Money Talks: The Shifting Effect of Limiting Monetary Incentives for Urology Resident Research.

OBJECTIVE: To assess incentive changes on resident publication behavior. In 2020, we demonstrated the positive effect of an unlimited $1000 publishing incentive for Urology residents. Following this publication, institutional changes led to a limit of a single $1000 publishing incentive per resident per year. METHODS: The PubMed database was assessed to quantify average resident primary authorship and average overall publications. Average primary authorships and total PubMed listings were then compared by year before any incentive (June 2008-June 2016), during unlimited incentive (July 2016-October 2020), and after the limited financial incentive (November 2020-June 2023). RESULTS: Scholarly activity from 30 out of 30 possible residents was evaluated. The average PubMed research participation for the program per year increased significantly from 2.44 preincentive to 8.0 when the incentive was unlimited but decreased to 4.0 when the incentive was limited (P = .026). Similarly, the average PubMed primary resident authorships per year increased from 1.0 preincentive to 6.25 during the unlimited incentive period but decreased to 2.0 when the incentive was limited (P < .001). CONCLUSION: Our data showed an unlimited monetary incentive resulted in a significant increase in average primary resident authorship and average resident participation for publications to PubMed. The limited monetary incentive model resulted in a significant decrease on resident publication and participation in research compared to unlimited incentives. However, limited monetary incentives have a positive, though restricted, effect on Urology resident publication and participation in research compared to no incentive.

Patient Portal Engagement Affects Postvasectomy Semen Analysis Completion.

OBJECTIVE: To identify factors that affect completion of postvasectomy semen analysis (PVSA) in men receiving telehealth prevasectomy counseling. Telehealth visits have become increasingly common for prevasectomy consultations. Prior studies have shown that men prefer telehealth vasectomy consultations over in-person options. Postvasectomy semen testing should be completed to confirm sterilization. METHODS: Three hundred and seventy-one men aged 19 and older who saw a single physician for a telehealth prevasectomy consultation and completed an in-office vasectomy were included in the study. Demographic information such as age, patient relationship status, and distance from the clinic were accessed via electronic medical record. Patients were assessed based on their engagement with electronic preprocedure instructions, and the primary outcome measured was completion of PVSA. RESULTS: 45.6% of men completed a PVSA. There was no significant difference in completion of the PVSA between those who opened their electronic instructions before their vasectomy and those who did not (46.1% vs 44.4%, P = .77). Of those who messaged the clinic for any reason at least once after their consultation, 62% completed their PVSA; 41% who did not contact the clinic completed the PVSA (P = .0009). CONCLUSION: While there was no difference in completion of PVSA in patients who opened their instructions vs those who did not, patients with a higher level of engagement with the patient portals were more likely to complete their semen test. By understanding factors influencing patient compliance with postvasectomy semen testing, healthcare professionals can develop targeted interventions to ensure safe and successful outcomes.

New Artificial Intelligence ChatGPT Performs Poorly on the 2022 Self-assessment Study Program for Urology.

INTRODUCTION: Large language models have demonstrated impressive capabilities, but application to medicine remains unclear. We seek to evaluate the use of ChatGPT on the American Urological Association Self-assessment Study Program as an educational adjunct for urology trainees and practicing physicians. METHODS: One hundred fifty questions from the 2022 Self-assessment Study Program exam were screened, and those containing visual assets (n=15) were removed. The remaining items were encoded as open ended or multiple choice. ChatGPT's output was coded as correct, incorrect, or indeterminate; if indeterminate, responses were regenerated up to 2 times. Concordance, quality, and accuracy were ascertained by 3 independent researchers and reviewed by 2 physician adjudicators. A new session was started for each entry to avoid crossover learning. RESULTS: ChatGPT was correct on 36/135 (26.7%) open-ended and 38/135 (28.2%) multiple-choice questions. Indeterminate responses were generated in 40 (29.6%) and 4 (3.0%), respectively. Of the correct responses, 24/36 (66.7%) and 36/38 (94.7%) were on initial output, 8 (22.2%) and 1 (2.6%) on second output, and 4 (11.1%) and 1 (2.6%) on final output, respectively. Although regeneration decreased indeterminate responses, proportion of correct responses did not increase. For open-ended and multiple-choice questions, ChatGPT provided consistent justifications for incorrect answers and remained concordant between correct and incorrect answers. CONCLUSIONS: ChatGPT previously demonstrated promise on medical licensing exams; however, application to the 2022 Self-assessment Study Program was not demonstrated. Performance improved with multiple-choice over open-ended questions. More importantly were the persistent justifications for incorrect responses-left unchecked, utilization of ChatGPT in medicine may facilitate medical misinformation.