Crafting medical MCQs with generative AI: A how-to guide on leveraging ChatGPT.

As medical educators grapple with the consistent demand for high-quality assessments, the integration of artificial intelligence presents a novel solution. This how-to article delves into the mechanics of employing ChatGPT for generating Multiple Choice Questions (MCQs) within the medical curriculum. Focusing on the intricacies of prompt engineering, we elucidate the steps and considerations imperative for achieving targeted, high-fidelity results. The article presents varying outcomes based on different prompt structures, highlighting the AI's adaptability in producing questions of distinct complexities. While emphasizing the transformative potential of ChatGPT, we also spotlight challenges, including the AI's occasional "hallucination", underscoring the importance of rigorous review. This guide aims to furnish educators with the know-how to integrate AI into their assessment creation process, heralding a new era in medical education tools.

Transcranial direct current stimulation as treatment for major depression in a home treatment setting (HomeDC trial): study protocol and methodology of a double-blind, placebo-controlled pilot study.

INTRODUCTION: Transcranial direct current stimulation (tDCS) of prefrontal cortex regions has been reported to exert therapeutic effects in patients with major depressive disorder (MDD). Due to its beneficial safety profile, its easy mode of application, and its cost-effectiveness, tDCS has recently been proposed for treatment at home. This would offer new chances for regionally widespread and long-term application. However, tDCS at home must meet the new methodological challenges of handling and adherence. At the same time, data from randomized controlled trials (RCT) investigating this mode of application are still lacking. In this pilot RCT, we therefore investigate the feasibility, safety, and effectiveness of a new antidepressant tDCS application set-up. METHODS AND ANALYSIS: The HomeDC trial will be conducted as a double-blind, placebo-controlled, parallel-group design trial. Thirty-two study participants with MDD will be randomly assigned to active or sham tDCS groups. Participants will self-administer prefrontal tDCS for 6 weeks. Active tDCS will be conducted with anode over F3, cathode over F4, for 5 sessions/week, with a duration of 30 min/day, and 2 mA stimulation intensity. Sham tDCS, conversely, follows an identical protocol in regard to electrode montage and timing, but with no electric stimulation between the ramp-in and ramp-out periods. Both conditions will be administered either as a monotherapy or an adjunctive treatment to a stable dose of antidepressant medication. Adjunctive magnetic resonance imaging (MRI) and electric field (E-field) modelling will be conducted at baseline. Primary outcome is feasibility based on successfully completed stimulations and drop-out rates. The intervention is considered feasible when 20 out of 30 sessions have been fully conducted by at least 75% of the participants. Effectiveness and safety will be assessed as secondary outcomes. DISCUSSION: In the HomeDC trial, the technical requirements for a placebo-controlled tDCS study in a home-based treatment setting have been established. The trial addresses the crucial points of the home-based tDCS treatment approach: uniform electrode positioning, frequent monitoring of stimulation parameters, adherence, and ensuring an appropriate home treatment environment. This study will further identify constraints and drawbacks of this novel mode of treatment. TRIAL REGISTRATION: www. CLINICALTRIALS: gov . TRIAL REGISTRATION NUMBER: NCT05172505. Registration date: 12/13/2021.

TDCS at home for depressive disorders: an updated systematic review and lessons learned from a prematurely terminated randomized controlled pilot study.

The application of transcranial direct current stimulation (tDCS) at home for the treatment of major depressive disorder (MDD) is the subject of current clinical trials. This is due to its positive safety profile, cost-effectiveness, and potential scalability for a wide outreach in clinical practice. Here, we provide a systematic review of the available studies and also a report on the results of a randomized controlled trial (RCT) on tDCS at home for the treatment of MDD. This trial had to be prematurely terminated due to safety concerns. The HomeDC trial is a double-blinded, placebo-controlled, parallel-group study. Patients with MDD (DSM-5) were randomized to active or sham tDCS. Patients conducted tDCS at home for 6 weeks with 5 sessions/week (30 min at 2 mA) anode over F3, cathode over F4. Sham tDCS resembled active tDCS, with ramp-in and ramp-out periods, but without intermittent stimulation. The study was prematurely terminated due to an accumulation of adverse events (AEs, skin lesions), so that only 11 patients were included. Feasibility was good. Safety monitoring was not sufficient enough to detect or prevent AEs within an appropriate timeframe. Regarding antidepressant effects, the reduction in depression scales over time was significant. However, active tDCS was not superior to sham tDCS in this regard. Both the conclusions from this review and the HomeDC trial show that there are several critical issues with the use of tDCS at home that need to be addressed. Nevertheless the array of transcranial electric simulation (TES) methods that this mode of application offers, including tDCS, is highly interesting and warrants further investigation in high quality RCTs. TRIAL REGISTRATION: www. CLINICALTRIALS: gov . TRIAL REGISTRATION NUMBER: NCT05172505. Registration date: 12/13/2021, https://clinicaltrials.gov/ct2/show/NCT05172505 . *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers) **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71 . For more information, visit: http://www.prisma-statement.org/.

Limits of near transfer: Content- and operation-specific effects of working memory training.

Working memory (WM) training typically leads to large performance gains in the practiced tasks, but transfer of these gains to other contexts is elusive. One possible explanation for the inconsistent findings of past research is that transfer may only occur when cognitive strategies acquired during training can also be applied in the transfer tasks. Therefore, we systematically varied the content domains and WM operations assessed by training and transfer tasks and, thereby, the extent to which similar cognitive strategies could be applied. We randomly assigned 171 young adults to one of eight experimental groups who trained one of two WM operations (storage and processing or relational integration) with materials from one of four content domains (verbal, numerical, figural-icon, or figural-pattern) to an active or to a passive control group. Before and after 12 sessions of adaptive training within 2-3 weeks, performance was assessed in all eight WM tasks. Bayesian generalized linear mixed-effects models revealed improved performance in the trained tasks compared to the active control group. However, these improvements did not generalize to tasks measuring the same WM operation with different materials. Moreover, the comparison of the training groups with an active and a passive control group showed considerable differences, thus highlighting the importance of distinguishing between active and passive control groups. Overall, the findings revealed no evidence for transfer between tasks assumed to afford the same strategies. Therefore, the adoption of specific cognitive strategies alone is unlikely to be responsible for transfer of WM training gains between tasks. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Delineating charge and capacitance transduction in system-integrated graphene-based BioFETs used as aptasensors for malaria detection.

Despite significant eradication efforts, malaria remains a persistent infectious disease with high mortality due to the lack of efficient point-of-care (PoC) screening solutions required to manage low-density asymptomatic parasitemia. In response, we demonstrate a quantitative electrical biosensor based on system-integrated two-dimensional field-effect transistors (2DBioFETs) of reduced graphene oxide (rGO) as transducer for high sensitivity screening of the main malaria biomarker, Plasmodium falciparum lactate dehydrogenase (PfLDH). The 2DBioFETs were biofunctionalized with pyrene-modified 2008s aptamers as specific PfLDH receptors. While we systematically optimize biosensor interface for optimal performance, aptamer-protein transduction at 2DBioFETs is elucidated based on delineation of charge and capacitance in an updated analytical model for two-dimensional rGO/biofunctional layer/electrolyte (2DiBLE) interfaces. Our 2DBioFET-aptasensors display a limit-of-detection down to 0.78 fM (0.11 pg/mL), dynamic ranges over 9 orders of magnitude (subfemto to submicromolar), high sensitivity, and selectivity in human serum validating their diagnostic potential as rapid PoC tests for malarial management.

Drivers of job satisfaction in midwifery-A work design approach.

BACKGROUND: Identifying common factors that influence job satisfaction for midwives working in diverse work settings is challenging. Applying a work design model developed in organisational behaviour to the midwifery context may help identify key antecedents of midwives job satisfaction. AIM: To investigate three job characteristics - decision-making autonomy, empowerment, and professional recognition as antecedents of job satisfaction in New Zealand (NZ) midwives. METHODS: Latent multiple regressions were performed on data from Lead Maternity Carer (LMC) midwives n = 327, employed midwives n = 255, and midwives working in 'mixed-roles' n = 123. FINDINGS: We found that professional recognition is positively linked to job satisfaction for midwives in all three work settings. At the same time, decision-making autonomy and empowerment were shown to influence job satisfaction for midwives working as LMCs only. DISCUSSION: Our main finding suggests that the esteem generated from being acknowledged as an expert and valuable contributor by maternity health colleagues is satisfying across all work contexts. Professional recognition encompasses the social dimension of midwifery work and influences midwives job satisfaction. Decision-making autonomy and empowerment are task and relational job characteristics that may not be similarly experienced by all midwives to noticeably influence job satisfaction. CONCLUSION: Given that job satisfaction contributes to recruitment, retention, and sustainability, our findings show that drivers of job satisfaction differ by midwifery work context. We present evidence to support tailored efforts to bolster midwives job satisfaction, especially where resources are limited.

Assessment of Diagnostic Competences With Standardized Patients Versus Virtual Patients: Experimental Study in the Context of History Taking.

BACKGROUND: Standardized patients (SPs) have been one of the popular assessment methods in clinical teaching for decades, although they are resource intensive. Nowadays, simulated virtual patients (VPs) are increasingly used because they are permanently available and fully scalable to a large audience. However, empirical studies comparing the differential effects of these assessment methods are lacking. Similarly, the relationships between key variables associated with diagnostic competences (ie, diagnostic accuracy and evidence generation) in these assessment methods still require further research. OBJECTIVE: The aim of this study is to compare perceived authenticity, cognitive load, and diagnostic competences in performance-based assessment using SPs and VPs. This study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy. METHODS: We conducted an experimental study with 86 medical students (mean 26.03 years, SD 4.71) focusing on history taking in dyspnea cases. Participants solved three cases with SPs and three cases with VPs in this repeated measures study. After each case, students provided a diagnosis and rated perceived authenticity and cognitive load. The provided diagnosis was scored in terms of diagnostic accuracy; the questions asked by the medical students were rated with respect to their quality of evidence generation. In addition to regular null hypothesis testing, this study used equivalence testing to investigate the absence of meaningful effects. RESULTS: Perceived authenticity (1-tailed t81=11.12; P<.001) was higher for SPs than for VPs. The correlation between diagnostic accuracy and perceived authenticity was very small (r=0.05) and neither equivalent (P=.09) nor statistically significant (P=.32). Cognitive load was equivalent in both assessment methods (t82=2.81; P=.003). Intrinsic cognitive load (1-tailed r=-0.30; P=.003) and extraneous load (1-tailed r=-0.29; P=.003) correlated negatively with the combined score for diagnostic accuracy. The quality of evidence generation was positively related to diagnostic accuracy for VPs (1-tailed r=0.38; P<.001); this finding did not hold for SPs (1-tailed r=0.05; P=.32). Comparing both assessment methods with each other, diagnostic accuracy was higher for SPs than for VPs (2-tailed t85=2.49; P=.01). CONCLUSIONS: The results on perceived authenticity demonstrate that learners experience SPs as more authentic than VPs. As higher amounts of intrinsic and extraneous cognitive loads are detrimental to performance, both types of cognitive load must be monitored and manipulated systematically in the assessment. Diagnostic accuracy was higher for SPs than for VPs, which could potentially negatively affect students' grades with VPs. We identify and discuss possible reasons for this performance difference between both assessment methods.

Complex problem solving: Profiles and developmental paths revealed via latent transition analysis.

Complexity is one of the major demands of adolescents' future life as adults. To investigate adolescents' competence development in applying problem-solving strategies in complex environments, we conducted a 2-wave longitudinal study in a sample of Finnish adolescents (11-17 years old; N = 1,959 at Time 1 and N = 1,690 at Time 2, 3 years later). In this study, we aimed to: (a) determine the optimal number of strategy use profiles while solving complex problems, (b) determine the number of meaningful developmental paths for each profile, and (c) test the impact of reasoning abilities and learning-related motivational beliefs on the probability that an adolescent with a given strategy use profile will take a given developmental path. Using latent transition analysis, we found 4 meaningful strategy use profiles: Proficient Explorers, Rapid Learners, Emerging Explorers, and Low-Performing Explorers. Forty-three percent of the participants were classified as having the same strategy use profile in Time 1 and Time 2. The strategy use of 34% was assessed as having improved between Time 1 and Time 2, while that of 21% was assessed as having declined between Time 1 and Time 2. Verbal reasoning ability and learning-related motivational beliefs predicted whether the developmental path of Emerging Explorers' was more likely to remain stable, improve, or decline over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Computer-Based Collaborative Problem Solving in PISA 2015 and the Role of Personality.

Collaborative problem solving (CPS) is an essential 21st century skill at the intersection of social collaboration and cognitive problem solving, and is increasingly integrated in educational programs, such as the influential Programme for International Student Assessment (PISA). As research has identified the impact of the Big Five personality traits either on cognitive ability or social collaboration skills in groups, this study firstly identified their impact on the conjoint construct of CPS. Results from structural equation modelling (N = 483) found openness to experience and agreeableness as predictors for CPS performance. The results are embedded in the lifelong learning and investment model by Ackermann and provide implications for PISA 2015, as original PISA 2015 CPS tasks were used.

Taking a Closer Look: An Exploratory Analysis of Successful and Unsuccessful Strategy Use in Complex Problems.

Influencing students' educational achievements first requires understanding the underlying processes that lead to variation in students' performance. Researchers are therefore increasingly interested in analyzing the differences in behavior displayed in educational assessments rather than merely assessing their outcomes. Such analyses provide valuable information on the differences between successful and unsuccessful students and help to design appropriate interventions. Complex problem-solving (CPS) tasks have proven to provide particularly rich process data as they allow for a multitude of behaviors several of which can lead to a successful performance. So far, this data has often been analyzed on a rather aggregated level looking at an average number of actions or predefined strategies with only a few articles investigating the specific actions performed. In this paper, we report the results of an exploratory analysis of CPS log-files that is aimed at distinguishing between students that applied the correct strategy to a problem but failed to solve it and those applying the strategy successfully. In that, the sequence of behavior displayed is reduced to interpretable parts (n-grams) that allow searching for meaningful differences between the two groups of students. This level of analysis allows finding previously undefined or unknown patterns within the data and increases our understanding of the processes underlying successful problem-solving behavior even further.

A LN/Si-Based SAW Pressure Sensor.

Surface Acoustic Wave (SAW) sensors are small, passive and wireless devices. We present here the latest results obtained in a project aimed at developing a SAW-based implantable pressure sensor, equipped with a well-defined, 30 µm-thick, 4.7 mm-in-diameter, Lithium Niobate (LN) membrane. A novel fabrication process was used to solve the issue of accurate membrane etching in LN. LN/Si wafers were fabricated first, using wafer-bonding techniques. Grinding/polishing operations followed, to reduce the LN thickness to 30 µm. 2.45 GHz SAW Reflective Delay-Lines (R-DL) were then deposited on LN, using a combination of e-beam and optical lithography. The R-DL was designed in such a way as to allow for easy temperature compensation. Eventually, the membranes were etched in Si. A dedicated set-up was implemented, to characterize the sensors versus pressure and temperature. The achieved pressure accuracy is satisfactory (±0.56 mbar). However, discontinuities in the response curve and residual temperature sensitivity were observed. Further experiments, modeling and simulations were used to analyze the observed phenomena. They were shown to arise essentially from the presence of growing thermo-mechanical strain and stress fields, generated in the bimorph-like LN/Si structure, when the temperature changes. In particular, buckling effects explain the discontinuities, observed around 43 °C, in the response curves. Possible solutions are suggested and discussed.

Effect of postoperative radiotherapy in pT1pN1cM0 and pT2p/cN0cM0 oropharyngeal squamous cell carcinoma.

OBJECTIVES/HYPOTHESIS: Consulting of patients with oropharyngeal carcinoma, classified as pT1pN1cM0 and pT2p/cN0cM0, about postoperative radiotherapy is a precarious task as data are lacking. The aim of this study was to evaluate the effects of postoperative radiotherapy for patients with intermediate-stage oropharyngeal carcinoma. STUDY DESIGN: Multicentric retrospective study. METHODS: This analysis was conducted at seven Austrian institutions and included data of patients treated between 2000 and 2012. A total of 81 patients with oropharyngeal squamous cell carcinoma were included, of whom 33 patients received postoperative radiotherapy. p16 status determined by immunohistochemistry was available in 68 patients. RESULTS: Median follow-up was 47.9 months. Postoperative radiotherapy showed no benefits in regard to overall survival (P = .701). In contrast, disease-free survival was significantly shortened in all patients without postoperative radiotherapy (P = .001). When dividing the cohort in dependence of p16, p16-positive patients did not benefit from postoperative radiotherapy regarding overall and disease-free survival (P = .934 and P = .102), whereas p16-negative patients showed improved disease-free survival after postoperative radiotherapy (P = .007). Multivariate analysis showed that outcome of postoperative radiotherapy is dependent on p16 status. CONCLUSIONS: In terms of disease-free survival, patients with p16-negative tumors may benefit from postoperative radiotherapy, whereas survival of p16-positive patients is good regardless of additional treatment. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:1075-1082, 2018.

Sometimes More is Too Much: A Rejoinder to the Commentaries on Greiff et al. (2015).

In this rejoinder, we respond to two commentaries on the study by Greiff, S.; Stadler, M.; Sonnleitner, P.; Wolff, C.; Martin, R. Sometimes less is more: Comparing the validity of complex problem solving measures. Intelligence 2015, 50, 100-113. The study was the first to address the important comparison between a classical measure of complex problem solving (CPS) and the more recent multiple complex systems (MCS) approach regarding their validity. In the study, we investigated the relations between one classical microworld as the initially developed method (here, the Tailorshop) with three more recently developed multiple complex systems (MCS; here, MicroDYN, Genetics Lab, and MicroFIN) tests. We found that the MCS tests showed higher levels of convergent validity with each other than with the Tailorshop even after reasoning was controlled for, thus empirically distinguishing between the two approaches. The commentary by Kretzschmar and the commentary by Funke, Fischer, and Holt expressed several concerns with how our study was conducted, our data was analyzed, and our results were interpreted. Whereas we acknowledge and agree with some of the more general statements made in these commentaries, we respectfully disagree with others, or we consider them to be at least partially in contrast with the existing literature and the currently available empirical evidence.