Management Questions Research Articles

Toward an improved causal test of network effects: Does alliance network position enhance firm innovation?

AbstractResearch SummaryAssessing whether network position causes firm outcomes is difficult because networks result from firms' strategic choices. To address this issue, we develop a research design that separates self‐driven network change from other‐driven change. Because other‐driven change suppresses the focal firm's agency, outcomes resulting from it can be interpreted as causal—under verifiable assumptions. We apply this method to reassess whether alliance network position affects firm innovation. Using data from the biotechnology industry, we find that structural holes (but not closure) increase firm innovation when self‐driven network change is involved but not when other‐driven change is involved. This raises two possibilities: network effects spuriously capture unobservable firm characteristics or network theories must be updated to account for agency.Managerial SummaryWe examine a crucial question for managers making decisions about alliance networks: Does a firm's position in its alliance network drive innovation, or is it a reflection of the firm's inherent qualities? Our research explores this question by examining network changes outside a firm's control. We find that bridging disconnected partners (structural holes) enhances innovation, but only when firms actively create these positions and not when these positions result from others' actions. Our findings suggest that network position alone does not drive innovation. Acknowledging that network position, per se, is not advantageous provides nuanced insight to better guide managerial decisions.

Holding Stakes in Water Management and Irrigation in Morocco : PIM policy Effects

The main policy reforms concerning irrigation management in Morocco over the last thirty years have been the introduction of mechanisms aimed at achieving financial autonomy of the Administration in charge of irrigation systems managemement -Offices Régionaux de Mise en Valeur Agricoles (ORMVA)- by applying appropriate water pricing and involvement of water users in the operation and maintenance of their irrigation systems, by transferring some responsibilities to water users' associations (AUEA). These policy reforms were presented by the World Bank projects (PAGI1 and PAGI 2) as crucial steps that Morocco should take to improve the productivity and sustainability of its irrigation sector. After more than thirty years, implementation of these reforms has been fraught with difficulties and many delays. Results and impacts are very timid and vague. The Moroccan GPI experience shows that an “ingredient” was missing to drive change. In fact, setting up new local organizations to participate in irrigation management and calls for new institutional arrangements to tackle the huge problems of moroccan large scale irrigation sector is not sufficient to drive change. A profound realistic thinking on irrigation governance and large concertation between water users are needed to meet the challenges of water scarcity, climate change and water security in the country. This article assesses the participation of Water Users' Associations (AUEA) established in Tadla irrigated scheme in Morocco. It reviews the contxt of adoption of the Participatory Irrigation Management (PIM) policy in Morocco and re-examines the process of initiating and developing AUEAs in large irrigated perimeters, analyzing the specific case of the Beni Amir irrigation project. The questions of participatory planning and joint management are at the heart of our analysis.

Toward “climate-driven”: innovation on legislation of modern marine fisheries law under era of blue carbon

Abstract Over the past decade, there has been increasing interest in the blue carbon project, which uses marine activities and organisms to take up carbon dioxide from the atmosphere and store it in ocean. Important question in contemporary and future fisheries management is how to coordinate the relationship among the offshore fishery, the fisheries resource conservation and blue carbon projects. Through comparative studies and normative analysis, this study explores the legislative aims of some representative international and national fisheries legislation and their creative reforms in recent years. The legislative purpose of fisheries laws has traditionally been to keep fishery resources above the Maximum Sustainable Yield (MSY) standard, while marine carbon sink resource protection is marginally inadequate. Given that the blue carbon project is inseparable from future fisheries industry development, the protection of marine carbon sink resources needs to be incorporated into the legislative aim of fisheries law in the future.

Intensity or Duration: That Is the Main Question of the Exercise Training Management in Stroke-Induced Neurological Deficit - A Systematic and Meta-analysis Study

Background: The neurological assessment plays a crucial role in evaluating stroke patients and is a skill that has been practiced by physicians for a long time, and further refined by practitioners. The purpose of the current study was to systematically review and synthesize the evidence-based neurological assessment of the different methods of treadmill-related training protocols in stroke patients. Evidence Acquisition: In this study, the appropriate studies were documented (N = 1270) using PubMed as the sole electronic database. Moreover, subgroup studies were provided based on training intensity and duration, categorized as low intensity-low duration, low intensity-high duration, high intensity-low duration, and high intensity-high duration. Training intensities were standardized to meters per second (m/s), and the training duration was calculated in terms of minutes per session, the number of sessions per week, and the total number of training weeks, which were then converted into minutes. The assessment of neurological recovery following stroke was conducted using standard neurological assessment scales. Results: This meta-analysis in humans found a notably positive standardized mean difference in protocols with high intensity and high duration (1.792; 95% CI = 0.566 to 3.02). Conclusions: In conclusion, the current meta-analysis suggests that practitioners using the high intensity-high duration protocol should regularly monitor the neurological outcomes, as they may be negatively impacted by the intensity and duration of the protocol.

Partnership or battle

University libraries live and change through interaction with the scientific community or without essential interaction they fail to evolve and grow. This article studies the effects of collaboration between professors and librarians on the strategic development of libraries, especially during times of crisis. This study was conducted at the University of Helsinki (established in 1640). It is based mostly on historical sources, such as the annual reports of the university and faculties, and documents outlining plans and decisions. The first crisis phase took place in the 1820s, when a fire destroyed academic collections and facilities and the university was relocated from Turku to Helsinki. A conflict arose between the contemporary needs of the scientific community and the need for a main library to replace the collections. Another upheaval was caused by the growing need for services for the post-war baby boomer generation. Nationwide library planning aimed for the creation of a separate national library and for merging faculty libraries with the main library. The third crisis phase involved the Finnish economic crisis of the 1990s and the digital revolution that continued into the 2000s. Solutions were sought through cooperation between the academic leadership, library management and personnel. The crisis led to the organisation of library services into two large entities. The success of extensive changes in academic libraries is one of the key questions in management. The crisis periods under examination show that significant reforms are only possible through close partnerships between the library, the research community and academic decision-makers.

The effectiveness of enhanced reality simulation on postmastectomy patient care management provided by nursing students: a quasi-experimental study

AimThe aim of this study was to evaluate the effect of enhanced reality simulation on nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. BackgroundBreast cancer is a common disease with increasing incidence and mastectomy is the treatment of choice. Postmastectomy patient care is a multidimensional and complex process. For various reasons, nursing students today graduate with inadequate clinical skills and do not have experience with many cases. DesignThis quasi-experimental study was conducted using a pretest–posttest design with a nonequivalent control group. MethodsThis study was conducted with fourth-year nursing students (78 students). Students were allocated to each group through a simple random allocation using IBM SPSS Statistics version 24. Research data were collected at the Clinical Simulation Training Center of the university in 2020–2021 academic year. The study group (n=39) learned using a scenario-based learning approach with moulage in a real clinical setting using enhanced reality simulation, while the control group (n=39) learned using the same scenario-based approach with the routine practice adult standard patient care model. The data were collected through the “Student Sociodemographic and Descriptive Characteristics Data Collection Form”, the “Student Satisfaction and Self-Confidence in Learning Scale”, the “Postmastectomy Patient Care Skills Checklist” and the “Pre–Post Knowledge Test on Postmastectomy Patient Care Management”. ResultsAll 78 participants completed the training course. The training significantly increased the Student Satisfaction and Self-Confidence in Learning Scale subdimension scores of both groups (p<0.05). The Postmastectomy Patient Care Management scores of the study group students who received enhanced reality simulation training significantly increased (p<0.05), while there was no significant effect on the scores of the control group students (p>0.05). While most the students in the study group increased their rates of correct answers to Postmastectomy Patient Care Management questions significantly (p<0.05) after the enhanced reality simulation training, the students in the control group showed no significant improvement (p>0.05). The training significantly (p<0.001) increased the mean postmastectomy patient care skills control scores. This increase had a high effect size on the study group. ConclusionEnhanced reality simulation is a learning method that increases nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. Learning with enhanced reality simulation is an effective approach for nursing education that improves nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care.

Surgical Management of Pediatric Dog Bites: A Systematic Review and Treatment Guideline

IntroductionDog bites are a unique and unusual injury in children, associated with atypical bacterial species, high infection rates, and controversial surgical treatment. Expert recommendations currently guide management and no surgical evidence-based guidelines exist. We conducted a systematic review to answer three management questions: (1) What are the best practices for wound management? (2) In what circumstances should prophylactic antibiotics be administered? (3) In what circumstances should rabies prophylaxis be given? MethodsA structured review was performed using a keyword search querying “pediatric” “dog bite” “management”. Results were reported according to the PRISMA methodology. The quality of nonrandomized studies was evaluated according to Methodological Index for Non-Randomized Studies (MINORS). Qualitative analysis was performed. ResultsA total of 803 studies were identified and 53 studies were included in the final analysis. Current literature suggests that primary closure of bites which are well irrigated and sharply debrided within 8 h of injury, is not associated with increased infection. While dog bites are associated with an overall high rate of infection (6–25 %), routine antibiotic prophylaxis in low-risk wounds does not lower that risk. Postexposure prophylaxis for rabies is indicated for all dog bites where the rabies status of the dog cannot be determined, or the animal cannot be quarantined for 10 days. ConclusionHigh-quality evidence regarding the surgical management of pediatric dog bites is limited. Trial data have demonstrated improved outcomes in wound healing and infection rates with a focus on copious irrigation and diligent wound debridement, although independent validation is needed. Level of EvidenceLevel II – systematic review.

The association between public managers' type of education and prioritizing core service provision and communication

AbstractAn important question in public management is whether public organizations should prefer or avoid specialist managers (i.e., managers whose professional backgrounds match the work they oversee). Research has shown that specialist managers are associated with better field‐specific performance in public organizations, and theory suggests that they lead differently than nonspecialist managers. However, there is no empirical evidence to support this latter claim. To remedy this, we investigate whether specialist managers prioritize core service provision more and communicate better than nonspecialist managers. Through multilevel regressions of employee reports of leaders' behaviors in the contexts of schools, eldercare, daycare, and employment, we find that specialist managers prioritize core service provision more in all contexts but schools and communicate better in eldercare and employment but not elsewhere. These findings are consistent with the theoretical expectations and thus emphasize the importance of educational background in shaping managerial behavior.

От погрома до обретения советской «земли Обетованной»: дисперсность, миграции и кон-солидация джегонасских горских евреев на Северном Кавказе (1917 г. – начало 1930-х гг.)

The article devotes itself to establishing and describing the key events in the “migration history” of the Dzhegonassko-Evreyskoe Mountain Jews. The problem is discussed in the context of this group’s post-revolutionary history, up until the beginning of the 1930s. The article analyzes the debatable issues of the fate of the devastated settlement of the Dzhegonas Jews in 1918 and in the subsequent period, their further dispersion on the North Caucasus territory. Additional evidence has been uncovered that confirms the residency of a large portion of this group of Mountain Jews in the village of Nevinnomysskaya, as well as their links to other groups of Mountain Jews. Addi-tional facts about the attempts of the Dzhegonas Jews to return to the lands of their old village in Karachay-Cherkessia in the first half of the 1920s have been revealed. It is shown how the ques-tion of land management of the Dzhegonas Jews turned out to be connected with the regular col-lection by the Soviet, Communist Party and other structures of a variety of accounting, statistical and other information about them (as well as about the Mozdok and Grozny mountain Jews). The forms and methods of consolidation of Dzhegonas Jews in the Soviet policy of indigenization of national minorities and the settlement of Terek District by mountain Jews organized by the au-thorities are studied.

Asymptomatic pediatric presentation of S-adenosylhomocysteine hydrolase deficiency.

S-adenosylhomocysteine hydrolase deficiency is an autosomal recessive inborn error of metabolism affecting methylation by disrupting the methionine cycle. Its clinical spectrum spans from severe perinatal encephalomyopathy and liver failure to asymptomatic course in patients with isolated hypermethioninemia. We present two new cases of S-adenosylhomocysteine hydrolase deficiency from Pakistani origin clinically asymptomatic at presentation. Both siblings showed mild chronic liver failure and elevation of creatine kinase. The older patient presented at 6 years of age with isolated verbal processing difficulty and mild diffuse leukodystrophy, reversible 12 months after introduction of methionine dietary restriction. The patient showed subtle atrophy in the muscle MRI at the age of 7 years. S-adenosylhomocysteine hydrolase deficiency was confirmed with homozygous missense variant c.146G>A (p.Arg49His) in the AHCY gene, a genotype previously reported in Pakistani patients with mild presentation. Dietary methionine restriction decreased plasma methionine but not plasma S-adenosylhomocysteine and S-adenosylmethionine. This work expands the mild spectrum of S-adenosylhomocysteine hydrolase deficiency with no noticeable clinical symptoms in children, highlighting a specific hotspot variant from South Asia. This mild form of the disease is likely underdiagnosed and raises the question of therapeutic management to prevent long-term complications documented in the literature, such as hepatocellular carcinoma and myopathy in early adulthood.

Performance of generative pre-trained transformer-4 on the certification test for mental health management: A factorial design

This study aimed to investigate the performance of generative pre-trained transformer-4 (GPT-4) on the Certification Test for Mental Health Management and whether tuned prompts could improve its performance. This study used a 3 × 2 factorial design to examine the performance according to test difficulty (courses) and prompt conditions. We prepared 200 multiple-choice questions (600 questions overall) for each course using the Certification Test for Mental Health Management (levels I-III) and essay questions from the level I test for the previous four examinations. Two conditions were used: a simple prompt condition using the questions as prompts and tuned prompt condition using techniques to obtain better answers. GPT-4 (gpt-4-0613) was adopted and implemented using the OpenAI API. The simple prompt condition scores were 74.5, 71.5, and 64.0 for levels III, II, and I, respectively. The tuned and simple prompt condition scores had no significant differences (OR = 1.03, 95% CI; 0.65-1.62, p = 0.908). Incorrect answers were observed in the simple prompt condition because of the inability to make choices, whereas no incorrect answers were observed in the tuned prompt condition. The average score for the essay questions under the simple prompt condition was 22.5 out of 50 points (45.0%). GPT-4 had a sufficient knowledge network for occupational mental health, surpassing the criteria for levels II and III tests. For the level I test, which required the ability to describe more advanced knowledge accurately, GPT-4 did not meet the criteria. External information may be needed when using GPT-4 at this level. Although the tuned prompts did not significantly improve the performance, they were promising in avoiding unintended outputs and organizing output formats. UMIN trial registration: UMIN-CTR ID = UMIN000053582.

To the ER? Can Patients Treat Their Anaphylaxis at Home?

To discuss if all patients who use self-injectable epinephrine outside the hospital setting require immediate emergency care. Prior to 2023, anaphylaxis management guidance universally recommended that patients who use self-injectable epinephrine outside of the hospital or clinic setting immediately activate emergency medical services and seek further care. Additional food-induced anaphylaxis management recommendations specified that all patients always carry 2 auto-injector devices and give a second dose of epinephrine if there was not immediate response within 5min of injection. Patients presenting for emergency care after epinephrine are often observed for up to 4-6h afterwards, even when completely asymptomatic. These management steps have lacked evidence for improving outcomes, and universal implementation of these approaches is not cost-effective as guidance for food allergic patients. Epinephrine pharmacokinetics and pharmacodynamics suggest that peak physiologic response is more likely to occur closer to 15min than before 5min, that few patients require a second dose of epinephrine as most stabilize within 15min of use, that 60min of observation after a patient stabilizes after epinephrine use may be adequate as patients infrequently have further sequelae, and that not everyone needs to carry 2 epinephrine auto-injectors on their person at all times. The most recent anaphylaxis practice parameter promotes a contextualized approach to these management questions, outlining the option for watchful waiting to gauge response to epinephrine before seeking emergency care, which has been proven as a more cost-effective management strategy. The recent updated anaphylaxis care guidelines support the evolution of anaphylaxis care, in that universal, immediate activation of emergency services is not required for using self-injectable epinephrine outside the hospital setting.

Diagnosis and management of pediatric acute liver failure: consensus recommendations of the Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN).

Timely diagnosis and management of pediatric acute liver failure (PALF) is of paramount importance to improve survival. The Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition invited national and international experts to identify and review important management and research questions. These covered the definition, age appropriate stepwise workup for the etiology, non-invasive diagnosis and management of cerebral edema, prognostic scores, criteria for listing for liver transplantation (LT) and bridging therapies in PALF. Statements and recommendations based on evidences assessed using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were developed, deliberated and critically reappraised by circulation. The final consensus recommendations along with relevant published background information are presented here. We expect that these recommendations would be followed by the pediatric and adult medical fraternity to improve the outcomes of PALF patients.

The analysis of the stock of the Republican scientific-technical library

Nowadays, the investigation of the questions of the scientific management of library stocks has gained great urgency (increased in importance). The tasks of increasing the efficiency of the formation and usage of library stocks highlight the necessity for systematic research into their peculiarities and tendencies of development. This article analyzes the peculiarities and tendencies of the development of the stocks of the Republican Scientific-Technical Library of Lithuania's Scientific-Research Institute of Scientific-Technical Information and Technical-Economic Research. The multifaceted research of the stocks should enable the improvement of library processes and information-bibliography services. The research carried out allows for the following conclusions: The Republican Scientific-Technical Library, by volume of stocks, is the largest library among scientific libraries of the republic. Its stocks total 40.4 percent of the whole stock of the United Republican Information Stock (URIS). The library is the main library in URIS, which organizes the stocks of special documentation and literature. A peculiarity of the stock is that special technical documentation and literature have predominated in the stock since 1970, totaling approximately 90.1 percent of the entire stock. The basic stocks are in the Republican Scientific-Technical Library in Vilnius, which total 87.6 percent of the entire stock. The superextensive growth of the special technical documentation and literature during 1967-1970 is accounted for by the organization of the departments of patents and technical documentation (as per the decision of the Council of Ministers of Lithuania). At present, the growth of the stock has stabilized. Every year during 1975-1982, the library received an average of 850.2 thousand documents. The growth of the quantity of the stocks, completion on the whole, and the growth of the stocks of special kinds of scientific-technical literature and documentation may be defined by a mathematical curve, which shows that from a certain moment, the speed of the growth of the volume of the stocks slows down due to limited resources.

Marketing Outcomes and Shareholder Value: A Review and Research Agenda

One of the most fundamental management questions is how market-based assets affect shareholder value. To provide an answer, we review the extensive literature on marketing outcomes and shareholder value using the Theory, Context, Characteristics, and Methodology (TCCM) framework. The analysis reveals that researchers mainly rely on the efficient market hypothesis, signaling theory, and market-based arguments to theorize the relationship between customer-based market assets and shareholder value. Researchers predominantly collect secondary data and employ event study, persistence methods, and instrumental variables approach to show that marketing actions (such as advertising and brand building) and customer-based market assets (such as customer satisfaction, customer loyalty, and brand equity) positively influence shareholder value. After outlining the findings, future research directions on the relationship between market assets and shareholder value are explored.

Machine learning for environmental justice: Dissecting an algorithmic approach to predict drinking water quality in California

The potential for machine learning to answer questions of environmental science, monitoring, and regulatory enforcement is evident, but there is cause for concern regarding potential embedded bias: algorithms can codify discrimination and exacerbate systematic gaps. This paper, organized into two halves, underscores the importance of vetting algorithms for bias when used for questions of environmental science and justice. In the first half, we present a case study of using machine learning for environmental justice-motivated research: prediction of drinking water quality. While performance varied across models and contaminants, some performed well. Multiple models had overall accuracy rates at or above 90 % and F2 scores above 0.60 on their respective test sets. In the second half, we dissect this algorithmic approach to examine how modeling decisions affect modeling outcomes – and not only how these decisions change whether the model is correct or incorrect, but for whom. We find that multiple decision points in the modeling process can lead to different predictive outcomes. More importantly, we find that these choices can result in significant differences in demographic characteristics of false negatives. We conclude by proposing a set of practices for researchers and policy makers to follow (and improve upon) when applying machine learning to questions of environmental science, management, and justice.

Large Language Model Influence on Management Reasoning: A Randomized Controlled Trial.

Large language model (LLM) artificial intelligence (AI) systems have shown promise in diagnostic reasoning, but their utility in management reasoning with no clear right answers is unknown. To determine whether LLM assistance improves physician performance on open-ended management reasoning tasks compared to conventional resources. Prospective, randomized controlled trial conducted from 30 November 2023 to 21 April 2024. Multi-institutional study from Stanford University, Beth Israel Deaconess Medical Center, and the University of Virginia involving physicians from across the United States. 92 practicing attending physicians and residents with training in internal medicine, family medicine, or emergency medicine. Five expert-developed clinical case vignettes were presented with multiple open-ended management questions and scoring rubrics created through a Delphi process. Physicians were randomized to use either GPT-4 via ChatGPT Plus in addition to conventional resources (e.g., UpToDate, Google), or conventional resources alone. The primary outcome was difference in total score between groups on expert-developed scoring rubrics. Secondary outcomes included domain-specific scores and time spent per case. Physicians using the LLM scored higher compared to those using conventional resources (mean difference 6.5 %, 95% CI 2.7-10.2, p<0.001). Significant improvements were seen in management decisions (6.1%, 95% CI 2.5-9.7, p=0.001), diagnostic decisions (12.1%, 95% CI 3.1-21.0, p=0.009), and case-specific (6.2%, 95% CI 2.4-9.9, p=0.002) domains. GPT-4 users spent more time per case (mean difference 119.3 seconds, 95% CI 17.4-221.2, p=0.02). There was no significant difference between GPT-4-augmented physicians and GPT-4 alone (-0.9%, 95% CI -9.0 to 7.2, p=0.8). LLM assistance improved physician management reasoning compared to conventional resources, with particular gains in contextual and patient-specific decision-making. These findings indicate that LLMs can augment management decision-making in complex cases. ClinicalTrials.gov Identifier: NCT06208423; https://classic.clinicaltrials.gov/ct2/show/NCT06208423.

Performance of ChatGPT on basic healthcare leadership and management questions

PurposeChatGPT is an LLM-based chatbot introduced in 2022. This study investigates the performance of ChatGPT-3.5 and ChatGPT-4 on basic healthcare leadership and management questions.MethodsChatGPT-3.5 and -4 (OpenAI, San Francisco, CA, USA) generated answers to 24 pre-selected questions on three different areas of management and leadership in medical practice: group 1) accessing management/leadership training, group 2) management/leadership basics, group 3) department management/leadership. Three readers independently evaluated the answers provided by the two versions of ChatGPT. Three 4-digit scores were developed to assess the quality of the responses: 1) overall quality score (OQS), 2) understandibility score (US), and 3) implementability score (IS). The mean quality score (MQS) was calculated from these three scores.ResultsThe interrater agreement was good for ChatGPT-4 (72%) and moderate for ChatGPT-3.5 (56%). The MQS of all questions reached a mean score of 3,42 (SD: 0,64) using ChatGPT-3.5 and 3,75 (SD: 0,47) using ChatGPT-4. ChatGPT-4 showed significantly higher MQS scores in group 2 and 3 questions than ChatGPT-3.5 (p = 0.039 and p < 0.001, respectively). Also, significant differences between ChatGPT-3.5 and ChatGPT-4 regarding OQS, US, and IS in group 3 questions were seen with significances reaching p < 0.001. Significant differences between the two chatbot versions were also present regarding OQS in question groups 1 and 2 (p = 0.035 each). 87.5% of the answers provided by ChatGPT-4 (21 of 24 answers) were considered superior to the answers provided by ChatGPT-3.5 for the same questions. Neither ChatGPT-3.5 nor ChatGPT-4 offered any inaccurate answers.ConclusionChatGPT-3.5 and ChatGPT-4 performed well on basic healthcare leadership and management questions, while ChatGPT-4 was superior.

Large language models' responses to liver cancer surveillance, diagnosis, and management questions: accuracy, reliability, readability.

To assess the accuracy, reliability, and readability of publicly available large language models in answering fundamental questions on hepatocellular carcinoma diagnosis and management. Twenty questions on liver cancer diagnosis and management were asked in triplicate to ChatGPT-3.5 (OpenAI), Gemini (Google), and Bing (Microsoft). Responses were assessed by six fellowship-trained physicians from three academic liver transplant centers who actively diagnose and/or treat liver cancer. Responses were categorized as accurate (score 1; all information is true and relevant), inadequate (score 0; all information is true, but does not fully answer the question or provides irrelevant information), or inaccurate (score - 1; any information is false). Means with standard deviations were recorded. Responses were considered as a whole accurate if mean score was > 0 and reliable if mean score was > 0 across all responses for the single question. Responses were also quantified for readability using the Flesch Reading Ease Score and Flesch-Kincaid Grade Level. Readability and accuracy across 60 responses were compared using one-way ANOVAs with Tukey's multiple comparison tests. Of the twenty questions, ChatGPT answered nine (45%), Gemini answered 12 (60%), and Bing answered six (30%) questions accurately; however, only six (30%), eight (40%), and three (15%), respectively, were both accurate and reliable. There were no significant differences in accuracy between any chatbot. ChatGPT responses were the least readable (mean Flesch Reading Ease Score 29; college graduate), followed by Gemini (30; college) and Bing (40; college; p < 0.001). Large language models provide complex responses to basic questions on hepatocellular carcinoma diagnosis and management that are seldomly accurate, reliable, or readable.

Brief Teaching Intervention Improves Medical Students' Dermatology Diagnostic Skills and Comfort in Performing Dermatology Exams.

Skin disease is a significant contributor to the global disease burden, with dermatologic health disparities adding to this burden. Internists, general practitioners, and other medical professionals often manage skin disease with limited exposure to dermatologic education in medical school. This study evaluated a brief educational intervention for medical students to improve dermatologic knowledge, diagnostic and communication skills, and comfort in performing dermatology-focused physical exams. A secondary focus of the intervention was to promote awareness of skin disease, detection, and prevention for patients with a variety of skin tones. Sixty-five first through fourth-year students at Rutgers RWJMS participated in a pre-test-post-test within-subject study. Students described images using open-ended responses followed by multiple-choice identification questions. Students watched a one-hour self-paced module created by a licensed dermatologist and completed a follow-up assessment. At pre-test, descriptions were brief and often inaccurate but significantly improved post-intervention to include descriptors such as primary morphology and demarcation. Accuracy on diagnostic and management questions significantly improved and comfort in advising patients and performing dermatologic exams significantly increased. A low-cost, brief, self-paced module can augment dermatologic education for medical students while increasing exposure to multiple skin tone presentations of lesions.