback was solicited from physicians specializing in general internal medicine or general medicine and experienced in medical education. Chi-square and Mann-Whitney U tests were performed to identify differences among cases, and linear regression was used to examine trends associated with physicians' experience. Thematic analysis of qualitative feedback was performed to identify areas for improvement and confirm the educational utility of the cases. RESULTS: Of the 73 invited participants, 71 (97%) responded. The respondents, primarily male (64/71, 90%), spanned a broad range of practice years (from 1976 to 2017) and represented diverse hospital sizes throughout Japan. The majority deemed the information quality (mean 0.77, 95% CI 0.75-0.79) and information accuracy (mean 0.68, 95% CI 0.65-0.71) to be satisfactory, with these responses being based on binary data. The average scores assigned were 3.55 (95% CI 3.49-3.60) for educational usefulness, 3.70 (95% CI 3.65-3.75) for clinical match, 3.49 (95% CI 3.44-3.55) for TA, and 2.34 (95% CI 2.28-2.40) for diagnosis difficulty, based on a 5-point Likert scale. Statistical analysis showed significant variability in content quality and relevance across the cases (P<.001 after Bonferroni correction). Participants suggested improvements in generating physical findings, using natural language, and enhancing medical TA. The thematic analysis highlighted the need for clearer documentation, clinical information consistency, content relevance, and patient-centered case presentations. CONCLUSIONS: ChatGPT-4-generated medical cases written in Japanese possess considerable potential as resources in medical education, with recognized adequacy in quality and accuracy. Nevertheless, there is a notable need for enhancements in the precision and realism of case details. This study emphasizes ChatGPT-4's value as an adjunctive educational tool in the medical field, requiring expert oversight for optimal application.

Medical training to effectively support patients who use substances across practice settings: a scoping review of recommended competencies.

Background: The responsibility for addressing the healthcare needs of PWUS is the responsibility of all physicians. Within the healthcare system, research consistently reveals inequitable experiences in healthcare with people who use substances (PWUS) reporting stigmatization, marginalization, and a lack of compassion. Objectives: The aim of this scoping review was to find and describe competencies being taught, developed, and fostered within medical education and then to provide recommendations to improve care for this population of patients. Results: Nineteen articles were included. Recommended knowledge competencies tend to promote understanding neurophysiological changes caused by substances, alongside knowing how to evaluate of 'risky' behaviours. Commonly recommended skills relate to the screening and management of substance use disorders. Recommended attitude competencies include identifying personal bias and establishing a patient-centered culture among practice teams. The disease model of addiction informed all papers, with no acknowledgement of potential beneficial or non-problematic experiences of substance use. To enhance knowledge-type competencies, medical education programs are advised to include addiction specialists as educators and prevent stigmatization through the hidden curriculum. Conclusion: To reduce experiences of stigmatization and marginalization among patients who use illicit substances and to improve quality of care, knowledge, skills, and attitudes competencies can be more effectively taught in medical education programs.Résumé.

Contexte: Il incombe à tous les médecins de répondre aux besoins en matière de soins de santé des consommateurs de substances psychoactives. Au sein du système de santé, les recherches révèlent régulièrement des expériences inéquitables en matière de soins de santé, les consommateurs de substances faisant état de stigmatisation, de marginalisation et d'un manque de compassion. Objectifs: L'objectif de cette étude exploratoire était de trouver et de décrire les compétences enseignées, développées et encouragées dans le cadre de la formation médicale, puis de formuler des recommandations pour améliorer les soins prodigués à ces patients. Résultats: Au total, 19 articles ont été inclus. Les compétences recommandées en matière de connaissances tendent à promouvoir la compréhension des changements neurophysiologiques causés par les substances, ainsi que la connaissance de l'évaluation des comportements « à risque ¼. Les compétences couramment recommandées concernent le dépistage et la gestion des troubles liés à l'usage de substances. Les compétences recommandées en matière d'attitude comprennent l'identification des préjugés personnels et l'instauration d'une culture centrée sur le patient au sein des équipes de praticiens. Tous les articles s'appuient sur le modèle pathologique de la toxicomanie et ne reconnaissent pas les expériences potentiellement bénéfiques ou non problématiques de la consommation de substances. Pour améliorer les compétences en matière de connaissances, il est conseillé aux programmes de formation médicale d'inclure des spécialistes de la toxicomanie en tant qu'éducateurs et de prévenir la stigmatisation par le biais d'un programme d'études caché. Conclusion: Pour réduire les expériences de stigmatisation et de marginalisation parmi les patients qui consomment des substances illicites et pour améliorer la qualité des soins, les connaissances, les aptitudes et les attitudes peuvent être enseignées plus efficacement dans les programmes de formation médicale.

Evaluation of a novel virtual reality Immersive Clinical Experience to enhance medical education curriculum.

Medical students often find the transition to clerkship challenging and stressful. The use of virtual reality (VR) technologies such as screen-based learning, 360-video and immersive VR using head-mount-devices is becoming more utilized in medical education. Immersive technologies in particular have been shown to lead to greater enthusiasm and provide higher knowledge gain for students compared to screen-based VR. The University of British Columbia Faculty of Medicine has developed a novel immersive patient experience using VR to enhance the clinical skills program and evaluate student perception regarding its formal integration into curricula. Students reported positive feedback on the experience, and interest in more immersive learning opportunities in future sessions. VR technology has the potential to enhance medical education and provide a safe immersive learning environment to build clinical acumen.

Les étudiants en médecine trouvent souvent la transition vers l'externat difficile et stressante. L'utilisation des technologies de réalité virtuelle (RV), telles que l'apprentissage sur écran, la vidéo à 360° et la RV immersive à l'aide de dispositifs de tête, est de plus en plus répandue dans le secteur de la formation médicale. On a démontré que les technologies immersives, en particulier, suscitent un plus grand enthousiasme et permettent aux étudiants d'acquérir davantage de connaissances que la RV sur écran. La Faculté de médecine de l'Université de la Colombie-Britannique a mis au point une nouvelle expérience immersive du patient en utilisant la RV pour améliorer le programme de compétences cliniques et évaluer la perception des étudiants concernant son intégration formelle dans les programmes d'études. Les étudiants ont fait part de leurs réactions positives à l'égard de l'expérience et de leur intérêt pour des possibilités d'apprentissage plus immersives dans les sessions futures. La technologie de la RV a le potentiel d'améliorer la formation médicale et de fournir un environnement d'apprentissage immersif sûr pour développer le sens clinique.