Probing artificial intelligence in neurosurgical training: ChatGPT takes a neurosurgical residents written exam.

Introduction: Artificial Intelligence tools are being introduced in almost every field of human life, including medical sciences and medical education, among scepticism and enthusiasm. Research question: to assess how a generative language tool (Generative Pretrained Transformer 3.5, ChatGPT) performs at both generating questions and answering a neurosurgical residents' written exam. Namely, to assess how ChatGPT generates questions, how it answers human-generated questions, how residents answer AI-generated questions and how AI answers its self-generated question. Materials and methods: 50 questions were included in the written exam, 46 questions were generated by humans (senior staff members) and 4 were generated by ChatGPT. 11 participants took the exam (ChatGPT and 10 residents). Questions were both open-ended and multiple-choice.8 questions were not submitted to ChatGPT since they contained images or schematic drawings to interpret. Results: formulating requests to ChatGPT required an iterative process to precise both questions and answers. Chat GPT scored among the lowest ranks (9/11) among all the participants). There was no difference in response rate for residents' between human-generated vs AI-generated questions that could have been attributed to less clarity of the question. ChatGPT answered correctly to all its self-generated questions. Discussion and conclusions: AI is a promising and powerful tool for medical education and for specific medical purposes, which need to be further determined. To request AI to generate logical and sound questions, that request must be formulated as precise as possible, framing the content, the type of question and its correct answers.

[Implementation of clinical ethics consultation in German hospitals]. / Wird Klinische Ethikberatung in Krankenhäusern in Deutschland implementiert?

BACKGROUND: There have been different initiatives for the implementation of clinical ethics consultation during the past years. The present study surveys current data. METHODS: A structured questionnaire was used. Of the 1,858 contacted hospitals throughout Germany 550 answered to that questionnaire (return rate 29,6 %). The survey took place between September 2013 and January 2014. RESULTS: The clinical ethics committee is the mostly implemented structure of clinical ethics consultation. Recommendations to implement those structures (ZEKO 2006, AEM 2010) show less influence than the legally binding standard (HKHG 2011). Structures of clinical ethics consultation are respected as instrument to solving ethical conflicts in clinical routines. CONCLUSIONS: Establishing ethics consultation should be promoted. Preferably appropriate legal rules for the implementation of clinical ethics consultation should be developed further as well as their structural framing.

[Advance directives in prehospital emergency treatment : prospective questionnaire-based analysis]. / Vorsorgedokumente in der präklinischen Notfallmedizin : Prospektive fragebogenbasierte Analyse.

BACKGROUND: The handling of advance directives (AD) in prehospital emergency treatment in Germany is characterized by instability. In the project "Advance directives in preclinical emergency medical aid" ("Patientenverfügungen in der präklinischen Notfallmedizin") the frequency and quality of ADs in emergency situations was investigated. AIM: The aim of this study was to fill the gaps in research and to collate data on how consideration of the self-determination of patients in emergency situations can be optimized. MATERIAL AND METHODS: Over a period of 12 months from December 2007 to December 2008 a questionnaire was included in the emergency documentation of the medical emergency service in Aachen. Emergency patients were asked by emergency physicians to provide an AD and the quantitative as well as qualitative features of these ADs were examined. Furthermore, the study recorded what kinds of problems occurred with ADs in emergency situations and what measures were needed to correct this deficiency. The reactions of patients were documented on a numeral rating scale with a score of 1 reflecting a negative and 10 reflecting a positive reaction. In the 12-month period emergency doctors recorded 1,321 missions and after application of the exclusion criteria (e.g. missing signature, incomplete documentation and late delivery) 1,047 documented questionnaires were available for the analysis. RESULTS: A total of 127 out of 1,047 emergency patients provided an AD, 44 had a durable power of attorney and 27 had appointed a legal representative for healthcare. Of the emergency patients 20 had a legal attendant and 43 out of the 127 ADs could be presented to the emergency team during the emergency mission. The emergency team often encountered difficulties regarding the handling of the ADs due to the time factor and unclear wording. The latter included the following problems: misleading formulation (19.1 %), difficulty with the complexity (14.9 %) and contradicting information (4 %). Only 29 (61.7 %) of the durable powers of attorney were signed and legally binding. From the view of the emergency physicians the following information was lacking but would be helpful in emergency situations: emergency plan, hierarchy of those given power of attorney, knowledge of risks regarding ADs and medication requirements. CONCLUSION: The results show that for an AD to apply in an emergency situation certain standards are necessary that assure the practicability, especially if a patient does not wish to be resuscitated. Most difficulties with ADs occurred with imprecise formulation, text length and inconsistency of statements. The following instructions were usually missing: hierarchy of those given power of attorney and specification on medication, information about the scope of the ADs, statement about resuscitation, extent and limitations of the desired treatment, especially with patients certified as terminally ill and instructions on who should decide about medical treatment in a conflict situation. A so-called emergency instruction which gives on a single page the patient's statement on resuscitation would have been very helpful in individual cases. The results suggest that patients may need more information and education about AD to guarantee patients rights and self-determination.

[Medical and medical ethical basis of precautionary options]. / Medizinische und medizinethische Grundlagen der Vorsorgemöglichkeiten.

The main activities of anesthesiologists in addition to the operation theatre are intensive and emergency treatment as well as pain and palliative care. Discussions and decisions about strategies and enforcement of therapy are indispensable in all areas. Acknowledgment of the patients' wishes and protection of patient autonomy are very important in the context of medical fiduciary duty. Determination of the aim of therapy and the patient's prognosis are of special importance. Against the background of the current amendments of patient advance directives different possibilities, such as advance directive and emergency forms in different areas of anesthesiology will be discussed.