Foundational and Clinical Science Integration in a Team-Based Learning Module Modeling Care of a Patient With Dyslipidemia.

Introduction: Foundational and clinical science integration, a long-standing goal of undergraduate medical education, benefits learners by promoting retention of critical knowledge and skills as well as their transfer to the clinical setting. We implemented a team-based learning (TBL) module in which foundational knowledge and skills from the disciplines of biochemistry, nutrition, and genetics were leveraged in a simulated patient encounter for diagnosis and management of a patient with dyslipidemia. Methods: The TBL was deployed in a first-year medical student cardiovascular system course with 125 students over three academic years. Following individual and team readiness assurance tests (iRAT and tRAT, respectively), teams participated in an initial application exercise requiring consideration of clinical and laboratory data and other risk factors to engage the patient in a shared decision-making process. Using dietary and family history narratives in subsequent application exercises, teams completed recommendations for an individualized diet plan and an assessment of potential disease inheritance patterns to formulate appropriate patient care management strategies. Results: Student engagement with prelearning materials and session team activities was high as judged by RAT performance and application exercise outcomes: iRAT question performance ranged from 89% to 99% for individual items, and tRAT performance was routinely 100%. Learners reported that the exercises were impactful and believed the learned foundational knowledge and skills were transferable to future patient care. Discussion: The dyslipidemia TBL module provides an illustration for early clinical learners of how foundational knowledge and skills can be operationalized and transferred for optimal patient care.

Performance of ChatGPT on Chinese Master's Degree Entrance Examination in Clinical Medicine.

BACKGROUND: ChatGPT is a large language model designed to generate responses based on a contextual understanding of user queries and requests. This study utilised the entrance examination for the Master of Clinical Medicine in Traditional Chinese Medicine to assesses the reliability and practicality of ChatGPT within the domain of medical education. METHODS: We selected 330 single and multiple-choice questions from the 2021 and 2022 Chinese Master of Clinical Medicine comprehensive examinations, which did not include any images or tables. To ensure the test's accuracy and authenticity, we preserved the original format of the query and alternative test texts, without any modifications or explanations. RESULTS: Both ChatGPT3.5 and GPT-4 attained average scores surpassing the admission threshold. Noteworthy is that ChatGPT achieved the highest score in the Medical Humanities section, boasting a correct rate of 93.75%. However, it is worth noting that ChatGPT3.5 exhibited the lowest accuracy percentage of 37.5% in the Pathology division, while GPT-4 also displayed a relatively lower correctness percentage of 60.23% in the Biochemistry section. An analysis of sub-questions revealed that ChatGPT demonstrates superior performance in handling single-choice questions but performs poorly in multiple-choice questions. CONCLUSION: ChatGPT exhibits a degree of medical knowledge and the capacity to aid in diagnosing and treating diseases. Nevertheless, enhancements are warranted to address its accuracy and reliability limitations. Imperatively, rigorous evaluation and oversight must accompany its utilization, accompanied by proactive measures to surmount prevailing constraints.

Use of In-Training Examination Scores as a Fellowship Candidate Evaluation Metric: Time for a Change.

ABSTRACT: In the field of obstetrics and gynecology (OB/GYN), the Council on Resident Education in Obstetrics and Gynecology (CREOG) administers an annual in-training examination to all OB/GYN residents as a formative educational tool for assessing medical knowledge and promoting self-improvement. Although the CREOG examination is not designed or intended for knowledge certification, many OB/GYN subspecialty fellowship programs request and use CREOG examination scores as a metric to evaluate fellowship candidates. Among the 57 gynecology-based urogynecology fellowship programs, 30 programs (53%) request CREOG examination scores to be submitted by candidates, as of March 2023. Although the use of CREOG examination scores as an evaluation metric may constitute a minor component within the fellowship match process, this practice fundamentally contradicts the intended purpose of the examination as an educational self-assessment. In addition, it introduces the potential for bias in fellowship recruitment, lacks psychometric validity in predicting specialty board examination failure, and shifts the CREOG examination from its original intention as low-stakes self-assessment into a high-stakes examination akin to a certification examination. For these reasons, we call upon the urogynecology community to prioritize the educational mission of the CREOG examination and reconsider the practice of requesting or using CREOG examination scores in the fellowship match progress.

Application of PRI-E-a combined learning method in oral and maxillofacial oncology education.

The traditional lecture-based learning (LBL) method is facing great challenges due to its low efficiency and single proceeding form. We designed a PRI-E learning mode that combined and modified problem-based, case-based, and evidence-based learning with a step-by-step approach. We evaluated the practical learning outcomes of using the PRI-E mode by comparing it with traditional lecture-based learning in oral and maxillofacial oncology education. "PRI-E" consists of the first letters of the English words Passion, Research, Innovation, and Education, and it means "the best Education". This prospective randomized controlled trial included 40 participants. We evenly divided the participants into the PRI-E (n = 20) and LBL group (n = 20) based on the entrance test scores. The same staff group designed and then taught the learning content with different group measures. The evaluation included the final test scores and questionnaire assessments. Without affecting the examination results, the PRI-E teaching method was more satisfactory and popular with participants in terms of ability development and classroom participation. Enacting the PRI-E teaching method required more time, but this did not affect its popularity among the participants. Compared with the LBL learning mode, the PRI-E learning mode was more organized and efficient in oral and maxillofacial oncology education without affecting academic performance. This model has a high degree of satisfaction, which is conducive to training students' comprehensive ability.

Foundations of Emergency Medicine: Impact of a Standardized, Open-access, Core Content Curriculum on In-Training Exam Scores.

Introduction: Learners frequently benefit from modalities such as small-group, case-based teaching and interactive didactic experiences rather than passive learning methods. These contemporary techniques are features of Foundations of Emergency Medicine (FoEM) curricula, and particularly the Foundations I (F1) course, which targets first-year resident (PGY-1) learners. The American Board of Emergency Medicine administers the in-training exam (ITE) that provides an annual assessment of EM-specific medical knowledge. We sought to assess the effect of F1 implementation on ITE scores. Methods: We retrospectively analyzed data from interns at four EM residency programs accredited by the Accreditation Council for Graduate Medical Education. We collected data in 2021. Participating sites were geographically diverse and included three- and four-year training formats. We collected data from interns two years before (control group) and two years after (intervention group) implementation of F1 at each site. Year of F1 implementation ranged from 2015-2018 at participating sites. We abstracted data using a standard form including program, ITE raw score, year of ITE administration, US Medical Licensing Exam Step 1 score, Step 2 Clinical Knowledge (CK) score, and gender. We performed univariable and multivariable linear regression to explore differences between intervention and control groups. Results: We collected data for 180 PGY-1s. Step 1 and Step 2 CK scores were significant predictors of ITE in univariable analyses (both with P < 0.001). After accounting for Step 1 and Step 2 CK scores, we did not find F1 implementation to be a significant predictor of ITE score, P = 0.83. Conclusion: Implementation of F1 curricula did not show significant changes in performance on the ITE after controlling for important variables.

Reflections on augmented reality codes for teaching fundamental defensive techniques to boxing beginners.

AR technology allows users to interact with virtual objects in real-world settings. Immersive AR experiences can enhance creativity and possibilities. Learners can explore real-life situations in a safe, controlled environment, understand abstract concepts and solve problems. This study investigates whether AR-codes affect boxing beginners' performance in some fundamental defensive techniques. An experimental and control group were created to implement a quasi-experimental design. By using the ASSURE instructional design model, AR technology was incorporated into the educational program and delivered in flipped classroom method to the experimental group. Comparatively, the control group is taught a program using a teacher's command style. A post-measurement of defensive boxing skills was conducted for both groups. Participants were 60 boxing beginners aged 12 to 14 who had enrolled in Port Fouad Sports Club's 2023/2024 training season in Port Said, Egypt. Randomly, participants were divided into control and experimental groups. They were homogenized and equivalent in terms of age, height, weight, IQ, physical fitness, and skill level. According to the study results, the experimental group performed better in post-measurements than the control group. The AR Codes technology had a large effect size on the learning of boxing defensive skills under study. Consequently, it is necessary to use AR Codes technology as an educational resource to enhance the learning process, integrate it with active learning strategies, and use it to teach defensive boxing skills and apply them to offensive and counterattack skills, thereby improving the learning process.

Evaluation of the creation of podcasts for instructional delivery in a post-graduate training elective course.

OBJECTIVES: To describe the creation of podcasts for instructional delivery and evaluate strengths and areas for improvement in a post-graduate training (PGT) elective course. METHODS: After creating a podcast series, students in the PGT elective from Spring 2021 to Fall 2022 listened to the series then completed a reflection based on five open-ended questions that provoked their thoughts and feelings about use of podcasts as a method of delivering information and teaching. Responses were downloaded and a content analysis was performed. Each investigator analyzed responses from all reflections to identify major themes and subthemes. Letter of intent assignment and overall course grades were compared to assess if podcasts affected student learning. RESULTS: Ninety-one students provided reflections about the use of podcasts in the PGT elective course, which revealed three major themes with 13 subthemes, including perception of guests, learner experience, and show and episode production. Students appreciated the various perspectives, authenticity, relatability, and diversity of the guest speakers; the learning environment was described as flexible, relatable, positive, and a safe space; the podcast design was noted to be informative, organized, and easily accessible. Areas for improvement included more interaction with guests and more visuals. Letter of intent assignment and overall course grades were similar before and after podcast implementation. CONCLUSION: The use of podcasts as an educational tool in a PGT elective course had a variety of characteristics that students preferred to traditional lecture-style classes.

Virtual self-care simulations for third-year pharmacy skills laboratory courses in three institutions.

BACKGROUND AND PURPOSE: This study was designed to determine whether a virtual, self-care activity improved knowledge and confidence in third-year student pharmacists. EDUCATIONAL ACTIVITY AND SETTING: Third-year student pharmacists (n = 386) from three institutions participated in the virtual self-care simulation during their respective practice laboratory course. A pre- and post-assessment collected 10 knowledge and five confidence questions, self-reported on 0-100 scale, mapped to learning outcomes and pharmacy standards. Responses for participants who provided consent and had linked assessments were analyzed. Additionally, students participated in a perception assessment following the simulation with the post-assessment. Each knowledge question was scored as binary (correct/incorrect), presented as percentage, and significance identified with a McNemar's test. Total knowledge score and confidence changes were presented as means with standard deviations and significance with a paired t-test. Student perceptions were presented as frequencies and percentages. FINDINGS: Total knowledge assessment demonstrated a significant improvement (p < 0.001) for the entire cohort of 198 study participants. Upon additional analysis, a single institution led the cohort to significant increase, with variable improvement and significance for each individual question. Confidence improved for the entire cohort of students and at each institution individually. The students perceived the virtual self-care activity favorably. SUMMARY: The third-year student virtual self-care activity improved knowledge and confidence with varying significance between institutions. Future studies will focus on the impact of continued reinforcement of self-care activities on student growth in knowledge and confidence.

Improving the ability to discriminate medical multiple-choice questions through the analysis of the competitive examination to assign residency positions in Spain.

INTRODUCTION: Psychometrics plays a vital role in evaluating educational research, including the analysis of multiple-choice exams. This study aims to improve the discriminatory ability of the "Médico Interno Residente" (MIR) medical exam in Spain, used to rank candidates for specialized healthcare training, through psychometric analysis. METHODS: We analyzed 2,890 MIR exam questions from 2009 to 2021 (totaling 147,214 exams), categorizing them based on methodology and response type. Evaluation employed classical test theory and item response theory (IRT). Classical test theory determined difficulty and discrimination indices, while IRT assessed the relationship between knowledge levels and question performance. RESULTS: Question distribution varied across categories and years. Frequently addressed knowledge areas included various medical specialties. Non-image-associated clinical cases were the easiest, while case-based clinical questions exhibited the highest discriminatory capacity, differing significantly from image-based case or negative questions. High-quality questions without images had longer stems but shorter answer choices. Adding images reduced discriminatory power and question difficulty, with image-based questions being easier. Clinical cases with images had shorter stems and longer answer choices. CONCLUSIONS: For improved exam performance, we recommend using a clinical case format followed by direct short-answer questions. Questions should be of low difficulty, providing clear and specific answers based on scientific evidence and avoiding ambiguity. Typical clinical cases with key characteristic features should be presented, excluding uncertain boundaries of medical knowledge. Questions should have lengthy stems and concise answer choices, minimizing speculation. If images are used, they should be typical, clear, consistent with the exam, and presented within clinical cases using clinical semiotics and propaedeutics.

Mastering your fellowship: Part 3, 2024.

The series 'Mastering your Fellowship' provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series aims to help family medicine registrars (and supervisors) prepare for this examination.

Identifying Medical Students in Difficulty Using Integration of Programmatic Assessment and Real-Time Evaluation Framework.

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Evolving Licensure Examination: Assessing Student Confidence and Accuracy With Next Generation NCLEX.

BACKGROUND: The Next Generation NCLEX (NGN) includes new item types. Little is known about nursing students' confidence and accuracy in answering these questions. METHOD: A descriptive comparative study examined prelicensure nursing students' confidence and accuracy in answering NGN-style items versus multiple-choice questions (MCQs) of the same content via a 12-item quiz. RESULTS: Less than one third of students (n = 194; 32.1%) reported feeling confident in answering NGN questions. Students' confidence levels had no relationship on scores with NGN items. When comparing NGN-style items to MCQs, students' (n = 221) scores on NGN-style items were lower with bowtie or a select-all-that-apply questions but higher with highlight table or matrix multiple-choice questions. CONCLUSION: Students' lack of confidence with certain item types suggests faculty should incorporate these item types into classroom activities or course assignments. NGN test-taking strategies also should be incorporated and frequently reinforced throughout the curriculum. [J Nurs Educ. 2024;63(4):252-255.].

Performance of ChatGPT on the Taiwan urology board examination: insights into current strengths and shortcomings.

PURPOSE: To compare ChatGPT-4 and ChatGPT-3.5's performance on Taiwan urology board examination (TUBE), focusing on answer accuracy, explanation consistency, and uncertainty management tactics to minimize score penalties from incorrect responses across 12 urology domains. METHODS: 450 multiple-choice questions from TUBE(2020-2022) were presented to two models. Three urologists assessed correctness and consistency of each response. Accuracy quantifies correct answers; consistency assesses logic and coherence in explanations out of total responses, alongside a penalty reduction experiment with prompt variations. Univariate logistic regression was applied for subgroup comparison. RESULTS: ChatGPT-4 showed strengths in urology, achieved an overall accuracy of 57.8%, with annual accuracies of 64.7% (2020), 58.0% (2021), and 50.7% (2022), significantly surpassing ChatGPT-3.5 (33.8%, OR = 2.68, 95% CI [2.05-3.52]). It could have passed the TUBE written exams if solely based on accuracy but failed in the final score due to penalties. ChatGPT-4 displayed a declining accuracy trend over time. Variability in accuracy across 12 urological domains was noted, with more frequently updated knowledge domains showing lower accuracy (53.2% vs. 62.2%, OR = 0.69, p = 0.05). A high consistency rate of 91.6% in explanations across all domains indicates reliable delivery of coherent and logical information. The simple prompt outperformed strategy-based prompts in accuracy (60% vs. 40%, p = 0.016), highlighting ChatGPT's limitations in its inability to accurately self-assess uncertainty and a tendency towards overconfidence, which may hinder medical decision-making. CONCLUSIONS: ChatGPT-4's high accuracy and consistent explanations in urology board examination demonstrate its potential in medical information processing. However, its limitations in self-assessment and overconfidence necessitate caution in its application, especially for inexperienced users. These insights call for ongoing advancements of urology-specific AI tools.

Learning with AI Language Models: Guidelines for the Development and Scoring of Medical Questions for Higher Education.

In medical and biomedical education, traditional teaching methods often struggle to engage students and promote critical thinking. The use of AI language models has the potential to transform teaching and learning practices by offering an innovative, active learning approach that promotes intellectual curiosity and deeper understanding. To effectively integrate AI language models into biomedical education, it is essential for educators to understand the benefits and limitations of these tools and how they can be employed to achieve high-level learning outcomes.This article explores the use of AI language models in biomedical education, focusing on their application in both classroom teaching and learning assignments. Using the SOLO taxonomy as a framework, I discuss strategies for designing questions that challenge students to exercise critical thinking and problem-solving skills, even when assisted by AI models. Additionally, I propose a scoring rubric for evaluating student performance when collaborating with AI language models, ensuring a comprehensive assessment of their learning outcomes.AI language models offer a promising opportunity for enhancing student engagement and promoting active learning in the biomedical field. Understanding the potential use of these technologies allows educators to create learning experiences that are fit for their students' needs, encouraging intellectual curiosity and a deeper understanding of complex subjects. The application of these tools will be fundamental to provide more effective and engaging learning experiences for students in the future.

Development of a validated assessment tool for medical students using simulated patients: an 8-year panel survey.

BACKGROUND: The use of simulated patients (SPs) to assess medical students' clinical performance is gaining prominence, underscored by patient safety perspective. However, few reports have investigated the validity of such assessment. Here, we examined the validity and reliability of an assessment tool that serves as a standardized tool for SPs to assess medical students' medical interview. METHODS: This longitudinal survey was conducted at Keio University School of Medicine in Japan from 2014 to 2021. To establish content validity, the simulated patient assessment tool (SPAT) was developed by several medical education specialists from 2008 to 2013. A cohort of 36 SPs assessed the performance of 831 medical students in clinical practice medical interview sessions from April 2014 to December 2021. The assessment's internal structure was analyzed using descriptive statistics (maximum, minimum, median, mean, and standard deviation) for the SPAT's 13 item total scores. Structural validity was examined with exploratory factor analysis, and internal consistency with Cronbach's alpha coefficients. The mean SPAT total scores across different SPs and scenarios were compared using one way analysis of variance (ANOVA). Convergent validity was determined by correlating SPAT with the post-clinical clerkship obstructive structured clinical examination (post-CC OSCE) total scores using Pearson's correlation coefficient. RESULTS: Of the 831 assessment sheets, 36 with missing values were excluded, leaving 795 for analysis. Thirty-five SPs, excluding one SP who quit in 2014, completed 795 assessments, for a response rate of 95.6%. Exploratory factor analysis revealed two factors, communication and physician performance. The overall Cronbach's alpha coefficient was 0.929. Significant differences in SPAT total scores were observed across SPs and scenarios via one-way ANOVA. A moderate correlation (r =.212, p <.05) was found between SPAT and post-CC OSCE total scores, indicating convergent validity. CONCLUSIONS: Evidence for the validity of SPAT was examined. These findings may be useful in the standardization of SP assessment of the scenario-based clinical performance of medical students.

R.I.M.E. and reason: multi-station OSCE enhancement to neutralize grade inflation.

To offset grade inflation, many clerkships combine faculty evaluations with objective assessments including the Medical Examiners Subject Examination (NBME-SE) or Objective Structured Clinical Examination (OSCE), however, standardized methods are not established. Following a curriculum transition removing faculty clinical evaluations from summative grading, final clerkship designations of fail (F), pass (P), and pass-with-distinction (PD) were determined by combined NBME-SE and OSCE performance, with overall PD for the clerkship requiring meeting this threshold in both. At the time, 90% of students achieved PD on the Internal Medicine (IM) OSCE resulting in overall clerkship grades primarily determined by the NBME-SE. The clerkship sought to enhance the OSCE to provide a more thorough objective clinical skills assessment, offset grade inflation, and reduce the NBME-SE primary determination of the final clerkship grade. The single-station 43-point OSCE was enhanced to a three-station 75-point OSCE using the Reporter-Interpreter-Manager-Educator (RIME) framework to align patient encounters with targeted assessments of progressive skills and competencies related to the clerkship rotation. Student performances were evaluated pre- and post-OSCE enhancement. Student surveys provided feedback about the clinical realism of the OSCE and the difficulty. Pre-intervention OSCE scores were more tightly clustered (SD = 5.65%) around a high average performance with scores being highly negatively skewed. Post-intervention OSCE scores were more dispersed (SD = 6.88%) around a lower average with scores being far less skewed resulting in an approximately normal distribution. This lowered the total number of students achieving PD on the OSCE and PD in the clerkship, thus reducing the relative weight of the NMBE-SE in the overall clerkship grade. Student response was positive, indicating the examination was fair and reflective of their clinical experiences. Through structured development, OSCE assessment can provide a realistic and objective measurement of clinical performance as part of the summative evaluation of students.

Improved cardiac auscultation competency interweaving visual, auditory, and tactile stimuli: a preliminary study.

Methods:   A pilot randomized controlled trial was conducted at our institution's simulation center with 32 first year medical students from a single medical institution. Participants were randomly divided into two equal groups and completed an educational module the identification and pathophysiology of five common cardiac sounds. The control group utilized traditional education methods, while the interventional group incorporated multisensory stimuli. Afterwards, participants listened to randomly selected cardiac sounds and competency data was collected through a multiple-choice post-assessment in both groups. Mann-Whitney U test was used to analyze the data. Results: Data were analyzed using the Mann-Whitney U test. Diagnostic accuracy was significantly higher in the multisensory group (Mdn=100%) compared to the control group (Mdn=60%) on the post-assessment (U=73.5, p<0.042). Likewise, knowledge acquisition was substantially better in the multisensory group (Mdn=80%) than in the control group (Mdn=50%) (U= 49, p<0.031). Conclusions: These findings suggest the incorporation of multisensory stimuli significantly improves cardiac auscultation competency. Given its cost-effectiveness and simplicity, this approach offers a viable alternative to more expensive simulation technologies like the Harvey simulator, particularly in settings with limited resources. Consequently, this teaching modality holds promise for global applicability, addressing the worldwide deterioration in cardiac auscultation skills and potentially leading to better patient outcomes. Future studies should broaden the sample size, span multiple institutions, and investigate long-term retention rates.

[Virtual training of practical competences in sonography]. / Sonographie als Gegenstand virtuellen Wissenstransfers zum praktischen Kompetenzerwerb.

OBJECTIVE: During the COVID-19 pandemic, a particular challenge in the transition to digital teaching was to teach practical skills such as sonography of the head and neck online. The aim of this study was to validate the digital sonography course for medical students established at the Freiburg University Hospital ENT Department. METHODS: Participants were 178 students of human medicine. The study group simulated the sonography examination at home with a dummy transducer using the Peyton method under the guidance of a tutor via video seminar. In a subsequent learning success check, the results of the students in the online course were compared with those of the control group, who learned sonography in the classroom. RESULTS: Students of the online course achieved comparable results to the classroom group. CONCLUSION: This study shows that practical skills which require extensive equipment such as a sonography machine can be taught to a certain extent digitally or at least in a hybrid form.