United States

Background
Effective communication in challenging patient interactions is crucial in medicine. While simulation labs are ideal for training, they lack universal accessibility. AI-based patient encounters provide an innovative tool for medical education that allow students to test new communication methods in a risk-free environment. We present an integrated educational module with best practice videos and an AI-based simulation app for honing skills in delivering difficult news to patients.

Methods 
The educational component includes videos on best practices for delivering bad news, followed by interactive training using an AI-powered app based on a Large-Language Model, programmed in Python. To build the AI simulation modules, a pilot case prompt was first created by specifying the clinical scenario and patient personality in ChatGPT-4o. This prompt was further refined to an appropriate length and personality specifications using an iterative prompting process within ChatGPT-4o. After testing this case in the app environment, multiple cases were designed using standardized prompts based on the pilot case specifying diagnoses, communication styles, and personality traits based on the Big Five model. The AI app incorporates diverse clinical scenarios presenting challenging situations and difficult conversations and provides personalized feedback based on the SPIKES protocol.

App Development 
The AI-powered app was developed to simulate realistic patient interactions. The OpenAI API was employed to generate patient responses and emotional cues using ChatGPT-4o from predefined cases. Each case includes a multidimensional prompt architecture, enabling the AI to portray various clinical scenarios and patient personalities accurately. A separate AI agent evaluates student performance using the SPIKES model criteria and provides real-time formative feedback on communication techniques.

Results 
The AI patient actors demonstrated accurate personality embodiments and significant emotional responses. In addition to giving appropriate responses, the app also provided body language and contextualizing statements in line with the encoded personality before beginning dialogue such as “fidgets nervously” or “takes a deep breath, trying to calm down.” The app assessed student performance against the SPIKES protocol and generated constructive feedback. The AI Patient Actor app for difficult conversations is openly available at https://patient-actor-dc.streamlit.app/.

Conclusion 
This fully integrated educational module, combining best practice videos and an AI simulation app, is an innovative tool for communication skills training that can provide formative skills training at scale. The module will be incorporated into Dartmouth&#39;s Geisel School of Medicine curriculum. Validation through cohort testing will follow.

AMA Research Challenge 2024 

Difficult conversations skills training using an AI-based patient actor app

Background
Effective communication in challenging patient interactions is crucial in medicine. While simulation labs are ideal for training, they lack universal accessibility. AI-based patient encounters provide an innovative tool for medical education that allow students to test new communication methods in a risk-free environment. We present an integrated educational module with best practice videos and an AI-based simulation app for honing skills in delivering difficult news to patients.

Methods 
The educational component includes videos on best practices for delivering bad news, followed by interactive training using an AI-powered app based on a Large-Language Model, programmed in Python. To build the AI simulation modules, a pilot case prompt was first created by specifying the clinical scenario and patient personality in ChatGPT-4o. This prompt was further refined to an appropriate length and personality specifications using an iterative prompting process within ChatGPT-4o. After testing this case in the app environment, multiple cases were designed using standardized prompts based on the pilot case specifying diagnoses, communication styles, and personality traits based on the Big Five model. The AI app incorporates diverse clinical scenarios presenting challenging situations and difficult conversations and provides personalized feedback based on the SPIKES protocol.

App Development 
The AI-powered app was developed to simulate realistic patient interactions. The OpenAI API was employed to generate patient responses and emotional cues using ChatGPT-4o from predefined cases. Each case includes a multidimensional prompt architecture, enabling the AI to portray various clinical scenarios and patient personalities accurately. A separate AI agent evaluates student performance using the SPIKES model criteria and provides real-time formative feedback on communication techniques.

Results 
The AI patient actors demonstrated accurate personality embodiments and significant emotional responses. In addition to giving appropriate responses, the app also provided body language and contextualizing statements in line with the encoded personality before beginning dialogue such as “fidgets nervously” or “takes a deep breath, trying to calm down.” The app assessed student performance against the SPIKES protocol and generated constructive feedback. The AI Patient Actor app for difficult conversations is openly available at https://patient-actor-dc.streamlit.app/.

Conclusion 
This fully integrated educational module, combining best practice videos and an AI simulation app, is an innovative tool for communication skills training that can provide formative skills training at scale. The module will be incorporated into Dartmouth's Geisel School of Medicine curriculum. Validation through cohort testing will follow.

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Artificial intelligence (AI) has significant potential in medicine, especially in diagnostics and education. ChatGPT has achieved levels comparable to medical students on text-based USMLE questions, yet there's a gap in its evaluation on image-based questions. This study evaluated ChatGPT-4's performance on image-based questions from USMLE Step 1, Step 2, and Step 3. The overall performance of ChatGPT-4 on USMLE Steps 1, 2, and 3 was evaluated using 376 questions, including 54 with images. The accuracy was 85.7% for Step 1, 92.5% for Step 2, and 86.9% for Step 3. For image-based questions, the accuracy was 70.8% for Step 1, 92.9% for Step 2, and 62.5% for Step 3. In contrast, text-based questions showed higher accuracy: 89.5% for Step 1, 92.5% for Step 2, and 90.1% for Step 3. Performance dropped significantly for difficult image-based questions in Steps 1 and 3 (p=0.0196 and p=0.0020 respectively), but not in Step 2 (p=0.9574). Despite these challenges, the AI's accuracy on image-based questions exceeded the passing rate for all three exams. ChatGPT-4 can handle image-based USMLE questions above the passing rate, showing promise for its use in medical education and diagnostics. Further development is needed to improve its direct image processing capabilities and overall performance.

Evaluating the Performance of ChatGPT-4o Vision Capabilities on Image-Based USMLE Step 1, Step 2, and Step 3 Examination Questions

Despite more female physicians in training than ever before, existing literature demonstrates the distressing reality that medical students continue to experience sexism in clinical settings. Research indicates that female medical students are more likely than male students to experience gender discrimination within evaluations, educational opportunities, and workplace relationships. Even though many medical students recognize sexism from patients as an issue, limited research exists on this topic. This study aims to quantify the extent to which medical students experience sexism from patients. 

The survey, yielding 58 responses (41 female and 17 male), revealed that 91% of respondents recognized sexism as a problem medical students face in clinical rotations. Specifically, 93% of females and 24% of males responded that they have faced sexism from patients in clinical settings. 85% of female students report being frequently mistaken for a nurse or nursing student, despite clear role introductions. Only 18% of male students reported being mistaken for other healthcare roles and, specifically, 0% reported being mistaken for nursing staff. Moreover, 66% of female students and 35% of male students received comments on their appearance or family planning from patients. 63% of females and 18% of males were subjected to inappropriate or sexually suggestive patient comments. Frequency analysis revealed that 7% of female students encounter sexism from patients weekly, 41% monthly, 46% yearly, and 5% never. In contrast, 71% of male students report never experiencing sexism from patients and 29% experience sexism from patients yearly. No male students reported monthly, weekly, or daily occurrences. Respondents shared examples of sexism they experienced in the free response section of the survey. Female students described countless instances of being mistaken for nurses and enduring sexually suggestive remarks from patients. Notably, one male student described observing the gender disparity, stating he is often mistaken for a doctor, while his female colleagues are consistently assumed to be nurses.

In conclusion, although both male and female medical students experience sexism from patients, female students are disproportionately affected by gender discrimination. These findings highlight the need for systemic change and policies to safeguard students and foster inclusive learning environments. Recommendations for improvement include implementing badge tags that state “medical student,” in addition to educating faculty to recognize and support students facing gender discrimination from patients.

Exploring how medical students experience sexism from patients in clinical settings

Medical education is an evolving process that continues to incorporate various modes of delivery to enrich medical students’ learning. Film is a unique medium that has been shown to be an effective teaching method in educating students about patient socioeconomic factors and clinical interactions. Although film is established as an effective teaching tool, there is little to no data regarding film’s effectiveness in improving medical students’ awareness and understanding of governmental healthcare policies. The aim of this study was to determine if medical students’ understanding of disability healthcare policy was significantly influenced after viewing the film Crip Camp. Medical students watched the film Crip Camp and engaged in peer-facilitated discussion of the film. Prior to the screening, participants completed a Likert scale and yes/no survey questionnaire to assess their baseline awareness of disability policy. Following the screening, students completed the survey again. The pre- and post-survey groups were compared for statistical significance using the Mann-Whitney U test. Furthermore, a One-Way Chi-Square analysis test was conducted. In total, 18 participants responded to the surveys given at the film screening. There was a statistically significant difference between pre- and post-survey answers regarding Question 1: “Do you think that the government is doing enough in 2024 to provide services for individuals with disabilities?”(U = 420, z = 8.81, p < 0.01). Furthermore, most students who answered “Mostly not” to the previous question, also indicated “Yes” regarding Question 2: “Do you think that the state of Michigan should establish opt-in in-patient facilities for those with severe disabilities?” (ꭓ² = 5.0294, df = 2, a = 0.05). The data suggests that there was a significant difference in participants’ understanding of disability healthcare policy after viewing Crip Camp. The number of students that answered “I don’t know” to Question 1 decreased from 8 to 3. Thus, it can be inferred that the film influenced the students’ understanding because they took a stance on Question 1 post-screening. Following the screening, significantly more students selected “Mostly not” for Question 1 and “Yes” for Question 2. Hence, it can be inferred that the students became more inclined to support the government establishing opt-in services for individuals with disabilities. The scope of future studies could aim to assess students’ knowledge on health policy, and whether our screenings impact their future approach to care.

Film as a Teaching Tool: Enhancing Medical Students' Understanding of Disability Healthcare Policy

Background: Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual (LGBTQIA+) individuals are less likely to afford medical care, have higher rates of depression, and are more likely to feel discriminated against by medical providers based on their sexual orientation or gender identity. These health disparities introduce a need for medical providers to be practiced in both LGBTQIA+ cultural competence and unique healthcare concerns; however, currently in the United States, there is no required pre-clinical medical education regarding LGBTQIA+ healthcare. Previous studies have shown that discussion-based learning and virtual patient interactions are effective in improving the knowledge and skills of medical students. Our purpose is to determine if a medical skills-based workshop utilizing simulated patient scenarios will improve medical students’ self-perceived knowledge and competence when providing care to members of the LGBTQIA+ community. 

Methods: A workshop was presented to 100 first-year medical students at one medical institution introducing LGBTQIA+ concepts, terminology, and unique healthcare concerns. An anonymous survey was administered after the workshop to determine participants’ self-perceived knowledge of LGBTQIA+ concepts and self-perceived competence in caring for members of this population. Knowledge was scored on a scale from 0 (low knowledge) to 10 (high knowledge); competence was determined by participants' level of agreement to several Likert-styled statements. A paired t-test was conducted to determine the significance (p < 0.05) of the difference in self-perceived knowledge before and after the workshop.

Results: Results indicated a significant increase (p < 0.001) of mean self-perceived knowledge in both LGBTQIA+ unique healthcare concerns and terminology in first-year medical students who completed the workshop. In addition, 84% of participants agreed or strongly agreed they felt more competent in their ability to use inclusive language when speaking with LGBTQIA+ patients. Particularly, participants who do not identify as LGBTQIA+ members demonstrated a benefit in their self-perceived competence of LGBTQIA+ terminology and knowledge of healthcare concerns. 

Conclusions: The results of this study demonstrate how an informational workshop utilizing interactive practice scenarios regarding LGBTQIA+ terminology and healthcare concerns strongly correlates with the improvement of self-perceived knowledge and competence of first-year medical students. Considering there is no standardized curriculum for LGBTQIA+ medical education, the pedagogy demonstrated can be extended to other medical institutions with the goal of molding future physicians who can provide quality care to members of the LGBTQIA+ community.

Improving Self-perceived Competence in LGBTQIA+ Healthcare in Medical School Preclinical Education

Abstract Title: Investigating Potential Bias in Medical School Assessments

Background: Assessments are critical in medical education, shaping career paths from entry to progression. Despite efforts for equity, disparities persist. Underrepresented minority groups and women score lower on the MCAT and USMLE, with differences by gender and ethnicity persisting. Biases extend to narrative assessments like letters of recommendation and MSPEs, where non-white students receive fewer strong descriptors, and gendered terms characterize 
female students. This study investigates how gender, race, language proficiency, and 
immigration status influence test outcomes, aiming to inform fair assessment practices.

Methods: 54 first-year medical students completed a practice test and demographic survey at the University of Central Florida College of Medicine. Test questions underwent Angoff scoring and 12-item writing flaw rubric evaluation. Students received immediate feedback and qualitative analysis of incorrect responses. Quantitative analysis included Mantel-Haenszel chisquare tests and two-sample tests for differential item functioning. Multivariate logistic regression assessed demographic predictors of test outcomes, combining quantitative and qualitative approaches.

Results: Logistic regression showed gender alone did not predict question outcomes, but its interaction with overall performance did. Non-uniform differential item functioning was observed, confirmed by significant Chi-square results. Limited study participation precluded separate race analysis, affecting statistical power. The Nagelkerke measure quantified variation explained by DIF. Ongoing analysis will examine group performance trends to identify broader disparities.

Conclusion: This study identifies nuanced biases in medical school assessments, particularly regarding gender. While logistic regression didn't directly predict gender's impact on question outcomes, its interaction with performance suggested predictive value. Significant Chi-square results confirmed differential item functioning, with ongoing analysis aiming to reveal broader performance trends among demographic groups. This insight informs efforts to foster fairness in 
medical education assessments.

Investigating Potential Bias in Medical School Assessments

Background 
Ophthalmology is a highly competitive specialty to match into, yet many medical students have limited exposure to the field. Early exposure and mentorship are essential to introduce students to ophthalmology, better preparing them for residency applications. 
Research on mentorship in ophthalmology for preclinical and clerkship students remains scarce, with no systematic review. Our objective is to conduct a comprehensive review of the critical role of mentorship in medical students' path in ophthalmology. We seek to offer actionable recommendations for medical schools to bridge the divide between preclinical education and clinical exposure to ophthalmology. 
Methods 
Using PRISMA methodology, a literature review was conducted via databases PubMed and Embase. The objective was to identify all published literature on ophthalmology mentorship programs for first through third-year medical students in the United States. 
Inclusion Criteria: 
Intervention: providing mentorship (clinical opportunity, personal mentorship, research exposure, etc.)
Setting: specific to ophthalmology 
Population: First, second, and third-year U.S. medical students 
English language 
Information from chosen articles was summarized into an evidence table. Areas of interest included number of students in the study, year in medical school, intervention type and length, and pre-and post-intervention measurement methods. 
Results 
93 articles were retrieved with 19 duplicates. 74 articles were screened by two independent reviewers. Titles and abstracts were screened, excluding 17 articles. The remaining 57 underwent full-text screening. Seven articles meeting all inclusion criteria were included in this review. Three additional articles were discovered in the references of reviewed articles and were added. 304 subjects were studied, comprising of first, second, and third-year medical students. One study also included four undergraduate students. Seven of ten articles reported significantly increased ophthalmology knowledge. Six of ten articles evaluated the change in student interest in ophthalmology. Five articles reported an interest increase post-intervention, with four articles indicating a statistically significant increase post-intervention. 
Conclusion 
The studies in this review highlight how early exposure to ophthalmology is crucial for enhancing students' skills and knowledge in preparation for elective rotations and residency applications in their fourth year. 
While only four studies showed a significant increase in interest in ophthalmology, this outcome may be influenced by students already interested in ophthalmology being more likely to participate in the offered mentorship and exposure programs. 
Structured programs aimed at providing exposure and mentorship to ophthalmology are invaluable resources for aspiring ophthalmologists. Medical schools can consider adopting similar initiatives to bridge the gap in pre-clinical ophthalmology exposure and knowledge.

Medical Student Ophthalmology Mentorship Initiatives in the United States: A Systematic Review​

Background
Wearable technology has become a rapidly growing consumer market which is expected to double between 2021 and 2026. One popular use for wearables is to track health outcomes. Amid escalating mistrust towards the medical community, this study investigates how varying levels of trust in the healthcare system affect an individual’s decision to track their health with wearables, the frequency of using wearables to track their health, and sharing the data with their providers.

Methods
Data from the 2022 Health Information National Trends Survey (HINTS) 6 was analyzed for trust in the healthcare system, use and sharing of health information from wearable devices, and socio-demographic characteristics (age, gender, income, and race). Level of trust in the healthcare system, the main study predictor, was categorized into four levels: not a lot, a little, somewhat, and a lot. Dependent variables were 1) use of a wearable device to track healthcare information; 2) willingness to share wearable health information with a provider; and 3) frequency of tracking metrics on a wearable over the past month.

Results
Among the 6,118 respondents, 84.8% reported moderate to high levels of trust in the U.S. healthcare system, and 33.2% used wearables in the past year to track their healthcare data. 70.8% of wearable users stated that they had used a wearable to track their health daily or nearly daily during the past month, and 78.1% of respondents were willing to share wearable data with a healthcare provider. Participants with a lot of trust were significantly more willing to share their wearable data with a healthcare provider (AOR:1.49;[95% CI 1.27-1.73]), after controlling for covariates. Increasing income levels resulted in a higher likelihood of using a wearable to track health data (AOR:1.33;[95% CI 1.29-1.37]) and increased frequency of tracking health metrics on wearables (AOR:1.10;[95% CI 1.06-1.13]). Men are also less likely to use wearables (AOR:0.62;[95% CI 0.54-0.70]) and track their health with them continuously (AOR:0.85;[95% CI 0.74-0.97]) than women.

Conclusion:
This study suggests that increasing levels of trust in the healthcare system, increasing income, and being female are associated with greater adoption of wearable technology for health information tracking and sharing.

Navigating the intersection between wearable technology, health data sharing, and trust in the U.S. healthcare system

Background: Resource limitations for medical students (MS) lead to higher attrition and decreased rate of overall matching, including matching into competitive specialties. Research shows that there are factors that influence student recruitment into competitive specialties including early research involvement, availability of specialty academic residency programs, accessibility of educational resources, mentorship, and networking opportunities. The Meharry
Medical College American Medical Association funded, Inter-institutional Multispecialty Interest Group Retreat [MIIGR] was developed in a resource limited environment, to impact these factors amongst MS. The purpose of this study is to analyze the students’ perception of MIIGR for navigating the medical career process (MCP) and the influence of factors impacting recruitment.
Methods; A survey was given to 179 medical students before and after the MIIGR. Among the 179 that completed the initial survey, 86 completed the post-survey. Eight were first years, 35 were second years, and 43 were third years. Forty of those who responded attended last year’s interest group retreat. Shapiro-Wilk and Levene's tests were used to determine the normality and homogeneity of each pre- and post-survey question. Data was examined overall and by year. All
analyses and graphics were conducted using R/RStudio version 4.3.2 and SPSS Version 29.
Results: After the MIIGR, MS had a significantly clearer understanding of the nature and role of a competitive application (p-value < 0.001), how to produce a competitive application for residency (p-value < 0.001), how objective measures play in a competitive application for residency (p-value < 0.001), role that research plays in a competitive application for residency (p-value < 0.001), the role that publications and frameworks that support publication activity play in a competitive application (p-value < 0.001), resources that can help in a competitive application (p-value < 0.001), the role of sub-internships play a competitive application for residency (p-value < 0.001) after attending the retreat. Survey data points also displayed utilized
scores (4 or 5) for MS who agree or strongly agree with the following: 93% of MS stated that faculty/residency program directors encouraged students to ask questions and actively participate, further MS noted the following ; increased awareness of residency program requirements(94%); that the retreat effectively increased awareness of available educational resources(75%); believed the retreat effectively enhanced early specialty involvement in research opportunities(74%); reported the retreat increased networking or awareness of networking opportunities;(88%)MS were able to connect with external mentors in their desired
specialty in the initial period after the IGR(67%),;provided some initial benefits and resources that otherwise may not have been as easily accessible due to not having specific academic specialty programs at their institution; (84%) reported an increased awareness of the competitive culture of various subspecialties;(87%) and 88% of attendees intended to use the information they gained from the retreat to position themselves to be a more competitive residency candidate.
Conclusion : MS perceived an improved awareness and utilization of resources potentially improving the navigation of MCP and applicant recruitment. Further research will evaluate longterm outcomes.

Navigation Through the Medical Career Process in a Resource Limited Environment

Background 
As public awareness of autism spectrum disorder (ASD) increases, so does the number of adults seeking assessment. Research regarding ASD, a neurobiological disorder with behavioral presentations, often overlooks autistic adults in favor of childhood expressions. Barriers for adults seeking autism assessments–including lengthy wait times and low provider knowledge–drive many individuals to self-diagnostic tools and leave them without appropriate accommodations or therapies. To date, a comprehensive study revolving around the occurrence or degree of autistic tendencies in healthcare students has not been conducted. The present research explored the relationship between pre-healthcare distinction and variegated autistic trait manifestations as defined by RAADS-R scores and subscores. 

Methods 
The cross-sectional study population consisted of 69 undergraduate students (34 pre-medical, 19 pre-dental, and 16 pre-nursing) enrolled in the 2024 Summer Health Professions Education Program at UTHealth Houston. The cohort was administered the RAADS-R screening tool followed by a 31-item QuestionPro survey measuring demographic, academic, and subjective data inquiring about participants’ feelings and confidence to obtain their desired healthcare degree in light of their RAADS-R results. Statistical analyses, including one-way t-tests, ANOVA, Fisher’s Exact, and linear regressions, were run to establish relationships between RAADS-R scores and various measures. 

Results 
One-way t-tests revealed that autistic traits along all RAADS-R categories are more significantly expressed (p<0.001) in pre-healthcare students than in the general population. Additionally, the cohort demonstrated significantly higher (p<0.001) language-driven behaviors and lower (p<0.05) social relatability-driven autistic behaviors than is required for diagnostic consideration. ANOVA tests revealed no significant variance (p>0.05) in RAADS-R scores between pre-healthcare tracks, which may be attributable to small group sizes. Fisher’s Exact tests revealed statistically significant (p<0.05) relationships between total RAADS-R scores and participants’ degree of surprise regarding their results and confidence in obtaining their desired degree. Further investigation with linear regression models confirmed a moderate positive linear relationship between total RAADS-R scores and participant surprise (r2=0.15, p<0.05) and a modest negative linear relationship between confidence to obtain their desired degree and total RAADS-R score (r2=0.07, p<0.05). 

Conclusion 
Results reveal an association between autistic trait manifestations and the pursuit of a pre-healthcare degree. These results introduce questions about why pre-healthcare students express higher autistic traits, how autistic traits impact student confidence to pursue healthcare degrees, and the implications on medical education, workplace culture, and accessibility of healthcare careers for adults expressing autistic traits.

Relationship Between Pre-Healthcare Track and Variegated Autistic Trait Manifestations as Defined by RAADS-R Scores

Introduction
Rutgers-Robert Wood Johnson Medical School’s (RWJMS) distinction program in Medical Innovation and Entrepreneurship (DiMIE) is an application-based multi-year innovation and entrepreneurship program for interested medical students. This study sought to examine the impact of the DiMIE Program on students’ acquisition of key entrepreneurial skills as well as attitudes toward completion of the program, and to investigate intentions to continue innovation in participants' future careers.

Methods
A Rutgers IRB-approved nineteen-question survey was distributed via email to all program participants who successfully attained their DiMIE. The survey was voluntary and participants were provided with the option to leave any questions unanswered. f

Results
86% (31/36) DiMIE alumni completed the survey. 68% (21/31) of participants were not confident or neutral in their entrepreneurial skills before beginning DiMIE. However, 84% (26/31) of participants felt the DiMIE improved their confidence in pursuing entrepreneurship The most reported tangible skills developed during the program were identification of clinical needs, design thinking, networking abilities, deck creation, pitch presentation skills, and market research. Participants noted a strong relationship with their mentor as one of the keys to success. 34% (10/29) of DiMIE alumni continued to grow their innovative ideas after completion of the requirements. 87% (27/31) said they were likely to do entrepreneurial projects in the future. Participants felt that adequate mentorship was instrumental for better project design and insight into clinical needs, and many desired more opportunities to connect with entrepreneurs. 

Discussion & Conclusions
Participants desire to learn more technical entrepreneurial skills and receive guidance in moving forward with their creative ideas. Medical institutions wishing to develop entrepreneurship programs should prioritize building robust networking communities, hosting workshops, and formally integrating innovation and entrepreneurship into medical school curricula. This integration will not only help medical students engage in entrepreneurship, but it also endows them with skills applicable to many areas of medicine including leadership, teamwork, and the ability to problem-solve in the future healthcare landscape.

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