2024 IUSM Education Day

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A Roadmap to Surgical Education: A Scoping Review of Educational Needs in Surgery
(2024-04-26) Yan, Yichuan; Krusing, Madeline; Awad, MIchael; Stefanidis, Dimitrios
Purpose: Understanding the educational needs can help organizations like the Association for Surgical Education to develop relevant solutions. However, relevant literature is limited to know the needs. Thus, the aim of this study was to identify the educational needs in surgical education literature. Methods: Following the PRISMA Statement guideline, we performed a scoping review with three search terms in two databases in tandem with three inclusion criteria to identify the literature pertinent to educational needs in surgery. Through content analysis of the abstracts of the identified literature, we inquired about the objectives, methods, data sources, and conclusions in each identified article to tease out the trends, specialties, participants, and topics of educational needs in surgical education literature. Descriptive statistics of frequency were used to present the data. Results: The PRISMA article selection procedures resulted in 212 peer-reviewed journal articles in the scoping review. The content analysis identified the trends of the needs in four areas including the trends of educational needs, surgical specialties, participants, and topics of educational needs. To synthesize the results of the data analysis, a heat map was created with the cross-section of the trends and topics of educational needs showing the hot topics and potential gaps in surgical education literature. Conclusions: The scoping review provides surgical educators and trainees an overview of the educational needs in the literature that can serve as a roadmap of educational needs to be taken into consideration by organizations like the ASE to help address the needs and advance the field.
Adoption and Attitudes of AI Large Language Models in Academic Settings and Beyond
(2024-04-26) Gomez, Victoria; Balle, Megan; McNulty, Margaret
Introduction and Objective: Large Language Models (LLMs) such as ChatGPT are artificial intelligence tools that have received significant attention regarding use in educational settings. The purpose of this study was to begin to obtain a clearer picture regarding how students and instructors are currently using LLMs so educational policies and practices can be modified appropriately to incorporate the quickly advancing technology. Materials and Methods: In an IRB-approved study, current students and instructors in health professional programs were asked to complete a survey that collected demographics, perceptions, and use of LLMs through Likert and free response questions. Descriptive statistics were performed on Likert items and free responses were analyzed using a thematic analysis framework. Results: The survey received 38 viable student responses and 21 from instructors. Overall, there was limited adoption of LLMs among students. ChatGPT was the most commonly used LLM. Of student respondents, 39.5% reported never using LLMs in their academic career. Of those not currently using an LLM, 35% did not plan to start, citing a lack of understanding. Students were more likely to perceive using LLMs as “lazy” and “cutting corners,” and primarily used it to create practice questions and/or as a search engine. Similarly, 22% of instructors never used LLMs in their academic career, though compared to students they felt there was more opportunity for LLMs in an academic setting. Indeed, 29% of students reported instructors spending time discussing the use of LLMs, while 21% of students reported instructors implementing the use of LLMs on assignments. The most common way instructors used LLMs themselves was for writing assistance such as cover letters and emails. Conclusion: These preliminary results indicate students and instructors are not yet extensively using LLMs in an academic setting, but instructors indicate there is potential for AI in higher education. With increased use and frequent updates, the possibilities of LLMs are likely not yet fully realized. Should current trajectories hold, LLMs could lead to substantial reform in medicine and medical education. Differences between how students and instructors perceive LLMs indicate a need for more discussion regarding how the technology can be practically integrated in educational settings, including clearer ethical guidelines. Significance/Implication: With AI and LLMs’ rising popularity and frequent improvements, it is vital to consider its use within and implications on the ever-changing medical school curriculum, including ongoing monitoring of use and application of LLMs by both students and educators.
Advancing AI in Medical Education: Understanding the Malpractice Landscape
(2024-04-26) Stephanian, Brooke; Karki, Sabin; Schantz, Eli
An Assessment of ChatGPT’s Performance as a Patient Counseling Tool: Exploring the Potential Integration of Large Language Model-based ChatBots into Online Patient Portals
(2024-04-26) Price, Charles; Brougham, Albert; Burton, Kyle; Dexter, Paul
BACKGROUND: With the advancement of online patient portals, patients now have unprecedented access to their healthcare providers. This has led to increased physician burden associated with electronic inbox overload [1]. Recent developments in artificial intelligence, specifically in Large Language Model-based chatbots (i.e. ChatGPT), may prove to be useful tools in reducing such burden. Can ChatGPT reliably be utilized as a patient counseling tool? ChatGPT can be described as “an advanced language model that uses deep learning techniques to produce human-like responses to natural language inputs” [5]. Despite concerns surrounding this technology (i.e. spreading of misinformation, inconsistent reproducibility, “hallucination” phenomena), several studies have demonstrated ChatGPT’s clinical savviness. One study examined ChatGPT’s ability to answer frequently asked fertility-related questions, finding the model’s responses to be comparable to the CDC’s published answers in respect to length, factual content, and sentiment [6]. Additionally, ChatGPT was found capable of achieving a passing score on the STEP 1 licensing exam, a benchmark set for third year medical students [7]. OBJECTIVE: This study aims to further evaluate the clinical decision making of ChatGPT, specifically the ability for ChatGPT to provide accurate medical counseling in response to frequently asked patient questions within the field of cardiology. METHODS: 35 frequently asked cardiovascular questions (FAQs) published by the OHSU Knight Cardiovascular Institute were processed through ChatGPT 4 (Classic Version) by OpenAI. ChatGPT’s answers and the provided answers by the OHSU Knight Cardiovascular Institute were assessed in respect to length, factual content, sentiment analysis, and the presence of incorrect/false statements. RESULTS: When comparing ChatGPT’s responses to the 35 FAQs against the published responses by OHSU, Chat GPT’s responses were significantly longer in length (295.4 vs 112.5 (words/response)) and included more factual statements per response (7.2 vs 3.5). Chat GPT was able to produce responses of similar sentiment polarity (0.10 vs 0.11 on a scale of -1 (negative) to 1 (positive)) and subjectivity (0.46 vs 0.43 on a scale from 0 (objective) to 1 (subjective)). 0% of ChatGPT’s factual statements were found to be false or harmful. CONCLUSIONS: The results of this study provide valuable insight into the clinical “knowledge” and fluency of ChatGPT, demonstrating its ability to produce accurate and effective responses to frequently asked cardiovascular questions. Larger scale studies with an additional focus on ChatGPT’s reproducibility/consistency may provide important implications for the future of patient education. Implementation of AI-based chatbots into online patient portals may prove to be assistive to physicians, alleviating the growing burden of electronic inbox volume.
Applying Cyclical Loading Parameters for In-Vitro Neo-Tendon Development
(2024-04-26) Darden, Faith; Jenkins, Thomas; Little, Dianne
INTRODUCTION: Annually, over 545,000 rotator cuff tear repairs occur in the USA. Current surgical methods have varied success, due to factors including tear size and patient age. The fibrotic tissue that results from repair is susceptible to re-tear: retear rate following repair is up to 94% for large tears. There is a need for better treatment. Tissue engineering is a potential solution. Poly(lactic acid) meltblown scaffolds produce neotendon but cannot withstand physiological strains. Here, we evaluate how cyclical tensile loading of poly(ε-caprolactone) (PCL) meltblown scaffolds affects neo-tendon development. METHODS: We seeded PCL with human adipose stem cells and cultured for 28 days with cyclic loading to 6% strain three times per week for 0, 125, 5,000, and 10,000 cycles/day using a tensile bioreactor. We characterized the viscoelastic mechanical properties using this protocol: preconditioning, hysteresis loops and 10 min stress relaxations at 1, 3, 5, and 7% strain, each followed by frequency sweeps at 0.1, 1, and 5 Hz, and a ramp-to-failure. We determined various parameters using custom MATLAB code. Data were evaluated for effect of loading using ANOVA with Tukey HSD post-hoc tests (n=3-5, α=0.05). RESULTS: Loading at 5,000 cycles (Fig. 1) improved sample linear modulus and yield stress compared to other loading groups, while increased loading led to decreased yield stretch. Samples loaded at 5,000 cycles had higher phase shifts at lower frequencies, suggesting greater stress dissipation. Stress relaxation decreased from 3% strain to 5% and 7% strain. There was no effect of loading on stress relaxation. Loading up to 5,000 cycles tended to increase energy storage and secant stiffness but dropped when increased to 10,000 cycles. CONCLUSION: Tendon viscoelastic properties are essential for their mechanical stability and function; scaffolds with similar mechanical function could improve repair. Tensile loading during culture improves mechanical function up to 5,000 cycles/day but loading at 10,000 cycles/day seems to cause damage to the fibers, reducing modulus, yield stretch, yield stress, stiffness, and energy storage at higher strains. Our data will establish if meltblown scaffolds are viable for preclinical studies and could inform rehabilitation protocols for engineered tendon development.
Assessing a Longitudinal Educational Experience for Continuous Quality Improvement
(Indiana University School of Medicine Education Day, 2024-04-26) Masseria, Anthony; Birnbaum, Deborah R.
This presentation explores the use of assessment tools to promote adaptability and continuous quality improvement (CQI) in a large educational program. The Scholarly Concentrations Program is a statewide program complementing the core medical school curriculum and empowering students to delve into topics of personal interest. The pilot was launched with a “CQI” mindset, and after three years, a robust assessment plan is gathering feedback. While “building the plane as we fly it”, the program has grown from 100 students in its first year to over 400 in its third. A robust, longitudinal evaluation plan is critical. The intended goal is to use this program example to replicate it with other large educational programs anywhere.
Change in Medical Students’ Attitudes Towards Family Planning after a Pregnancy Options Counseling Panel
(2024-04-26) Peipert, Leah J.; Brown, Lucy; King, Carli; Bhamidipalli, Surya Sruthi; Stout, Julianne; Peipert, Jeffrey F.; Caldwell, Amy
INTRODUCTION: Abortion is one of the most commonly performed procedures in the U.S., but abortion education is lacking in medical curricula. Previous studies have shown that clinical exposure to abortion care in medical school can change students’ attitudes about abortion, yet few medical schools incorporate abortion education during students’ preclinical years. STUDY OBJECTIVE: This study evaluates changes in medical students’ attitudes after a virtual pregnancy counseling panel intervention during pre-clinical medical education at Indiana University School of Medicine. We hypothesized that students would feel more comfortable counseling and treating patients for unplanned pregnancy after attending the virtual panel. METHODS: Students participated in a “Pregnancy Options Panel” during their second-year course covering reproductive health. The panel consisted of OBGYNs, a pediatrician, and a social worker. Using a case study format, panelists guided discussion of appropriate care for a patient diagnosed with an unintended pregnancy. Two identical 19-item surveys consisting of multiple-choice and open-ended questions were electronically disseminated before and after the panel to assess students’ comfort and beliefs about family planning counseling and treatment. Statistical analyses were performed using non-parametric statistics (Wilcoxon signed rank and McNemar’s test) to compare before and after responses of participants. The study was IRB exempt. RESULTS: The second-year medical school class enrolled in the reproductive health course at Indiana University was composed of 366 students with 189 students (51.6%) identifying as female. Of the 366 students, 171 students (46.7%) completed surveys before and after the panel. Demographics were as follows: 60.6% female, 37.6% male, 64.9% white, 2.9% black, 84.6% non-Hispanic, and 10.7% Hispanic. After the pregnancy panel, students reported increased comfort when contemplating referral to an abortion provider, prescribing a medication abortion, and performing a surgical abortion compared to prior to the panel (p<0.01, all comparisons). Students were more likely to withhold disclosing their personal beliefs about abortion when counseling a pregnant patient (64.6% vs 42.3%, p<0.01), felt more capable of approaching the conversation about pregnancy options in a genuinely neutral manner (86.4% vs 71.6%, p<0.01), and had a significant increase in preparedness to counsel on continuing pregnancy, abortion, and adoption (p<0.01). CONCLUSIONS: Our pregnancy options counseling panel effectively guided students through a common reproductive health scenario counseling a patient with unintended pregnancy. Second year preclinical medical students felt more prepared to counsel patients neutrally and without influence of their own beliefs after attending the educational event. Students additionally felt more comfortable referring to an abortion provider, prescribing a medical abortion, and performing a surgical abortion after the panel, emphasizing how exposure to family planning scenarios can influence future physicians’ comfort providing non-judgmental counseling and abortion care. Expert panels comprised of health professionals with diverse clinical and social perspectives on pregnancy options can serve as an instructional model for preparing medical students for their obstetric and gynecological clinical clerkship and improving pre-clinical medical curriculum on the often-neglected topic of abortion.
Characteristics associated with access to kidney transplantation services in the Ohio River Valley
(2024-04-26) Kelty, Catherine; Buford, Jade; Drewry, Kelsey; Adebiyi, Oluwafisayo; Sharfuddin, Asif; Fridell, Jonathan; Sher, Jawad; Huml, Anne; Moe, Sharon; Patzer, Rachel
Comparing Student Satisfaction Metrics: Strategic Student Survey versus Traditional Tools
(2024-04-26) Kochhar, Komal; Masseria, Anthony; Walsh, Sarah; Skillman, Brian; Duham, Jennifer; Wallach, Paul
Background: Utilizing multiple methods to assess student satisfaction across the medical curriculum can provide a longitudinal view of the student experience and allow for more timely interventions. To this end, we developed the Strategic Student Survey (S3) to assess student satisfaction across all 4 years, which serves to complement other established assessments such as the AAMC Year Two Questionnaire (Y2Q), End of Clerkship (EOC) evaluations, and the AAMC Graduation Questionnaire (GQ). Objective: To determine the extent to which our internal survey (Strategic Student Survey) results mirror those of the Y2Q, EOC evaluations, and GQ. Methods: The S3 consists of ~50 questions derived from the Liaison Committee for Medical Education’s Independent Student Analysis survey instrument and customized with our school-specific elements. The S3 was administered annually to all medical students from first to fourth year (MS1 – MS4), starting in 2018. The S3 results were collated and grouped by class year with the corresponding Y2Q, EOC, and GQ results. Responses to questions that were common across the S3, Y2Q, EOC, and GQ were compared for the last 3 years. Results: S3 outcomes closely aligned with responses from the other instruments. For instance, the Class of 2023 “strongly agreed” or “agreed” with the statement “I am satisfied with the quality of my medical education” as follows: S3 responses (From MS2s: 77%, From MS3s: 88%, From MS4s: 93%); Y2Q responses (From MS2s: 80%); GQ responses (From MS4s: 91%). Similarly, the evaluation of 8 clerkships demonstrated a consistent pattern of high ratings across the S3, EOC, and GQ. For example, the Classes of 2021, 2022, 2023 rated the quality of the Internal Medicine clerkship as “Excellent” or “Very Good” in this way: S3 responses (From MS3s: 86%, 87%, and 89%, respectively, for these 3 class years); EOC responses (From MS3s: 87%, 91%, and 86%); GQ responses (From MS4s: 88%, 87%, and 92%). Conclusion: These findings indicate that the S3 is a reliable alternative to the Y2Q, EOC, and GQ for gauging student satisfaction. In fact, initial review of the data suggest that S3 may even be a better predictor of GQ responses than EOC. Because S3 is administered during each class year of medical school, it allows for the early identification and address of student concerns, contributing to maintaining LCME accreditation standards.
Determining the Needs for Pediatric Diabetes Education among Nurses
(2024-04-26) Ray, Lauren; Delecaris, Angela
INTRODUCTION: Inpatient management of children and adolescents with diabetes requires a cohesive multidisciplinary team confident in the needs of patients requiring insulin. Previous studies have reported diabetes-related knowledge deficiency in adult-medicine nurses, however there is limited literature in pediatric nurses. Other researchers have trialed various diabetes education (DiabEd) programs in small cohorts and encountered barriers with study retention. At our hospital, pediatric patients with diabetes are often, but not always, admitted to a specific unit (8 East, 8E), which may lead to unequal experience in nurses caring for these children on other units. OBJECTIVE: Our objective was to measure the previous experience, training, comfort, and knowledge of pediatric nurses related to insulin and diabetes care. We also sought to understand the distribution of patients with insulin needs across units of the hospital. METHODS: A needs assessment was conducted with surveys to nursing representatives, review of diabetes resources available on each unit, and data surrounding insulin usage and incident reports pertaining to diabetes or insulin. Surveys consisted of six questions regarding current DiabEd provided for nurses and interest in further DiabEd. A pretest consisted of 2 validated tools: a modified Diabetes Self-Report Tool (mDSRT) and modified Diabetes Knowledge Test 2 (mDKT2). The mDSRT used a 4-point Likert scale for 10 items covering confidence in aspects of inpatient diabetes care, with higher scores reflecting higher confidence. The mDKT2 consisted of 15 multiple choice questions. RESULTS: Of 8 non-acute care units (nonACUs) evaluated, 25% had standard diabetes-specific training for new nurses and none had ongoing education after orientation. Seven units expressed the desire for additional DiabEd. Unit resources were out-of-date and 63% of nonACUs lacked any physical resources. Although nonACUs outside of 8E were responsible for only 16% of insulin usage in the hospital over the prior 24 months, they were referenced in 29% of incident reports. Of 47 nurses who completed the pretest, 13 (28%) missed >1 hypoglycemia-related question and 31 (66%) missed >1 ketone-related question. Of all survey responders, 22 (45%) reported receiving no DiabEd in the prior 2 years, 86% of whom had taken care of patients with diabetes in that timeframe. There were no differences in mDKT2 scores between nurses who had received DiabEd within the last 2 years (12.9+/-1.4) and those who had not (12.8+/-1.8, p=0.812). Nurses on 8E scored higher on the mDSRT (3.6+/-0.5, n=5) compared to nurses on other nonACUs (2.9+/-0.5, n=44; p=0.004). There was a positive correlation between mDSRT and mDKT2 scores (p<0.001, r=0.512), representing higher confidence with higher diabetes knowledge scores. CONCLUSION: The needs assessment and pretest data are consistent with previous studies in adult-medicine nurses and support the need for ongoing DiabEd for pediatric nurses. To our knowledge, this is the first study to evaluate educational needs of nurses related to diabetes care in children and adolescents and to create a curriculum to meet those needs. From these findings, a new DiabEd curriculum was developed and is currently implemented, with posttest data planned.

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