Senior Residents Research Articles

Development of a residents’ needs assessment-based novel pathology residency boot camp designed on the graduated release of responsibility model

Boot camps in medical education have emerged as effective tools for addressing knowledge gaps and facilitating the integration of incoming residents into clinical training. We developed a pathology boot camp designed on a needs assessment survey, the graduated release of responsibility model, and active involvement of senior residents as educators. A comprehensive survey was administered to current first-year residents to assess educational needs to identify significant knowledge gaps and difficult areas. Based on these findings, a four-week, three-phase curriculum was developed, comprising introductory didactics, hands-on training, and mentorship under senior residents. Pre- and post-tests, as well as resident surveys, were used to evaluate the efficacy of the boot camp curriculum. Senior residents unanimously expressed the need for a boot camp, expressing challenges in histology, workflow, autopsy, and laboratory operations. Pre- and post-boot camp assessment tests showed a 15% knowledge improvement. Most pathology programs across the country have implemented structured pathology boot camps. The strengths of our boot camp included the emphasis on the previous year's residents' feedback, and the challenges that they encountered, serving as a comparison group; a graduated release of responsibility model; and the involvement of senior residents as designated mentors for the duration of the boot camp. The pathology boot camp presented here serves as a promising model for addressing foundational knowledge deficits among incoming residents. By tailoring the curriculum to meet specific educational needs and leveraging senior residents as educators, institutions can better prepare residents for the challenges of clinical training.

HoLEP Learning Curve-Resident Perspective: Survey of Senior Residents from High-Volume Tertiary Center.

Objective: We aim to report the learning curve and experience performing holmium laser enucleation of the prostate (HoLEP) from a resident standpoint trained at a tertiary high-volume center. Methods: An electronic survey was distributed to 10 surveyees that included recently graduated chief residents trained at Indiana University in the past 3 years i.e., between 2020 and 2022 with a 100% response rate. The questionnaire focused on HoLEP training experience based on a recently established mentorship curriculum in training the residents through each individual step of the surgery. Results: The average learning curve for performing HoLEP was reported to be greater than 25 cases with 50% of the residents reporting >50 cases to master the technique. The surgical difficulty of steps of the HoLEP were rated on a subjective scale of 1-5: 1 = very easy, 2 = easy, 3 = neutral, 4 = hard, and 5 = very hard. The common challenging steps in decreasing the order of difficulty as reported are performing apical enucleation, joining anterior and posterior planes, and dividing anterior commissure with a mean rating of 3.5, 3.1, and 3.1, respectively. The most difficult aspect of the surgery to master was performing apical dissection (60%). Comparing operative parameters for HoLEP with transurethral resection of the prostate in aspects of resection volume and times, 70% of candidates reported it better for HoLEP whereas 20% had similar times for both procedures. A total of 90% of the residents felt confident to offer HoLEP as part of their practice without the need for any further training. Regarding the initial challenge of including HoLEP surgery in practice, the majority (60%) reported difficulty with equipment set up in their practice while 20% reported difficulty maintaining efficient operating room (OR) times and turnover. Conclusion: We believe HoLEP can be performed immediately after residency training and incorporated into practice with high volume, repeated exposure to HoLEP surgery throughout residency based on study results. The average learning curve reported for performing HoLEP was greater than 25 cases.

Knowledge and Practices Related to Research Misconduct among Healthcare Researchers in India: Cross-Sectional Study

ABSTRACT Introduction: Practices known to harm the integrity of scientific and medical research during planning, conduct, documentation, and reporting are termed as research misconduct. It is an unfortunate, prevalent reality of the research world. In the present study, we tried to assess the knowledge about research misconduct, its determinants, observed practices of research misconduct among healthcare practitioners, level of satisfaction with the order of authorship in one’s published manuscript, and their views for action to be taken against those involved in research misconduct in our institution. Materials and Methods: This cross-sectional study recruited eligible participants (Faculty Members and Senior Residents of Medical, Dental, and Nursing Professionals) through one-to-one interviews and web-based platforms. Data analysis was conducted by using Statistical Package for the Social Sciences 23(SPSS-23). Result: Of the 356 participants, around 60% had complete knowledge about research misconduct, and 74.2% had observed research misconduct in their workplace at some point in time. There was no association between correct knowledge about research misconduct and the type of healthcare researchers, awareness of the International Committee of Journal of Medical Ethics (ICJME), and training on good clinical practices. 54.8% of the participants considered those involved in research misconduct should not be permitted to be co-guide and guide of students. Conclusion: Training of healthcare researchers on publication ethics and good clinical practice guidelines seems to improve knowledge about research misconduct. Further, stringent action should be taken against those who conduct research misconduct.

The Impact of Fellowship Affiliation on Urogynecology Training in Obstetrics and Gynecology Residency

ObjectiveTo compare characteristics of Urogynecology training and number of “Incontinence and Pelvic Floor” cases logged between OB/GYN residencies affiliated and those not affiliated with Urogynecology fellowships. DesignA retrospective descriptive analysis was performed of OB/GYN residency programs, their Urogynecology training, and association with Urogynecology fellowship programs during the 2023-2024 academic year. Program websites for ACGME-accredited OB/GYN residency programs were reviewed to determine availability, timing, and length of Urogynecology training. ACGME data for “Incontinence and Pelvic Floor” cases were analyzed by training year and association with Urogynecology fellowship programs from the 2012-2013 to 2022-2023 academic year. Data was analyzed using SPSS. SettingThis research was conducted at Harbor-UCLA Medical Center. ParticipantsNone. InterventionsNone ResultsInformation was obtained for 85.9% of programs. Nearly all (97.0%) had dedicated Urogynecology rotations, and 64.4% had rotations in > 1 year of training. Association with Urogynecology fellowship did not affect the availability of Urogynecology training overall nor the overall number of rotations. Urogynecology rotations occurred most often in the third (PGY3) year of residency, though 43.6% of programs had training for junior (PGY1, PGY2) residents. Residencies with associated Urogynecology fellowships were more likely to have a rotation for PGY2 residents and for junior residents overall. From 2012-2023, the number of “Incontinence and Pelvic Floor” cases declined by 36.3%, with trainees at residencies not affiliated with Urogynecology fellowships logging more cases than those at a fellowship-affiliated residency. ConclusionWhile the majority of OB/GYN residencies have dedicated Urogynecology training, most rotations are for senior residents. Training programs associated with Urogynecology fellowships are more likely to expose junior residents to the field, but their trainees log fewer “Incontinence and Pelvic Floor” cases overall. Earlier exposure may enrich surgical training and help residents prepare for their career, whether in Urogynecology or as a generalist.

Factors Affecting Choice of Subspecialisation amongst Orthopaedic Surgery Residents in Southern Nigeria

Abstract Background: As the field of surgery continues to evolve, subspecialty training is fast becoming integral to surgical education. Presently, orthopaedic surgery residents have opportunities to subspecialise in different areas. Objectives: The aim of this study was to determine the factors affecting the choice of desired subspecialties amongst orthopaedic surgery residents in southern Nigeria. Materials and Methods: This study was a cross-sectional study conducted amongst senior orthopaedic surgery residents in southern Nigeria. A well-structured questionnaire designed using the free software Google Forms was electronically distributed to senior orthopaedic residents in Nigeria through online forums (WhatsApp, email, and Telegram). Data obtained were analysed using IBM Statistical Product and Service Solutions version 26. The odds ratio and the associated 95% confidence interval were used to assess outcomes, and a P value <0.05 defined that the difference was statistically significant. Results: At the end of the study period, 53 orthopaedic surgery senior residents completed and submitted the questionnaire with a response rate of 73.6%; 50.9% were married with children and 49.1% were single. The most agreed key factor influencing the choice of orthopaedic surgery subspecialisation from the study was lifestyle considerations (79.2%). Other major factors considered to be also very important were the needs of the region (73.6%), active mentorship (71.7%), ergonomics (64.6%), rotation experiences (47.2%), cost of acquiring the training (41.5%), and salary and financial privileges (37.7%). Overall, 24.5% of respondents chose spine surgery as their desired subspecialty, 18.9% arthroplasty, 17% arthroscopy, 17% paediatrics, 13.2% reconstructive orthopaedics, 5.7% musculoskeletal oncology, and 4.7% hand and foot surgery. Our study revealed a significant statistical relationship between having children and choice of a subspecialty (Fischer’s = 0.032; χ2 = 0.033), as the married female residents tend to have more family considerations in their final choice of subspecialisation. Conclusion: The choice of orthopaedic surgery subspecialisation amongst orthopaedic surgery residents in southern Nigeria is affected by different factors, such as mentorship, needs of region, desire to work in academic settings, and ergonomics.

The Burden, Challenges, and Prospects of Hand Surgery Practice in South Eastern Nigeria

Abstract Background: Hand injuries sometimes cause significant loss of function with psychological and functional consequences. The national status on dedicated specialised hand surgery units, hand surgery fellowship programmes, and outcome of operative hand surgery cases is generally lacking. Aims: To determine the current state of hand surgery practice in south eastern Nigeria and identify the major challenges to its practice and proffer realistic solutions. Methods: This was a prospective and cross-sectional study conducted amongst accredited hospitals for plastic surgery training in south eastern Nigeria amongst plastic surgery senior residents. Data were collected using a well-structured online questionnaire validated by a panel of investigators created as a Google form. Data analysis was carried out using Statistical package for Social Sciences by IBM, version 22. Ethical approval was obtained from the health, research, and ethical committee of the University of Enugu Teaching Hospital, Enugu, Nigeria. Results: There was a 70.59% response rate with 24 residents filling and submitting the questionnaire. Lack of fellowship training opportunities in hand surgery represents the most important challenge of hand surgery practice, followed by lack of appropriate facilities in government institutions in contrast to a lack of funding in private ones. Other major challenges include lack of adequate funding, lack of facilities, late presentation of cases, and lack of appropriate follow-up physiotherapy protocol. Availability of competent hand surgery specialists was significantly correlated with the frequency of hand surgery cases in the facilities (P = 0.000; χ2 = 20.400). Conclusion/Recommendation: The current state of hand surgery practice in south eastern Nigeria is not yet optimal. The creation of more hand fellowship trainings and courses bagged first place in recommended solutions by nearly half of the respondents. Provision of modern facilities, creation of dedicated hand surgical units, and better funding to the specialty were other suggestions.

Comparison Between Resident and Attending Surgeons as Assistants on Adolescent Idiopathic Scoliosis Surgery: No Differences in Outcomes, Complications Rate, or Pedicle Screw Placement Accuracy.

Retrospective cohort study. The aim of the present study was to determine if the level of training of the first assistant (resident or attending surgeon) has an influence on the radiographic outcome of AIS surgery and on the accuracy rate of the pedicle screws placement. Adolescent idiopathic scoliosis (AIS) surgery is a challenging procedure that requires a dedicated team of skilled professionals. Therefore, understanding the learning curve is of outstanding importance to guarantee the best outcomes and the highest safety to the patients. A retrospective analysis of patients who underwent surgery for AIS with a minimum follow-up of 2 years was conducted. All patients were operated by an experienced spine surgeon, assisted by and attending surgeon (group A) or a senior resident (group B). Radiographic outcomes were assessed. Through postoperative CT scan, accuracy of pedicle screw placement was measured (using Gertzbein-Robbins classification). Groups were then statistically compared. A total of 120 patients were included (mean age 15.3±3.39y, major curve Cobb 60.7±11.9 degrees). No difference was found between groups in terms of preoperative characteristics and postoperative radiographic (correction rate, thoracic kyphosis, screw density) outcomes or complications. Operative time and estimated blood loss were significantly higher in Group B (P=0.045 and P=0.024, respectively). Of the 2746 pedicle screws inserted (1319 group A and 1427 group B), 2452 had a perfect intrapedicular trajectory (absolute accuracy of 89.29%) and 2697 had a breach <2mm (relative accuracy of 97.56%). No difference was found among groups in terms of absolute or relative accuracy (P=0.06 and P=0.23, respectively). AIS cases assisted by senior residents have longer operative time and higher blood loss, but this does not negatively affect the overall radiographic outcome and does not place the patient at increased risk of complications. III.

Promoting Senior Resident Autonomy; Tools to empower senior residents on inpatient wards

Promoting Senior Resident Autonomy; Tools to empower senior residents on inpatient wards

Community Life Circle, Neighbourly Interaction, and Social Cohesion: Does Community Space Use Foster Stronger Communities?

Neighbourhood social cohesion has emerged as a prominent concern in urban governance worldwide. As the primary domain of residents’ daily activities, the community life circle contributes to neighbourly interaction and social cohesion. This study investigates the role of space use within the community life circle in promoting social cohesion in Chongqing, China. Through an in-depth activity diary survey and structural equation model analysis, we empirically examine the interplay between community space use, neighbourly interaction, and social cohesion. Our findings suggest that the 15 min community life circle plays a crucial role in residents’ daily lives, particularly among senior residents. However, the contribution of community space use to social cohesion is fully mediated by neighbourly interaction. Furthermore, not all patterns of community space use contribute to social cohesion equally; space use engaged with diverse companions on workdays significantly enhances neighbourly interaction and social cohesion. The study enriches the existing literature by deepening our understanding of the role of the community life circle in fostering socially cohesive and sustainable neighbourhoods.

How to be sure of a complete removal of Essure® implant? A radiological study of Essure® microinserts

PurposeLaparoscopic cornuectomy, one of the most performed surgical techniques to remove Essure® implants, is associated with a risk of fragmentation of the device. We aimed to assess the diagnostic accuracy of the intraoperative radiograph of the removed Essure® microinserts compared with intraoperative inspection of the device. Study designIn this French retrospective cohort study including 66 patients, two experienced gynecologists and two residents evaluated the intraoperative radiograph in a blind manner. Diagnostic accuracy was calculated for each observer. ResultsThe global sensitivity and specificity for intraoperative radiograph to detect a residual fragment for both senior gynecologists and residents were, respectively 87.5 % (±3.3) and 80.0 % (+/12.2). Pooled positive (PPV) and negative predictive values (NPV) for intraoperative radiograph were respectively 99.2 % (±0.5) and 21.6 % (±6.4). There was a statistically significant difference in intraoperative radiograph analysis between senior gynecologists and residents (sensitivity: 91.4 %±0.8 vs 79.6 %±1.5, p = 0.02; specificity: 100% vs 50.0 %, p < 0.0001; PPV: 100 % vs 98.0 % ±0.1, p = 0.0007; NPV: 26.8 % ±1.8 vs 7.2 % ±0.5, p = 0.009).Sensitivity and specificity of the intraoperative inspection of the removal specimen was respectively 95.3 % and 100 % (PPV and NPV were, respectively 100 and 40 %).There were no statistically significant differences in diagnostic accuracy between intraoperative radiographs analysis and intraoperative inspection of the device for the senior gynecologists. ConclusionsIntraoperative radiograph of the removed Essure® implants analysis is a difficult skill needing specific training. Postoperative pelvic X-ray is still recommended in clinical practice after laparoscopic cornuectomy.

Stress a determinant for bruxism in medical students-a qualitative and quantitative assessment.

Abstract- Background-Bruxism is an oral habit consisting of involuntary rhythmic or spasmodic nonfunctional gnashing, grinding, or clenching of teeth, unlike chewing movements of the mandible, which may lead to occlusal trauma. There are many scientific reports about the coexistence of bruxism, stress. Objective- the purpose of this study is to assess the development of symptoms of bruxism due to stress in medical students and to evaluate the correlation between occurrence of bruxism and perceived stress. Methodology- A mixed method survey questionnaire was prepared regarding questions based on scientific evidence of co-relation between bruxism, stress and stress faced by medical students. This survey based questionnaire was circulated digitally pan India and the respondents were undergraduate, post graduate students and junior and senior residents from different medical institutions. Therefore a random sample of 300 participants was selected, and gender, age, stress factors specific results were derived. Result- 14.7% of students are suffering from moderate bruxism and 85.3% of students suffering from severe bruxism due to stress. The test result showed that stress was main factor affecting the habit of bruxism with chi square value 12.39 and p value is 0.006. Conclusion- The study found that majority of the participating medical students reported to have bruxism majorly due to stress and Corelated variables majorly responsible for stress are large course of study, competition in this field, overthinking about the study related problems and uncertainty of result what is expected and do not feel happy with their own work performance.

Assessing ChatGPT's theoretical knowledge and prescriptive accuracy in bacterial infections: a comparative study with infectious diseases residents and specialists.

Advancements in Artificial Intelligence(AI) have made platforms like ChatGPT increasingly relevant in medicine. This study assesses ChatGPT's utility in addressing bacterial infection-related questions and antibiogram-based clinical cases. This study involved a collaborative effort involving infectious disease (ID) specialists and residents. A group of experts formulated six true/false, six open-ended questions, and six clinical cases with antibiograms for four types of infections (endocarditis, pneumonia, intra-abdominal infections, and bloodstream infection) for a total of 96 questions. The questions were submitted to four senior residents and four specialists in ID and inputted into ChatGPT-4 and a trained version of ChatGPT-4. A total of 720 responses were obtained and reviewed by a blinded panel of experts in antibiotic treatments. They evaluated the responses for accuracy and completeness, the ability to identify correct resistance mechanisms from antibiograms, and the appropriateness of antibiotics prescriptions. No significant difference was noted among the four groups for true/false questions, with approximately 70% correct answers. The trained ChatGPT-4 and ChatGPT-4 offered more accurate and complete answers to the open-ended questions than both the residents and specialists. Regarding the clinical case, we observed a lower accuracy from ChatGPT-4 to recognize the correct resistance mechanism. ChatGPT-4 tended not to prescribe newer antibiotics like cefiderocol or imipenem/cilastatin/relebactam, favoring less recommended options like colistin. Both trained- ChatGPT-4 and ChatGPT-4 recommended longer than necessary treatment periods (p-value = 0.022). This study highlights ChatGPT's capabilities and limitations in medical decision-making, specifically regarding bacterial infections and antibiogram analysis. While ChatGPT demonstrated proficiency in answering theoretical questions, it did not consistently align with expert decisions in clinical case management. Despite these limitations, the potential of ChatGPT as a supportive tool in ID education and preliminary analysis is evident. However, it should not replace expert consultation, especially in complex clinical decision-making.

Sense of Purpose, Reduced Stress, and Connection as Protective Factors for Longevity: An Exploration of Barriers

ABSTRACT Background Utilizing the Blue ZonesⓇ framework and the nine lifestyle factors that promote well-being with longevity, an interdisciplinary team of researchers examined protective factors and barriers to engaging in each of the nine lifestyle factors. Purpose To report on protective factors and barriers to improving three of the nine lifestyle factors – sense of purpose, stress, and connection. Methods Using a mixed-method approach, 185 residents living in a rural community in the mid-southern part of the USA participated in this study via e-mail and social media. Results Notable demographic factors including age were significantly associated with fewer obstacles to achieving purpose, reduced stress, and leaving the home regularly. Qualitative responses link disruptions from the COVID-19 pandemic and isolation to feelings of disconnect. Discussion Work, hobbies, and resilience were protective factors to achieving purpose, low stress, and connections. Translation to Health Education Practice Barriers (isolation and disruption) were salient during the pandemic. However, direct human interactions mattered in promoting belonging, having a sense of purpose, and reducing stress. Technologies should also be promoted as a necessary alternative in periods like COVID-19, to help communities and senior residents feel engaged and less lonely. Likewise, hobbies, and the resilience of local residents should be highlighted as sources of inspiration to promote healthy lifestyle practices that achieve low stress levels, good relationships, and a sense of purpose.

A Comprehensive Training Model for Simulation of Intracranial Aneurysm Surgery Using a Human Placenta and a Cadaveric Head.

Aneurysmal surgery is technically complex, and surgeon experience is an important factor in therapeutic success, but training young vascular neurosurgeons has become a complex paradigm. Despite new technologies and simulation models, cadaveric studies still offer an incomparable training tool with perfect anatomic accuracy, especially in neurosurgery. The use of human placenta for learning and improving microsurgical skills has been previously described. In this article, we present a comprehensive simulation model with both realistic craniotomy exposure and vascular handling consisting of a previously prepared and perfused human placenta encased in a human cadaveric specimen. Humans' placentas from the maternity and cadaveric heads from the body donation program of the anatomy laboratory were used. Placentas were prepared according to the established protocol, and aneurysms were created by catheterization of a placental artery. Ten participants, including senior residents or young attendees, completed an evaluation questionnaire after completing the simulation of conventional unruptured middle artery aneurysm clipping surgery from opening to closure. The skin incision, muscle dissection, and craniotomy were assessed as very similar to reality. Brain tissue emulation and dissection of the lateral fissure were judged to be less realistic. Vascular management was evaluated as similar to reality as closure. Participants uniformly agreed that this method could be implemented as a standard part of their training. This model could provide a good model for unruptured aneurysm clipping training.

Patient satisfaction with women vs men surgical interns and senior residents

BackgroundPatient satisfaction is critical for referrals and reimbursement of surgical faculty but remains poorly characterized for residents. We investigated whether patient evaluations of surgical trainees vary by resident gender. MethodsSurgical inpatients evaluated surgical resident care postoperatively after positively identifying trainees. Evaluations (Consumer Assessment of Healthcare Providers and Systems Surgical Care Surveys (S-CAHPS)) were scored by the “top-box” method, stratified by training level, and compared between women and men residents. ResultsNinety-one percent of patients participated (n ​= ​324/357). Patients recognized women interns less than men (75.0 ​% vs 87.2 ​%, p ​= ​0.01). S-CAHPS scores for women vs men interns were equivalent except for spending sufficient time with patients (75.6 ​% vs 88.0 ​%, p ​= ​0.02). For senior residents, there was no difference in patient recognition of women vs men (83.9 ​% vs 85.2 ​%, p ​= ​0.91) or in any S-CAHPS scores (p ​> ​0.05). ConclusionsGendered differences in patient evaluations of surgical trainees exist for interns but resolve by senior years. Future work should explore how patient evaluations can support trainee development while ensuring patients recognize the role of surgical residents regardless of gender.

Rotation X: An Innovative Quality Improvement Focused Curriculum Built Into an Internal Medicine Residency

Background: The Accreditation Council for Graduate Medical Education (ACGME) states that resident physicians must participate in quality improvement (QI) and patient safety (PS) initiatives during their training. Furthermore, once residents enter the workforce as attending physicians, their performance is often based on metrics related to the quality of care provided and the patient’s experience while in the hospital. However, many internal medicine residency programs have a variation of curriculum that is focused on QI and PS. Methods: At our institution, we sought to incorporate education in QI and PS in a longitudinal and structures fashion throughout a resident’s three years of training. Hence, Rotation X was created as both a collaborative and innovative one-week long curriculum with targeted teaching across the continuum of residency training. Rotation X was implemented as a mandatory rotation for all post graduate year (PGY) 1 and 3 trainees in our internal medicine program. During this rotation, learners meet with the clinical documentation improvement (CDI) team, learn about the process of completing a root cause analysis, and review a case with the quality improvement team. Learners also participate in multidisciplinary meetings including a nursing-physician series, focused on improving communication in the hospital, and met with patients nearing discharge to learn about their unique perspective during inpatient hospital stay. Results: All residents participating in Rotation X were surveyed over the course of a year to ascertain their perspective on the rotation. We collated responses from the PGY-1s (interns) and PGY-3s (senior residents). Of the PGY-3 class, at least 80% found the heart failure/pharmacy session, RN-MD session, root cause analysis (RCA) session, CDI session, and catheter associated urinary tract infection (CAUTI) rounds either very or extremely useful. Of the intern class, more than 75% found all session at least somewhat useful with at least half finding the sessions very or extremely useful to their training. Conclusions: With the growing landscape of QI and PS in medicine, we sought out to seamlessly integrate a focused curriculum into our internal medicine residency program. Rotation X, a one-week long rotation embedded with collaborative sessions, was curated to engage our learners in these domains. We found that the curriculum was well received by both our interns and senior residents. Our curriculum is easily adaptable and can be integrated into existing programs, with the capacity to tailor Rotation X sessions to a program’s goals and focus points in the domain of quality improvement.

Educating Our Future Medical Leaders: An Innovative Longitudinal Course Across Surgical and Medical Specialties in Graduate Education.

Increasing healthcare system complexity, multidisciplinary care delivery, and the need to deliver high-quality, cost-effective care drive a critical need for leadership development. Currently, few examples of multidisciplinary leadership development exist in the medical education literature. The Accreditation Council for Graduate Medical Education (ACGME) has identified leadership domains as essential milestones in residency education, encompassing areas such as interpersonal communication, quality improvement, and systems-based practice. Presently, published GME leadership curricula vary widely in content, delivery, and duration and rarely include multispecialty cohorts. The study authors designed and implemented a longitudinal leadership curriculum for a multispecialty cohort of senior residents and fellows from multiple hospitals within a large integrated GME program. Between July 2022-June 2023, authors delivered 12 monthly sessions on core leadership concepts. Sessions delivered relevant work-based content via large-group didactics with embedded opportunities for small-group interactive experiential and reflective practice, critical thinking, and application. Thirty GME trainees participated in the longitudinal curriculum. Interval pre-/post-session assessments demonstrated significant improvement in composite scores for 6 of 9 sessions assessed. Participants rated each module's overall importance, applicability, and acceptability highly on a summative program evaluation. This longitudinal leadership curriculum adheres to best leadership development practices, demonstrates improvement in knowledge and self-reported attitudes and behaviors related to cognitive, character, and emotional leadership domains, and develops a psychologically safe community of practice for GME participants.

Portable Medication Reminder System for Elderly and Alzheimer's Patients

As healthcare demands rise and the senior population grows, innovative results are essential for cases with habitual ails and memory-related conditions like Alzheimer's. Introduces a movable drug memorial System designed for hospitals, old age homes, and independent elderly citizens. The system, erected around an Arduino UNO microcontroller, integrates an IR detector, buzzer, TV display, RTC module, keypad, LED, and GSM module, working together to give timely drug monuments. In hospitals, it integrates into patient care routines, driving visual and audile monuments for nursing staff to insure timely drug delivery. This integration helps drug crimes and ensures that cases are cleaved to their prescribed treatment plans. Old age homes profit from the stonerfriendly device, allowing residents to manage their drug schedules via the TV display and keypad. The system's simplicity and trust ability can significantly ameliorate the quality of life for senior residents. For independent seniors, the movable system provides monuments through the TV display and buzzer, with the GSM module transferring SMS cautions to family members or caregivers if boluses are missed. This point is particularly precious for those who live alone, offering peace of mind to both the seniors and their families. Alzheimer's cases, floundering with memory loss and drug adherence, gain significantly from this system. The combination of visual and audile monuments, along with the straightforward keypad and TV display, offers an effective tool for managing their drug needs. By icing timely drug input, alleviates the progression of symptoms and enhances the overall well-being of Alzheimer's cases.

Accuracy of OBGYN Resident Physician Clinical Estimation of Fetal Weight in Term Pregnancies Before and After a Teaching Curriculum

Purpose: Accurate prediction of fetal birth weight can improve antepartum and intrapartum shared decision-making with patients. Therefore, this study primarily sought to determine if OBGYN residents are more accurate at clinically estimating fetal weight via Leopold maneuvers following a teaching curriculum including a hands-on simulation model. Secondary aims were to determine if accuracy changes depending on training level, maternal or fetal characteristics. Methods: A paired t-test was used to evaluate the primary aim of the teaching curriculum’s effect on accuracy of correct fetal weight estimation. Nineteen residents served as their own controls to assess differences in accuracy by performing 10-12 estimates prior to and after the teaching curriculum. The curriculum consisted of a short verbal workshop with images of how to perform Leopold maneuvers, along with five models that were created to represent a gravid uterus with a fetus measured in the 5th, 25th, 50th, 75th, 95th percentiles. Residents were also tested on models with unknown weights to confirm accuracy prior to completing the teaching curriculum. The inclusion criteria during the fetal weight estimates pre- and post-curriculum was as follows: mother had to deliver during hospital admission; gestational age was between 37 weeks and 41 weeks; singleton pregnancy; mother had not undergone rupture of membranes; mother was English speaking. Accuracy was defined as estimated fetal weight within 10% of actual birth weight. Generalized Logistic Mixed Models were used to assess accuracy when adjusting for PGY level, maternal and fetal characteristics. Maternal characteristics including age, BMI, race, pregestational diabetes, gestational diabetes, polyhydramnios, and oligohydramnios were abstracted from maternal medical charts via retrospective chart review. Infant characteristics including fetal macrosomia, fetal growth restriction, and gestational age were also recorded. Analyses were conducted using SAS 9.4; all p-values were two-sided and p-values &lt;0.05 were deemed statistically significant. Results: Nineteen OBGYN residents performed a total of 443 Leopold maneuvers to estimate fetal weight. Overall, resident estimation accuracy within 10% of actual birth weight improved from 65.5% to 67.4% (p=0.49) after the teaching curriculum. Senior residents showed a greater improvement after the teaching curriculum than junior residents, however it was not statistically significant. This could be due to the low sample size. Increasing gestational age was associated with higher odds of accurate estimation of fetal weight (OR 1.34, p=0.0295). There were no other differences in accuracy based on other maternal or fetal factors. Conclusion: The teaching of Leopold maneuvers is often not formalized in residency programs. This study did not show the expected improvement in accuracy of fetal weight estimation. Considerations that may impact clinical estimations include improving the simulation model, revising the teaching curriculum, and/or doing the teaching curriculum more frequently. Incorporating this hands-on simulation annually within the residency program educational curriculum to standardize the learning experience may be beneficial.

Assessing Generative Pretrained Transformers (GPT) in Clinical Decision-Making: Comparative Analysis of GPT-3.5 and GPT-4.

Artificial intelligence, particularly chatbot systems, is becoming an instrumental tool in health care, aiding clinical decision-making and patient engagement. This study aims to analyze the performance of ChatGPT-3.5 and ChatGPT-4 in addressing complex clinical and ethical dilemmas, and to illustrate their potential role in health care decision-making while comparing seniors' and residents' ratings, and specific question types. A total of 4 specialized physicians formulated 176 real-world clinical questions. A total of 8 senior physicians and residents assessed responses from GPT-3.5 and GPT-4 on a 1-5 scale across 5 categories: accuracy, relevance, clarity, utility, and comprehensiveness. Evaluations were conducted within internal medicine, emergency medicine, and ethics. Comparisons were made globally, between seniors and residents, and across classifications. Both GPT models received high mean scores (4.4, SD 0.8 for GPT-4 and 4.1, SD 1.0 for GPT-3.5). GPT-4 outperformed GPT-3.5 across all rating dimensions, with seniors consistently rating responses higher than residents for both models. Specifically, seniors rated GPT-4 as more beneficial and complete (mean 4.6 vs 4.0 and 4.6 vs 4.1, respectively; P<.001), and GPT-3.5 similarly (mean 4.1 vs 3.7 and 3.9 vs 3.5, respectively; P<.001). Ethical queries received the highest ratings for both models, with mean scores reflecting consistency across accuracy and completeness criteria. Distinctions among question types were significant, particularly for the GPT-4 mean scores in completeness across emergency, internal, and ethical questions (4.2, SD 1.0; 4.3, SD 0.8; and 4.5, SD 0.7, respectively; P<.001), and for GPT-3.5's accuracy, beneficial, and completeness dimensions. ChatGPT's potential to assist physicians with medical issues is promising, with prospects to enhance diagnostics, treatments, and ethics. While integration into clinical workflows may be valuable, it must complement, not replace, human expertise. Continued research is essential to ensure safe and effective implementation in clinical environments.