Medical Preparedness Research Articles

Extremity War Injury Symposium 2024: Sports Medicine and Medical Readiness Section Summary

Collaboration between military and civilian investigators is necessary to develop strategies for optimizing treatments to diminish the sequelae of non–battle-related musculoskeletal injuries, which are highly prevalent among servicemembers. The 2024 Extremity War Injuries Symposium provided a forum whereby a diverse group of clinicians and researchers could develop strategies for optimizing treatments and diminishing the sequelae of conditions that are highly prevalent among active individuals. Key points were as follows: 1. The value of collaborations between military and civilian investigators cannot be overemphasized. These synergies can leverage the capabilities of established infrastructures in order to answer important questions pertaining to short-term outcomes—for example, warrior readiness of anterior cruciate ligament reconstructions among servicemembers and long-term posttraumatic osteoarthritis (PTOA) outcomes among civilian cohorts. 2. Current and future prospective trials will inform future treatment decisions related to multiligamentous knee injuries and glenohumeral instability. 3. Novel approaches to addressing PTOA in the acute postinjury period will need longitudinal surveillance to measure their impact on improving clinical outcomes and diminishing residual functional deficits.

Dental Emergency Rates at an Expeditionary Medical Facility Supporting Operation Inherent Resolve.

A core objective of U.S. medical services is to ensure the medical and dental readiness of military personnel. Oral diseases, resulting in pain, infection, or functional impairment, greatly affect the operational effectiveness of military personnel. This study aimed to compare the current causes of dental emergencies and the rates of dental disease nonbattle injuries in a deployed setting with those documented in previous research. Additionally, the study sought to determine if these rates have decreased because of preventive measures or potential improvements in overall oral health. Each soldier reporting to the health facility for dental care was screened by a dentist to determine the presence of a dental emergency. The reason for seeking care was classified into 1 of 7 categories and the rate of dental emergencies per 1,000 military members per calendar year was calculated. The majority of emergencies (38.60%) were due to tooth fractures and/or caries. The second most common reason for visiting the dental clinic was pain from a tooth requiring endodontic therapy (16.81%). This was followed by musculoskeletal or nonendodontic tooth pain (16.10%), most often associated with stress. Periodontal issues accounted for 14.33% of emergencies. Teeth requiring extraction made up 7.16% of all emergencies, prosthodontic bonding complications accounted for 5.16%, and orthodontic bonding complications affected 1.84% of individuals. The dental disease nonbattle injuries rates determined from the current study were 154 emergencies per 1,000 personnel per year for Air Force members and 264 emergencies per 1,000 personnel per year for Army members, which align with previous research findings. The results of this study confirm that dental emergencies continue to be a threat to overall readiness in deployed environments. The primary etiologic factor in the current study was as a result of tooth fracture and/or caries.

Paederus Dermatitis: Two Outbreaks of an Entomologic Disease in Austere Expeditionary Care.

Paederus dermatitis, also known as dermatitis linearis, is an acute cutaneous condition caused by contact with the potent vesicant toxin paederin, produced by endosymbiotic Pseudomonas-like bacteria within Paederus spp. beetles. Paederin is a protein synthesis inhibitor that halts cell division, leading to vesiculation and necrotic breakdown of the epidermis. The resultant damage facilitates secondary infection, especially in austere conditions. Between October 2022 and July 2023, several US special operations teams forward deployed to various countries in East Africa reported over 17 cases of painful, blistering skin eruptions consistent with Paederus dermatitis, 2 of which are summarized in this report. To confirm the best treatment approach, 1 team's medic reached back to a deployed infectious disease physician in the same Combatant Command as well as through the DoD ADVISOR line to a dermatologist in the United States. All cases were managed with irrigation, followed by a combination of topical steroid and antibacterial ointments, with resolution occurring after 3 to 7 days, whereas 38% of the cases in July 2023 developed secondary cellulitis by day 7, requiring oral antibiotic treatment. Strict preventative measures were implemented to limit exposure while carefully observing each case, as this was critical to optimize medical readiness of the team. Ultimately, we seek to highlight the identification of beetles specific to East Africa, seasonal prevalence, and the importance of preventative measures as they vary depending on specific beetle characteristics. Additionally, we reiterate classic presentation features that help avoid misdiagnosis for cases that occur outside of the typical epidemiologic criteria.

Energy expenditure during physical work in cold environments: physiology and performance considerations for military service members.

Effective execution of military missions in cold environments requires highly trained, well-equipped, and operationally ready service members. Understanding the metabolic energetic demands of performing physical work in extreme cold conditions is critical for individual medical readiness of service members. In this narrative review, we describe 1) the extreme energy costs of performing militarily relevant physical work in cold environments, 2) key factors specific to cold environments that explain these additional energy costs, 3) additional environmental factors that modulate the metabolic burden, 4) medical readiness consequences associated with these circumstances, and 5) potential countermeasures to be developed to aid future military personnel. Key characteristics of the cold operational environment that cause excessive energy expenditure in military personnel include thermoregulatory mechanisms, winter apparel, inspiration of cold air, inclement weather, and activities specific to cold weather. The combination of cold temperatures with other environmental stressors, including altitude, wind, and wet environments, exacerbates the overall metabolic strain on military service members. The high energy cost of working in these environments increases the risk of undesirable consequences, including negative energy balance, dehydration, and subsequent decrements in physical and cognitive performance. Such consequences may be mitigated by the application of enhanced clothing and equipment design, wearable technologies for biomechanical assistance and localized heating, thermogenic pharmaceuticals, and cold habituation and training guidance. Altogether, the reduction in energy expenditure of modern military personnel during physical work in cold environments would promote desirable operational outcomes and optimize the health and performance of service members.

Enabling efficient patient discharge with a mindset, toolset, and skillset framework.

33 Background: Timely access to care for patients coming through the emergency center can be achieved by efficiently discharging patients. When continued bed growth is not sustainable, improvements in team-based approaches to discharges are necessary and require a multi-pronged approach. Our institution embarked on a process improvement effort anchored on completing 1 out of 2 patients discharged by 12PM. We hypothesize that a discharge before noon will assist with getting our next patient to a bed by 2PM. We conducted a pilot on our Stem Cell Transplant units to test and enable our case for change allowing for scale and spread to other units. Methods: Our multi-pronged framework was focused on mindset, toolset, and skillset. As our first step, executive leadership set direction to achieve a shift in mindset by socializing the case for change using a hospital throughput framework including a 9-12-2 branding. A discharge launchpad [toolset] was established to define expectations of discharge tasks including accountability within a 2-day window of medical readiness for discharge. This served as the tool aligning various teams to a date for task completion. Lastly, we evaluated skillset and defined best practices for the unit RN role and APP, along with others, which included empowering various roles to discharge patients. Results: For discharges during the baseline period of 12/1/2022 - 11/30/2023 from the Stem Cell Transplant service, the percent of discharge orders in by 9AM was 10.3% and discharges completed by 12PM was 12.2%. The pilot period month of April 2024 resulted in a month close performance of 52.5% for orders in by 9AM and 55.4% of patients discharged by 12PM. The average time spent by Stem Cell patients boarding in our emergency center during the baseline period was 6 hours and 34 minutes with a reduction to 2 hours and 23 minutes in April 2024. There were no Stem Cell beds added during the pilot period compared to baseline. The period of 12/1/2023 – 3/31/2024 was excluded to limit any improving data from the Hawthorne effect since throughput socialization began during those months. Conclusions: We met the goal within one month with plans underway to assess sustainability for implementation readiness for scale and spread to other units. Early efforts made to scale this model within the institution confirm the multi-pronged model approach is necessary. Additionally, we believe that a frontline leadership model would contribute best to implementation success. Missing any component of the multi-pronged approach or team member, such as the APP role without the RN role, will not yield the ultimate result of discharging patients by noon. This change requires a coordinated, team-based approach. The new institutional governance structure for hospital throughput, including academic and operational departments, and a logistics center in the future may contribute to building trust in leadership’s commitment to improving patient care.

Readiness, knowledge, and perception towards artificial intelligence of medical students at faculty of medicine, Pelita Harapan University, Indonesia: a cross sectional study

IntroductionArtificial intelligence (AI) enables machines to perform many complicated human skills which require various levels of human intelligence. In the field of medicine, AI helps physicians in making diagnoses and treatments for patients with more efficiency, accuracy, and precision. In order to prepare medical students who are the future healthcare workforce, it is important to enhance their readiness, knowledge and perception toward AI. This study aims to assess Pelita Harapan University (PHU) medical students’ readiness, knowledge, and perception toward AI.MethodsA quantitative cross-sectional study was conducted to assess respondents’ readiness, knowledge and perception toward AI. An online questionnaire was distributed via Google Forms to all batch of medical students. Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS) questionnaire was used to evaluate AI readiness, while an adapted questionnaires was used to evaluate knowledge and perception toward AI. Data were then analyzed using IBM Statistical Package for Social Sciences (SPSS) version 23.0.ResultsA total of 650 respondents were included in this study. Most respondents were in pre-clinical phase (88%) while the remaining were in clinical phase (12%). Overall, the total mean score for AI readiness was 73.34 of 100. Respondents had a mean score 24.52 ± 5.26 of 40, 27.78 ± 4.65 of 40, 10.57 ± 2.07 of 15, and 10.47 ± 2.00 of 15 in the cognitive, ability, vision, and ethics domain respectively. Generally, respondents had sufficient knowledge and positive perception toward AI. There were also significant correlation between readiness and knowledge with gender, having studied coding previously in high school, and having family or close friends working in AI field. Social media also had a good influence on enchancing readiness in the domain of ability and ethics, and perception towards AI.ConclusionMedical students of PHU mostly showed neutral to favorable response on readiness, knowledge, and perception towards AI. Incorporating AI into high school and medical curriculum is an important step to prepare medical students’ encounter and partnership with AI as the future workforce in medicine.

On-call simulation: Evaluating cost and impact.

On-call simulation has been shown to improve the confidence of prospective junior doctors in undertaking on-call shifts. Despite this, it is not mandated in UK medical school curricula, leading to variations in provision. Barriers to widespread implementation may include doubts surrounding effectiveness, feasibility of delivering on-call simulation across multiple sites and unknown costs. To address these gaps in the literature, we designed and implemented a multi-site on-call simulation programme. We aimed to evaluate it both educationally, using student preparedness to complete on-call shifts as our outcome, and economically, by performing a cost-outcome description. An on-call simulation programme, 'Bleep 101', was developed and implemented at eight hospitals. Students were 'bleeped' around a circuit of written scenarios including clinical emergencies, prescribing and distractor tasks. Students could escalate to their facilitator on the phone for advice at any time. Sessions concluded with a 30-minute debrief focusing on prioritisation and communication skills. Between 2018 and 2023, 217 students took part and completed feedback forms. Post-session feedback using Likert scales demonstrated a significant increase in preparedness to complete an on-call shift (pre-4/10, post-7/10, p < 0.01) with outcomes consistent across sites. A cohort of 20 students completed paired pre- and post-session feedback to evaluate the impact of the session on specific skills. This demonstrated increased confidence in using a bleep, prioritisation, gathering information and handing over. The costs of implementation at one site were reported, demonstrating a cost of £1.99/student/year or £99.48/student/year excluding costs saved by volunteers and room hire. This study indicates that on-call simulation can be delivered at a low cost using existing medical education infrastructure within hospitals. Results suggested an improvement in medical students' preparedness for on-call practice. We therefore recommend on-call simulation be available to all medical students as part of medical school curricula.

Differences in Musculoskeletal Injury and Disability Rates in U.S. Navy Sailors Aboard Aircraft Carrier and Amphibious Assault Ships.

Musculoskeletal injuries (MSKI) are the most common clinical condition in the military that affect medical readiness. Evaluation of MSKI burden and the effects of these injuries on readiness in large deck Navy ships is warranted. A retrospective cohort study assessing population-level MSKI rates, short-term disability (restricted duty), and long-term disability episode counts of all Sailors assigned to U.S. Navy Aircraft Carriers (CVNs) and Amphibious Assault Ships (LHA/LHD) from November 2016 to February 2023 was extracted from the Musculoskeletal Naval Epidemiological Surveillance Tool. A negative binomial regression and general additive (Gaussian) models evaluate the association of ship platform, deployment status, days underway, and sex with MSKI rates and the proportion of cases that resulted in short-term disability, returned-to-duty following restricted duty, or progressed to long-term disability. Sailors attached to CVNs contributed a mean 17,893.8 ± 23,280.6 person-months, with those attached to LHA/LHDs contributing an average 5,981.8 ± 8,432.7 person-months. Aboard CVNs, MSKI occurred at a rate of 0.30 ± 0.16/1,000 person-months while deployed and 0.64 ± 0.31/1,000 person-months in homeport. Aboard LHA/LHDs, Sailors incurred MSKI at a rate of 0.59 ± 0.58/1,000 person-months while on deployment and 1.24 ± 0.68/1,000 person-months in homeport. Among Sailors aboard CVNs, short-term disability occurred in 7.95 ± 7.75% of MSKI cases while deployed and 5.13 ± 5.26% while in homeport. Aboard LHA/LHDs, 8.57 ± 13.42% of MSKI cases were placed on short-term disability while deployed and 4.95 ± 5.27% while in homeport. In the multivariable assessment of short-term disability, being deployed underway was a significant factor (B = 3.62 P = .03, variance explained = 3.86%). Sailors that were female and served aboard LHA/LHDs returned to full duty at a significantly greater frequency compared to their male counterparts and Sailors serving aboard CVNs. None of the independent variables evaluated were associated with long-term disability. The findings in the current study demonstrate the substantial burden of MSKI aboard large deck ships, both in homeport and while deployed. Inclusion of a physical therapist aboard LHA/LHDs, like the CVN, may help to prevent and mitigate the effects of MSKI through early access to specialized care and integral injury prevention and performance optimization methods.

Medical Students' Readiness for Prescription Communication Skills Training: A Needs Assessment Study.

Background and objectives The quality of doctor-patient communication plays a crucial role in determining positive medical outcomes. Medical educators may be able to develop effective programs to orient the students toward learning communication skills with the aid of assessment of the attitude of medical students toward such learning. Recently, the National Medical Commission's updated syllabus strongly emphasized on the value of training in prescription communication skills (PCS), in pharmacology. Our study utilizes the Communication Skills Attitude Scale (CSAS) to explore medical students' attitudes toward learning PCS in a private medical college, aiming to address the dearth of data in the Indian context. Methodology This cross-sectional study assessed the attitudes of 131 second-year medical students at Adichunchanagiri Institute of Medical Sciences toward PCS training. Validated, 26-item CSAS was used to measure their attitudes which include 13 items of Positive Attitude Scale (PAS) and 13 items of Negative Attitude Scale (NAS), and data analysis was conducted using independent t-tests to explore potential associations based on socio-demographic factors. Results The study scale showed an acceptable internal consistency of 0.71 (Cronbach's alpha) with 0.92 and 0.76 for PAS and NAS, respectively. The overall mean PAS score and NAS score were 54.2±6.9 and 34.7±6.3, respectively, indicating that the majority of students recognized the significance of communication skills for their future medical practice. Male students had significantly lower PAS scores (52.1±7.4) compared to female students (55±6.6) (p=0.02). Students with a rural background had significantly higher PAS scores (56.2±6.1) (p=0.01) compared to those with an urban background (53.2±9.8). No significant association was seen with demographic parameters like schooling background, presence of doctors in the family, and mother tongue they spoke. Conclusion The study revealed that second-year medical students had a strong inclination toward learning PCS. Therefore, greater emphasis should be placed on providing adequate training in PCS to the students to ensure effective doctor-patient interactions.

The Impact of Pregnancy Readiness on Lupus Activity, Maternal Mental Health, and Pregnancy Outcomes.

Among individuals with systemic lupus erythematosus (SLE) who became pregnant, we explored the impact of medical readiness for pregnancy and personal readiness for pregnancy on the following aspects of maternal health: (1) provider-reported disease activity, (2) patient-perceived disease activity, (3) mood symptoms, (4) pregnancy-related health behaviors, and (5) pregnancy outcomes. All study participants were enrolled in a prospective registry, met Systemic Lupus Collaborating Clinics (SLICC) criteria for SLE, and had at least one pregnancy. Patient-reported outcomes were collected at the first rheumatology visit during pregnancy. "Medically ready" for pregnancy was defined as (1) <1 g of proteinuria, (2) no rheumatic teratogens at conception, and (3) continuing pregnancy-compatible SLE medications after conception. "Personally ready" was defined as planned pregnancy based on a London Measure of Unplanned Pregnancy score ≥10. Multivariable logistic regression models estimated the association of pregnancy readiness with each outcome of interest. Among the 111 individuals enrolled, lack of medical readiness for pregnancy was associated with significantly higher rates of active disease and worse pregnancy outcomes; however, these patients did not perceive themselves as having higher disease activity. Lack of personal readiness for pregnancy was associated with significantly higher patient-perceived disease activity. Although medical readiness did not impact depressive symptoms substantially, lack of personal readiness for pregnancy was associated with much higher maternal depressive symptoms. To improve pregnancy outcomes among individuals with SLE, greater focus is needed on improving medical optimization before conception. For maternal mental health and quality of life, greater focus is needed on decreasing the incidence of unplanned pregnancy.

Examining the influence of team-based learning on medical students' comprehension and attitudes regarding psychedelic therapies.

This study evaluates the impact of a two-hour team-based learning (TBL) curriculum on medical students' knowledge, comprehension, ethical understanding, and attitudes towards psychedelic therapies. Sixty-three pre-surveys and fifty post-surveys assessed students' perceived knowledge and attitudes using Likert scales. Forty-eight matched pre/post-knowledge tests with multiple-choice questions quantified changes in comprehension. The TBL approach featured independent learning, team readiness assessments, and application exercises. Post-curriculum, students demonstrated significantly improved test scores (mean 41.4% increase, p < 0.0001) and more positive attitudes across 16 of 18 items (p ≤ 0.0495). Overall attitude scores increased 23% (p < 0.0001). Qualitative feedback reflected enhanced comfort discussing psychedelics clinically. While some students expressed support for psychedelic-assisted therapy, others cited reservations. This innovative curriculum bridged an important education gap given the increasing relevance of psychedelic medicine. Findings suggest TBL enhances medical student preparedness in this emerging field. Continued curricular development is warranted to ensure proper psychedelic education aligns with patient needs and legislative policies. As psychedelic research progresses, maintaining instructional excellence is crucial for future healthcare professionals.

Embracing the Future of Health Care: Investigating Medical Students' Willingness to Become Online Doctors.

Purpose: With the rapid advancement of technology, online health care services are becoming increasingly prominent. This study aims to investigate medical students' perceptions, attitudes, and readiness to adopt online health care services. Methods: Based on a literature review, this study constructed a conceptual model describing the relationships among medical students' perception, personality traits, and usage intention, grounded in the Technology Acceptance Model and Technology Readiness Index (TRI). The data for this study were collected from January to February 2023 through a questionnaire survey at Wenzhou Medical University, China. The proposed hypotheses were tested using structural equation modeling through AMOS software. Results: Out of the 340 respondents, 281 (82.6%) validly responded. Among these, 58.4% of medical students agreed and strongly agreed with the intention to become an online doctor. Within the TRI's motivational factors, optimism positively and significantly affected perceived usefulness (PU) and perceived ease of use (PEOU). Innovativeness also significantly enhanced PEOU. Among the inhibitory factors, insecurity was found to have a negative and statistically significant influence on PU. The rest of the dimensions did not have a significant effect on either PU or PEOU. Importantly, both PU and PEOU demonstrated a direct and substantial effect on usage intention. Conclusions: This study emphasizes the significance of comprehending medical students' readiness to adopt the role of online doctors in shaping the future of health care. By equipping medical students with the necessary skills and competencies, health care institutions can effectively leverage the full potential of online health care services while ensuring the provision of high-quality, accessible, and patient-centered care in the digital era.

Disease and Non-Battle Injury in Deployed Military: A Systematic Review and Meta-analysis.

Disease and non-battle injury (DNBI) has historically been the leading casualty type among service members in warfare and a leading health problem confronting military personnel, resulting in significant loss of manpower. Studies show a significant increase in disease burden for DNBI when compared to combat-related injuries. Understanding the causes of and trends in DNBI may help guide efforts to develop preventive measures and help increase medical readiness and resiliency. However, despite its significant disease burden within the military population, DNBI remains less studied than battle injury. In this review, we aimed to evaluate the recently published literature on DNBI and to describe the characteristics of these recently published studies. This systematic review is reported in the Prospective Register of Systematic Reviews database. The systematic search for published articles was conducted through July 21, 2022, in Cumulative Index of Nursing and Allied Health, Cochrane Library, Defense Technical Information Center, Embase, and PubMed. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses, the investigators independently screened the reference lists on the Covidence website (covidence.org). An article was excluded if it met any of the following criteria: (1) Published not in English; (2) published before 2010; (3) data used before 2001; (4) case reports, commentaries, and editorial letters; (5) systematic reviews or narrative reviews; (6) used animal models; (7) mechanical or biomechanical studies; (8) outcome was combat injury or non-specified; (9) sample was veterans, DoD civilians, contractors, local nationals, foreign military, and others; (10) sample was U.S. Military academy; (11) sample was non-deployed; (12) bioterrorism study; (13) qualitative study. The full-text review of 2 independent investigators reached 96% overall agreement (166 of 173 articles; κ = 0.89). Disagreements were resolved by a third reviewer. Study characteristics and outcomes were extracted from each article. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis of pooled estimates of incidence rates for disease (D), non-battle injury (NBI), and combined DNBI was created using random-effects models. Of the 3,401 articles, 173 were included for the full review and 29 (16.8%) metall inclusion criteria. Of the 29 studies included, 21 (72.4%) were retrospective designs, 5 (17.2%) were prospective designs, and 3 (10.3%) were surveys. Across all studies, the median number of total cases reported was 1,626 (interquartile range: 619.5-10,203). The results of meta-analyses for 8 studies with reported incidence rates (per 1,000 person-years) for D (n = 3), NBI (n = 7), and DNBI (n = 5) showed pooled incidence rates of 22.18 per 1,000 person-years for D, 19.86 per 1,000 person-years for NBI, and 50.97 per 1,000 person-years for combined DNBI. Among 3 studies with incidence rates for D, NBI, and battle injury, the incidence rates were 20.32 per 1,000 person-years for D, 6.88 per 1,000 person-years for NBI, and 6.83 per 1,000 person-years for battle injury. DNBI remains the leading cause of morbidity in conflicts involving the U.S. Military over the last 20 years. More research with stronger designs and consistent measurement is needed to improve medical readiness and maintain force lethality. Systematic Review and Meta-Analysis, Level III.

Exposome Signatures of Gastrointestinal Disorders Among Active Duty Service Members.

We evaluated the risk factors associated with gastrointestinal disorders (GD) among the soldiers of the Army and Marine Aviation community (AMAC) using an exposomic approach. Specifically, we aimed to determine the medical and operational factors associated with reported GD in the Military Health System. Longitudinal data were obtained from the Medical Assessment and Readiness System (MARS) housed at Womack Army Medical Center, Fort Liberty, NC, for a retrospective cohort study that included 79,249 active duty United States AMAC active duty service members (ADSMs) from October 2015 to December 2019. Multivariable mixed-effects logistic regression was used to assess the relationship between the incidence occurrence of GD and variables including rank, service time, deployment, Armed Forces Qualification Test score, education, tobacco use, alcohol use, age, gender, race, ethnicity, body mass index (BMI), and marital status. The incidence of GD included 22,813 person-years of observations with a rate of 2.2 per 100 person-years and a period prevalence of 3.2%. GD was independently associated with rank, service time, and deployment (all P < 0.05). The high-risk categories associated with GD in the AMAC included age, BMI, race (not ethnicity), marital status, and service time. Our data also show that deployment time, not geographical location, was associated with a higher risk of GD. Together, these analyses suggest that White ADSMs older than 33 years of age who have experienced marriage, longer service time, and deployments appear to have a higher risk of GDs. Our assessment shows the utility of using an exposomic approach to create a member-specific, big data-informed personalized clinical algorithm of health outcomes.

Assessment Study of ChatGPT-3.5's Performance on the Final Polish Medical Examination: Accuracy in Answering 980 Questions.

The use of artificial intelligence (AI) in education is dynamically growing, and models such as ChatGPT show potential in enhancing medical education. In Poland, to obtain a medical diploma, candidates must pass the Medical Final Examination, which consists of 200 questions with one correct answer per question, is administered in Polish, and assesses students' comprehensive medical knowledge and readiness for clinical practice. The aim of this study was to determine how ChatGPT-3.5 handles questions included in this exam. This study considered 980 questions from five examination sessions of the Medical Final Examination conducted by the Medical Examination Center in the years 2022-2024. The analysis included the field of medicine, the difficulty index of the questions, and their type, namely theoretical versus case-study questions. The average correct answer rate achieved by ChatGPT for the five examination sessions hovered around 60% and was lower (p < 0.001) than the average score achieved by the examinees. The lowest percentage of correct answers was in hematology (42.1%), while the highest was in endocrinology (78.6%). The difficulty index of the questions showed a statistically significant correlation with the correctness of the answers (p = 0.04). Questions for which ChatGPT-3.5 provided incorrect answers had a lower (p < 0.001) percentage of correct responses. The type of questions analyzed did not significantly affect the correctness of the answers (p = 0.46). This study indicates that ChatGPT-3.5 can be an effective tool for assisting in passing the final medical exam, but the results should be interpreted cautiously. It is recommended to further verify the correctness of the answers using various AI tools.

Assessing Corpsmen Training Needs: Enhanced Medical Readiness in the Indo-Pacific for Near Peer.

Naval operations rely on Corpsmen to provide combat casualty and primary care services to the fleet, including the Fleet Marine Force. The United States faces new conflict challenges with near-peer adversaries in the modern geo-political climate. Corpsmen will likely require new skills to care for patients in anti-access/area-denial regions and transport patients across expansive maritime environments. To help them adapt to these new challenges, we evaluated the need for Corpsmen curriculum reform at the III Marine Expeditionary Force (MEF). This model begins with a general needs assessment to target gaps between the current and ideal approaches identified by the stakeholders. We identified 4 primary stakeholders within the Fleet Marine Force community: Marine Commanders (Society), Marines receiving treatment (Patients), Corpsmen providing care (Health Care Workers), and medical providers supervising Corpsmen (Medical Educators). We invited all ranks from III MEF to participate. The participants were interviewed in a mixture of focus groups and individual interviews in conversational and open-ended discussions. Transcripts of these discussions were analyzed and inductively coded using principles of grounded theory to identify prevailing themes that connected across interviews. The study was exempted by the Institutional Review Board at Naval Medical Center San Diego and Headquarters Marine Corps. The study involved 47 participants, including all stakeholders in III MEF and ranks from E1 through general officers. Through interviews and focus groups, 4 key themes emerged regarding Corpsmen's education: "Training," "Tasking," "Performance," and "Impact". "Training" discussions covered formal education, including gaps in basic training and the applicability of skills in civilian settings. "Tasking" examined daily responsibilities and equipment needs, such as teaching roles and first-responder care. "Performance" highlighted the quality of care and challenges in maintaining skills amid non-clinical tasks. Lastly, "Impact" assessed Corpsmen's influence on mission success and job satisfaction, revealing positive and negative perceptions among participants regarding their role and career prospects. The discussion emphasizes the importance of contextual factors in developing a Corpsmen-based curriculum, focusing on themes such as Training, Performance, and Impact. Tasking highlights critical areas for curriculum development, especially in educating Corpsmen as Educators, Leaders, and First-responder Caregivers. Gaps in training were identified, particularly in Non-trauma and First-responder Care, impacting Corpsmen's ability to handle diseases and injuries independently. Drawing parallels with Community Health Worker and Physician Extender (PE) education paradigms, we suggest adapting existing models to meet Corpsmen's needs. The discussion also delves into the history of employing PEs and developing training programs within the Naval Service. We propose a combination of Community Health Worker and PE-based education to enhance Corpsmen's competency and job satisfaction while facilitating their transition to civilian health care. Standardized curricula and training programs could improve skill transferability and readiness for Corpsmen in both military and civilian settings.

CALMER Conflict: A Novel Curriculum for Graduating Medical Students to Manage and Defuse Patient-Provider Conflict.

Workplace violence disproportionately affects healthcare workers and verbal aggression from patients frequently occurs. While verbal de-escalation is the first-line approach to defusing anger, there is a lack of consistent curricula or robust evaluation in undergraduate medical education. To develop a medical school curriculum focused on de-escalation skills for adult patients and evaluate effectiveness with surveys and an objective structured clinical examination (OSCE). We implemented this curriculum in the "Get Ready for Residency Bootcamp" of a single large academic institution in 2023. Forty-four fourth-year medical students PROGRAM DESCRIPTION: The curriculum consisted of an interactive didactic focused on our novel CALMER framework that prioritized six evidence-based de-escalation skills and a separate standardized patient practice session. The post-curriculum survey (82% response rate) found a significant increase from 2.79 to 4.11 out of 5 (p ≤ 0.001) in confidence using verbal de-escalation. Preparedness improved with every skill and curriculum satisfaction averaged 4.79 out of 5. The OSCE found no differences in skill level between students who received the curriculum and those who did not. This evidence-based and replicable de-escalation skill curriculum improves medical student confidence and preparedness in managing agitated patients.

Strengthening Military Medical Provider Readiness: A Comprehensive Examination of VHA-MHS Partnerships.

Military medical readiness, particularly in surgical specialties, remains a significant concern within the Military Health System (MHS). While initiatives like the U.S. Army Military-Civilian Trauma Team (AMCT3) Program have addressed some readiness gaps, they primarily focus on trauma care, leaving other crucial medical specialties underserved. Leveraging partnerships between the Department of Veterans Affairs (VA) and the Defense Health Agency (DHA) emerges as a strategic approach to address these challenges comprehensively. Further collaboration between the VA and MHS is an opportunity to enhance military medical provider readiness, covering expanded medical specialties and health care personnel. By utilizing resource-sharing agreements (RSAs) and the Joint Incentive Fund (JIF), opportunities for increased collaboration and interoperability between the VA and MHS are explored. Challenges such as maintaining partnerships, addressing billing issues, and navigating local-level politics are identified, with proposed solutions, including establishing a centralized interagency office to monitor and manage specialty care partnerships. A comprehensive approach to enhancing military medical provider readiness through VA-MHS partnerships is crucial. By addressing readiness gaps and optimizing resource utilization, such collaboration would likely improve the overall readiness of the medical force, benefiting both military and veteran patient populations.

Utilization of antiobesity medications within the Military Health System.

The prevalence of overweight and obesity among beneficiaries of the Military Health System (MHS) is 41.6% and 30.5%, respectively. This incurs significant medical, fiscal, and military readiness costs. It is not currently known how the utilization of antiobesity medications (AOMs) within the MHS compares with that in the Veterans Health Administration or the private sector. Our aim was to assess the utilization of AOMs within the MHS. A cross-sectional study was conducted using data gathered from the MHS Data Repository and the inclusion of all adult TRICARE Prime and Plus beneficiaries ages 18 to 64 years who were prescribed at least one TRICARE-approved AOM during the years 2018 to 2022. The total study population included 4,414,127 beneficiaries, of whom 1,871,780 were active-duty service members. The utilization of AOMs among the eligible population was 0.56% (0.44% among active-duty personnel). Liraglutide was the most-prescribed AOM (36% of the total). Female sex, age greater than or equal to 30 but less than 60 years, and enlisted or warrant officer rank were all associated with statistically significant higher odds of receiving AOMs. Comparable with the US private sector, the MHS significantly underutilizes AOMs, including among active-duty service members, despite coverage of AOMs since 2018.

Artificial Intelligence Readiness, Perceptions, and Educational Needs Among Dental Students: A Cross-Sectional Study.

With Artificial Intelligence (AI) profoundly affecting education, ensuring that students in health disciplines are ready to embrace AI is essential for their future workforce integration. This study aims to explore dental students' readiness to use AI, perceptions about AI in health education and healthcare, and their AI-related educational needs. A cross-sectional survey was conducted among dental students at the College of Dental Medicine, Qatar University. The survey assessed readiness for AI using the Medical Artificial Intelligence Readiness Scale (MAIRS). Students' perceptions of AI in healthcare and health education and their educational needs were also explored. A total of 94 students responded to the survey. AI readiness scores were average (3.3 ± 0.64 out of 5); while participants appeared more ready for the vision and ethics domains of MAIRS, they showed less readiness regarding cognition and ability. Participants scored average on AI perceptions (3.35 ± 0.45 out of 5), with concerns regarding AI risks and disadvantages. They expressed a high need for knowledge and skills related to AI use in healthcare (84%), AI for health-related research (81.9%), and AI in radiology and imaging procedures (79.8%). Student readiness had a significant correlation with AI perceptions and perceived level of AI knowledge. This is the first study in Qatar exploring dental students' AI readiness, perceptions, and educational needs regarding AI applications in education and healthcare. The perceived AI knowledge gaps could inform future curricular AI integration. Advancing AI skills and deepening AI comprehension can empower future dental professionals through anticipated advances in the AI-driven healthcare landscape.