Three Effective, Efficient, and Easily Implementable Ways to Integrate A.I. Into Medical Education.

As a medical school CEO who is following the development of A.I. very closely, I believe that med students are eager to adopt the possibilities that A.I. tools can deliver in their training. Not only do these students already use variations of A.I. in other areas of their lives, but they also embrace advanced technology and understand how to use it. With the tech readiness of today's students in mind, I have devised three recommendations for how to best infuse A.I. into medical education. This strategic guidance can deliver significant benefits to today's tech-fluent medical school students and enhance their training in their journeys to become doctors.

Increasing Diversity in the Physician Workforce: Pathway Programs and Predictive Analytics.

PROBLEM: Lack of diversity in the physician workforce has well-documented negative impacts on health outcomes. Evidence supports the use of pathway or pipeline programs to recruit underrepresented in medicine students. However, data on how a pathway program should deliver instruction are lacking. This report describes a multiyear project to build such a system with the goal of increasing diversity within medical school cohorts and ultimately the physician workforce. APPROACH: In the 2015-2016 academic year, the Ponce Health Sciences University started a 3-phase project to create a data-driven medical school feeder system by coupling a pathway program with predictive analytics. Phase 1 launched the pathway program. Phase 2 developed and validated a predictive model that estimates United States Medical Licensing Examination (USMLE) Step 1 performance. Phase 3 is underway and focuses on adoption, implementation, and support. OUTCOMES: Data analysis compared 2 groups of students (pathway vs direct) across specific factors, including Medical College Admission Test (MCAT) score, undergraduate grade point average (GPA), first-generation status, and Step 1 exam performance. Statistically significant differences were found between the 2 groups on the MCAT exam and undergraduate GPA; however, no significant differences were found between groups for first-generation status and performance on the Step 1 exam. This finding supports the authors' hypothesis that although pathway students have significantly lower mean MCAT exam scores compared with direct students, pathway students perform just as well on the USMLE Step 1 exam. NEXT STEPS: Next steps include expanding the project to another campus, adding more socioeconomic status and first-generation data, and identifying best curricular predictors. The authors recommend that medical school programs use pathway programs and predictive analytics to create a more data-centered approach to accepting students with the goal of increasing physician workforce diversity.

Business Models for Successfully Maintaining Games for Health.

Videogames for health provide innovative, exciting, and possibly highly effective new media for helping players change their behaviors or otherwise benefit their health. Getting the right videogames into the hands of players who can benefit most in a way that pays for the continued innovation and creation of such games is a current challenge. Entertainment videogame companies, which create games primarily to enhance players' enjoyment, have used the general business marketplace (e.g., online stores, walk-in stores, app stores) to deliver their products directly to consumers and earn enough capital to invest in making new products. No one believes, however, that enough kids or adults would use the general business marketplace to purchase games for health in sufficient volume to provide the down payment for the innovation and creation of new games for health. A successful business model is critical to the financial future of games for health. We asked members of our Editorial Board who are in health-related companies (Fikry Isaac, MD, MPH), in several game development companies (Chris Ashford, Ron Goldman, David J. Lenihan, Brent Poole, and Richard Buday, FAIA), and the head of the Games for Health Europe Foundation (Jurriaan van Rijswijk, MSc) to address questions in a roundtable about the current and possible future business models for games for health.

Health Games: A Key Component for the Evolution of Wellness Programs.

Healthcare cost growth has been a major concern for both governments and employers. Considerable efforts have been made to "bend the trend" or find ways to control costs. At the highest levels, this has been the move from indemnity care models to managed care and then to consumer-directed health models using Healthcare Reimbursement Accounts and Healthcare Spending Accounts in plan designs. Accompanying this move in plan design has been an effort to get the consumer/patient/employee more engaged and responsible for his or her health expenditures, health decision-making, and activities. Consumers have gone through the phases of health being doctor-centric (indemnity care model), to health plan-centric (managed care models), to consumer-centric (consumer-directed health models). There is currently a need to incorporate wellness into the equation. Simply put, wellness is intended to keep people out of the health system by reducing the risk factors that would put them into the system in the first place. This includes things like smoking cessation, exercise, weight management, nutrition, and other factors over which individuals have a significant level of control over, as well as condition management such as medication adherence, and condition monitoring (such as glucose monitoring for diabetics). Wellness will become increasingly more common for major buyers, initially large self-funded employers and then health plans that will offer it as a part of their overall Plan Design and Administration services. Wellness initiatives will also be offered by Federal and State governments and will include programs for the elderly and at-risk populations as well as for the general population. The measure of success of wellness programs to actually "bend the trend" will be engagement. How large a piece of the population can be captured and retained will be the critical metric for success…and metrics require real data and will be used by the entire healthcare value-chain to measure efficacy and efficiency of "wellness spending."

Impacts of climate change on phosphorus loading from a grassland catchment: implications for future management.

Dynamic modelling was used to quantify the impact of projected climate change, and potential changes in population and land use, on phosphorus (P) export from a sub-catchment in SW Ireland using the Generalised Watershed Loading Functions (GWLF) model. Overall the results indicated that the increase in annual total phosphorus loads attributable to climate change was greater than that from either population or land use change, and therefore that future climate variability will pose an increasingly significant threat to the successful long-term implementation of catchment management initiatives. The seasonal pattern in projected P export mirrored changes in streamflow, with higher rates between January and April and lower rates in summer. The potential reduction in export in summer was, however, negated when increases in population were included in simulations. A change in the slurry spreading period from that stipulated in national regulations to the months between April and September could potentially mitigate against future increases in dissolved P export in spring. The results indicate that projected changes in climate should be included when undertaking modelling exercises in support of decision making for catchment management plans.

Use of a static magnetic field to promote recovery after peripheral nerve injury.

OBJECT: While pulsed electromagnetic stimulation has been shown to enhance peripheral nerve regeneration, the effect of a static magnetic field on nerve repair is less clear. The aim of this study was to establish what effect an imposed exogenous static magnetic field has on peripheral nerve regeneration after transection and repair. METHODS: Three groups of six adult sheep were used. The first group acted as normal controls. In the second group, the median nerve was divided and immediately repaired by entubulation within a "controlled-release" biodegradable glass tube. In the third group, small magnets were applied to the sides of the biodegradable glass tubes before the median nerve was repaired using these magnetic tubes. The sheep were allowed to recover and were reexamined 10 months later. The animals underwent comprehensive morphometric (cross-sectional morphometry and measurement of internodal lengths), electrophysiological (determinations of stimulated jitter, maximum conduction velocity, refractory period, and F waves), and isometric tension (isometric twitch and tetanic tension) assessments. CONCLUSIONS: Exogenously applied static electromagnetic fields do not enhance peripheral nerve regeneration.