ChatGPT Performs on the Chinese National Medical Licensing Examination.

ChatGPT, a language model developed by OpenAI, uses a 175 billion parameter Transformer architecture for natural language processing tasks. This study aimed to compare the knowledge and interpretation ability of ChatGPT with those of medical students in China by administering the Chinese National Medical Licensing Examination (NMLE) to both ChatGPT and medical students. We evaluated the performance of ChatGPT in three years' worth of the NMLE, which consists of four units. At the same time, the exam results were compared to those of medical students who had studied for five years at medical colleges. ChatGPT's performance was lower than that of the medical students, and ChatGPT's correct answer rate was related to the year in which the exam questions were released. ChatGPT's knowledge and interpretation ability for the NMLE were not yet comparable to those of medical students in China. It is probable that these abilities will improve through deep learning.

At what stages of licensing do graduated driver licensing systems reduce crashes? Example from Queensland, Australia.

Evaluations of new graduated licensing systems (GLS) commonly examine pre-post young driver crash rates relative to another driver group. This comparison approach is important to account for other influences on crashes over time, but has limited ability to determine which GLS components are most effective and at what stage during the licensing process. We previously identified declines in young driver crashes in Queensland, Australia, following introduction of a new GLS in 2007. The objective of the current research was to conduct complementary modelling to identify at what points through the licensing process had particular GLS policies contributed to reductions. Crash trends were explored for learner and provisional drivers under the new GLS versus previous system for three time periods relative to the month of acquiring a provisional licence: the preceding learner period, the first month of provisional licensure (when crashes typically peak), and the overall provisional period. Interrupted time series analyses were conducted for the log ratio of crashes per 10,000 licensed (learner and provisional) drivers with the total number of licensed drivers as an offset. The greatest declines were found in the first month of licensure, with indications that a longer learner period, higher supervised driving hours, and a new provisional night-passenger restriction were key contributors to provisional crash reductions. There was also some indication that a restriction on all phone use reduced crashes during the learner period. We conclude that time series analysis focusing on licensing stage, rather than calendar time only, offers a complementary approach to analysing GLS effectiveness by better identifying where and how changes impact crashes.

Toward Multistate Pharmacy Practice: Enhancing Mobility and Portability of Pharmacist Licensure.

Pharmacists are licensed in all 50 states. As society becomes increasingly mobile and interconnected, several models of cross-state pharmacy practice have emerged, straining the current state-based system of licensure. The nursing profession has provided a model for license portability that offers 3 primary advantages over the current pharmacist licensure model while still protecting safety: (1) faster speed, (2) lower cost, and (3) reduced administrative burden. A hybrid approach for the pharmacy profession that builds off of the expedited license transfer model and adds a mutual recognition model is ideal.

Impact of medical fitness to drive policies in preventing property damage, injury, and death from motor vehicle collisions in Ontario, Canada.

INTRODUCTION: Drivers with medical conditions and functional impairments are at increased collision risk. A challenge lies in identifying the point at which such risk becomes unacceptable to society and requires mitigating measures. This study models the road safety impact of medical fitness-to-drive policy in Ontario. METHOD: Using data from 2005 to 2014, we estimated the losses to road safety incurred during the time medically-at-risk drivers were under review, as well as the savings to road safety accrued as a result of licensing decisions made after the review process. RESULTS: While under review, drivers with medical conditions had an age- and sex-standardized collision rate no different from the general driver population, suggesting no road safety losses occurred (RR = 1.02; 95% CI: 0.93-1.12). Licensing decisions were estimated to have subsequently prevented 1,211 (95% CI: 780-1,730) collisions, indicating net road safety savings resulting from medical fitness to drive policies. However, more collisions occurred than were prevented for drivers with musculoskeletal disorders, sleep apnea, and diabetes. We theorize on these findings and discuss its multiple implications. CONCLUSIONS: Minimizing the impact of medical conditions on collision occurrence requires robust policies that balance fairness and safety. It is dependent on efforts by academic researchers (who study fitness to drive); policymakers (who set driver medical standards); licensing authorities (who make licensing decisions under such standards); and clinicians (who counsel patients on their driving risk and liaise with licensing authorities). Practical Applications: Further efforts are needed to improve understanding of the effects of medical conditions on collision risk, especially for the identified conditions and combinations of conditions. Results reinforce the value of optimizing the processes by which information is solicited from physicians in order to better assess the functional impact of drivers' medical conditions on driving and to take suitable licensing action.

Stay-at-home orders and firearms in the United States during the COVID-19 pandemic.

Firearms are a leading cause of death and injury in the United States, and this trend has continued during the COVID-19 pandemic. We sought to identify whether states designated gun retailers as essential businesses in their stay-at-home orders and characterize other references that could affect firearm acquisition during the COVID-19 pandemic. In this cross-sectional policy review, we assessed stay-at-home orders issued in March or April 2020. Orders were reviewed in their entirety, and any reference to firearms, firearm retailers, shooting ranges, or other relevant elements was documented. Forty-three states and the District of Columbia issued stay-at-home orders. Most considered federal firearm licensees to be among essential businesses or made provisions for them to remain open during widespread business closures. Others referenced the US Department of Homeland Security's Cybersecurity and Infrastructure Security Agency (CISA) advisory memorandum on essential critical infrastructure workers which named workers supporting firearm manufacturing and retail among essential workers. Therefore, stay-at-home orders issued in most states included provisions for firearms retailers to remain open, at least in some capacity. Only four states and the District of Columbia did not include federal firearms licensees among essential businesses or include provisions for them to be open. Meanwhile, an all-time high in firearm background checks indicates firearm sales have markedly increased. Given the associations between firearm access and injury risk, the effects of continued firearm access facilitated by these orders should be the focus of future research.

USMLE Step 1 Scoring Changes and the Urology Residency Application Process: Program Directors' Perspectives.

OBJECTIVE: To capture the perspectives of urology program directors (PDs) regarding the change in United States Medical Licensing Examination (USMLE) Step 1 scoring to pass/fail (binary) and the impact of this change on the urology residency application process. METHODS: A validated survey was developed and distributed via email to urology PDs at all Accreditation Council for Graduate Medical Education-accredited programs. RESULTS: A total of 65 PDs completed the survey, for a response rate of 49.0%. Most PDs (58.7%) did not agree that binary USMLE Step 1 scoring is a good idea. The majority (84.6%) felt that this change would make it more difficult to compare applicants objectively and that the change would increase emphasis on Step 2 clinical knowledge (CK) scores. Likewise, 73.8% of PDs reported that they would start requiring applicants to submit Step 2 CK scores and 78.5% of PDs felt that Step 2 CK should remain numerically scored. Free text responses highlighted concerns for students at medical schools with pass/fail grading and the potential impact this change could have on the early match. CONCLUSION: Urology PDs have generally negative perspectives towards binary scoring of USMLE Step 1. They believe the change will make residency selection more arduous and less objective, without increasing medical student well-being. PDs anticipate a heavier emphasis on USMLE Step 2 CK scores and this may alter the urology early match process. Modifications to application requirements and interview schedules may be necessary to uphold an unbiased selection of applicants with respect to the early match timeline.

Resident Selection in the Wake of United States Medical Licensing Examination Step 1 Transition to Pass/Fail Scoring.

INTRODUCTION: The numeric score for the United States Medical Licensing Examination Step 1 is one of the only universal, objective, scaled criteria for comparing the many students who apply to orthopaedic surgery residency. However, on February 12, 2020, it was announced that Step 1 would be transitioning to pass/fail scoring. The purpose of this study was to (1) determine the most important factors used for interview and resident selection after this change and (2) to assess how these factors have changed compared with a previous report on resident selection. METHODS: A survey was distributed to the program directors (PDs) of all 179 orthopaedic surgery programs accredited by the Accreditation Council for Graduate Medical Education. Questions focused on current resident selection practices and the impact of the Step 1 score transition on expected future practices. RESULTS: A total of 78 PDs (44%) responded to the survey. Over half of PDs (59%) responded that United States Medical Licensing Examination Step 2 clinical knowledge (CK) score is the factor that will increase most in importance after Step 1 transitions to pass/fail, and 90% will encourage applicants to include their Step 2 CK score on their applications. The factors rated most important in resident selection from zero to 10 were subinternship performance (9.05), various aspects of interview performance (7.49 to 9.01), rank in medical school (7.95), letters of recommendation (7.90), and Step 2 CK score (7.27). Compared with a 2002 report, performance on manual skills testing, subinternship performance, published research, letters of recommendations, and telephone call on applicants' behalf showed notable increases in importance. DISCUSSION: As Step 2 CK is expected to become more important in the residency application process, current applicant stress on Step 1 scores may simply move to Step 2 CK scores. Performance on subinternships will remain a critical aspect of residency application, as it was viewed as the most important resident selection factor and has grown in importance compared with a previous report.

The effect of extending graduated driver licensing to older novice drivers in Indiana.

INTRODUCTION: Graduated driver licensing (GDL) systems have been shown to reduce rates of crashes, injuries, and deaths of young novice drivers. However, approximately one in three new drivers in the United States obtain their first driver's license at age 18 or older, and thus are exempt from most or all provisions of GDL in most states. METHOD: In July 2015, the state of Indiana updated its GDL program, extending its restrictions on driving at night and on carrying passengers during the first 6 months of independent driving, previously only applicable to new drivers younger than 18, to all newly-licensed drivers younger than 21 years of age. The current study examined monthly rates of crashes per licensed driver under the affected conditions (driving at night and driving with passengers) among Indiana drivers first licensed at ages 18, 19, and 20 under the updated GDL system compared with drivers licensed at the same ages under the previous GDL system. We used Poisson regression to estimate the association between the GDL system and crash rates, while attempting to control for other factors that might have also influenced crash rates. We used linear regression to estimate the association between the GDL system and the proportion of all crashes that occurred under conditions restricted by the GDL program. RESULTS: Results showed, contrary to expectations, that rates of crashes during restricted nighttime hours and with passengers were higher among drivers licensed under the updated GDL system. This mirrored a statewide increase in crash rates among drivers of all ages over the study period and likely reflected increased overall driving exposure. The proportions of all crashes that were at night or with passengers did not change. Practical Applications: More research is needed to understand how older novice drivers respond when GDL systems originally designed for younger novice drivers are applied to them.

Fear Over Facts: When Fellow Clinicians Become a Barrier to Dissemination of Exposure and Response Prevention for Obsessive-Compulsive Disorder-A Clinical Response to Licensing Board Investigation of Exposure and Response Prevention.

In 2018, a graduate level student filed a complaint regarding the use of exposure-based therapy for persons with obsessive-compulsive disorder (OCD) experiencing violent obsessions. In the investigation, the licensing board expressed concern about safety of us of exposure and response prevention (ERP) with children and in public venues. The licensing board also struggled with accurate assessment of a clinician's efficacy in following the gold-standard treatment for OCD. Despite extensive research demonstrating ERP is a safe, effective treatment for OCD, stigma against exposure based treatments remain strong, even among clinicians. This commentary article discusses the specific licensing investigation and implications for change throughout the field of psychotherapy.

Characteristics of Professional Physical Therapist Faculty and Doctor of Physical Therapy Programs, 2008-2017: Influences on Graduation Rates and First-Time National Physical Therapy Examination Pass Rates.

OBJECTIVE: Graduation rates and first-time National Physical Therapy Examination (NPTE) pass rates among Doctor of Physical Therapy (DPT) programs have ranged from 30% to 100% and 0% to 100% between 2008 and 2017, respectively. Prior studies on predictors of graduation rates and NPTE pass rates from DPT programs have used cross-sectional data and have not studied faculty data. This study sought to understand how trends in DPT faculty and program characteristics correlated with graduation rates and first-time NPTE pass rates. METHODS: This study was a retrospective panel analysis of yearly data from 231 programs between 2008 and 2017. Random effects models estimated the correlations between faculty and program characteristics regarding graduation rates and first-time NPTE pass rates. RESULTS: Graduation rates peaked when programs devoted 25% of faculty time, on average, to scholarship. The number of peer-reviewed publications was positively correlated with graduation rates; however, the trend was logarithmic, indicating a diminishing rise in graduation rates as the number of publications exceeded 1 per faculty full-time equivalent. Tenure-track status, faculty of color, and part-time faculty were all negatively correlated with first-time NPTE pass rates. However, these 3 trends are likely not meaningful, because the predicted rates of decline in pass rates were minimal. CONCLUSIONS: Faculty engagement in scholarly activities can positively influence graduation rates, but only up to a certain level of faculty time devoted to scholarship. IMPACT: This is the first study to provide data on the influence of faculty on DPT student outcomes and will help education programs develop strategies to improve those outcomes.

The Relationship Between Accreditation Cycle and Licensing Examination Scores: A National Look.

PURPOSE: Accreditation aims to ensure all training programs meet agreed-upon standards of quality. The process is complex, resource intensive, and costly. Its benefits are difficult to assess because contextual confounds obscure comparisons between systems that do and do not include accreditation. This study explores accreditation's influence "within system" by investigating the relationship between accreditation cycle and performance on a national licensing examination. METHOD: Scores on the computer-based portion of the Medical Council of Canada Qualifying Examination Part I, from 1993 to 2017, were examined for all 17 Canadian medical schools. Typically completed upon graduation from medical school, results within each year were transformed for comparability across administrations and linked to timing within each school's accreditation cycle. ANOVAs were used to assess the relationship between accreditation timing and examination scores. Secondary analyses isolated 4-year from 3-year training programs and separated data generated before versus after implementation of a national midcycle informal review program. RESULTS: Performance on the licensing exam was highest during and shortly after an accreditation site visit, falling significantly until the midpoint in the accreditation cycle (d = 0.47) before rising again. This pattern disappeared after introduction of informal interim review, but too little data have accumulated post implementation to determine if interim review is sufficient to break the influence of accreditation cycle. CONCLUSIONS: Formal, externally driven, accreditation cycles appear associated with educational processes in ways that translated into student outcomes on a national licensing examination. Whether informal, internal, interim reviews can mediate this effect remains to be seen.

The Pursuit of Research-supported Treatment in Batterer Intervention: The Role of Professional Licensure and Theoretical Orientation for Duluth and CBT Programs.

PURPOSE: The purpose of this study was to understand the importance of research-supported practice for batterer intervention programs. METHODS: This study applied descriptive statistics and chi-square analyses to a novel dataset from the Domestic Violence Perpetrator Treatment Survey (N = 411). This was a 69-item survey developed by domestic violence providers and researchers to understand the role of research-supported practice in the treatment of intimate partner violence (IPV). RESULTS: This study found statistically significant differences between Duluth oriented programs and Cognitive Behavioral Therapy (CBT) oriented programs with respect to the importance of research-supported practices and motivational interviewing, a strategy found effective in treatment of IPV by extant research. DISCUSSION: There appears to have been an evolution among practitioners toward more eclecticism, and an acknowledgment that programs should be research-supported. CONCLUSION: Implications of this study for education and treatment are discussed.

Eswatini Nursing Council Regulatory Reforms: Process towards Entry to Practice Examination.

Objective: To identify and to measure entry level competencies (knowledge, skills, attitudes, judgements) for nurses to practice safely and effectively in the Kingdom of Eswatini. Introduction: Eswatini, formerly known as Swaziland, is a small sub-Saharan country between South Africa and Mozambique. There are four nursing programs approved by the Eswatini Nursing Council (ENC) that provide nursing education in the areas of general nursing, midwifery, mental health and community health. The mandate of the ENC is to protect the public and to this end licensed nurses must be able to meet standardized entry level requirements. Methods: We identified gaps in expected competencies of new nurses led to comprehensive strategies by many stakeholders to close the gaps. Nursing competencies were categorized into seven learning domains with specific, measurable indicators included in each domain. Specific clinical skills essential for entry to practice were identified. Results: Provision of Quality Care; Information Management Systems; Emergency/Trauma/Disaster Management; Infection Prevention & Control; Leadership and Management; Ethics/Legal Issues/Professional Conduct; and Prevention/Treatment & Care of HIV, AIDS, TB are the seven competency domains that are measured on a newly developed standardized entry to practice multiple choice examination. Essential clinical skills are also assessed prior to obtaining licensure. Conclusion: Implementing these standards will ensure that nurses in Eswatini have the appropriate skill set to deliver care to their patients, improve their communities' health, and enable the kingdom to make advances towards universal health coverage and attainment of the sustainable development goals.

Pharmaceutical patents: reconciling the human right to health with the incentive to invent.

In developed countries that protect core aspects of the fundamental human right to the highest attainable standard of health, how does that right intersect with intellectual property rights? Here, the human rights implication of providing access to all cancer drugs recommended by experts in a developed country is considered in the context of conflict between the incentive to invent and the rights of others to access medicines. Effective incentives to innovate in developed countries can lead to global improvements in access to medicine if the intellectual property system is calibrated to permit this. This depends partly on the usefulness of compulsory licensing and alternative mechanisms facilitating global access to drugs. This review considers tensions between fundamental rights to access essential medicines and rights of the inventor and investors, including the pharmaceutical industry.

Restricting alcohol outlet density through cumulative impact provisions in planning law: Challenges and opportunities for local governments.

INTRODUCTION: There is international interest in how to limit growth in alcohol availability in areas of high outlet density in order to reduce alcohol-related harms. Town planning legislation in Victoria, Australia, allows local government officers to refuse planning permits for new licensed premises on 'cumulative impact' grounds (impacts from existing alcohol outlet density). State guidelines (PN61) outline how local government planners should approach cumulative impact assessments. This paper explores officers' views and experience assessing cumulative impact in order to understand whether the legislation assists officers limit alcohol availability in areas of high outlet density. METHODS: Interviews with 22 officers from 11 local governments who were recruited with purposive sampling to reflect a range of licensing environments. Interview transcripts were analysed inductively, and content categorized accordingly. FINDINGS: Officers challenged the definition and relevance of the alcohol outlet density threshold provided in state guidelines. They faced problems securing relevant amenity data for assessing cumulative impact and pointed to the guidelines' inadequacy for assessing off-premise licences. They pointed to the limits of cumulative impact assessments as a tool for planning and were unconvinced they would lead to reductions in permits granted. CONCLUSIONS: A single state-wide density threshold to guide cumulative impact assessments is unlikely to be a relevant measure for several local governments. A greater orientation towards municipal variation and alcohol outlet characteristics is needed. Further research is needed to investigate whether cumulative impact assessments increase restrictions on liquor licence planning permits and whether the adoption of local planning policies strengthens restrictive permit decision-making. International implications of the research are noted.