Management Questions Research Articles

Inflammatory bowel disease associated knowledge in South Indian populations: rational Study.

The pivotal of the study was to compare the effectiveness of education in disease-associated knowledge of Inflammatory Bowel Disease (IBD) patients between pre-test and post-test using the IBD-KNOW questionnaire and patient educational resources. This study used a patient proforma and IBD- KNOW questionnaire to perform the study prospectively by interviewing method. The patient selection was based on inclusion and exclusion criteria by convenient sampling technique from November 2018 to July 2019 at a multispecialty hospital. Knowledge scores and inter-item correlation were calculated between the pre-test and post-test by R Programming software with p<0.05. Among 40 patients with IBD diagnosis, the baseline sociodemographic characteristics were recorded. The response rate of IBD knowledge between the pre-test and post-test resulted in significant differences with varying scales but the response rate was lesser in the domains of management and pregnancy-based questions in the pre-test and post-test. Recently there was a swift in IBD incidence, this may be improved by affording suitable patient education and counseling for further knowledge level in managing the disease by coping strategy. On comparison between the pre-test and post-test, this study recommends innovative educational methods to enable continuing education for chronic disease which can be easily accessible and reliable for IBD patients.

GEOSPATIAL STRUCTURE OF PILGRIMAGE ROUTES IN TERNOPIL REGION

The article considers the postulate that the tourist is a resource (monetary), and then the main mission of territorial communities is to attract him to their development, using various methods. Combining the principle of tourist attraction, infrastructure, and hospitality on the one hand and attracting new resources (capital investments) is a prerequisite for long-term planning. Therefore, the question of strategic management in the development of tourism arises.&#x0D; Pilgrimage tourism faced new challenges related to Russia's aggression (war) against Ukraine, which led to the emergence of an even greater desire of believers to pray together for soldiers, for the success of military operations, as well as spiritual self-purification and become a real Christian, not just a practicing one.&#x0D; Within Ternopil region, 3 pilgrimage districts are clearly visible, namely Northern, Central, and Southern.&#x0D; Northern district, the routes of which run through the territory of the Kremetskyi administrative district. It covers the district center and 14 pilgrimage sites, of which only five sights are the most visited (Pochaiv city, Vyshnievets village, Mali Zagaytsi village, Stary Pochaiv village, Velyki Berezhtsi village, Lishnya village) . The total number of sacred objects of pilgrimage is 19.2% of the indicator in the Ternopil region. However, in terms of value, they are probably on a par with other regions. The central object of pilgrimage here is the city of Pochaiv.&#x0D; Central district routes, which run through the territory of the Ternopil administrative district. It covers the regional and at the same time district center and 36 pilgrimage sites, of which only 11 are the most visited, located in (the village of Zarvanytsia, the city of Ternopil, the village of Kolodiivka, the village of Krasnopuscha, the village of Skoriki, the village of Zadrist) . The central object of pilgrimage here is the village. Zarvanytsia&#x0D; This area has the largest number of sacred objects (36, which is 49.3% of all in the region) and the centers of diocesan denominations operate. In Ternopil, this is primarily the Cathedral of the Nativity of Christ (the center of the Ternopil-Buchatka Diocese of the OCU), the Cathedral of Saints Equal-to-the-Apostles Constantine and Elena (the center of the Ternopil Eparchy of the OCU); the Cathedral of Faith, Hope, Love and their Matter Sophia (the center of the Ternopil Diocese of the Ukrainian Orthodox Church (MP); the Cathedral of the Immaculate Conception of the Holy Mother of God (the center of the Ternopil-Zboriv Metropolitanate, which includes the Ternopil-Zboriv Archdiocese), etc.&#x0D; Routes of the southern district, which run through the territory of the Chortkiv administrative district. It covers the district center and 23 pilgrimage sites, of which only 3 are the most visited, located in (the village of Yazlivets, the village of Ulashkivtsi, the village of Savelyvka). The central object of pilgrimage here is the village. Yazlivets miraculous figure of the Mother of God (copy).&#x0D; In this area there is a large number of sacred objects (23, which is 31.5% of all in the region) and there are centers of diocesan denominations.&#x0D; Ternopil-Terebovlyan Eparchy of the OCU and Buchach Greek-Catholic Eparchy, which is part of the Ternopil-Zboriv Metropolitanate.&#x0D; The isolated geospatial structure of pilgrimage routes and its detailed characteristics show, however, that there is a certain delay in the response of both state and church structures, which do not take into account the change in regional determinants of economic growth.&#x0D; Key words: pilgrimage, pilgrimage tourism, pilgrimage routes.

Burden of hyperphagia and obesity in Bardet–Biedl syndrome: a multicountry survey

BackgroundSigns and symptoms of Bardet–Biedl syndrome (BBS) occur during early childhood, progress over time, and place substantial, multifaceted burden on patients and their caregivers. Hyperphagia may be a contributing factor to early-onset obesity in BBS; however, there are limited insights into its impacts on patients and caregivers. We quantified disease burden as it relates to the physical and emotional impacts of hyperphagia in BBS.MethodsThe CAREgiver Burden in BBS (CARE-BBS) study was a multicountry, cross-sectional survey of adult caregivers of patients with BBS who have had hyperphagia and obesity. The survey consisted of questionnaires including Symptoms of Hyperphagia, Impacts of Hyperphagia, Impact of Weight on Quality of Life (IWQOL)-Kids Parent Proxy, and Patient-Reported Outcome Measurement Information System (PROMIS) v1.0-Global Health 7. In addition, clinical characteristics, medical history, and weight management questions were included. Outcomes were scored and summarized descriptively in aggregate and by country, age, and obesity severity according to weight class.ResultsThere were 242 caregivers of patients with BBS who completed the survey. Caregivers observed hyperphagic behaviors throughout the day, with negotiating for food (90%) and waking up and asking or looking for food during the night (88%) being the most frequent. Hyperphagia had at least a moderate negative impact on most patients’ mood/emotions (56%), sleep (54%), school (57%), leisure (62%), and familial relationships (51%). Hyperphagia affected concentration at school (78%), and symptoms of BBS contributed to patients missing ≥ 1 day of school a week (82%). Responses from the IWQOL-Kids Parent Proxy suggested obesity most greatly negatively affected physical comfort (mean [standard deviation (SD)], 41.7 [17.2]), body esteem (41.0 [17.8]), and social life (41.7 [18.0]). On the PROMIS questionnaire, mean (SD) global health score for pediatric patients with BBS and overweight or obesity (36.8 [10.6]) was lower than the general population (mean, 50).ConclusionsEvidence from this study suggests that hyperphagia and obesity may have broad negative impacts on the lives of patients with BBS, including physical health, emotional well-being, school performance, and personal relationships. Therapies that target hyperphagia may alleviate the extensive clinical and nonclinical impacts experienced by patients with BBS and their caregivers.

Resisting Ex-Appropriation: Artistic Remains at Times of Environmental Instability

With rapidly spreading extractive practices on a global scale, the amount of residue generated raises the question of waste management and economic externalities. Are humans, and most crucially the Earth, equipped to welcome such an exponentially increasing quantity of restants? Artworks, as inexhaustible in their readings, are congenial to this idea of irreducible remains. In this paper, I argue Derrida’s treatment of remains might provide a waste-based approach to ecocriticism which, in turns, can be leveraged to articulate an insightful reading of some artworks in times of extractive overconsumption and environmental destabilisation. Lee Bae’s Issu du feu (2000) and House of Moon (2014), Emerson Pontes’s Mil Quase Mortos: Boiúna, and Rochelle Goldberg’s Cannibal Actif (2018) are three contemporary artworks that directly challenge those externalities by explicitly engaging with remains ranging from charcoal, human-made waste and oil. Through a formal analysis of these artworks and a close reading of Derrida’s Feu la cendre, ‘Biodegradables Seven Diary Fragments,’ and the seminars Manger l’autre and Rhétorique du cannibalisme, it appears that eco-deconstruction is perhaps above all a matter of engaging with the structure of remains.

간호대학생의 근거기반 통증간호, 욕창관리와 낙상예방간호 및 배액관리 프로토콜 개발

Purpose : The purpose of this study is to develop an evidence-based nursing protocol to systematically educate nursing students on pain management, pressure ulcer care and fall prevention, and drainage tube management, which are the core nursing skills newly established during the 4th cycle.&#x0D; Methods : This is a methodological study intended to develop a protocols for pain management, pressure ulcer care, fall prevention care, and drainage tube management of nursing students by preparing a preliminary protocol to develop systematic pain management, pressure ulcer care and fall prevention care, and drainage tube management protocol for the core nursing skills education of nursing students, and by verifying content validity and user validity to investigate clinical applicability.&#x0D; Result : This study developed a protocol consisted of 18 questions for pain management, 17 questions for pressure ulcer care and fall prevention care, and 25 questions for the drainage tube management protocol of newly established core nursing skills.&#x0D; Conclusion : In the court of developing the protocol, an expert group was included to evaluate the appropriateness and applicability of the protocol use, and hence, it is expected that it will be used effectively for the evaluation of core nursing skills.

Letter: The Urgency of Neurosurgical Leadership in the Era of Artificial Intelligence.

Letter: The Urgency of Neurosurgical Leadership in the Era of Artificial Intelligence.

On the Quina side: A Neanderthal bone industry at Chez-Pinaud site, France.

Did Neanderthal produce a bone industry? The recent discovery of a large bone tool assemblage at the Neanderthal site of Chagyrskaya (Altai, Siberia, Russia) and the increasing discoveries of isolated finds of bone tools in various Mousterian sites across Eurasia stimulate the debate. Assuming that the isolate finds may be the tip of the iceberg and that the Siberian occurrence did not result from a local adaptation of easternmost Neanderthals, we looked for evidence of a similar industry in the Western side of their spread area. We assessed the bone tool potential of the Quina bone-bed level currently under excavation at chez Pinaud site (Jonzac, Charente-Maritime, France) and found as many bone tools as flint ones: not only the well-known retouchers but also beveled tools, retouched artifacts and a smooth-ended rib. Their diversity opens a window on a range of activities not expected in a butchering site and not documented by the flint tools, all involved in the carcass processing. The re-use of 20% of the bone blanks, which are mainly from large ungulates among faunal remains largely dominated by reindeer, raises the question of blank procurement and management. From the Altai to the Atlantic shore, through a multitude of sites where only a few objects have been reported so far, evidence of a Neanderthal bone industry is emerging which provides new insights on Middle Paleolithic subsistence strategies.

How resilient are waterways of the Asian Himalayas? Finding adaptive measures for future sustainability

AbstractThe high‐mountain system, a storehouse of major waterways that support important ecosystem services to about 1.5 billion people in the Himalaya, is facing unprecedented challenges due to climate change during the 21st century. Intensified floods, accelerating glacial retreat, rapid permafrost degradation, and prolonged droughts are altering the natural hydrological balances and generating unpredictable spatial and temporal distributions of water availability. Anthropogenic activities are adding further pressure onto Himalayan waterways. The fundamental question of waterway management in this region is therefore how this hydro‐meteorological transformation, caused by climate change and anthropogenic perturbations, can be tackled to find avenues for sustainability. This requires a framework that can diagnose threats at a range of spatial and temporal scales and provide recommendations for strong adaptive measures for sustainable future waterways. This focus paper assesses the current literature base to bring together our understanding of how recent climatic changes have threatened waterways in the Asian Himalayas, how society has been responding to rapidly changing waterway conditions, and what adaptive options are available for the region. The study finds that Himalayan waterways are crucial in protecting nature and society. The implementation of integrated waterways management measures, the rapid advancement of waterway infrastructure technologies, and the improved governance of waterways are more critical than ever.This article is categorized under: Engineering Water &gt; Sustainable Engineering of Water

Artificial intelligence in sport management education: Playing the AI game with ChatGPT

The launch of ChatGPT, an Artificial Intelligence (AI) ChatBot, in late 2022 made many people look to the disruption such technology could play in education. This study aimed to identify the quality of short answer outputs for sport management questions from ChatGPT and suggestions on utilizing ChatGPT in the functional areas of sport management. The study was exploratory, and the methodology used was a generic qualitative inquiry. The results indicated that ChatGPT produces grammatically quality, complete, and topically accurate outputs for short answer questions. The findings indicate the pros and cons of utilizing Artificial Intelligence chatbots, such as ChatGPT, in the sports management higher education classroom. The discussion gives practical suggestions on how ChatGPT can supplement and support sport management education.

Performance of ChatGPT, GPT-4, and Google Bard on a Neurosurgery Oral Boards Preparation Question Bank.

General large language models (LLMs), such as ChatGPT (GPT-3.5), have demonstrated the capability to pass multiple-choice medical board examinations. However, comparative accuracy of different LLMs and LLM performance on assessments of predominantly higher-order management questions is poorly understood. We aimed to assess the performance of 3 LLMs (GPT-3.5, GPT-4, and Google Bard) on a question bank designed specifically for neurosurgery oral boards examination preparation. The 149-question Self-Assessment Neurosurgery Examination Indications Examination was used to query LLM accuracy. Questions were inputted in a single best answer, multiple-choice format. χ 2 , Fisher exact, and univariable logistic regression tests assessed differences in performance by question characteristics. On a question bank with predominantly higher-order questions (85.2%), ChatGPT (GPT-3.5) and GPT-4 answered 62.4% (95% CI: 54.1%-70.1%) and 82.6% (95% CI: 75.2%-88.1%) of questions correctly, respectively. By contrast, Bard scored 44.2% (66/149, 95% CI: 36.2%-52.6%). GPT-3.5 and GPT-4 demonstrated significantly higher scores than Bard (both P < .01), and GPT-4 outperformed GPT-3.5 ( P = .023). Among 6 subspecialties, GPT-4 had significantly higher accuracy in the Spine category relative to GPT-3.5 and in 4 categories relative to Bard (all P < .01). Incorporation of higher-order problem solving was associated with lower question accuracy for GPT-3.5 (odds ratio [OR] = 0.80, P = .042) and Bard (OR = 0.76, P = .014), but not GPT-4 (OR = 0.86, P = .085). GPT-4's performance on imaging-related questions surpassed GPT-3.5's (68.6% vs 47.1%, P = .044) and was comparable with Bard's (68.6% vs 66.7%, P = 1.000). However, GPT-4 demonstrated significantly lower rates of "hallucination" on imaging-related questions than both GPT-3.5 (2.3% vs 57.1%, P < .001) and Bard (2.3% vs 27.3%, P = .002). Lack of question text description for questions predicted significantly higher odds of hallucination for GPT-3.5 (OR = 1.45, P = .012) and Bard (OR = 2.09, P < .001). On a question bank of predominantly higher-order management case scenarios for neurosurgery oral boards preparation, GPT-4 achieved a score of 82.6%, outperforming ChatGPT and Google Bard.

Towards Interactive Governance: Embedding Citizen Participation in Local Government

In this article, we explore the embedding of citizen participation in local government. Our study combines and synthesizes the focal aspects of two theoretical streams—citizen participation and interactive governance—in a novel way to identify, illustrate, and analyze the layers of governance required for citizen participation. The analysis shows how the institutional pervasiveness and holistic nature of citizen participation affects the strategic, executive, and citizen interface layers of governance and their interconnections. The research contributes to the literature on embedding citizen participation in government by emphasizing the need to address citizen participation as a profound question of governance and management.

The application of high-resolution vessel wall imaging in the in situ bypass surgeries for complex anterior cerebral artery aneurysms

ObjectiveComplex anterior cerebral artery (ACA) aneurysms are still technically challenging to treat. Bypass surgery is needed to achieve aneurysm obliteration and ACA territory revascularization. Severe atherosclerosis of aneurysm walls can cause clip slippage, intraoperative rupture, postoperative ischemic events. How to assess the atherosclerotic changes in vascular walls by high-resolution vessel wall magnitude resonance imaging (VWI) is the key question in complex ACA aneurysm surgical management. MethodsThis retrospective single-center study included eight patients diagnosed with complex anterior cerebral arteries admitted to our hospital for bypass surgery from January 2019 to April 2022. We discussed the application of VWI in aneurysms treated with in situ bypass and reviewed previous experience of revascularization strategies for complex ACA aneurysms. ResultsIn this study, we treated 8 cases of complex ACA aneurysms (3 communicating aneurysms/5 postcommunicating aneurysms) over the prior one year. In situ side-to-side anastomosis (1 A2-to-A2/6 A3-to-A3) was performed in seven cases, and trapping combined with excision was performed in another case. Following bypass, complete trapping was performed in 4 cases, and proximal clipping was performed in 3 cases. No surgery-related neurological dysfunctions were observed. The final modified Rankin scale was 0 in seven of the eight cases and 2 in one case. ConclusionHigh-resolution VWI, as a favorable preoperative assessment tool, provides insight into patient-specific anatomy and microsurgical options before operations, which can help neurosurgeons develop individualized and valuable surgical plans.

Video-based surgical curriculum for open-globe injury repair, VI: other trauma sequelae.

As one of the most severe forms of ocular trauma, open-globe injury (OGI) causes significant vision loss. Timely and meticulous repair of these injuries can improve patient outcomes. This video-based educational curriculum is intended to serve as an efficient yet comprehensive reference for OGI repair. We hope that these video-based articles help surgeons and trainees from around the world find answers to specific surgical questions in OGI management. The curriculum has been divided into six separate review articles, each authored by a different set of authors, to facilitate a systematic and practical approach to the subject of wound types and repair techniques. The sixth article highlights special considerations in the management of open-globe injuries and their sequelae, including management of traumatic cataracts and trauma to the iris.

Video-based surgical curriculum for open-globe injury repair, V: scleral wounds.

As one of the most severe forms of ocular trauma, open-globe injury (OGI) causes significant vision loss. Timely and meticulous repair of these injuries can improve patient outcomes. This video-based educational curriculum is intended to serve as an efficient yet comprehensive reference for OGI repair. We hope that these video-based articles help surgeons and trainees from around the world find answers to specific surgical questions in OGI management. The curriculum has been divided into six separate review articles, each authored by a different set of authors, to facilitate a systematic and practical approach to the subject of wound types and repair techniques. The fifth article highlights special considerations in the management of full-thickness scleral wounds during OGI repair.

Implementing a health-system–wide antibiotic stewardship program in ambulatory surgery centers

Background: In 2016, the CDC released the Core Elements of Outpatient Antibiotic Stewardship, which extended the requirements previously released for hospital facilities and nursing homes to the outpatient setting. Several regulatory agencies focused on outpatient antimicrobial use. However, The Joint Commission and the Ambulatory Surgery Center (ASC) Leapfrog Group excluded ambulatory surgery centers from their medication management standards and questions. Due to the public health and patient safety benefits of implementing an antimicrobial stewardship program (ASP) and increasing regulatory interest in the matter, the Hospital Corporation of America (HCA) Ambulatory Surgery Division formally launched a nationwide ASP for its ambulatory surgery centers in March 2021. Methods: HCA is a large healthcare system with 146 ASCs in 16 states in 2021. The structure of the ASCs are local surgery centers with a medical director, a nurse responsible for infection prevention, and a pharmacist at a regional level. The types of surgeries vary based on location and ASC site. In 2019, a multidisciplinary team formed the corporate planning committee. The program was modeled after the CDC Core Elements and The Joint Commission’s requirements for an ASP. Each ASC was asked to build a local ASP team, led by a local physician and a regionally based pharmacist. In addition, a stewardship goal was established to update all preoperative antibiotic surgical-site infection prophylaxis order sets. The corporate committee provided educational resources, including evidence-based guidelines for appropriate antibiotic selection for surgical-site infections. They collected antibiotic cost per case as a baseline metric to track and analyze. Pediatric, ophthalmic, and gastrointestinal endoscopic procedures were excluded from the program. Results: From January 1, 2020, through December 31, 2021, including only centers that were operational during this period and excluding single specialty endoscopy centers, antibiotic cost per case decreased annually from $2.38 to $1.84 (t = 4.157; P &lt; .005), and the postoperative infection rate also declined from 0.370 to 0.304 (t = 2.079; P = .040). Conclusions: Our findings suggest that implementing a health-system–wide outpatient antibiotic stewardship program in the ambulatory surgery center setting is feasible and may contribute to decreased antibiotic cost per case and improved postoperative surgical site infection rates.Disclosures: None

Detecting and analysing intraspecific genetic variation with eDNA: From population genetics to species abundance.

Advancements in environmental DNA (eDNA) approaches have allowed for rapid and efficient species detections in diverse environments. Although most eDNA research is focused on leveraging genetic diversity to identify taxa, some recent studies have explored the potential for these approaches to detect within-species genetic variation, allowing for population genetic assessments and abundance estimates from environmental samples. However, we currently lack a framework outlining the key considerations specific to generating, analysing and applying eDNA data for these two purposes. Here, we discuss how various genetic markers differ with regard to genetic information and detectability in environmental samples and how analysis of eDNA samples differs from common tissue-based analyses. We then outline how it may be possible to obtain species absolute abundance estimates from eDNA by detecting intraspecific genetic variation in mixtures of DNA under multiple scenarios. We also identify the major causes contributing to allele detection and frequency errors in eDNA data, discuss their consequences for population-level analyses and outline bioinformatic approaches to detect and remove erroneous sequences. This review summarizes the key advances required to harness the full potential of eDNA-based intraspecific genetic variation to inform population-level questions in ecology, evolutionary biology and conservation management.

A simulation model for predicting hospital occupancy for Covid-19 using archetype analysis

COVID-19 pandemic has sent millions of people to hospitals worldwide, exhausting on many occasions the capacity of healthcare systems to provide care patients required to survive. Although several epidemiological research works have contributed a variety of models and approaches to anticipate the pandemic spread, very few have tried to translate the output of these models into hospital service requirements, particularly in terms of bed occupancy, a key question for hospital managers. This paper proposes a tool for predicting the current and future occupancy associated with COVID-19 patients of a hospital to help managers make informed decisions to maximize the availability of hospitalization and intensive care unit (ICU) beds and ensure adequate access to services for confirmed COVID-19 patients. The proposed tool uses a discrete event simulation approach that uses archetypes (i.e., empirical models of trajectories) extracted from empirical analysis of actual patient trajectories. Archetypes can be fitted to trajectories observed in different regions or to the particularities of current and forthcoming variants using a rather small amount of data. Numerical experiments on realistic instances demonstrate the accuracy of the tool’s predictions and illustrate how it can support managers in their daily decisions concerning the system’s capacity and ensure patients the access the resources they require.

Business-nonprofit hybrid organizing: a dynamic approach to balancing benefits and costs.

Efforts to address complex public health challenges can benefit from cross-sector collaboration, while also fostering growing business sector engagement in promoting health equity. What form business-nonprofit collaboration should take, however, is a difficult question for managers and leaders. Hybrid organizational forms, which combine for-profit and nonprofit elements within a single organization in unconventional ways, offer an innovative and potentially promising approach. Yet, while existing typologies of cross-sector collaboration have identified hybrid forms at one end of a continuum of possible forms of collaboration, these typologies do not differentiate the diversity such hybrid forms may take, and the costs and benefits of these innovative hybrid forms are poorly understood. This leaves managers interested in promoting public health through business-nonprofit hybrid organizing with limited guidance about how to maximize potential merits while mitigating drawbacks. We performed a qualitative comparative case study of three examples of business-nonprofit hybrid organizing. Data collection included 113 interviews with representatives from 42 organizations and observation of case study activities. We used thematic analysis within and across cases to characterize the form of hybrid organizing in each case and to examine benefits and costs of different forms for supporting initiatives. We identified two hybrid, collaborative forms - Appended and Blended forms. Each form had benefits and costs, the significance of which shifted over time contingent on changing strategic priorities and operating environments. Benefits and costs of particular forms become more or less important for establishing and sustaining initiatives under different conditions, requiring a dynamic view. No particular form of business-nonprofit hybrid organizing is inherently better than another. Optimizing hybrid organizing and ensuring resilient collaborations may mean allowing collaborative forms to evolve. Practitioners can manage tradeoffs between benefits and costs through an ongoing process of assessing the fit between a given collaborative form, strategic priorities, and relevant features of the operating environment. This dynamic view offers important insights for ensuring the resilience of business-nonprofit collaborative efforts to enhance public health.

Of Newcomers and Supervisors: Ethical Issues in Supervising Newcomers in Qualitative Health Research

This contribution focuses on our experiences as lecturers and supervisors in qualitative healthcare research in medicine, public health research and sociology, and the role of research ethics in guiding students in their qualitative studies. We argue that students themselves are vulnerable during the transition of becoming a qualitative researcher and that reflection on research is essential. Therefore, the selection of a topic, potential role conflicts and questions of field contingencies management become crucial elements in both teaching and researching. We use qualitative case vignettes, as suggested by Langer, to offer a reflective account of our experience. Protecting students from harm and preventing them from inadvertently causing harm to others are of utmost importance to us. Through these vignettes, we aim to provide a nuanced and reflective view of our experiences in supervising qualitative research.

Performance of ChatGPT on a Radiology Board-style Examination: Insights into Current Strengths and Limitations.

Background ChatGPT is a powerful artificial intelligence large language model with great potential as a tool in medical practice and education, but its performance in radiology remains unclear. Purpose To assess the performance of ChatGPT on radiology board-style examination questions without images and to explore its strengths and limitations. Materials and Methods In this exploratory prospective study performed from February 25 to March 3, 2023, 150 multiple-choice questions designed to match the style, content, and difficulty of the Canadian Royal College and American Board of Radiology examinations were grouped by question type (lower-order [recall, understanding] and higher-order [apply, analyze, synthesize] thinking) and topic (physics, clinical). The higher-order thinking questions were further subclassified by type (description of imaging findings, clinical management, application of concepts, calculation and classification, disease associations). ChatGPT performance was evaluated overall, by question type, and by topic. Confidence of language in responses was assessed. Univariable analysis was performed. Results ChatGPT answered 69% of questions correctly (104 of 150). The model performed better on questions requiring lower-order thinking (84%, 51 of 61) than on those requiring higher-order thinking (60%, 53 of 89) (P = .002). When compared with lower-order questions, the model performed worse on questions involving description of imaging findings (61%, 28 of 46; P = .04), calculation and classification (25%, two of eight; P = .01), and application of concepts (30%, three of 10; P = .01). ChatGPT performed as well on higher-order clinical management questions (89%, 16 of 18) as on lower-order questions (P = .88). It performed worse on physics questions (40%, six of 15) than on clinical questions (73%, 98 of 135) (P = .02). ChatGPT used confident language consistently, even when incorrect (100%, 46 of 46). Conclusion Despite no radiology-specific pretraining, ChatGPT nearly passed a radiology board-style examination without images; it performed well on lower-order thinking questions and clinical management questions but struggled with higher-order thinking questions involving description of imaging findings, calculation and classification, and application of concepts. © RSNA, 2023 See also the editorial by Lourenco et al and the article by Bhayana et al in this issue.