Generative Artificial Intelligence Performs at a Second-Year Orthopedic Resident Level.

Introduction Artificial intelligence (AI) models using large language models (LLMs) and non-specific domains have gained attention for their innovative information processing. As AI advances, it's essential to regularly evaluate these tools' competency to maintain high standards, prevent errors or biases, and avoid flawed reasoning or misinformation that could harm patients or spread inaccuracies. Our study aimed to determine the performance of Chat Generative Pre-trained Transformer (ChatGPT) by OpenAI and Google BARD (BARD) in orthopedic surgery, assess performance based on question types, contrast performance between different AIs and compare AI performance to orthopedic residents. Methods We administered ChatGPT and BARD 757 Orthopedic In-Training Examination (OITE) questions. After excluding image-related questions, the AIs answered 390 multiple choice questions, all categorized within 10 sub-specialties (basic science, trauma, sports medicine, spine, hip and knee, pediatrics, oncology, shoulder and elbow, hand, and food and ankle) and three taxonomy classes (recall, interpretation, and application of knowledge). Statistical analysis was performed to analyze the number of questions answered correctly by each AI model, the performance returned by each AI model within the categorized question sub-specialty designation, and the performance of each AI model in comparison to the results returned by orthopedic residents classified by their respective post-graduate year (PGY) level. Results BARD answered more overall questions correctly (58% vs 54%, p<0.001). ChatGPT performed better in sports medicine and basic science and worse in hand surgery, while BARD performed better in basic science (p<0.05). The AIs performed better in recall questions compared to the application of knowledge (p<0.05). Based on previous data, it ranked in the 42nd-96th percentile for post-graduate year ones (PGY1s), 27th-58th for PGY2s, 3rd-29th for PGY3s, 1st-21st for PGY4s, and 1st-17th for PGY5s. Discussion ChatGPT excelled in sports medicine but fell short in hand surgery, while both AIs performed well in the basic science sub-specialty but performed poorly in the application of knowledge-based taxonomy questions. BARD performed better than ChatGPT overall. Although the AI reached the second-year PGY orthopedic resident level, it fell short of passing the American Board of Orthopedic Surgery (ABOS). Its strengths in recall-based inquiries highlight its potential as an orthopedic learning and educational tool.

Trends in Orthopaedic Surgery Workforce Diversity: Analyzing Changes Over Time.

INTRODUCTION: There are many reasons why orthopaedic surgeons move or change careers. We asked the questions: (1) What is the geographic distribution of orthopaedic surgeons with respect to age, sex, and race and ethnicity? (2) How has our workforce changed over time with regard to these factors? (3) Are there any patterns or trends detected regarding policy or regulatory events that coincide with these differences? METHODS: The American Academy of Orthopaedic Surgeons surveys over 30,000 members, collecting data on demographics, age, race sex, and practice statistics. We calculated geographic distributions and evaluated these differences over time-potential influences from malpractice suits or tort reform were investigated. RESULTS: Overall surgeon density increased over time. The largest negative changes were noted in District of Columbia, Wyoming, and North Dakota and positive changes in Colorado, South Dakota, and West Virginia. Age across all states increased (mean 1.7 years). Number of female surgeons increased in most states (4.6% to 5.7%). Number of African Americans increased from 1.6% to 1.8%, Hispanic/LatinX from 1.8% to 2.2%, Asian from 5.5% to 6.7%, and multiracial from 0.8% to 1.2%. No change was noted in the percentage of Native American surgeons. DISCUSSION: Surgeon density increased from 2012 to 2018; the cause for this change was not evident. Small increases in surgeon population, female surgeons, and in some underrepresented minorities were seen.

Exploring Novel Non-pharmacologic Approaches to Address Preoperative Anxiety and Postoperative Pain in Pediatric Patients Undergoing In-Patient Surgical Procedures: A Scoping Review.

The pediatric population is more prone to experiencing anxiety and fear before undergoing an inpatient surgical procedure than adults. Non-pharmaceutical interventions, such as music therapy and virtual reality programs, have shown significant promise in reducing the post-operative pain associated with pre-operative anxiety of patients and their caregivers. While there is evidence to support the use of non-pharmaceutical treatment in the mitigation of pre-operative anxiety, there are limited published reports of non-pharmacological interventions for pre-operative anxiety in children undergoing inpatient surgical procedures. The goal of this scoping review was to identify and classify specific non-pharmacological interventions utilized inpatient among children to improve pre-operative anxiety and post-operative complications inflicting pain. Comprehensive searches were conducted using Ovid Medline, Embase Emtree, CINAHL Complete, and COCHRANE Central databases. The articles had to be peer-reviewed, written in English, published between 2000-2022, and contain measurements of pre-operative anxiety and post-operative pain to be included in the scoping review. Articles that reported findings on patients younger than 18 undergoing elective and/or routine surgeries, excluding emergent surgical cases, were selected. After a systemized screening process, 9 articles were selected for the final review. The findings indicated that non-pharmacological interventions such as virtual reality, hypnosis, and clowns reduced pre-operative anxiety and post-operative pain in pediatric patients. This scoping review identified a wide range of non-pharmacological interventions to mitigate the post-operative effects of pre-operative anxiety among children, including but not limited to music, visual reality, and other holistic methods. More longitudinal studies are warranted to understand the specific interventions that may be the most efficacious.