United States

BACKGROUND: Artificial Intelligence (AI) generative large language models (LLMs) are powerful and increasingly accessible tools with potential applications in healthcare education and training. The annual Orthopedic In-training Examination (OITE) is widely used to assess resident academic progress and preparation for the American Board of Orthopedic Surgery (ABOS)  Part 1.

METHODS: Open AI’s ChatGPT and Google’s Bard generative language models were administered the 2022 OITE examination. Question stems that contained  images were input without, then with a text based description of the imaging findings.

RESULTS: ChatGPT answered 69.1% of questions correctly, when provided with text describing accompanying media this increased to 77.8% correct. In contrast Bard answered 49.8% of questions correctly and this increased to 58% correct when provided with text describing imaging in question stems (p&amp;lt;0.0001.) ChatGPT was most accurate in questions within the Shoulder category with a 90.9% accuracy. Bard performed best in the Sports subspecialty category scoring 65.4% correct.  ChatGPT performed above the published mean of Accreditation Council for Graduate Medical Education (ACGME) orthopedic resident test-takers (66%.)  
CONCLUSIONS: There is significant variability in the accuracy of publicly available AI
models on the OITE. AI generative language software may play numerous potential roles in the
future assisting orthopedic education including simulating patient presentations and clinical scenarios, customizing individual learning plans and driving evidence-based case discussion.  Further research and collaboration within the orthopedic community is required to safely adopt these tools and minimize risks associated with their use.

2023 AMA Research Challenge

Performance of Two Artificial Intelligence Generative Language Models on the Orthopedic In-training Examination

BACKGROUND: Artificial Intelligence (AI) generative large language models (LLMs) are powerful and increasingly accessible tools with potential applications in healthcare education and training. The annual Orthopedic In-training Examination (OITE) is widely used to assess resident academic progress and preparation for the American Board of Orthopedic Surgery (ABOS)  Part 1.

METHODS: Open AI’s ChatGPT and Google’s Bard generative language models were administered the 2022 OITE examination. Question stems that contained  images were input without, then with a text based description of the imaging findings.

RESULTS: ChatGPT answered 69.1% of questions correctly, when provided with text describing accompanying media this increased to 77.8% correct. In contrast Bard answered 49.8% of questions correctly and this increased to 58% correct when provided with text describing imaging in question stems (p&lt;0.0001.) ChatGPT was most accurate in questions within the Shoulder category with a 90.9% accuracy. Bard performed best in the Sports subspecialty category scoring 65.4% correct.  ChatGPT performed above the published mean of Accreditation Council for Graduate Medical Education (ACGME) orthopedic resident test-takers (66%.)  
CONCLUSIONS: There is significant variability in the accuracy of publicly available AI
models on the OITE. AI generative language software may play numerous potential roles in the
future assisting orthopedic education including simulating patient presentations and clinical scenarios, customizing individual learning plans and driving evidence-based case discussion.  Further research and collaboration within the orthopedic community is required to safely adopt these tools and minimize risks associated with their use.

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Background: Fellowship Directors (FDs) and Division Chiefs (DCs) have a profound impact on the current and future trainees in orthopaedics, yet no previous study has analyzed the academic, leadership, and demographic characteristics of FDs and DCs in arthroplasty. This study’s purpose was to evaluate the demographic characteristics, scholarly work, and educational training of FDs and DCs in academic orthopaedic arthroplasty divisions in the United States.

Methods: Orthopaedic arthroplasty fellowships were identified using the American Association of Hip and Knee Surgeons Directory. Data on each FD and DC was gathered via the program’s respective websites, personal profiles, curriculum vitae, and online searches. Information collected included sex, race/ethnicity, fellowship training institution, time since fellowship graduation, academic rank, additional degrees, time at current institution, time in current role, additional leadership positions held, h-index, ResearchGate score, and ResearchGate interest score. H-index was compared between FDs and DCs and the correlation between h-index and academic rank was calculated. 

Results: There were 116 FDs and 77 DCs from 137 orthopaedic arthroplasty programs included. Of these, 20 were co-FDs and 22 were both FD and DC. Overall, 98.3% were males. For race/ethnicity, 83.8% were Caucasian, 11.0% Asian, 3.5% Hispanic, and 1.7% African American. Average age in years was 52.7, years since fellowship graduation was 18.1, years at current institution was 13.9, years in current role was 9.8. Thirty had additional degrees. Average h-index, RG, and RI scores were 16.9, 27.6, and 1309.5, respectively. Overall, 29.6% were full Professor, 26.6% Associate Professor, and 23.1% Assistant Professor. There was a moderate positive correlation between academic rank and h-index. The top fellowship programs to produce future FDs and DCs were Massachusetts General Hospital (17), Hospital for Special Surgery (17) and Mayo Clinic (13). 

Conclusion: A striking lack of diversity exists in orthopaedic arthroplasty leadership, with most FDs and DCs being white males. There was a moderate positive correlation between professorship and h-index. Furthermore, there are specific fellowship programs that play an important role in producing future arthroplasty leaders. Greater efforts are needed to increase diversity among arthroplasty leadership in United States academic orthopaedic programs.

Academic, Leadership, and Demographic Characteristics of Orthopaedic Arthroplasty Leadership in the United States

Background
Gender disparities are well established in the surgical field, despite increasing prevalence of women in surgical specialties. Currently in otolaryngology, 33% of residents and 28% of faculty in academic programs are women. Women comprise 13% of full professor positions, 12% of otolaryngology program director positions, and 3.5% of otolaryngology department chair positions. Disparities in woman’s career can be seen in the manner in which they are evaluated. A public method of evaluation is through the distribution of awards. Professional awards are intended to identify and reward those that are considered the best in their field. Externally, awards are beneficial to an individual by adding more value to their resumes or curriculum vitae. Internally, these awards allow for improved self-perception and self-confidence. This study aims to evaluate gender disparities in otolaryngology residency training with a focus on awards in residency.

Methods
122 OHNS training programs were sent emails with a survey link requesting participation. Questions including number of women residents as well as questions pertaining to specific awards were detailed. Primary outcome measures were total number and percentages of awardrecipients that were women. Further analysis stratification was completed for geographic location and award type.

Results
15% of programs contacted participated in our survey. Data was gathered from 2010-2019. The percentage of women in a given OHNS residency program ranged from 0% to 55%. Awards distributed to women in a program ranged from 6% to 50%. Women were disproportionately awarded in all residency program except one, in which they were over-awarded. Overall, women were found to be 42% less likely to receive a residency award compared to men (OR, 0.58; 95% CI, 0.42 to 0.81; P = 0.001). Statistical significance was identified in awards of academic excellence, where women residents were found to be 54% less likely to receive an award, as well as in teaching awards, where women were 51% less likely to receive an award. When addressing whether the responder believed gender bias existed in otolaryngology residency, 58% felt there may be some bias, while 24% responded yes, and 12% responded no.

Conclusion
Gender inequalities exist at several stages within an individual’s academic career including at the resident trainee level. This study demonstrates that women are disproportionately distributed residency awards when compared to their male colleagues in OHNS. Knowledge of these disparities must be made to prevent a negative long-standing impact on women residents within OHNS programs.

Gender Disparities in Otolaryngology-Head and Neck Surgery Residency Awards

Background D/deaf individuals are at risk for poor health outcomes compared to their hearing counterparts due to communication and cultural differences. Given the high prevalence of hearing loss, health professionals and trainees should be aware of this issue. DEAFMed is a novel educational program designed to address these topics. We hypothesized that this program would effectively introduce health professions students to Deaf culture and how to communicate effectively with patients with hearing differences to improve their delivery of equitable care.
Methods In its pilot year, this prospective cohort study included 98 health professionals and trainees across medicine, occupational therapy, and nursing at a single institution. Participants attended up to five 90-minute seminars that discussed Deaf culture and American Sign Language (ASL). Participants took pre- and post-intervention surveys to assess changes in attitudes and beliefs. Incentives for participation included remote access via Zoom, free food, and medical humanities course credit. Primary outcomes included comfort in approaching care of the D/deaf patient and awareness of common misbeliefs about the community. Results were analyzed using descriptive statistics and Wilcoxon matched-pairs signed rank tests.
Ó 2023 American Medical Association. All rights reserved.
Results Only one lecture was found to have statistically significant changes in participant attitudes and beliefs (p = 0.03). The lack of statistical significance between pre- and post- intervention is likely due to an insufficiently powered cohort. However, on a scale of 1 (strongly disagree) to 5 (strongly agree), participants consistently agreed that the medical school should offer more formal programs addressing health care and D/deaf people (4.66±0.16) and that the experience is likely to positively impact attitudes and behavior in future interactions with all patients with limited English proficiency or alternative primary communication modalities (4.46±0.18). Furthermore, participants’ responses indicated that they felt more comfortable in their understanding of Deaf culture because of their participation in DEAFMed (4.20±0.16).
In the upcoming academic year, the DEAFMed programming will expand to include more opportunities for attendees to learn and practice ASL during every session to bolster engagement.
Conclusion Overall, the results suggest a positive response to the DEAFMed pilot and support the feasibility and importance of replicating this intervention in medical education. Future interventions with dedicated communication exercises in English and ASL are expected to enhance engagement.

DEAFMed: Deaf Education and Awareness for Medical Students

There appears to be an association between musculoskeletal (MSK) symptoms and computer use leading to sick leave, efficiency loss, and work-related sickness (Oha 2014, Khan 2012). Earlier studies by Bernard et al in 1994 found a dose-response relationship between the duration of computer work and musculoskeletal complaints. In 2012 musculoskeletal disorders were responsible for 34% of all workplace injuries and illnesses and cost $45-54 billion to the US economy (Bureau of Labour Statistics 2014, National Research Council 2001). 

Laptop use specifically has been steadily increasing since 2005-52.8%, 2007-75.8% (Jacobs 2009), and in 2014, 95.4% of University students reported using a laptop (Dockrell 2015). The laptop's "face down forward head posture" may compromise the resting spinal columns' double "S-shape" affecting the entire spine and neck (Annetts 2012, Toosizadeh 2012) including lumbar and pelvic areas which allow stability during sitting (Annetts 2012). 

The mass of the head falls in front of the center of gravity for the C-spine which passively stretches ligaments and joint capsules resulting in chronic neck pain (turtle neck posture, text neck) (Cho 2008). This chronic stress may lead to prominent exostosis projecting from the occipital squama (Shahar 2018).

Medical Residents at The Wright Center for Graduate Medical Education are involved in high-intensity medical management of patients in our FQLA facility and the standard tools used in the facility are laptops that are signed in, and out daily and used at home. This RCT trial randomizes a laptop stand, USB mouse, and keyboard to determine if there is an effect on MSK pain using a modified NORDIC questionnaire combined with a Visual Analogue Scale distributed via Google Docs at baseline, 3 months, and 6 months involving half of the incoming first-year residents in Family Medicine, Internal Medicine, Physical Medicine and Rehab and Psychiatry (n=57).


Randomized Controlled Trial of Laptop Stand, USB Keyboard/Mouse to Reduce Upper Body/Spine Pain in First-Year Medical Residents

**Scoring is only possible in the semifinals hall**

**Abstract:**



Guidelines and Recommendations for Providing Disability-Competent Care for Individuals with Physical Disabilities: A Narrative Review

Background
The relationship between manual dexterity, specialty choice, and the use of OMT in newlyadmitted osteopathic medical students remains unclear. Previous research suggests a connection between hand dexterity and surgical skill development, but there is a gap in understanding how manual skills relate to career choices and interest in OMT. This study investigates this connection, aiming to shed light on the influence of hand dexterity on career path and incorporation of osteopathic skills.
Methods
30 newly admitted RowanSOM students underwent a timed-Purdue pegboard assessment to measure their hand dexterity. The completion time was recorded, and shorter times indicated higher scores. Afterwards, the students completed a survey to determine their interest in specific specialties and their desire to practice OMT in the future. For the surveys, the “desire to practice OMT” and “the desire to pursue a surgical specialty” were quantified via a score on a scale from -2 to 2. The relationship between specialty/OMT interest and hand testing was thus explored.
Statistical analysis of the collected data was conducted using SPSS software.
Results
A non-parametric statistical analysis was performed on data collected from a sample of 30 newly admitted RowanSOM students, consisting of 17 women and 13 men, with an average age of 24.37 ± 2.798 years. Hand dexterity was measured by the time taken to complete the Perdue Pegboard exercise. Interest in a surgical specialty and OMT was measured using a scored survey on a scale from -2 to 2, with -2 representing Strongly Disagree and 2 representing Strongly Agree. There was a positive correlation between dominant hand proficiency in the assembly task and
interest in performing OMT, as indicated by a Pearson correlation value of 0.371 (p = 0.044). This suggests a statistically significant correlation between faster completion times on the Perdue Pegboard test and interest in OMT.
Conclusion
This project investigated the influence of inherent hand dexterity on medical career paths and the incorporation of osteopathic skills. It found a significant correlation between better performance on the Perdue Pegboard hand dexterity test and interest in OMT. The collected data provides support for the positive correlation between hand dexterity and the desire to practice OMT. Conducting this project on a larger scale could validate these results. If this correlation is consistently observed in future trials, it could impact the recruitment of medical school candidates and the development of skills in undergraduate pipeline programs and the preclinical years.

Exploring the Link between Manual Skills, Specialty Selection, and the Aspiration to Practice OMT in Newly Enrolled Osteopathic Medical Students

Introduction:

Hispanic women pursue breast augmentation surgery more than any other minority group.1 Additionally, breast implant removals increased by 34.4% in 2019 and by 8% in 2020, perhaps due to rising concerns for breast implant-associated anaplastic large cell lymphoma.2 However, this trend may not be reflected in all racial segments. Patient education materials (PEMs) with advanced readability can limit Hispanic patients’ health literacy and understanding of treatment plans, increasing barriers to breast implant removal and worsening health outcomes. When compared to non-Hispanic Whites, Hispanics attain less highschool and college education, have less household income, and face higher poverty rates.3 These factors negatively influence health literacy. Despite the National Institutes of Health recommending PEMs be written at the 6th-7th grade readability level, online PEMs are often difficult to read. This study assessed and compared the readability of Spanish and English online breast implant removal PEMs.


Methods:

The English and Spanish terms “breast implant removal” and “extracción de implantes mamarios” were queried on Google and the first fifty Uniform Resource Locators (URLs) for each search term were selected. Included resources were non-video, free articles. Each URL was categorized into private business (private clinics, independent practice), institutional (governmental agencies, medical schools/teaching hospitals, medical sources), and academic (journal article, book chapter) groups. To ensure analyses provided useful insights into resources used by patients rather than surgeons, academic articles were regarded as a separate entity and analyzed independently. Readability scores were generated using the Simple Measure of Gobbledygook (SMOG) and the Spanish SMOG scales.


Results:

PEMs published by private businesses comprised the majority (> 60%) of both English and Spanish articles. Overall, online breast implant removal PEMs surpassed recommended reading levels in both English (x̄ = 12.2, highschool senior) and Spanish (x̄ = 11.0, high school junior). Among PEMs in the private business category, those written in English were more difficult to read than Spanish (p < 0.00001). As a whole, English PEMs were similarly more difficult to read than Spanish PEMs (p < 0.00001, excluding academic). There were no significant differences in readability when comparing English and Spanish institutional PEMs, English private business and English institutional PEMs, or Spanish private business and Spanish institutional PEMs.


Conclusion:

Our findings show that the readability of English and Spanish materials for breast implant removal exceeds recommended levels. This discrepancy may have ramifications for certain groups as breast implant removal is a procedure that can have significant cosmetic and psychological impacts.4 It is vital that these patients are provided with educational material appropriate to their literacy level in order for them to understand the procedure, its implications, and indications. Additionally, the significant proportion of PEMs authored by private businesses may be concerning due to an inherent self-serving bias. Online information for breast implant removals should be revised and/or standardized materials should be created by healthcare providers and national organizations in order to more fully educate the public and prospective patients prior to intervention.

Are Difficult to Read Patient Education Materials Problematic? A Readability Assessment of Online Patient Education Resources Related to Breast Implant Removal and Breast Implant Illness.

Background: The recognition of cultural complications as part of the learning paradigm of medical training is slowly becoming a vital focus. An innovative cultural complications curriculum (CCM), pioneered by groups from the University of Maryland and Michigan, has been implemented within M+M teaching conferences across select institutions. Its adoption on a nationwide platform attests to its efficacy in delivering impactful social medicine education that is engaging, thought-provoking, and purpose-driven. This study aims to illuminate the journey and tangible strides achieved in integrating the CCM into our monthly M+M teaching conferences within the UPMC Plastic Surgery Department. 
Methods: We used the freely available, established, CCM toolkit online, which focuses on 12 core DEI concepts. This curriculum emphasizes an active, safe, and evidence-based discussion format. We administered pre- and post-initiation surveys to assess the department's initial interest and subsequent feedback. 
Results: We received 63 completed pre-initiation surveys that included all members of our department. 78% of respondents expressed profound initial interest in this initiative. Additionally, 64% of respondents felt positive that their colleagues are committed to learning about diversity, equity, and inclusion. We received 33 completed post-initiation survey responses from CCM attendees that represented all department members. 60% of respondents expressed either that they agreed or strongly agreed that they “learned valuable information from the CCM”. 86% and 88% of respondents either strongly agreed or agreed that “incorporating DEI principles is important for good patient care and ...for a successful workplace", respectively. 64% and 67% of respondents felt more equipped to identify Overt Bias and Implicit Bias, respectively. There was a noteworthy increase in the number of respondents who believed they possessed effective strategies to address overt bias when encountered with someone more senior in the organizational hierarchy and when it involved patients (56% vs. 46%, 77% vs. 52%; respectively). Additionally, there was a marked decrease in the number of respondents who felt ill-equipped to address implicit bias when encountering individuals at various hierarchical levels (15% vs. 38% with seniors, 6% vs. 18% with like-peers, 3% vs. 10% with juniors). 
Conclusions: Through this study, we were successful in achieving positive outcomes by implementing this established curriculum within our department. While our perspectives on this endeavor remain positive, we must acknowledge the formidable challenges we encountered during the initiation phase that could be encountered by others planning to champion this initiative within their department/division. We were able to deliver education on social medicine topics in a unique format that prioritizes sharing lived experiences and evidence-based discussion over passive learning.

Cultural ‘Complications’ Morbidity and Mortality Plastic Surgery Grand Rounds: The Pitt Plastic Surgery Experience

Background
Scar management is an integral part of postoperative care in plastic surgery. The approach may vary based on skin tone. Hence, comprehensive training on scar prevention and treatment of all Fitzpatrick skin types is important in resident education. Nationwide, plastic surgery residents use the American Society of Plastic Surgeons (ASPS) Resident Education Curriculum as an online resource during their training. A previous study found that this online resource generally does not equitably represent patients of diverse skin tones. The aim of our study was to assess the representation of diverse skin tones in the ASPS Resident Education Curriculum teaching materials specifically on scarring. We hypothesized that the modules focused on scarring do not equitably represent patients of diverse skin tones.

Methods
The ASPS Resident Education Curriculum was reviewed to select teaching modules that mentioned the term “scar” in their learning objectives. Visual aids were then identified in the selected modules. Three independent raters scored these visual aids on the Fitzpatrick scale I-VI. The Fitzpatrick scale ratings were categorized into 3 groups: I-II, III-IV, and V-VI. One-way ANOVA and Tukey’s post-test analysis were performed to compare Fitzpatrick scales I-II versus V-VI. Percent agreement was used to calculate inter-rater reliability among the raters. 

Results
Between September 8-10, 2022, we identified three modules that mentioned “scar” in their learning objectives. These included 21 visual aids: 65% reflected a Fitzpatrick scale of I-II (14±1.53), 29% a scale of III-IV (6±1.73), and 6% a scale of V-VI (1±0.58). There were significantly more visual aids categorized as Fitzpatrick I-II versus Fitzpatrick V-VI (p<0.001). We did not identify a dedicated module on teaching plastic surgery residents scar prevention or treatment. The inter-rater reliability between the three raters was 74.6%.

Conclusion
Our study demonstrates that skin tone representation in scar management teaching materials for plastic surgery residents is skewed towards Fitzpatrick scales I-II, representing the lightest skin tones. Adequate knowledge of scar prevention and treatment of all skin tones is essential given that hypertrophic or keloid scars often occur in individuals of darker skin tones. We recommend creating a dedicated scar management module in the ASPS Resident Education Curriculum containing diverse representation of skin tones.

Diversity in Scar Teaching Materials in the ASPS Resident Education Curriculum

Background
As a student, it is no easy task to endure the pace, rigor, and responsibility of medical school. Prior studies have well established that medical students experience higher rates of stress, depression, anxiety, and burnout compared to the general population. However, the most effective techniques to combat these alarming rates remain unclear. In this paper, we sought to identify the benefits of psychotherapy for medical students experiencing stress-induced mood disorders. These include an array of mental health concerns, ranging from perfectionism to suicidal ideation. Psychotherapy (I.e., talk therapy) is a method of discussing one’s life events in order to identify ways to improve their own beliefs, thoughts, and actions. Therapy can be targeted for certain mood disorders or psychopathology, and has been shown to be very effective for many people. We sought to discuss and evaluate the potential successes of therapy in reducing mental health concerns amongst medical students, while also discussing the barriers and issues that stand between the utilization of therapy in this population.
Methods
A literature review regarding the relationship between medical students and therapy was conducted using the following sites: PubMed, Google Scholar, NIH, and ASA Psych. There were no exclusion criteria, allowing inclusion of an array of articles, including primary literature, clinical trials, and case-studies. Articles and websites deemed to contain peer-reviewed evidence were read carefully and used as relevant citations.
Results
While overall current data is limited, several studies showed improvement in medical student mental health after trials with therapy and therapy-learned techniques including mindfulness. The primary barrier from pursuing therapy as a means of mental health support was stigma. This stigma is a result of the competitive and invasive nature of medical education, with students fearing that seeking mental health help would make them perceived as weak by their peers and evaluators. Students also attribute issues such as accessibility, busy schedules, and financial cost to their hesitancy to try therapy. 
Conclusion
While still relatively underexplored, the preliminary outcomes of medical students participating in therapy is promising for improvement of stress-induced mood disorders. Medical school curriculums must prioritize student wellness by dismantling barriers of stigma, accessibility, and negative self-perception in order to promote options such as therapy. We believe this research should be taken further by looking into patient outcomes after seeing providers who have previously gone to or are currently in therapy. 




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Performance of Two Artificial Intelligence Generative Language Models on the Orthopedic In-training Examination

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