The Promise and Perils of Artificial Intelligence in Health Professions Education Practice and Scholarship.

ABSTRACT: Artificial intelligence (AI) methods, especially machine learning and natural language processing, are increasingly affecting health professions education (HPE), including the medical school application and selection processes, assessment, and scholarship production. The rise of large language models over the past 18 months, such as ChatGPT, has raised questions about how best to incorporate these methods into HPE. The lack of training in AI among most HPE faculty and scholars poses an important challenge in facilitating such discussions. In this commentary, the authors provide a primer on the AI methods most often used in the practice and scholarship of HPE, discuss the most pressing challenges and opportunities these tools afford, and underscore that these methods should be understood as part of the larger set of statistical tools available.Despite their ability to process huge amounts of data and their high performance completing some tasks, AI methods are only as good as the data on which they are trained. Of particular importance is that these models can perpetuate the biases that are present in those training datasets, and they can be applied in a biased manner by human users. A minimum set of expectations for the application of AI methods in HPE practice and scholarship is discussed in this commentary, including the interpretability of the models developed and the transparency needed into the use and characteristics of such methods.The rise of AI methods is affecting multiple aspects of HPE including raising questions about how best to incorporate these models into HPE practice and scholarship. In this commentary, we provide a primer on the AI methods most often used in HPE and discuss the most pressing challenges and opportunities these tools afford.

A Qualitative Analysis on the Effectiveness of Peer Feedback in Team-Based Learning.

Introduction: There is limited information on medical students' perceptions of peer feedback in team-based learning (TBL), both in terms of its value and how it has affected them as they move forward in their careers. The primary goals of this study were to examine students' perceptions about their peer feedback experiences throughout medical school and into residency and to identify areas for improvement to develop a more valuable experience. Materials and Methods: This study utilized exploratory qualitative research. A total of six focus group sessions were conducted, in which each group consisted of medical students or residents. All participants were asked for their thoughts about peer feedback using semi-structured interviews. The sessions were transcribed and thematic analysis of student responses was completed by independent reviewers. Results: A total of 11 first-year, 12 second-year, 12 rising third-year, and 10 rising fourth-year medical students participated in the focus groups. In addition, three graduates participated in the study. Overall, four key themes were identified regarding the peer feedback experience. These included (1) preparation and training, (2) procedure and implementation, (3) evaluation of student feedback, and (4) student considerations. Discussion: The participants indicated that the idea of providing and receiving effective peer feedback throughout the medical school curriculum was a valuable experience. This analysis raised awareness about several potential areas of difficulty for students in regard to the peer feedback process used in TBL. Quality improvement initiatives may include educating students about the use of constructive feedback, adding self-reflection, or using oral instead of written feedback.

The status of neurology fellowships in the United States: clinical needs, educational barriers, and future outlooks.

The need for subspecialty-trained neurologists is growing in parallel with increasing disease burden. However, despite the immense burden of neurological diseases, like headache and neurodegenerative disorders, recruitment into these subspecialties remains insufficient in the United States. In this manuscript, a group of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review and discuss the current landscape of neurology fellowships in the United States, the factors driving fellowship recruitment and the educational barriers. Moreover, suggestions to potentially improve recruitment for under-selected fellowships, which can contribute towards an alignment between neurological education and neurological needs, and future educational scenarios are discussed.

Suicide Assessment and Management Team-Based Learning Module.

Introduction: Suicide is a global health problem that health care providers must feel comfortable addressing. Unfortunately, many health care providers are not equipped to assess and treat patients at risk for suicide due to lack of training and education. Interactive resources are needed to educate health professions students about the management of suicidal patients. Methods: The suicide assessment and management team-based learning (TBL) module was developed to address the gap in suicide education. After completing the module, students were able to identify key elements for a comprehensive assessment of a patient's risk for suicide and to discuss clinical management for a suicidal patient. The activity was designed for second-year medical students during a psychopathology course, the last organ-system course prior to clerkships. This module could also be used or modified to meet the educational requirements for other health professions, including medical residents, nurse practitioner students, and physician assistant students. Results: A total of 342 students among 62 teams participated in the TBL over a period of 3 consecutive years. The class averages for the individual Readiness Assurance Test ranged from 80% to 88%. The class averages for the team Readiness Assurance Test and application questions were comparable across all 3 years. Course evaluations showed the TBL helped students think critically and integrate information to prepare them for their future careers. Discussion: Overall, this TBL was an effective educational tool that stimulated high-quality discussion, in which students remained engaged and asked thought-provoking questions.

Multimodal Analysis of STRADA Function in Brain Development.

mTORopathies are a heterogeneous group of neurological disorders characterized by malformations of cortical development (MCD), enhanced cellular mechanistic target of rapamycin (mTOR) signaling, and epilepsy that results from mutations in mTOR pathway regulatory genes. Homozygous mutations (del exon 9-13) in the pseudokinase STE20-related kinase adaptor alpha (STRAD-α; STRADA), an mTOR modulator, are associated with Pretzel Syndrome (PS), a neurodevelopmental disorder within the Old Order Mennonite Community characterized by megalencephaly, intellectual disability, and intractable epilepsy. To study the cellular mechanisms of STRADA loss, we generated CRISPR-edited Strada mouse N2a cells, a germline mouse Strada knockout (KO-/-) strain, and induced pluripotent stem cell (iPSC)-derived neurons from PS individuals harboring the STRADA founder mutation. Strada KO in vitro leads to enhanced mTOR signaling and iPSC-derived neurons from PS individuals exhibit enhanced cell size and mTOR signaling activation, as well as subtle alterations in electrical firing properties e.g., increased input resistance, a more depolarized resting membrane potential, and decreased threshold for action potential (AP) generation. Strada-/- mice exhibit high rates of perinatal mortality and out of more than 100 litters yielding both WT and heterozygous pups, only eight Strada-/- animals survived past P5. Strada-/- mice are hypotonic and tremulous. Histopathological examination (n = 5 mice) revealed normal gross brain organization and lamination but all had ventriculomegaly. Ectopic neurons were seen in all five Strada-/- brains within the subcortical white matter mirroring what is observed in human PS brain tissue. These distinct experimental platforms demonstrate that STRADA modulates mTOR signaling and is a key regulator of cell size, neuronal excitability, and cortical lamination.

Active Learning in Psychiatry Education: Current Practices and Future Perspectives.

Over the past few decades, medical education has seen increased interest in the use of active learning formats to engage learners and promote knowledge application over knowledge acquisition. The field of psychiatry, in particular, has pioneered a host of novel active learning paradigms. These have contributed to our understanding of the role of andragogy along the continuum of medical education, from undergraduate to continuing medical education. In an effort to frame the successes and failures of various attempts at integrating active learning into healthcare curricula, a group of educators from the A. B. Baker Section on Neurological Education from the American Academy of Neurology reviewed the state of the field in its partner field of medical neuroscience. Herein we provide a narrative review of the literature, outlining the basis for implementing active learning, the novel formats that have been used, and the lessons learned from qualitative and quantitative analysis of the research that has been done to date. While preparation time seems to present the greatest obstacle to acceptance from learners and educators, there is generally positive reception to the new educational formats. Additionally, most assessments of trainee performance have suggested non-inferiority (if not superiority). However, occasional mixed findings point to a need for better assessments of the type of learning that these new formats engender: knowledge application rather than acquisition. Moreover, this field is relatively nascent and, in order to ascertain how best to integrate active learning into psychiatry education, a framework for quantitative outcome assessments is needed going forward.

Hydrocephalus as the presenting symptom of sarcoidosis: A case report and review of literature.

Hydrocephalus is rare in sarcoidosis, especially as the presenting symptom. Neurosarcoidosis as a cause of unexplained communicating hydrocephalus should be considered in cases of abnormal cerebrospinal fluid (CSF) and negative infectious and tumoral studies.

Strategic Considerations for Applying the Flipped Classroom to Neurology Education.

Nowadays, the "flipped classroom" approach is taking the center stage within medical education. However, very few reports on the implementation of the flipped classroom in neurology have been published to date, and this educational model still represents a challenge for students and educators alike. In this article, neurology educators from the American Academy of Neurology's A. B. Baker Section on Neurological Education analyze reports of flipped classroom in other medical/surgical subspecialties, review the current implementation in neurology, and discuss future strategies to flip the neurology curriculum through contextualization of the benefits and the consequences. ANN NEUROL 2020;87:4-9.

Education Research: Flipped classroom in neurology: Principles, practices, and perspectives.

How to most effectively deliver a large amount of information in an engaging environment that encourages critical thinking is a question that has long plagued educators. With ever-increasing demands on both resident and faculty time, from shrinking duty hours to increased patient complexity, combined with the exponential growth of medical knowledge and unequal access to the spectrum of neurologic subspecialties around the country, this question has become especially pertinent to neurology residency training. A team of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review the current evidence regarding the implementation of the flipped classroom format. This educational model has only recently been applied to health care education along the training continuum, and a small collection of articles has, so far, used disparate methods of curricular implementation and assessment. While the feedback from learners is generally positive, a number of obstacles to implementation exist, most notably learner time commitments. These are presented with discussion of potential solutions along with suggestions for future studies.

[Prevalencia y genotipos del virus del papiloma humano en muestras de tejido laríngeo de pacientes con cáncer de laringe del noreste de México]. / Prevalence and genotypes of the human papillomavirus in laryngeal tissue samples of patients with laryngeal cancer from Northeastern Mexico.

ANTECEDENTES: El cáncer de laringe representa el 21.7% de las neoplasias malignas de vías aerodigestivas superiores. La prevalencia del virus del papiloma humano (VPH) en el cáncer de laringe oscila entre el 0 y el 80%. MÉTODO: Se incluyeron 112 muestras de tejido laríngeo de pacientes con cáncer de laringe. Se amplificó el ADN y se analizó la presencia y el genotipo del VPH mediante hibridación reversa (INNO-LiPA®). Se realizaron pruebas de ji cuadrada, Fisher y t de Student no pareada. RESULTADOS: Se incluyeron muestras de 107 hombres (95.5%) y 5 mujeres (4.5%), con una edad de 65.3 ± 10.1 años, con antecedente de tabaquismo 108 (96.4%), alcoholismo 9 (8.0%) y carcinoma epidermoide moderadamente diferenciado queratinizante 96 (85.7%). Se identificó VPH en 60 (53.5%), VPH-11 en 51 (45.5%), VPH-52 en 27 (24.1%), VPH-16 en 9 (8.0%), VPH-45 en 3 (2.6%) y coinfección por más de un genotipo en 31 (27.6%). No hubo diferencia entre pacientes con y sin infección por VPH en cuanto a edad, sexo, localización, diagnóstico histopatológico, tabaquismo ni alcoholismo (p > 0.05). CONCLUSIONES: La prevalencia de infección por VPH en el cáncer de laringe fue del 53.5%, con coinfección por más de un genotipo en el 27.6%. El genotipo más frecuente fue el VPH-11, tipo de bajo riesgo, seguido por el VPH-52, de alto riesgo oncogénico. BACKGROUND: Laryngeal cancer represents 21.7% of malignancies of the upper aerodigestive tract. The prevalence of the Human Papillomavirus (HPV) in laryngeal cancer ranges 0 to 80%. METHODS: We included 112 laryngeal tissue samples obtained from patients with laryngeal cancer. DNA was extracted and amplified by PCR. HPV presence and genotype were analyzed by the reverse hybridization INNO-LiPA® assay. Chi-square, Fisher's and unpaired Student t tests were used. RESULTS: Samples from 107 male (95.5%) and 5 female patients (4.5%) were evaluated, aged 65.3±10.1 years, 108 with smoking history (96.4%), 9 with alcoholism history (8.0%), and in 96 the histological diagnosis was moderately differentiated keratinizing squamous cell carcinoma (85.7%). HPV was detected in 60 samples (53.5%), HPV-11 in 51 (45.5%), HPV-52 in 27 (24.1%), HPV-16 in 9 (8.0%), HPV-45 in 3 (2.6%), and coinfection by more than one genotype in 31 (27.6%). There was no difference between patients with and without HPV infection with respect to age, sex, tumor location and histology, smoking and alcoholism history (p>0.05). CONCLUSIONS: The prevalence of HPV infection in laryngeal cancer was 53.5% with coinfection with more than one genotype in 27.6%. The most frequent genotype was HPV-11, an oncogenic low-risk genotype, followed by HPV-52, a high-risk genotype.

[Group B streptococcal perinatal infection: A Global, Latin American and Mexican Overview]. / Infección perinatal por estreptococo del grupo B: panorama global, en América Latina y en México.

Group B streptococci (Streptococcus agalactiae) cause a number of infections in women during pregnancy and postpartum, such as urinary tract infection, chorioamnionitis and endometritis, consequently may affect the newborn. Group B streptococci is the most common cause of severe infections in newborns in developed countries. Studies on the epidemiology of group B streptococci infections in Latin America are still limited. This information is also unknown in Mexico, but studies carried out in the center of the country have found high rates of vaginal colonization in pregnant women and there are case series and case reports of newborns. Microbiological and molecular epidemiology studies in Mexico have shown that populations of group B streptococci have a clonal distribution and that there are clones with genetic and phenotypic characteristics of high virulence that appear to be responsible for most of perinatal pathology. However, the actual role of group B streptococci in perinatal pathology in Mexico is unknown. Consequently, whether to perform or not the screening for determining the group B streptococci colonization status in pregnant women, and the indication or not for intrapartum antibiotic prophylaxis to prevent neonatal group B streptococci infection in Mexico, are still controversial.

ß1-C121W Is Down But Not Out: Epilepsy-Associated Scn1b-C121W Results in a Deleterious Gain-of-Function.

UNLABELLED: Voltage-gated sodium channel (VGSC) ß subunits signal through multiple pathways on multiple time scales. In addition to modulating sodium and potassium currents, ß subunits play nonconducting roles as cell adhesion molecules, which allow them to function in cell-cell communication, neuronal migration, neurite outgrowth, neuronal pathfinding, and axonal fasciculation. Mutations in SCN1B, encoding VGSC ß1 and ß1B, are associated with epilepsy. Autosomal-dominant SCN1B-C121W, the first epilepsy-associated VGSC mutation identified, results in genetic epilepsy with febrile seizures plus (GEFS+). This mutation has been shown to disrupt both the sodium-current-modulatory and cell-adhesive functions of ß1 subunits expressed in heterologous systems. The goal of this study was to compare mice heterozygous for Scn1b-C121W (Scn1b(+/W)) with mice heterozygous for the Scn1b-null allele (Scn1b(+/-)) to determine whether the C121W mutation results in loss-of-function in vivo We found that Scn1b(+/W) mice were more susceptible than Scn1b(+/-) and Scn1b(+/+) mice to hyperthermia-induced convulsions, a model of pediatric febrile seizures. ß1-C121W subunits are expressed at the neuronal cell surface in vivo However, despite this, ß1-C121W polypeptides are incompletely glycosylated and do not associate with VGSC α subunits in the brain. ß1-C121W subcellular localization is restricted to neuronal cell bodies and is not detected at axon initial segments in the cortex or cerebellum or at optic nerve nodes of Ranvier of Scn1b(W/W) mice. These data, together with our previous results showing that ß1-C121W cannot participate in trans-homophilic cell adhesion, lead to the hypothesis that SCN1B-C121W confers a deleterious gain-of-function in human GEFS+ patients. SIGNIFICANCE STATEMENT: The mechanisms underlying genetic epilepsy syndromes are poorly understood. Closing this gap in knowledge is essential to the development of new medicines to treat epilepsy. We have used mouse models to understand the mechanism of a mutation in the sodium channel gene SCN1B linked to genetic epilepsy with febrile seizures plus. We report that sodium channel ß1 subunit proteins encoded by this mutant gene are expressed at the surface of neuronal cell bodies; however, they do not associate with the ion channel complex nor are they transported to areas of the axon that are critical for proper neuronal firing. We conclude that this disease-causing mutation is not simply a loss-of-function, but instead results in a deleterious gain-of-function in the brain.

Autonomic Nervous System Team-Based Learning Module.

INTRODUCTION: The team-based learning (TBL) instructional strategy promotes learning and retention, enhances student engagement, allows for a deeper understanding of foundational and applied concepts, and helps students' develop lifelong learning skills. The autonomic nervous system (ANS) TBL was created for first-year medical students in the Neuroscience 1 course at Oakland University William Beaumont School of Medicine. METHODS: The module covered the pathophysiology of ANS-related diseases and therapeutic agents that impact ANS function. By the conclusion of the module, students were able to diagnose different disease processes of the ANS, identify potential complications, and formulate appropriate management strategies. Four faculty members used backward design to create the ANS TBL. The preparatory assignment included reviewing content from previous didactic lectures and consolidating key information in provided tables. Key concepts were evaluated with readiness assurance tests. All application exercises adhered to the 4 S's. RESULTS: Over the course of 2 years, the class averages for the individual readiness assurance test were 79.8% and 87.6%. The class averages for the team readiness assurance test and application exercises were similar across both years. Course evaluations revealed that students found the TBL relevant and valuable. DISCUSSION: Similar TBL modules available on MedEdPORTAL are not integrated to include different aspects of the basic and clinical sciences. This ANS TBL was used to help students integrate several essential concepts, including neuroanatomy, neurophysiology, neuropharmacology, and clinical neurology. Students were very enthusiastic and engaged throughout the ANS TBL as it contained relevant case-based scenarios with questions that were meaningful for clinical practice.

Dravet syndrome patient-derived neurons suggest a novel epilepsy mechanism.

OBJECTIVE: Neuronal channelopathies cause brain disorders, including epilepsy, migraine, and ataxia. Despite the development of mouse models, pathophysiological mechanisms for these disorders remain uncertain. One particularly devastating channelopathy is Dravet syndrome (DS), a severe childhood epilepsy typically caused by de novo dominant mutations in the SCN1A gene encoding the voltage-gated sodium channel Na(v) 1.1. Heterologous expression of mutant channels suggests loss of function, raising the quandary of how loss of sodium channels underlying action potentials produces hyperexcitability. Mouse model studies suggest that decreased Na(v) 1.1 function in interneurons causes disinhibition. We aim to determine how mutant SCN1A affects human neurons using the induced pluripotent stem cell (iPSC) method to generate patient-specific neurons. METHODS: Here we derive forebrain-like pyramidal- and bipolar-shaped neurons from 2 DS subjects and 3 human controls by iPSC reprogramming of fibroblasts. DS and control iPSC-derived neurons are compared using whole-cell patch clamp recordings. Sodium current density and intrinsic neuronal excitability are examined. RESULTS: Neural progenitors from DS and human control iPSCs display a forebrain identity and differentiate into bipolar- and pyramidal-shaped neurons. DS patient-derived neurons show increased sodium currents in both bipolar- and pyramidal-shaped neurons. Consistent with increased sodium currents, both types of patient-derived neurons show spontaneous bursting and other evidence of hyperexcitability. Sodium channel transcripts are not elevated, consistent with a post-translational mechanism. INTERPRETATION: These data demonstrate that epilepsy patient-specific iPSC-derived neurons are useful for modeling epileptic-like hyperactivity. Our findings reveal a previously unrecognized cell-autonomous epilepsy mechanism potentially underlying DS, and offer a platform for screening new antiepileptic therapies.

El conejo como modelo experimental de entrenamiento en cirugía laparoscópica pediátrica / The rabbit as an experiemntal model for training in pediatric laparoscopic surgery

La cirugía laparoscópica ofrece nuevos retos para el cirujano pediatra, de ahí la necesidad de lograr un adecuado entrenamiento antes de intervenir directamente a los pacientes. Se han diseñado distintos modelos para el entrenamiento, tanto In vitro, como In vivo. Evaluar la utilidad del conejo como modelo experimental de entrenamiento en cirugía laparoscópica pediátrica. Se incluyeron en el estudio 19 conejos de la especie Oryctolagus cuniculus, 16 hembras y 3 machos. Se realizaron 65 procedimientos quirúrgicos de nivel I, II y III, distribuidos de la siguiente manera: 16 laparoscopias diagnósticas, 12 esterilizaciones, 12 ooforectomías, 8 apendicetomías, 10 gastrostomías, 2 rafias gástricas, 2 gastroenteroanastomosis y 3 anastomosis intestinales. El tiempo medido para realizar la laparoscopia diagnóstica incluyó la colocación y fijación de los tres trocares, así como la revisión sistemática de todos los cuadrantes de la cavidad abdominal. El tiempo del resto de los procedimientos se cronometró sin tomar en cuenta la colocación de los trocares. Los promedios de tiempo para realizar cada procedimiento quirúrgico fueron: laparoscopia diagnóstica: 29,17 min., esterilización: 4,33 min., ooforectomía: 4,47 min., apendicectomía: 22,17 min., gastrostomía: 32,10 min., rafia gástrica: 15,05 min., gastroenteroanastomosis: 49,05 min. y anastomosis intestinal: 106,67 min. Los costos del material quirúrgico, anestésico y conejos, se estimo en 160 BsF por cada animal, para un total de 3040 BsF invertidos. El conejo constituye un adecuado modelo para entrenamiento en cirugía laparoscópica pediátrica, ya que es posible realizar y simular un gran número de procedimientos quirúrgicos, además de ser económico y disponible

Laparoscopic surgery offers new challenges for the general surgeon and pediatric surgeon, hence the need for an adequate training before intervening patients directly. There are different models designed in vitro as well as in vivo. To evaluate the utility of the rabbit as an experimental model for pediatric laparoscopic surgery training. Nineteen rabbits of the species Oryctolagus cuniculus were included in the study, 16 females and 3 males. Sixty five surgical procedures of Level I, Level II and Level III were distributed as follows: 16 diagnostic laparoscopies, 12 surgical sterilizations, 12 oophorectomy, 8 appendectomies, 10 gastrostomies, 2 gastric sutures, 2 gastroenteroanastomosis and 3 intestinal anastomosis. The measured time to perform the diagnostic laparoscopy included the placement and trocars fixation as well as the rabbit systematic revision of all abdominal cavity quadrants, while the time for the remaining procedures was timed without considering the placement of the trocar. The average times for each surgical procedure were: diagnostic laparoscopy: 29.17 min., surgical sterilization: 4.33 min., oophorectomy: 4.47 min., appendectomy: 22.17 min., gastrostomy: 32.10 min., gastric suture: 15.05 min., gastroenteroanastomosis: 49.05 min., and intestinal anastomosis: 106.67 min. The cost of surgical material, anesthetics and rabbits, was estimated in 160 BsF per animal involved, for a total investment of 3.040 BsF. We conclude that the rabbit is an adequate model for pediatric laparoscopic surgery training because it is possible to simulate a large number of surgical procedures, besides its low costs and availability