Medical Education Care Research Articles

Generative Artificial Intelligence and Large Language Models in Primary Care Medical Education.

Generative artificial intelligence and large language models are the continuation of a technological revolution in information processing that began with the invention of the transistor in 1947. These technologies, driven by transformer architectures for artificial neural networks, are poised to broadly influence society. It is already apparent that these technologies will be adapted to drive innovation in education. Medical education is a high-risk activity: Information that is incorrectly taught to a student may go unrecognized for years until a relevant clinical situation appears in which that error can lead to patient harm. In this article, I discuss the principal limitations to the use of generative artificial intelligence in medical education-hallucination, bias, cost, and security-and suggest some approaches to confronting these problems. Additionally, I identify the potential applications of generative artificial intelligence to medical education, including personalized instruction, simulation, feedback, evaluation, augmentation of qualitative research, and performance of critical assessment of the existing scientific literature.

52116 Assessment of an Evidence-Based Dermatology Curriculum for Primary Care Medical Education

52116 Assessment of an Evidence-Based Dermatology Curriculum for Primary Care Medical Education

Reimagining Undergraduate Critical Care Medical Education: A Path for the Next Decade.

Foundational training in critical care medicine is an integral part of both undergraduate and graduate medical education. Yet, many medical school graduates enter residency underprepared to care for critically ill patients because of a lack of ubiquity of undergraduate critical care education and the heterogeneity of existing didactic and clinical experiences. This Perspective explores the importance of undergraduate critical care education, the current national and international landscape, innovative educational strategies and exemplar curricula, and recent advances in assessment that may better reflect learner-centered educational outcomes. As broad curricular reforms push medical education toward a more innovative, interactive, and collaborative future, now is the time to rethink and reimagine undergraduate critical care education.

Analysis of current initial programs of palliative and hospice care in medical education of Ukraine

Analysis of current initial programs of palliative and hospice care in medical education of Ukraine

Ethical issues of medical schools and their academic departments accepting gifts from pharma

The ethical implications of medical schools or any of their academic departments accepting large corporate donations, mainly from pharmaceutical companies, have been long debated. Although such contributions are common in other graduate institutions, medical schools must be convinced about potential conflicts of interest and public opinion. We re-explore the benefits these kinds of gifts would afford for improved educational and research resources against the ethical dilemmas this kind of donation would present and concerns about public perception and actual conflict of interest. Using the principles of beneficence, nonmaleficence, autonomy, and distributive justice, we discuss the physicians’ obligations and conceivable patient backlash that may ensue. Ultimately, we recognize the necessity for financial resources to support academic missions but contend that health care facilities and medical education must be equipped while ensuring a complete lack of bias in sponsorship.

“That is when I understood everything”: Ideological trajectories of pro-choice female doctors in Mexico

ObjectivesThere is little global evidence about how physicians become abortion clinicians or advocates. We describe the ideological trajectories of self-identified pro-choice female Mexican doctors and the factors that made them become pro-choice. Study DesignIn this qualitative study we conducted semi-structured interviews with members of the Mexican Network of Female Pro-choice Physicians (Red de Médicas por el Derecho a Decidir - México). Participants came from 8 diverse states in Mexico. We used a feminist epistemology approach and analyzed data using inductive coding as well as a priori categories (becoming pro-choice, trajectories, and training). ResultsWe included 24 female pro-choice physicians. We identified five intersecting factors that influenced becoming pro-choice: feminism, personal experiences, confrontation with the inequalities and violence that women experience, role models, and routine exposure to abortion care. Participants described three ideological trajectories: being pro-choice before studying medicine, not having a specific opinion, and changing from “pro-life” to “pro-choice”. Participants described an absence of abortion training in medical schools or stigmatizing training, and the use of alternative training sources. ConclusionIn the absence of training on abortion during the medical education, a combination of intersecting personal as well as work-related experience may turn doctors in to pro-choice abortion clinicians and/or advocates. Training on abortion care in medical education and stigma reduction in Mexican society is essential. The findings of this study may be used to develop comprehensive medical curricula as well as strategies directed at doctors in who have never received training on abortion care, such as promoting interactions between doctors and non-medical abortion providers, education on inequalities and violence against women, moving beyond a public health to a human rights and gender perspective, and exposure to routine safe abortion care. ImplicationsMexican female doctors become pro-choice clinicians who provide abortion care and/or advocates in spite of their medical education.

Medical Student Experiences and Perceptions of ChatGPT and Artificial Intelligence: Cross-Sectional Study.

Artificial intelligence (AI) has the potential to revolutionize the way medicine is learned, taught, and practiced, and medical education must prepare learners for these inevitable changes. Academic medicine has, however, been slow to embrace recent AI advances. Since its launch in November 2022, ChatGPT has emerged as a fast and user-friendly large language model that can assist health care professionals, medical educators, students, trainees, and patients. While many studies focus on the technology's capabilities, potential, and risks, there is a gap in studying the perspective of end users. The aim of this study was to gauge the experiences and perspectives of graduating medical students on ChatGPT and AI in their training and future careers. A cross-sectional web-based survey of recently graduated medical students was conducted in an international academic medical center between May 5, 2023, and June 13, 2023. Descriptive statistics were used to tabulate variable frequencies. Of 325 applicants to the residency programs, 265 completed the survey (an 81.5% response rate). The vast majority of respondents denied using ChatGPT in medical school, with 20.4% (n=54) using it to help complete written assessments and only 9.4% using the technology in their clinical work (n=25). More students planned to use it during residency, primarily for exploring new medical topics and research (n=168, 63.4%) and exam preparation (n=151, 57%). Male students were significantly more likely to believe that AI will improve diagnostic accuracy (n=47, 51.7% vs n=69, 39.7%; P=.001), reduce medical error (n=53, 58.2% vs n=71, 40.8%; P=.002), and improve patient care (n=60, 65.9% vs n=95, 54.6%; P=.007). Previous experience with AI was significantly associated with positive AI perception in terms of improving patient care, decreasing medical errors and misdiagnoses, and increasing the accuracy of diagnoses (P=.001, P<.001, P=.008, respectively). The surveyed medical students had minimal formal and informal experience with AI tools and limited perceptions of the potential uses of AI in health care but had overall positive views of ChatGPT and AI and were optimistic about the future of AI in medical education and health care. Structured curricula and formal policies and guidelines are needed to adequately prepare medical learners for the forthcoming integration of AI in medicine.

Ethnopsychopharmacology: Clinical and scientific writing pearls.

The concept of ethnopsychopharmacology aims to predict or explain the pharmacologic response to psychiatric medications based on the influence of biologic and nonbiologic factors. Interactions involving these factors are complex and influence patient outcomes in health care. Pharmacists and other clinicians working in patient care environments, research, or medical education should engage in lifelong learning to enhance ethnopsychopharmacologic knowledge gaps, which ultimately may improve and individualize care across diverse populations. Through two cases, this paper provides pearls on how biogeographical ancestry and cytochrome P450 status may influence pharmacotherapy selection, dosing, or response. A third scenario highlights a publication, like many other published works, with deficiencies in how data on ancestry, race, and ethnicity are collected or reported. Current recommendations on the use of inclusive language in scientific writing are reviewed, with attention to specific examples.

A descriptive analysis of otolaryngology presence on the social media platform TikTok.

In recent years, the video sharing app TikTok has become a new venue for health care providers and medical educators. Research on health care information within the app has primarily focused on cosmetic and plastic surgery content. TikTok could potentially be a tool used to educate the public on otolaryngology-related topics. This study is the first to analyze the quality and quantity of otolaryngology-related TikTok content. A cross-sectional study of TikTok accounts using otolaryngology-related hashtags within the preceding 6 months was conducted on February 4, 2023. Deductive qualitative analysis was performed between two coders to identify themes of the accounts and their content. A total of 47 accounts were selected for analysis. Facial plastic surgery was the most represented specialty (n = 20; 43%) and pediatric otolaryngology the least represented (n = 1; 2%). Content posted was primarily educational in nature (n = 30; 64%) and 66% (n = 31) of content creators advertised contact information in their account biography. The majority of accounts were in English (n = 30; 64%) and originated in the United States (n = 30; 64%). More accounts were run by male (n = 29; 62%) than female content creators. Otolaryngology is a broad specialty with unequal representation of the related subspecialties on TikTok, a popular social media platform. The majority of current content focuses on patient education in facial plastic surgery. Future studies are warranted to examine the potential growth and impact of otolaryngology content on this video-based platform. 2.

Radiology Residents' Perceptions of Artificial Intelligence: Nationwide Cross-Sectional Survey Study.

Artificial intelligence (AI) is transforming various fields, with health care, especially diagnostic specialties such as radiology, being a key but controversial battleground. However, there is limited research systematically examining the response of "human intelligence" to AI. This study aims to comprehend radiologists' perceptions regarding AI, including their views on its potential to replace them, its usefulness, and their willingness to accept it. We examine the influence of various factors, encompassing demographic characteristics, working status, psychosocial aspects, personal experience, and contextual factors. Between December 1, 2020, and April 30, 2021, a cross-sectional survey was completed by 3666 radiology residents in China. We used multivariable logistic regression models to examine factors and associations, reporting odds ratios (ORs) and 95% CIs. In summary, radiology residents generally hold a positive attitude toward AI, with 29.90% (1096/3666) agreeing that AI may reduce the demand for radiologists, 72.80% (2669/3666) believing AI improves disease diagnosis, and 78.18% (2866/3666) feeling that radiologists should embrace AI. Several associated factors, including age, gender, education, region, eye strain, working hours, time spent on medical images, resilience, burnout, AI experience, and perceptions of residency support and stress, significantly influence AI attitudes. For instance, burnout symptoms were associated with greater concerns about AI replacement (OR 1.89; P<.001), less favorable views on AI usefulness (OR 0.77; P=.005), and reduced willingness to use AI (OR 0.71; P<.001). Moreover, after adjusting for all other factors, perceived AI replacement (OR 0.81; P<.001) and AI usefulness (OR 5.97; P<.001) were shown to significantly impact the intention to use AI. This study profiles radiology residents who are accepting of AI. Our comprehensive findings provide insights for a multidimensional approach to help physicians adapt to AI. Targeted policies, such as digital health care initiatives and medical education, can be developed accordingly.

Lost in translation: the case for embedding newcomer care in medical education.

Lost in translation: the case for embedding newcomer care in medical education.

Complexity-Based Triaging and Scheduling for Reducing Clinic Wait Times in Student-Run Free Clinics

Student-run free clinics are a valuable resource for both patients who lack access to care and undergraduate medical education. Free clinics often face specific challenges, such as long clinic wait times, necessitating the development of strategies to minimize wait time and enhance patient satisfaction. We propose the use of a patient complexity score to facilitate patient scheduling and the proper assignment of students to complex patients based on training level. A numeric score estimating the complexity of each patient may provide valuable information to clinic organizers and ultimately reduce patient wait times.

Perspectives on Professional Development Among University and Community Pediatric Hospitalists.

Multiple professional societies have emphasized the importance of professional development for physicians. This qualitative study aimed to explore pediatric hospitalists' perceptions of professional development needs and to refine a framework for professional development in pediatric hospital medicine (PHM). We conducted four focus groups in April to May 2019 with 19 pediatric hospitalists at six clinical sites within a single institution. Participants identified key components of professional development including skill development, personal growth, career satisfaction, and individualization. Hospitalists agreed upon 8 domains of professional development: clinical excellence, advocacy, global health, health care administration, informatics, medical education, quality improvement, and research. They also identified missing the mentorship necessary to change their passions into career advancement, highlighted barriers and facilitators, and noted that an alignment in personally meaningful projects to what is meaningful to the institution was in everyone's best interests. Faculty programs should build infrastructure to aid pediatric hospitalists in achieving their career goals.

Transformative learning in clinical reasoning: a meta-synthesis in undergraduate primary care medical education

ABSTRACT Clinical reasoning is a vital medical education skill, yet its nuances in undergraduate primary care settings remain debated. This systematic review explores clinical reasoning teaching and learning intricacies within primary care. We redefine clinical reasoning as dynamically assimilating and prioritising synthesised patient, significant other, or healthcare professional information for diagnoses or non-diagnoses. This focused meta-synthesis applies transformative learning theory to primary care clinical reasoning education. A comprehensive analysis of 29 selected studies encompassing various designs made insights into clinical reasoning learning dimensions visible. Primary care placements in varying duration and settings foster diverse instructional methods like bedside teaching, clinical consultations, simulated clinics, virtual case libraries, and more. This review highlights the interplay between disease-oriented and patient-centred orientations in clinical reasoning learning. Transformative learning theory provides an innovative lens, revealing stages of initiation, persistence, time and space, and competence and confidence in students’ clinical reasoning evolution. Clinical teachers guide this transformation, adopting roles as fortifiers, connoisseurs, mediators, and monitors. Patient engagement spans passive to active involvement, co-constructing clinical reasoning. The review underscores theoretical underpinnings’ significance in shaping clinical reasoning pedagogy, advocating broader diversity. Intentional student guidance amid primary care complexities is vital. Utilising transformative learning, interventions bridging cognitive boundaries enhance meaningful clinical reasoning learning experiences. This study contributes insights for refining pedagogy, encouraging diverse research, and fostering holistic clinical reasoning development.

Twelve Tips for Integrating Bioethics and Palliative Care in Medical Education

It is important to integrate bioethics and palliative care (PC) in addition to providing the appropriate teaching of end-oflife care to future doctors. This article presents an evaluation of the updated literature and thus proposes to integrate the principles of bioethics with PC in medical schools. Accordingly, these 12 tips aim to highlight the necessary key points to help facilitate the teaching of PC and bioethics to medical students. These points are: addressing of bioethical theories according to the context experienced; supporting shared decisions; encouraging the development of a care plan based on beneficence, non-maleficence, and dignity; relieving uncomfortable physical symptoms and the avoidance of dysthanasia; promoting comfort through palliative sedation; understanding vulnerabilities and promoting the patient’s autonomy; taking care of those who care; integratingspirituality and the respect of religious practices; taking care of family members and informal caregivers; understanding and respecting research participants; developing awareness of medically assisted death and ethical-legal limits; and including PC and bioethics themes in all student experiences related to terminality during medical school.

Virtual Care and Virtual Medical Education: A Canadian Medical Student Perspective

&#x0D; Background: The COVID-19 pandemic had accelerated the adoption of virtual care as an extension of routine clinical practice. In addition, pre-clinical undergraduate medical education was affected by the transition to both synchronous and asynchronous online learning. The objective of this study was to assess the current experience and knowledge of medical students with regards to virtual care. A secondary objective was to identify opportunities for improvement in the undergraduate medical curriculum.&#x0D; Methods: An electronic survey was distributed to undergraduate medical students in Canadian medical schools. Main sections of the survey addressed experience with virtual care encounters and perceived impact of virtual learning on medical education.&#x0D; Result: Out of our 53 respondents, the majority (80%) of medical students perceived high educational importance of virtual care encounters. 91% of the students recognized the developing role of virtual care in current and future medical practices. 55% of the surveyed showed readiness to conduct virtual care in the current curriculum. 94% of the responses stated the preferred feedback method for clinical learning was immediate faculty assessment following the encounter.&#x0D; Discussion: The results from this study provided insight on the medical learner’s experience while navigating virtual care and identified areas of improvements at an institutional level. Effective medical training that integrates the advantages of virtual care is crucial.

Respect and reflexivity: international education partnerships in primary care

ABSTRACT The UK general practice model has been described as the ‘jewel in the crown’ of the National Health Service and is widely respected and emulated around the world. In recent years, there has been a particular interest in the UK approach to primary care medical education, including at undergraduate and postgraduate levels, leading to a number of international education partnerships designed to draw on the best of UK experience and expertise in this area. Drawing on the limited academic literature in this area, and the authors’ personal experiences of working across many international partnership projects with countries around the world, this article reflects on the central importance of respect and reflexivity when engaging in such work. A respectful approach relies on a genuine and deep curiosity for the local context, and a desire to empower partners to build their own solutions that are contextually authentic. A reflexive approach, meanwhile, relies on those engaging in partnerships to understand themselves as ‘invited guests’ and to remain mindful of current and historical power differentials and inequities when framing their engagement, looking both inwardly and outwardly as they conduct themselves. As primary care education around the world develops and expands, there may be a greater role for international partnerships and it is critically important that those engaging in such partnerships bring a thoughtful and scholarly lens to this work.

Developing a career as a GP educationalist: contemporary challenges and workforce solutions

ABSTRACT GP educationalists are crucial in training the future medical workforce and in developing and advancing the field of primary care medical education, yet opportunities in the UK are patchy and varied. In this article, a group of GP educationalists summarise the challenges facing the sustainability of this particular group of clinical academics and outline opportunities available at each career stage, from medical students through to senior GP educationalists. Recommendations to support the growth of this workforce include the development of a nationally recognised framework for GP educationalist careers, collaboration with professional and educational bodies and taking steps to level out opportunities in order to reduce existing inequity.

Community‐engaged primary care medical education

Community-engaged medical education (CEME) requires medical schools to partner with local communities to help address community priorities, whilst enhancing the learning experiences of students. Current literature on CEME has focused on evaluating its effects on students; however, there remains a gap in exploring whether CEME initiatives can have a sustainable impact for communities. The Community Action Project (CAP) at Imperial College London, is an eight-week, community-engaged, quality improvement project for Year 3 medical students. Students initially consult with clinicians, patients and wider community stakeholders to understand local needs and assets, and identify a health priority to address. They then work with relevant stakeholders to design, implement and evaluate a project to help address their identified priority. All CAPs (n= 264) completed in the 2019-2021 academic years were evaluated for evidence of several key areas, including community engagement and sustainability. 91% of projects evidenced a needs analysis, 71% demonstrated patient involvement in their development, and 64% demonstrated sustainable impacts from their projects. Analysis revealed the topics frequently addressed, and the formats used by students. Two CAPs are described in more detail to demonstrate their community impact. The CAP demonstrates how the principles of CEME (meaningful community engagement and social accountability) can lead to sustainable benefits for local communities through purposeful collaboration with patients and local communities. Strengths, limitations and future directions are highlighted.

The Need for Improved End-of-Life Care Medical Education: Causes, Consequences, and Strategies for Enhancement and Integration.

End-of-life (EOL) care is a unique area of medicine that emphasizes holistic patient-centered care. It requires clinicians to consider a patients' mental, emotional, spiritual, social and physical comforts and engage patients and their families in complex discussions and decisions. It is an area of medicine that requires sensitivity in communication in order to respond to a wide range of emotions from patients and their families. Given these intricacies, it is essential that healthcare professional trainees are exposed early in their careers so they can be better equipped to address EOL situations effectively. While many medical schools have integrated this important element in pre-clinical education, a formalized and standardized curriculum could allow for students to better engage in EOLcare scenarios that they will face as future physicians. In this editorial, we discuss potential strategies to incorporate EOL care didactics and experiential learning earlier in medical education as well as the consequences of inadequate EOL care education, particularly in medical schools, in its current state.