Embracing digital health: German otolaryngology patients' usage and prospects of digital information and communication technologies for cross-sectoral care.

Objective: The usage of digital information and communication technologies in European healthcare is growing. Unlike numerous technological possibilities, the present use of these technologies and perspectives towards them in relation to otolaryngology care have so far been of less interest. This study evaluates the utilisation of and attitudes towards digital information and communication technologies in cross-sectoral otolaryngology care among German patients. Methods: A structured interview-based study was conducted at the outpatient facility of a tertiary hospital in Germany. It focused on chief complaints, current use of digital technologies, estimated benefits of increased digital technology use in otolaryngology care, and sociodemographic data. The detailed statistical analysis employed Chi-squared tests and multivariate logistic regression. Results: A total of 208 otolaryngology patients completed the interview. Digital communication technologies exhibited a high penetration rate (91.8%) and were regularly used in daily life (78.7%) and for health reasons (73.3%). Younger age (p ≤ 0.003) and higher education levels (p ≤ 0.008) were significantly correlated with the increased digital communication technology use. The overall potential of eHealth technologies was rated significantly higher by younger patients (p ≤ 0.001). The patients' chief complaints showed no significant influence on the current and potential use of these technologies for cross-sectoral otolaryngology care. Conclusion: Regardless of their chief complaints, German otolaryngology patients regularly use digital information and communication technologies for health reasons and express interest in their further use for cross-sectoral care. To enhance digital patient communication in otolaryngology, attention should be given to treatment quality, usability, data security and availability and financial remuneration for service providers.

Insights into discrepancies in professional identities and role models in undergraduate medical education in the context of affective burden.

Introduction: International evidence strongly suggests that medical students are at high risk of mental health problems. This distress, which can be mediated by a variety of individual, interpersonal and contextual factors within the curriculum, can be mitigated by effective coping strategies and interventions. Central to this discourse is the recognition that the challenges of professional identity formation can contribute significantly to medical students' distress. The focus of our study is therefore to examine discrepancies in professional identities and role models in undergraduate medical education in relation to affective burden. Methods: Medical students at different stages of university education and high school graduates intending to study medicine were surveyed in a cross-sectional study. The study employed Osgood and Hofstätter's polarity profile to evaluate the self-image of participants, the image of an ideal and real physician, and their correlation with depression (PHQ-9) and anxiety (GAD-7). Results: Out of the 1535 students recruited, 1169 (76.2%) participated in the study. Students rated their self-image as somewhere between a more critical real image of physicians and a more positive ideal image. Medical students at all training levels consistently rated the ideal image as remaining constant. Significant correlations were found between the professional role models of medical students and affective symptoms, particularly for the discrepancy between the ideal image of a physician and their self-image. Furthermore, 17% and nearly 15% reported significant symptoms of depression and anxiety, respectively. Discussion: Our study adds to the growing body of knowledge on professional identity formation in medicine and socialisation in the medical environment. The study highlights the importance of discrepancies between self-image and ideal image in the experience of depressive and anxiety symptoms. Primary prevention-oriented approaches should incorporate these findings to promote reflective competence in relation to professional role models and strengthen the resilience of upcoming physicians in medical training.

How professional and academic pre-qualifications relate to success in medical education: Results of a multicentre study in Germany.

OBJECTIVE: Every year, many applicants want to study medicine. Appropriate selection procedures are needed to identify suitable candidates for the demanding curriculum. Although research on medical school admissions has shown good predictive validity for cognitive selection methods (undergraduate GPA, aptitude tests), the literature on applicants with professional and/or academic experience prior to entering medical school remains slim. In our study, we therefore aimed to examine the association between academic success in medical school and having previously completed vocational training in the medical field, voluntary service (≥11 months) or an academic degree. METHODS: Data were collected in a multicentre, cross-sectional study at five medical schools in Germany (Baden-Wuerttemberg) from students during medical school (i.e. 3rd-, 6th-, and 10th-semester and final-year students). Academic success was assessed according to scores on the first and second state examinations, the total number of examinations repeated and the number of semesters beyond the standard period of study. For the analysis we calculated ordinal logistic regression models for each outcome variable of academic success. RESULTS: A total of N = 2,370 participants (response rate: RR = 47%) participated in the study. Having completed vocational training was associated with a higher amount of repeated examinations (small effect), while having an academic degree was associated with worse scores on the second state examination (medium effect). No significant association emerged between voluntary service and academic success. CONCLUSION: The results indicate that professional and academic pre-qualifications pose no advantage for academic success. Possible associations with the financing of study and living conditions of students with pre-qualifications were analysed and discussed in an exploratory manner. However, the operationalisation of academic success from objective and cognitive data should be critically discussed, as the benefits of prior experience may be captured by personal qualities rather than examination results.

The Predominance of the Health-Promoting Patterns of Work Behavior and Experience in General Practice Teams-Results of the IMPROVEjob Study.

This study aims to identify the distribution of the "Work-related behavior and experience patterns" (Arbeitsbezogenes Verhaltens-und Erlebnismuster, AVEM) in general practitioners and their teams by using baseline data of the IMPROVEjob study. Members of 60 general practices with 84 physicians in a leadership position, 28 employed physicians, and 254 practice assistants participated in a survey in 2019 and 2020. In this analysis, we focused on AVEM variables. Age, practice years, work experience, and working time were used as control variables in the Spearman Rho correlations and analysis of variance. The majority of the participants (72.1%) revealed a health-promoting pattern (G or S). Three of eleven AVEM dimensions were above the norm for the professional group "employed physicians". The AVEM dimensions "striving for perfection" (p < 0.001), "experience of success at work" (p < 0.001), "satisfaction with life" (p = 0.003), and "experience of social support" (p = 0.019) differed significantly between the groups' practice owners and practice assistants, with the practice owners achieving the higher values, except for experience of social support. Practice affiliation had no effect on almost all AVEM dimensions. We found a high prevalence of AVEM health-promoting patterns in our sample. Nearly half of the participants in all professional groups showed an unambitious pattern (S). Adapted interventions for the represented AVEM patterns are possible and should be utilized for maintaining mental health among general practice teams.

Medical students' attitudes and perceived competence regarding medical cannabis and its suggestibility.

INTRODUCTION: The global trend of legalizing medical cannabis (MC) is on the rise. In Germany, physicians have prescribed MC at the expense of health insurers since 2017. However, the teaching on MC has been scant in medical training. This study investigates medical students' attitudes and perceived competence regarding MC and evaluates how varying materials (videos/articles) impact their opinions. METHODS: Fourth-year medical students were invited to participate in the cross-sectional study. During an online session, students viewed a video featuring a patient with somatoform pain discussing her medical history, plus one of four randomly assigned MC-related materials (each an article and a video depicting a positive or negative perspective on MC). Students' opinions were measured at the beginning [T0] and the end of the course [T1] using a standardized questionnaire with a five-point Likert scale. We assessed the influence of the material on the students' opinions using paired-sample t-tests. One-way analysis of variance and Tukey post-hoc tests were conducted to compare the four groups. Pearson correlations assessed correlations. RESULTS: 150 students participated in the course, the response rate being 75.3% [T0] and 72.7% [T1]. At T0, students felt a little competent regarding MC therapy (M = 1.80 ± 0.82). At T1, students in groups 1 (positive video) and 3 (positive article) rated themselves as more capable in managing MC therapy [Formula: see text], and students in groups 3 (positive article) and 4 (negative article) felt more skilled in treating patients with chronic pain [Formula: see text]. Compared to the other groups, group 2 students (negative video) felt significantly less competent. They perceived cannabis as addictive, hazardous and unsuitable for medical prescription. DISCUSSION: This study showed that medical students lack knowledge and perceived competence in MC therapy. Material influences their opinions in different ways, and they seek more training on MC. This underlines that integrating MC education into medical curricula is crucial to address this knowledge gap.

A Generative Pretrained Transformer (GPT)-Powered Chatbot as a Simulated Patient to Practice History Taking: Prospective, Mixed Methods Study.

BACKGROUND: Communication is a core competency of medical professionals and of utmost importance for patient safety. Although medical curricula emphasize communication training, traditional formats, such as real or simulated patient interactions, can present psychological stress and are limited in repetition. The recent emergence of large language models (LLMs), such as generative pretrained transformer (GPT), offers an opportunity to overcome these restrictions. OBJECTIVE: The aim of this study was to explore the feasibility of a GPT-driven chatbot to practice history taking, one of the core competencies of communication. METHODS: We developed an interactive chatbot interface using GPT-3.5 and a specific prompt including a chatbot-optimized illness script and a behavioral component. Following a mixed methods approach, we invited medical students to voluntarily practice history taking. To determine whether GPT provides suitable answers as a simulated patient, the conversations were recorded and analyzed using quantitative and qualitative approaches. We analyzed the extent to which the questions and answers aligned with the provided script, as well as the medical plausibility of the answers. Finally, the students filled out the Chatbot Usability Questionnaire (CUQ). RESULTS: A total of 28 students practiced with our chatbot (mean age 23.4, SD 2.9 years). We recorded a total of 826 question-answer pairs (QAPs), with a median of 27.5 QAPs per conversation and 94.7% (n=782) pertaining to history taking. When questions were explicitly covered by the script (n=502, 60.3%), the GPT-provided answers were mostly based on explicit script information (n=471, 94.4%). For questions not covered by the script (n=195, 23.4%), the GPT answers used 56.4% (n=110) fictitious information. Regarding plausibility, 842 (97.9%) of 860 QAPs were rated as plausible. Of the 14 (2.1%) implausible answers, GPT provided answers rated as socially desirable, leaving role identity, ignoring script information, illogical reasoning, and calculation error. Despite these results, the CUQ revealed an overall positive user experience (77/100 points). CONCLUSIONS: Our data showed that LLMs, such as GPT, can provide a simulated patient experience and yield a good user experience and a majority of plausible answers. Our analysis revealed that GPT-provided answers use either explicit script information or are based on available information, which can be understood as abductive reasoning. Although rare, the GPT-based chatbot provides implausible information in some instances, with the major tendency being socially desirable instead of medically plausible information.

Parenting the parent without losing sight of the child. A qualitative study of therapists' experiences with intergenerational adversities in perinatal psychotherapy.

The complex work of addressing intergenerational adversities, like violence, abuse, and neglect through perinatal psychotherapy, is understudied. Especially noticeable is the paucity of studies giving voice to the therapists. This study explored therapeutic processes through the perspectives of seven Norwegian therapists. A qualitative approach was chosen with individual interviews and a follow-up focus group. Data were analyzed using reflexive thematic analysis. We identified one overarching theme: To maintain a reflective therapeutic capacity, and two main themes with associated subthemes: 1) Alliance work when a caring system comes to therapy to fight generations of adversities and 2) The complex therapeutic work of addressing generational adversities in perinatal psychotherapy. Findings from the present study indicate that maintaining a reflective stance is essential yet challenging when addressing intergenerational adversities, requiring a holding environment for the therapists. The primary vehicle of change was perceived as a safe enough therapeutic alliance to explore new ways of being together, contrasting earlier experiences. A key question raised was how to give caregivers enough time to trust the therapist without compromising the safety and development of the child. The essence of the therapeutic work was to reduce risk factors and increase protective factors through multiple ports of entry.

El complejo trabajo de abordar el tema de adversidades intergeneracionales, como violencia, abuso y negligencia a través de la sicoterapia perinatal, no se ha estudiado lo suficiente. Especialmente perceptible es la escasez de estudios que les den voz a los terapeutas. Este estudio exploró los procesos terapéuticos a través de perspectivas de siete terapeutas noruegos. Se escogió un acercamiento cualitativo con entrevistas individuales y un grupo de enfoque como seguimiento. Se analizaron los datos usando un análisis temático reflexivo. Identificamos un tema global: Mantener una capacidad terapéutica reflexiva, así como dos temas principales con subtemas asociados: 1) Trabajo en alianza cuando un sistema de cuidados llega a la terapia, para combatir generaciones de adversidades y 2) El complejo trabajo terapéutico de abordar el tema de adversidades generacionales en la sicoterapia perinatal. Los resultados del presente estudio indicaron que mantener una postura de reflexión es esencial, aunque desafiante, cuando se aborda el tema de adversidades generacionales, lo cual requiere un entorno o espacio favorable para los terapeutas. La percepción es que el vehículo primario para el cambio es una suficientemente segura alianza terapéutica para explorar nuevas maneras de vivir juntos, contrastando las experiencias anteriores. Una pregunta clave que se planteó fue cómo darles a los cuidadores suficiente tiempo para que le tengan confianza al terapeuta sin comprometer la seguridad y el desarrollo del niño. La esencia del trabajo terapéutico fue reducir los factores de riesgo e incrementar los factores de protección por medio de múltiples puertas de entrada.

Le travail complexe qui consiste à s'attaquer aux adversités intergénérationnelles comme la violence, la maltraitance et la négligence au travers de la psychothérapie périnatale est sous-étudié. On constate surtout la rareté d'études donnant la parole aux thérapeutes. Cette étude a exploré les processus thérapeutiques au travers des perspectives de sept thérapeutes norvégiens. Une approche qualitative a été choisie avec des entretiens individuels et un groupe d'étude de suivi. Des données ont été analysées en utilisant une analyse réflective thématique. Nous avons identifié un thème général: maintenir une capacité thérapeutique réflective et deux thèmes principaux avec des sous-thèmes liés: 1) le travail d'alliance quand un système attentif en arrive à la thérapie pour contrecarrer des générations d'adversités et 2) le travail thérapeutique complexe qui consiste à s'attaquer aux adversités intergénérationnelles en psychothérapie périnatale. Les résultats de cette étude ont indiqué que le maintien d'une position de réflexion est essentiel mais pose également un défi lorsqu'on on s'attaque aux adversités intergénérationnelles, exigeant un environnement thérapeutique soutenant pour les thérapeutes. Le principal véhicule de changement a été perçu comme une alliance thérapeutique étant assez sûre pour l'exploration de nouvelles façons d'être ensemble, en contraste avec des expériences précédentes. Une question clé qui a été soulevée était de comment donner aux personnes prenant soin des enfants assez de temps pour avoir confiance au thérapeute sans compromettre la sécurité et le développement de l'enfant. L'essence du travail thérapeutique a consisté à réduire les facteurs de risque et à accroître les facteurs protecteurs au travers de plusieurs ports d'entrée.

Assessing ChatGPT's Mastery of Bloom's Taxonomy Using Psychosomatic Medicine Exam Questions: Mixed-Methods Study.

BACKGROUND: Large language models such as GPT-4 (Generative Pre-trained Transformer 4) are being increasingly used in medicine and medical education. However, these models are prone to "hallucinations" (ie, outputs that seem convincing while being factually incorrect). It is currently unknown how these errors by large language models relate to the different cognitive levels defined in Bloom's taxonomy. OBJECTIVE: This study aims to explore how GPT-4 performs in terms of Bloom's taxonomy using psychosomatic medicine exam questions. METHODS: We used a large data set of psychosomatic medicine multiple-choice questions (N=307) with real-world results derived from medical school exams. GPT-4 answered the multiple-choice questions using 2 distinct prompt versions: detailed and short. The answers were analyzed using a quantitative approach and a qualitative approach. Focusing on incorrectly answered questions, we categorized reasoning errors according to the hierarchical framework of Bloom's taxonomy. RESULTS: GPT-4's performance in answering exam questions yielded a high success rate: 93% (284/307) for the detailed prompt and 91% (278/307) for the short prompt. Questions answered correctly by GPT-4 had a statistically significant higher difficulty than questions answered incorrectly (P=.002 for the detailed prompt and P<.001 for the short prompt). Independent of the prompt, GPT-4's lowest exam performance was 78.9% (15/19), thereby always surpassing the "pass" threshold. Our qualitative analysis of incorrect answers, based on Bloom's taxonomy, showed that errors were primarily in the "remember" (29/68) and "understand" (23/68) cognitive levels; specific issues arose in recalling details, understanding conceptual relationships, and adhering to standardized guidelines. CONCLUSIONS: GPT-4 demonstrated a remarkable success rate when confronted with psychosomatic medicine multiple-choice exam questions, aligning with previous findings. When evaluated through Bloom's taxonomy, our data revealed that GPT-4 occasionally ignored specific facts (remember), provided illogical reasoning (understand), or failed to apply concepts to a new situation (apply). These errors, which were confidently presented, could be attributed to inherent model biases and the tendency to generate outputs that maximize likelihood.

Anxiety and Somatoform Syndromes Predict Transplant-Focused Internet Use in the Course of an Organ Transplantation.

Background: e-Health interventions are increasing in the field of organ transplantations; however, the literature lacks evidence regarding needs, attitudes, and preferences of organ recipients and donors during the course of an organ transplantation. Methods: In a cross-sectional study, 70 subjects were assessed using self-rated and validated questionnaires, such as the PRIME MD Patient Health Questionnaire (PHQ-D) and the Essen Resource Inventory (ERI). Group differences and a multiple linear regression were also applied. Results: Organ recipients had significantly higher scores for depression (U = 245.00, z = -2.65, p = 0.008, Cohen's d = 0.32), somatoform (U = 224.50, z = -2.99, p = 0.003, Cohen's d = 0.37), and stress syndromes (U = 266.00, z = -2.25, p = 0.008, Cohen's d = 0.27). They also named the internet and apps as resources to find information regarding organ transplants (U = 177.50, z = -2.07, p = 0.017, Cohen's d = 0.28; Z = -2.308, p = 0.021) and preferred to use apps to monitor the physical condition (Z = -2.12, p = 0.034) significantly more than organ donors. Anxiety and somatoform syndromes were significant predictors to search for information regarding the transplant process (F[6,38] = 3.98, p < 0.001; R2 = 0.386). Conclusions: e-Health interventions are promising in accompanying the course of an organ transplant for patients to be informed and educated. Predominantly, potential organ recipients might benefit from apps to record physical parameters. However, anxiety syndromes might hinder patients from searching for information about the transplant process, while somatoform syndromes might enable patients who are searching for such information.

Medical Students' Attitudes Toward AI in Medicine and their Expectations for Medical Education.

Objectives: Artificial intelligence (AI) is used in a variety of contexts in medicine. This involves the use of algorithms and software that analyze digital information to make diagnoses and suggest adapted therapies. It is unclear, however, what medical students know about AI in medicine, how they evaluate its application, and what they expect from their medical training accordingly. In the study presented here, we aimed at providing answers to these questions. Methods: In this survey study, we asked medical students about their assessment of AI in medicine and recorded their ideas and suggestions for considering this topic in medical education. Fifty-eight medical students completed the survey. Results: Almost all participants were aware of the use of AI in medicine and had an adequate understanding of it. They perceived AI in medicine to be reliable, trustworthy, and technically competent, but did not have much faith in it. They considered AI in medicine to be rather intelligent but not anthropomorphic. Participants were interested in the opportunities of AI in the medical context and wanted to learn more about it. They indicated that basic AI knowledge should be taught in medical studies, in particular, knowledge about modes of operation, ethics, areas of application, reliability, and possible risks. Conclusions: We discuss the implications of these findings for the curricular development in medical education. Medical students need to be equipped with the knowledge and skills to use AI effectively and ethically in their future practice. This includes understanding the limitations and potential biases of AI algorithms by teaching the sensible use of human oversight and continuous monitoring to catch errors in AI algorithms and ensure that final decisions are made by human clinicians.

Nanoparticle display of prefusion coronavirus spike elicits S1-focused cross-reactive antibody response against diverse coronavirus subgenera.

Multivalent antigen display is a fast-growing area of interest toward broadly protective vaccines. Current nanoparticle-based vaccine candidates demonstrate the ability to confer antibody-mediated immunity against divergent strains of notably mutable viruses. In coronaviruses, this work is predominantly aimed at targeting conserved epitopes of the receptor binding domain. However, targeting conserved non-RBD epitopes could limit the potential for antigenic escape. To explore new potential targets, we engineered protein nanoparticles displaying coronavirus prefusion-stabilized spike (CoV_S-2P) trimers derived from MERS-CoV, SARS-CoV-1, SARS-CoV-2, hCoV-HKU1, and hCoV-OC43 and assessed their immunogenicity in female mice. Monotypic SARS-1 nanoparticles elicit cross-neutralizing antibodies against MERS-CoV and protect against MERS-CoV challenge. MERS and SARS nanoparticles elicit S1-focused antibodies, revealing a conserved site on the S N-terminal domain. Moreover, mosaic nanoparticles co-displaying distinct CoV_S-2P trimers elicit antibody responses to distant cross-group antigens and protect male and female mice against MERS-CoV challenge. Our findings will inform further efforts toward the development of pan-coronavirus vaccines.

Evaluation of the feasibility of a video-transmitted surgical ward round: a proof of concept study.

BACKGROUND: Surgical ward rounds are key element to point-of-care interprofessional postoperative treatment and technical and communicational aspects are relevant for the patient's safety and satisfaction. Due to COVID-19 restrictions, the training opportunity of experiencing a face-to-face surgical ward round was massively hampered and thus, we developed a digital concept. This study aims to investigate the feasibility of video-transmitted ward rounds integrating surgical and communicational aspects with live streaming from wards. Further, medical students were asked for their satisfaction and their subjective learning success. METHODS: The proof-of-concept study consisted of self-reported subjective evaluation of competences in ward round skills. Qualitative feedback was collected to gain deeper insight and students' empathy was rated by using the student version of the Jefferson Empathy Scale (JES). RESULTS: One hundred three medical students participated. The students were satisfied with the video-transmitted ward round (M = 3.54; SD = 1.22). In the subjective evaluation students' ward round competencies rose significantly (p < .001, Mpre = 3.00, SD = 0.77; Mpost = 3.76, SD = 0.75). The surgeon was rated as empathic (M = 119.05; SD = 10.09). In the qualitative feedback they named helpful aspects like including an expert for communication. However, they preferred the face-to-face setting in comparison to the digital concept. CONCLUSIONS: It was feasible to implement a video-transmitted ward round within a pandemic. The format worked technically, was well-accepted and also led to a subjective rise in the students' competencies. Video-transmitted ward rounds may be integrated to support the medical education, though, they cannot replace the face-to-face setting.

Tutors´ and Students' Agreement on Social and Cognitive Congruence in a Sonography Peer-assisted-learning Scenario.

Purpose: Peer-assisted learning has become an integral part within medical education and has been proven to be effective in teaching medical skills. Cognitive and social congruence are important factors that explain the effectiveness of peer-assisted learning. However, although theory suggests this, there is no study to date that demonstrates that students and tutors agree upon the level of cognitive and social congruence. Thus, we compared tutors' and students' perception of cognitive and social congruence and their agreement on the causes of congruence. Methods: 36 students and 9 tutors from 9 courses were asked to answer questionnaires for their perception of cognitive and social congruence in a peer-assisted learning sonography scenario. Results: Students and tutors experienced cognitive congruence (t = 0.8277, df = 8, p = .4318, 95% CI = [-0.232; 0.491]) and social congruence (t = 0.962, df = 8, p = .364, 95% CI = [-0.145; 0.354]) similarly. In contrast, students and tutors disagreed on causes of cognitive congruence (agreement = 53.90%) and social congruence (agreement = 58.49%). Tutors rated their empathy and interest toward students as the main cause. Students rated the helpfulness, effectiveness, and approachableness of the tutor as the main cause. Conclusions: Our study filled the gap in previous research on cognitive and social congruence. Consistent with theoretical considerations, it was shown that students and tutors do indeed experience cognitive and social congruence similarly. Nevertheless, differences also emerged that may carry more or less weight depending on the research question. Future studies should therefore carefully examine whether the assessment of cognitive and social congruence of students and tutors is necessary.

Training medical students in motivational interviewing using a blended learning approach: a proof-of-concept study.

Background: Difficulties in implementing behavior change in patients with chronic diseases are common in clinical practice. Motivational interviewing (MI) helps clinicians to support patients in overcoming ambivalence while maintaining self-determination. The inclusion of MI in German medical training curricula is still rare. Furthermore, the effects of systematic teaching of MI, especially via blended learning, have hardly been investigated. Methods: Medical students participated in three curricular events related to MI, consisting of instructional videos and theoretical and practical components in a blended learning format. The aim of the study was to investigate the effect of teaching MI in students' medical education. A controlled, non-randomized study was conducted with an intervention group and a control group. Both groups completed questionnaires on their experience and knowledge related to MI, completed a knowledge test and rated their satisfaction with the course. MI was taught in the 6th semester of medical coursework as part of a psychosomatic course, in the 8th semester during a psychiatry course and in the 9th semester during a weekly psychiatry clerkship. Results: Data from the intervention group (n = 35) and control group (n = 14) were analyzed, with 65.7% of students participating in all three parts of the curriculum. Overall interest in learning MI was high, with M = 2.92 (SD = 1.00). The results indicate a greater increase in knowledge over time in the intervention group. The majority (62.86%) stated that the curriculum was relevant to their future career. Free-form text responses indicated a high level of satisfaction with practical relevance. Conclusion: This study demonstrates the usefulness of an MI curriculum for medical students. The integration of MI into medical curricula is a promising curricular addition to improve doctor-patient communication. Future research should address patient perceptions of MI competencies and the persistence of acquired competencies.

How to communicate with patients in written asynchronous online conversations: an intervention study with undergraduate medical students in a cross-over design.

Introduction: The patient-physician encounter is the core element in the treatment of patients and the diagnosis of disease. In these times of digitalization, patient-physician communication is increasingly taking place online: patients embrace new possibilities offered digitally, and physicians are encouraged to adapt accordingly. Since a huge part of online communication is written, this study aims to investigate how medical students communicate with patients online by focusing on their written competencies and whether an intervention might improve their competencies. Methods: This study was performed in an explanatory cross-sectional manner with a cross-over design. Second-year medical students participated. An intervention was developed on how to formulate an appropriate written response to a patient's request and integrated a longitudinal communication class. The intervention consists of education on general set-up (e.g., greetings), syntax, spelling, content and kind of communication (e.g., appreciative attitude). After meeting a patient in a simulated role play medical students received the patient's request via a digital platform. The control group had the same simulated role play and the same task but they received the intervention on communication afterwards. Intervention and control group were statistically compared based on a checklist. Results: Twenty-nine medical students took part in the study. The results showed that the medical students had basic competencies in dealing with written communication independent if they received the intervention (CG: M = 3.86 ± 1.23 vs. IG: M = 4.07 ± 1.03; p = 0.625). Similar results were also for the emotional competency ratings (MCG = 3.36 ± 1.08; MIG = 3.67 ± 0.98; p = 0.425).The intervention was able to lead to a more appreciative response toward patient. Discussion: Intervention on basic competencies such as simple language and clear presentation might not be needed as an integral part in medical education. However, medical students should learn how to present empathic and authentic behavior in written online communication.

Mirror Therapy in Patients with Somatoform Pain Disorders-A Pilot Study.

Patients with chronic pain report reduced quality of life and high symptom burden while often responding insufficiently to treatment options. Mirror therapy has been proven to be effective in treating phantom limb pain and other conditions such as CRPS. This study was designed to investigate the efficacy of mirror therapy in patients with somatoform pain disorders on symptom severity and associated physiological parameters. Fifteen patients with persistent somatoform pain disorder (F45.40) or chronic pain disorder with somatic and psychological factors (F45.41) participated and received four weeks of tablet-based mirror therapy. Symptom severity was measured with established questionnaires, and their thermal detection, pain thresholds, and heart rate variability (HRV) were also assessed. After mirror therapy, pain intensity was reduced (z = -2.878, p = 0.004), and pain thresholds for cold stimuli were also diminished, i.e., the subjects became more sensitive to cold stimuli (z = -2.040, p = 0.041). In addition, a reduction of absolute power in the low-frequency band of HRV (t(13) = 2.536, p = 0.025) was detected. These findings indicate that this intervention may reduce pain intensity and modulate associated physiological parameters. As these results are limited by several factors, e.g., a small sample size and no control group, they should be validated in further studies investigating this novel intervention in these patients.

Behavior of broilers and impacts occurring to them during mechanical loading under field conditions.

Mechanical loading has been used increasingly in recent years alongside the manual loading of broilers. The aim of this study was to analyze the influence of various factors on the behavior of broilers and the impacts occurring to broilers during loading with a loading machine in order to identify risk factors and thus improve animal welfare. During 32 loadings we assessed escape behavior, wing flapping, flip, bumping into an animal, and bumping against the machine or container by evaluation of video recordings. The parameters were analyzed for influences of rotation speed, container type (GP container vs. SmartStack container), husbandry system ("Indoor Plus" vs. "Outdoor Climate"), and season. In addition, the behavior and impact parameters were correlated with the loading-related injuries. The results showed that an increase in rotation and conveyor belt speed was associated with an elevated risk of all behaviors or impacts, except for a lower risk of escape behavior. The seasonal influence showed that the risk of wing flapping, bumping into an animal, and bumping against the machine or container was highest in fall. The comparison of the container types showed that the risk of escape behavior, wing flapping, and bumping into an animal was increased when loading with the SmartStack container, but the risk of bumping against the machine or container was reduced. For animals of the husbandry system "Outdoor Climate," the risk of bumping into an animal and bumping against the machine or container was reduced. In addition, we found an influence of the examined parameters on the loading-related injuries. Increased escape behavior reduced the risk of severe injuries (fractures, dislocations, epiphysiolyses). Wing flapping and bumping against the machine or container increased the risk of hematomas and abrasions. The risk of hematomas was increased if broilers bumped into conspecifics. In summary, our analysis revealed that the behavior and impacts on the animals during loading are influenced by each of the analyzed factors and that they in turn can affect loading-related injuries.

Chatbots for future docs: exploring medical students' attitudes and knowledge towards artificial intelligence and medical chatbots.

Artificial intelligence (AI) in medicine and digital assistance systems such as chatbots will play an increasingly important role in future doctor - patient communication. To benefit from the potential of this technical innovation and ensure optimal patient care, future physicians should be equipped with the appropriate skills. Accordingly, a suitable place for the management and adaptation of digital assistance systems must be found in the medical education curriculum. To determine the existing levels of knowledge of medical students about AI chatbots in particular in the healthcare setting, this study surveyed medical students of the University of Luebeck and the University Hospital of Tuebingen. Using standardized quantitative questionnaires and qualitative analysis of group discussions, the attitudes of medical students toward AI and chatbots in medicine were investigated. From this, relevant requirements for the future integration of AI into the medical curriculum could be identified. The aim was to establish a basic understanding of the opportunities, limitations, and risks, as well as potential areas of application of the technology. The participants (N = 12) were able to develop an understanding of how AI and chatbots will affect their future daily work. Although basic attitudes toward the use of AI were positive, the students also expressed concerns. There were high levels of agreement regarding the use of AI in administrative settings (83.3%) and research with health-related data (91.7%). However, participants expressed concerns that data protection may be insufficiently guaranteed (33.3%) and that they might be increasingly monitored at work in the future (58.3%). The evaluations indicated that future physicians want to engage more intensively with AI in medicine. In view of future developments, AI and data competencies should be taught in a structured way during the medical curriculum and integrated into curricular teaching.

Virtual Reality for Emergency Medicine Training in Medical School: Prospective, Large-Cohort Implementation Study.

BACKGROUND: Virtual reality (VR)-based simulation is being increasingly used to train medical students in emergency medicine. However, because the usefulness of VR may depend on various factors, the best practices for implementing this technology in the medical school curriculum are yet to be determined. OBJECTIVE: The overall objective of our study was to assess the perceptions of a large cohort of students toward VR-based training and to identify the associations between these attitudes and individual factors, such as gender and age. METHODS: The authors implemented a voluntary, VR-based teaching session in the emergency medicine course at the Medical Faculty in Tübingen, Germany. Fourth-year medical students were invited to participate on a voluntary basis. Afterward, we asked the students about their perceptions, collected data on individual factors, and assessed the test scores achieved by them in the VR-based assessment scenarios. We used ordinal regression analysis and linear mixed-effects analysis to detect the impact of individual factors on the questionnaire answers. RESULTS: A total of 129 students participated in our study (mean age 24.7, SD 2.9 years; n=51, 39.8% male; n=77, 60.2% female). No student had previously used VR for learning, and only 4.7% (n=6) of the students had prior experience with VR. Most of the students agreed that VR can convey complex issues quickly (n=117, 91%), that VR is a useful addition to mannequin-based courses (n=114, 88%) or could even replace them (n=93, 72%), and that VR simulations should also be used for examinations (n=103, 80%). However, female students showed significantly less agreement with these statements. Most students perceived the VR scenario as realistic (n=69, 53%) and intuitive (n=62, 48%), with a relatively lower agreement for the latter among female respondents. We found high agreement among all participants (n=88, 69%) for immersion but strong disagreement (n=69, 54%) for empathy with the virtual patient. Only 3% (n=4) of the students felt confident regarding the medical content. Responses for the linguistic aspects of the scenario were largely mixed; however, most of the students were confident with the English language (not native) scenarios and disagreed that the scenario should be offered in their native language (female students agreed more strongly than male students). Most of the students would not have felt confident with the scenarios in a real-world context (n=69, 53%). Although physical symptoms during VR sessions were reported by 16% (n=21) of the respondents, this did not lead to the termination of the simulation. The regression analysis revealed that the final test scores were not influenced by gender, age, or prior experience in emergency medicine or with virtual reality. CONCLUSIONS: In this study, we observed a strong positive attitude in medical students toward VR-based teaching and assessment. However, this positivity was comparatively lower among female students, potentially indicating that gender differences need to be addressed when VR is implemented in the curriculum. Interestingly, gender, age, or prior experience did not influence the final test scores. Furthermore, confidence regarding the medical content was low, which suggests that the students may need further training in emergency medicine.