Out-of-Hospital Birth in Medical Education: A Thematic Analysis of Question Banks for Medical Licensing Examinations in the United States.

OBJECTIVES: This study assessed the content of US Medical Licensing Examination question banks with regard to out-of-hospital births and whether the questions aligned with current evidence. METHODS: Three question banks were searched for key words regarding out-of-hospital births. A thematic analysis was then utilized to analyze the results. RESULTS: Forty-seven questions were identified, and of these, 55% indicated a lack of inadequate, limited, or irregular prenatal care in the question stem. CONCLUSIONS: Systematic studies comparing prenatal care in out-of-hospital births versus hospital births are nonexistent, leading to the potential for bias and adverse outcomes. Adjustments to question stems that accurately portray current evidence are recommended.

Historical Inequities in Medical Education - Commitment to Opportunity, Diversity, and Equity at the University of Hawai'i School of Medicine.

Medical education in the US has contributed to institutionalized racism through historically exclusionary practices, which has led to health disparities and inequities in health care today. The 1910 Flexner report, which favored schools with greater resources, led to the closure of nearly half of medical schools in the Us, which were mostly small schools located in rural communities that served economically disadvantaged, ethnic minority, and female populations. Closing these schools ultimately limited the availability of physicians willing to serve disadvantaged and minority populations in impoverished and underserved communities. In order to transform medical education to be more equitable, medical schools must be proactive in opportunity, diversity, and equity efforts. This not only includes efforts in admissions and faculty hiring, but also curricula related to social and health disparities, interracial interactions between students and faculty, and service learning activities that engage and work with marginalized communities. The University of Hawai'i John A. Burns School of Medicine has a longstanding commitment to diversity, which is integral to the school's mission. Providing opportunities to underserved populations has been a priority since establishment of the school. As one of the most diverse univeristies in the US, the school of medicine continues to focus on opportunity, diversity, and equity priorities in both its strategic planning and overall mission.

[ChatGPT for use in technology-enhanced learning in anesthesiology and emergency medicine and potential clinical application of AI language models : Between hype and reality around artificial intelligence in medical use]. / ChatGPT im Einsatz für "technology-enhanced learning" in Anästhesiologie und Notfallmedizin und potenzielle klinische Anwendung von KI­Sprachmodellen : Zwischen Hype und Wirklichkeit um künstliche Intelligenz im medizinischen Einsatz.

BACKGROUND: The utilization of AI language models in education and academia is currently a subject of research, and applications in clinical settings are also being tested. Studies conducted by various research groups have demonstrated that language models can answer questions related to medical board examinations, and there are potential applications of these models in medical education as well. RESEARCH QUESTION: This study aims to investigate the extent to which current version language models prove effective for addressing medical inquiries, their potential utility in medical education, and the challenges that still exist in the functioning of AI language models. METHOD: The program ChatGPT, based on GPT 3.5, had to answer 1025 questions from the second part (M2) of the medical board examination. The study examined whether any errors and what types of errors occurred. Additionally, the language model was asked to generate essays on the learning objectives outlined in the standard curriculum for specialist training in anesthesiology and the supplementary qualification in emergency medicine. These essays were analyzed afterwards and checked for errors and anomalies. RESULTS: The findings indicated that ChatGPT was able to correctly answer the questions with an accuracy rate exceeding 69%, even when the questions included references to visual aids. This represented an improvement in the accuracy of answering board examination questions compared to a study conducted in March; however, when it came to generating essays a high error rate was observed. DISCUSSION: Considering the current pace of ongoing improvements in AI language models, widespread clinical implementation, especially in emergency departments as well as emergency and intensive care medicine with the assistance of medical trainees, is a plausible scenario. These models can provide insights to support medical professionals in their work, without relying solely on the language model. Although the use of these models in education holds promise, it currently requires a significant amount of supervision. Due to hallucinations caused by inadequate training environments for the language model, the generated texts might deviate from the current state of scientific knowledge. Direct deployment in patient care settings without permanent physician supervision does not yet appear to be achievable at present.

Using Qualitative Questionnaires in Medical Education Research.

Most students in Health Profession Education courses are new to the world of qualitative research. Faced with the challenge of designing a research project, they are often drawn towards using the questionnaire as a data collection method, commonly assuming that utilising open-ended questions alone constitutes qualitative research design. Designing questionnaires that meet the standards of rigour is challenging, and this common assumption reflects inexperience with and misunderstandings of qualitative ontology, as well as the lack of methodological literature on designing and developing qualitative questionnaires. This paper is written with research supervisors as well as students in mind, as it is aimed to help elucidate the decision-making process and the justification for using a qualitative questionnaire. Drawing upon examples of research conducted by our students, and the wider literature, we demonstrate how qualitative questionnaires can produce rich and meaningful findings when they (1) prioritise qualitative research values, and (2) follow a rigorous design process when the questionnaire is developed. We conclude by offering a simple framework for developing rigorous qualitative questionnaires to those who may consider using this approach.

Contribution of ethical reasoning learning sessions on medical training.

INTRODUCTION: Ethical reasoning is an important skill for all physicians who often face complex ethical dilemmas in their daily practice. Therefore, medical training should include methods for learning ethical theories and concepts, as well as how to apply them in practical situations. AIM: Assess the contribution of an Ethical Reasoning Learning session to fifth medical students' training through a comparison of results of the same objective and structured clinical examination (OSCE) in the form of simulated interview before and after sessions. METHODS: Four 45- minutes' sessions of Ethical Reasoning Learning (ERL) were implemented during a psychiatry internship for four groups of 5th-year students of the faculty of medicine of Monastir (Tunisia). Each session was divided into 7 parts: introduction, reading of a clinical vignette, brainstorming concerning the problems posed by this clinical situation, classification of the problems, identification of the principles of medical ethics, construction of the ethical matrix, and a conclusion. RESULTS: Fifty-seven students participated in the study divided into 4 groups. We found a significant difference in the means of the OSCE scores before and after the ERL session and a significant difference between the probability of respecting medical secrecy during pre and post-ethical reasoning learning sessions (p <0.001). We have found an effect of ERL sessions on the acquisition of this ethical competence by medical students. CONCLUSION: We learned that an ERL session has improved medical training in ethics applied to psychiatry. Other sessions dealing with other ethical skills are necessary to confirm these results.

Crafting medical MCQs with generative AI: A how-to guide on leveraging ChatGPT.

As medical educators grapple with the consistent demand for high-quality assessments, the integration of artificial intelligence presents a novel solution. This how-to article delves into the mechanics of employing ChatGPT for generating Multiple Choice Questions (MCQs) within the medical curriculum. Focusing on the intricacies of prompt engineering, we elucidate the steps and considerations imperative for achieving targeted, high-fidelity results. The article presents varying outcomes based on different prompt structures, highlighting the AI's adaptability in producing questions of distinct complexities. While emphasizing the transformative potential of ChatGPT, we also spotlight challenges, including the AI's occasional "hallucination", underscoring the importance of rigorous review. This guide aims to furnish educators with the know-how to integrate AI into their assessment creation process, heralding a new era in medical education tools.

Nurturing the Human Dimension in Digital and Medical Spaces Through Pedagogy of Care - a Case of Creative Enquiry.

The COVID-19 pandemic ushered in digital learning experiences to front and centre of medical education in disruptive ways. As the pandemic subsides students and educators sigh in relief, longing to move away from the loneliness and disconnection and back to the norms of face-to-face learning and consulting. In the field of medical education however, the need for digital education has exponentially increased over the decade with strong evidence for future growth. We face the pressure of increasing student numbers on clinical placement and some students now desire or even need hybrid options for the flexibility of time, place, and pace. There is persistent criticism that digital education lacks human connection. This paper argues, however, that it is possible and vital to humanise the virtual learning experience, though particular attention needs to be given to digital pedagogy and relational aspects of learning and teaching. Drawing on Noddings' pedagogies of care and her theoretical model, we unpack one case-study of a medical education elective course that transitioned online during the pandemic. The aim of this paper is to engage medical educators with the pedagogy of care and relational pedagogy literature, which are currently almost absent from the medical education literature, as applied to the digital education realm. Core themes include modelling care and connection, enabling dialogue, inviting student engagement and practice in caring for each other and supporting the deeper work of being present themselves and confirming each other. Limitations and implications for future research will also be explored.

Lung ultrasound teaching in medical education: a pilot study at a Brazilian medical school.

OBJECTIVE: To evaluate cognitive learning, ability to perform and interpret lung ultrasound exams, and self-perception of learning among medical students after a short pedagogical intervention at a medical school in Brazil. METHODS: An experimental pilot study was conducted with medical students at different stages of their education (basic cycle, clinical cycle, and medical internship). The participants underwent a cognitive test before and after the intervention, a practical test, a test to recognize lung ultrasound pathologies, and a qualitative evaluation test at the end of the intervention. Statistical analysis was performed using a significance level of p < 0.05. RESULTS: A total of 42 students were included in the study, with a median age of 23 years and a predominance of males. The mean score of the pre-intervention cognitive test was 2.97 ± 0.87, and that of the post-intervention test was 6.57 ± 1.41, showing significant improvement (p < 0.001). The score of the practical test and that of the recognition of pathologies test also showed significant improvement after the intervention. There was no significant difference in execution time between the groups. Students in the clinical cycle had a better self-perception of learning. CONCLUSIONS: Theoretical teaching and practical training of lung ultrasound in a short pedagogical intervention can improve cognitive performance, practical skills, and interpretation of the exam. The level of learning achievement was higher among more advanced students in medical education. Additionally, the students in the clinical cycle had a better perception of their learning.

Assessment by mini clinical evaluation exercise (Mini-CEX) in the intensive care unit.

INTRODUCTION: Mini Clinical Evaluation Exercise (mini-CEX) is one of the assessment tools in medical education. It includes three steps: overview of clinical situation, observation and feedback. AIM: To evaluate the feasibility of mini-CEX as a formative assessment tool for medical trainees in 5th year of medicine in a teaching intensive care unit (ICU). METHODS: Single-center qualitative research conducted in ICU during the 2nd semester of the academic year 2022-2023. Seven core clinical skill assessments were done, and the performance was rated on a 9-point scale. An assessment of the method was conducted with both trainees and clinical educators. RESULTS: We conducted six mini-CEX recorded sessions. All medical students had marks under the average of 4.5. In the first period, the highest mark was obtained for counselling skills (4.5). The best score was obtained for clinical judgement (4) in the second period and for management plan (4) in the third period. Most of medical trainees (11 sur 12) were satisfied with the method and feedback was according to them the most useful step. Ten students agreed fully to introduce this assessment tool in medical educational programs. Two medical educators out of three did not practice this method before. They agreed to include mini-CEX in the program of medical education of the faculty of medicine of Tunis. However, they did not agree to use it as a summative assessment tool. CONCLUSION: Our study demonstrates that we can use the mini-CEX in medical teaching. Both trainees and educators were satisfied with the method.

A Brief Review of Anatomy Education in Korea, Encompassing Its Past, Present, and Future Direction.

Anatomy is a foundational subject in medicine and serves as its language. Hippocrates highlighted its importance, while Herophilus pioneered human dissection, earning him the title of the founder of anatomy. Vesalius later established modern anatomy, which has since evolved historically. In Korea, formal anatomy education for medical training began with the introduction of Western medicine during the late Joseon Dynasty. Before and after the Japanese occupation, anatomy education was conducted in the German style, and after liberation, it was maintained and developed by a small number of domestic anatomists. Medicine in Korea has grown alongside the country's rapid economic and social development. Today, 40 medical colleges produce world-class doctors to provide the best medical care service in the country. However, the societal demand for more doctors is growing in order to proactively address to challenges such as public healthcare issues, essential healthcare provision, regional medical service disparities, and an aging population. This study examines the history, current state, and challenges of anatomy education in Korea, emphasizing the availability of medical educators, support staff, and cadavers for gross anatomy instruction. While variations exist between Seoul and provincial medical colleges, each manages to deliver adequate education under challenging conditions. However, the rapid increase in medical student enrollment threatens to strain existing anatomy education resources, potentially compromising educational quality. To address these concerns, we propose strategies for training qualified gross anatomy educators, ensuring a sustainable cadaver supply, and enhancing infrastructure.

Role of artificial intelligence (Google bard) in morphological, histopathological, and radiological image identifications: Objective Structured Practical Examination (OSPE) type-based performance.

OBJECTIVES: To evaluate the role of artificial intelligence (Google Bard) in figures, scans, and image identifications and interpretations in medical education and healthcare sciences through an Objective Structured Practical Examination (OSPE) type of performance. METHODS: The OSPE type of question bank was created with a pool of medical sciences figures, scans, and images. For assessment, 60 figures, scans and images were selected and entered into the given area of the Google Bard to evaluate the knowledge level. RESULTS: The marks obtained by Google Bard in brain structures, morphological and radiological images 7/10 (70%); bone structures, radiological images 9/10 (90%); liver structure and morphological, pathological images 4/10 (40%); kidneys structure and morphological images 2/7 (28.57%); neuro-radiological images 4/7 (57.14%); and endocrine glands including the thyroid, pancreas, breast morphological and radiological images 8/16 (50%). The overall total marks obtained by Google Bard in various OSPE figures, scans, and image identification questions were 34/60 (56.7%). CONCLUSION: Google Bard scored satisfactorily in morphological, histopathological, and radiological image identifications and their interpretations. Google Bard may assist medical students, faculty in medical education and physicians in healthcare settings.

Beyond the surface: unveiling gaps in medical education through eyes of diverse learners.

Inadequate education regarding disease manifestations in diverse skin colors hinders diagnosis and exacerbates health disparities. All levels of medical trainees report low confidence in accurately identifying disease in skin of color (SOC). To help further elucidate these concerns, our research aims to assess medical student confidence in recognizing cutaneous diseases in SOC and their viewpoints regarding SOC education within their institution. An eight-question, open-ended survey was provided to medical students before and after a SOC presentation. The survey assessed participants' confidence in their diagnostic ability and perspectives on educational material. Among the 70 attendees, 58 (82.8%) and 64 (91.4%) completed the pre- and post-seminar surveys, respectively. There was a significant discrepancy in confidence levels when assessing cutaneous manifestations of internal pathology in light (Monk Skin Colors 1-5) versus dark (Monk Skin Colors 6-10) skin (p < 0.009). Notably, 78.7% (37/47) perceived the institutional learning materials as insufficient for SOC. Post-seminar reflections indicated that 87.2% (40/46) of students lacked confidence in diagnosing SOC, with 78.7% (32/46) citing inadequate curriculum coverage as the cause. An additional 8.5% (6/46) identified the predominance of white-centric medical descriptions as a hindrance. Students collectively called for improved educational approaches, including better visual representation of diseases in darker skin. Medical education must continue to strive for increased SOC representation to train competent physicians in treating a diverse patient population and reduce disparities in SOC patients.

Adapting to new challenges in medical education: a three-step digitization approach for blended learning.

This research work focuses on evaluating the development of our three-step digitization approach, designed to transform traditional lectures into engaging digital learning experiences. Aimed at offering an easy-to-use solution for educators, this approach addresses the pressing challenges of modern educational environments by enhancing accessibility, engagement, and effectiveness of learning through digital means.Quantitative analysis demonstrated a notable increase in knowledge gain for students engaged with the digital format (t(230) = -2.795, p = 0.006) over traditional methods. Additionally, it was observed that the online setting significantly improved concentration levels (t(230) = -5.801, p < .001) and reduced distractions (t(230) = 2.848, p = 0.005). Emotional assessments, based on the Achievement Emotions Questionnaire (AEQ), indicated an elevation in enjoyment (t(230) = -4.717, p < .001) and a reduction in anxiety (t(230) = 9.446, p < .001) within the digital learning environment. A substantial preference for the digital course format was expressed by 61.0% of participants, with 71.4% acknowledging its superior efficiency compared to 14.3% for traditional lectures.Qualitative feedback underscored the digital format's flexibility, comprehensive learning experience, and immediate feedback as key benefits. Nevertheless, nuances such as a preferred understanding in face-to-face interactions and the absence of a social component in digital settings were noted.To conclude, the findings from this study illuminate the significant advantages of the three-step digitization approach in meeting contemporary educational challenges. By facilitating an enhanced knowledge acquisition and fostering a supportive emotional climate, this approach signifies a promising direction for the future of medical education and beyond, fusing the convenience of digital solutions with the depth and engagement of traditional learning methodologies.

Metaverse-powered basic sciences medical education: bridging the gaps for lower middle-income countries.

BACKGROUND: Traditional medical education often lacks contextual experience, hindering students' ability to effectively apply theoretical knowledge in real-world scenarios. The integration of the metaverse into medical education holds great enormous promise for addressing educational disparities, particularly in lower-middle-income countries (LMICs) accompanied by rapid technological advancements. This commentary paper aimed to address the potential of the metaverse in enhancing basic sciences education within the constraints faced by universities in LMICs. We also addressed learning design challenges by proposing fundamental design elements and a suggested conceptual framework for developing metaverse-based teaching methods.The goal is to assist educators and medical practitioners in comprehensivley understanding key factors in immersive teaching and learning. DISCUSSION: By immersing medical students in virtual scenarios mimicking real medical settings and patient interactions, the metaverse enables practice in clinical decision-making, interpersonal skills, and exposure to complex medical situations in a controlled environment. These simulations can be customized to reflect local healthcare challenges, preparing medical students to tackle specific community needs. Various disciplines, including anatomy, physiology, pharmacy, dentistry, and pathology, have begun leveraging the metaverse to offer immersive learning experiences, foster interdisciplinary collaborations, and facilitate authentic assessments. However, financial constraints pose a significant barrier to widespread adoption, particularly in resource-limited settings like LMICs. Addressing these challenges is crucial to realizing the full potential of metaverse technology in medical education. CONCLUSION: The metaverse offers a promising solution for enhancing medical education by providing immersive, context-rich learning experiences. This paper proposes a conceptual framework and fundamental design elements to aid faculty educators and medical practitioners in effectively incorporating metaverse technology into their teaching methods, thus improving educational outcomes in LMICs.

The metaverse offers a transformative pathway for basic sciences medical education in lower-middle-income countries (LMICs) through leveraging 3D human replicas, virtual dissection, laboratories, and simulations.A metaverse-based learning design may easily combine a variety of learning theories, instructional design models, and/or conceptual frameworks, including constructivism, the ADDIE model, universal design, and minimalism.Unlocking the full potential of VR and AR in basic sciences medical education for LMIC universities requires collaborative synergy among educators, policymakers, and technology developers, with a crucial emphasis on equitable access and resource allocation.Despite the immense promise held by metaverse-powered education, it is crucial to address issues surrounding technology accessibility, learning design challenges, and implementation barriers in LMICs as we provide guidance to educators and practitioners worldwide.