Vanessa Hui

Purpose The recent surge in artificial intelligence (AI)-related technologies presents an opportunity for revolutionary advances in traditional methods of medical education. ChatGPT is one such application of AI that can take free-form text as input and generate a human-like response. This study sought to evaluate ChatGPT’s performance on a simulated surgery shelf exam and assess its potential as a learning tool for medical students. Methods Two 50-question tests were randomly selected from the National Board of Medical Examiners (NBME) practice surgery shelf exams. ChatGPT (Generative Pretrained Transformer-4o, September 2024) evaluated each question sequentially. Questions with images were excluded. Responses were recorded, and a board-certified general surgeon evaluated each justification. Each justification was graded as either having no errors, minor errors that do not significantly impact understanding of the topic, or major errors that significantly impact understanding of the topic. Results ChatGPT answered 96.6% of questions correctly. 9.2% of all responses contained minor errors, and 9.2% contained major errors. Among correctly answered questions, 9.5% contained minor errors, while 6.0% contained major errors. All major errors were due to incorrect information that was presented as correct. Conclusion ChatGPT demonstrates high accuracy when assessed on its ability to correctly answer multiple-choice questions that medical students could encounter on a surgery shelf exam. However, caution must be used when using ChatGPT as an adjunct to traditional education methods. With 15.5% of ChatGPT’s correct responses containing errors, often confidently asserting false information, students risk learning incorrect information if unaware of this limitation.

Background/Objectives: Colorectal surgeons continue to care for an aging cancer population with increasing comorbidities and frailty. Frailty, characterized by a systemic physiologic decline associated with aging, is an increasingly popular focus in surgical outcomes research. This retrospective study investigates how frailty impacts outcomes in the octogenarian and nonagenarian populations undergoing surgical treatment for colon cancer. Methods: Data from the National Surgical Quality Improvement Program (NSQIP) colectomy-targeted variables dataset from 2015 to 2021 were utilized for this analysis, including patients 80 years of age and older. Frailty was assessed using the five-factor modified frailty index (mFI-5). The study examined post-operative outcomes across frailty groups in this population. Results: From 2015–2021, there were 10,671 patients aged 80 years and older who underwent colectomy for colon cancer, of whom 1,259 (11.8%) were 90 years or older and 2,844 (26.7%) were severely frail. Frailty significantly impacted post-operative colectomy outcomes in this population. On univariate analysis, frail patients had higher rates of pneumonia (p = 0.015), unplanned intubation (p = 0.012), stroke (p < 0.001), myocardial infarction (p = 0.011), readmission (p < 0.001), long length of stay (p < 0.001), and mortality (p < 0.001) compared to non-frail patients. On multivariate analysis, severe frailty (mFI-5 of 2 or more) was associated with an increased odds of unplanned intubation (aOR 2.41, 95% CI 1.27–4.59), long length of stay (aOR 1.73, 95% CI 1.44–2.09), readmission (aOR 1.84, 95% CI 1.42–2.39), and mortality (aOR 1.95, 95% CI 1.20–3.15) compared to non-frail patients. Conclusions: Frailty plays a critical role in influencing the outcomes of octogenarians and nonagenarians undergoing colectomy for colon cancer within the NSQIP dataset. Future work should investigate whether addressing frailty prior to surgery in this population can improve patients’ post-operative courses.

Purpose Firearm injuries are a major public health crisis; however, providers are not routinely educated on how to discuss this topic with their patients. To address this gap, a firearm safety curriculum was developed for medical students during their surgery clerkship. Perceptions, knowledge, and preparedness for counseling patients was evaluated before and after dissemination. Methods All second-year medical students enrolled in the surgery core clerkship from March 2023 to March 2024 were included. The curriculum consists of a 30-min didactic presentation discussing gun violence with techniques to identify and counsel at-risk patients followed by a 30-min, interactive case-based discussion where students simulate counseling strategies. Pre- and post-session surveys included a 5-point Likert scale to evaluate efficacy of the curriculum. Paired student’s t test was conducted to compare pre- and post-survey responses. Results Of the 249 students, 54.6% % were female, 50.9% were White, and mean age was 25 ± 2 years. While 91.9% of students responded that they had never owned a gun, 37.8% had lived in a home where a gun was present, and 48.2% had fired a gun before. Only 24.7% of students had previously taken a gun-safety course, and 15.4% received training on counseling patients on firearm safety. One hundred thirty three students completed both pre- and post-session surveys for analysis. After the course, students had higher agreement on the importance of physician’s roles and responsibilities in patient education on firearm safety, and students felt more prepared to counsel patients. Knowledge of patient risk factors for firearm injury increased significantly from students being able to identify 1.4 ± 1.1 risk factors correctly on pre-test to identifying 2.6 ± 1.6 risk factors correctly on post-test ( t (64) = − 5.6, p  < 0.01). Conclusion The firearm safety curriculum is a simple and effective tool that augments students’ knowledge and understanding of gun violence, as well as prepares them to counsel patients on firearm safety. This curriculum can be widely implemented as an important intervention to equip future physicians with the necessary tools to help address the firearm crisis in the United States.

Purpose of ReviewMpox, formerly known as monkeypox, is a zoonotic illness caused by a virus that is part of the Orthopoxvirus family. Originally identified in humans in the Democratic Republic of Congo in 1970, the disease has been endemic in central African nations. In 2022, an outbreak of Monkeypox warranted a declaration by the World Health Organization (WHO) that the virus was a Public Health Emergency of International Concern. Prior literature documented the dermatological manifestations of the disease, but fewer papers have described and navigated the complexities of mpox gastrointestinal manifestations. We aim to update the current literature on the gastrointestinal (GI) manifestations of mpox, through a review of the literature via PubMed search for English language papers reporting GI manifestations of the virus.Recent FindingsIndividual reports of symptomatic manifestations of mpox have been reported. Upper and lower GI symptoms have been described and, in multiple cases, required multidisciplinary team care to successfully treat the patients.SummaryGI manifestations of mpox disease are reported in a variety of severities and, in some instances, may require multidisciplinary management.

Indocyanine Green (ICG) has significantly advanced minimally invasive surgery. It is widely recognized for its ability to visualize blood vessel patency in real-time across various surgical specialties. While its primary use in colorectal surgery is to evaluate anastomoses for leaks, numerous other applications have been documented in the literature. In this review, we aim to explore both established and emerging applications of ICG fluorescence in colorectal surgery, with the goal of improving patient outcomes. This includes preoperative tumor marking and the detection of metastatic disease. Some applications, such as lymphatic mapping, require further research to determine their impact on clinical practices. Conversely, others, like the intraoperative localizations of ureters, necessitate additional procedures and are not yet widely accepted by the surgical community. However, the development of alternative compounds could offer better solutions. Future research should focus on areas like quantitative ICG and protocol standardization in prospective multicenter studies.

Introduction: Colorectal cancer is the third most common cancer and the third leading cause of cancer deaths in the United States. As rectal squamous cell carcinoma (SCC) is an uncommon colorectal cancer, there is limited data on this clinical entity. We aimed to evaluate the tumor characteristics, treatment, and clinical outcomes of this rare deadly disease. Methods: Pathological specimens from 2017 to 2022 at a single National Cancer Institutedesignated cancer center were screened for all rectal cases with a diagnosis of SCC. All patients with a primary rectal SCC were included. Patients who had extension to the dentate line or evidence of an anal mass, and those who were treated at an outside institution, were excluded. Demographic, treatment, outcome, and surveillance data was extracted. Results: There were 56 specimens identified, nine of which met inclusion criteria. Most patients were White (78%), Hispanic (78%), and female (67%). The average age at diagnosis was 57 y [52-65]. All patients had nodal involvement at the time of clinical staging. All patients were treated with Nigro protocol, with one patient treated with surgery first. The median time of follow-up was 12 mo after initial treatment, 33% had recurrence, with median time to recurrence of 25 mo. Overall, mortality from rectal SCC was 33% at a median time of 37 mo from initial diagnosis. Conclusions: Rectal SCC is a colorectal cancer that is not fully understood. Our findings showed that treatment mirrors that of anal SCC, with similar rates of survival to both rectal adenocarcinoma and anal SCC. (c) 2024 Elsevier Inc. All rights reserved.

Purpose Recent trends in medical education have shifted towards earlier clinical experiences with reduced preclinical time, thereby decreasing didactic time for human anatomy prior to surgical rotations. Here we assess a dedicated program designed to teach relevant general surgery principles to students at the beginning of their surgical clerkship. Methods All medical students who rotated on the surgery clerkship from 2022 to 2023 at a single institution were included. Students voluntarily and anonymously completed identical assessments prior to, 24 h after, and 10 weeks after participating in a required 4-h in-person prosection-based anatomy session. The assessment was comprised of (1) written multiple-choice questions, (2) image-based multiple-choice questions using intraoperative photographs, and (3) confidence scoring utilizing a 5-point Likert scale. Results Pre-session and post-session and post-clerkship test survey completion rates were 52% ( n  = 104), 27.5% ( n  = 55), and 20% ( n  = 30), respectively. Post-session and post-clerkship test written, image-based, and confidence scores were significantly higher than pre-test scores. Post-session and post-clerkship test scores were not different with the exception of written-based questions. Conclusions A focused general surgery anatomy session improves both written-based and image-based test performance as well as overall confidence in medical students’ understanding of surgical anatomy while completing the surgery clerkship. As medical school curricula continue to evolve with earlier clinical exposure at the expense of dedicated anatomy didactics, new methods that teach surgically relevant anatomy should continue to be explored to optimize medical education.

Purpose This study aims to assess the effectiveness of a 4th-year medical student (MS4) Transition to Internship Bootcamp curriculum in improving students’ attitudes towards and perception of preparedness for surgical residency. Methods A 4-week Transition to Internship Bootcamp curriculum was implemented for MS4 students who matched into a surgical residency program. The curriculum consisted of lectures on patient care, common surgical diseases, administrative and surgical principles, and hands-on practice of common bedside procedures and basic operating skills. Students completed a pre- and post-Bootcamp survey that measured their perceptions of preparedness of various intern-level skills. The surveys included a 5-point Likert scale and open response questions on general attitudes. The survey data was analyzed with univariate analysis at p  < 0.05 and thematic analyses of open responses. Results Of the 30 students who participated in the bootcamp, 50% were male and 50% White, with an average age of 27 years. Twenty-eight students completed both pre- and post-Bootcamp surveys and there was a significant increase in perceived preparedness across all bootcamp skills ( p  < 0.001). Prior to the bootcamp, students were concerned of their preparedness for the practical skills required for surgical internship. Following the bootcamp, students indicated an enhanced confidence in both knowledge and skillset. Conclusions The Transition to Internship Bootcamp enhances students’ preparedness for surgical internship and their confidence in various surgical skills. Positive response to hands-on skills lab experiences particularly highlights the importance of such training. Implementing specialty-focused training during the MS4 year strengthens readiness and self-assurance for surgical residency.

Ostomy formation is a vital component in the treatment of advanced gastrointestinal diseases, including colorectal cancer and inflammatory bowel disease. It usually involves externalizing a part of the colon or small bowel to the skin surface. Thus, the creation of an ostomy can often have a major negative impact on quality of life. This study aimed to evaluate whether the use of an ostomy belt could improve quality of life measures in stoma patients through a prospective interventional open-label study of 17–80-year-old English- and Spanish-speaking patients with stomas who were using an ostomy belt for 8 weeks. Changes in quality of life were assessed using the Stoma Quality of Life Scale questionnaire at baseline, at 4 weeks, and at 8 weeks post ostomy belt use. A total of 45 patients enrolled (20 female, mean age 48) in the study. The ostomy belt significantly improved quality of life scores from baseline to 4 weeks regarding overall life satisfaction (F(2, 76) = 14.77, p < 0.001) and in the domains of work/social function (F(2, 72) = 30.32, p < 0.001), sexuality/body image (F(2, 68) = 3.34, p = 0.04), and stoma function (F(2, 72) = 8.72, p < 0.001). These improvements were sustained at the 8-week follow-up. No significant differences were observed in the domains of financial impact and skin irritation. This study represents the first prospective interventional study that provides evidence for the simple low-cost intervention of ostomy support belt use in improving quality of life in patients with a stoma.

Objective: Numerous institutions have reduced preclinical didactic time to facilitate earlier clinical exposure during the second year of medical education. However, the effects that shortened preclinical education may have on performance in the surgery clerkship are unclear. This study aims to compare the clinical and examination performance of second- (MS2) and third-year (MS3) students synchronously completing an identical surgery clerkship. Design: All students completing the surgery clerkship (identical didactics, examinations, clinical rotations, etc.) were included. MS3s received 24 months of preclinical education, whereas MS2s received 14 months. Performance outcomes included weekly quizzes based on lectures, NBME Surgery Shelf Exam, numeric clinical evaluations, objective structured clinical examination (OSCE) scores, and overall clerkship grades. Setting: University of Miami Miller School of Medicine. Participants: All second- (MS2) and third-year (MS3) medical students completing the Surgery Clerkship over 1 year (n = 395). Results: There were 199 MS3 (50%) and 196 MS2 (50%) students. MS3s demonstrated higher median shelf exams (77% vs 72% MS2s), weekly quiz score averages (87% vs 80% MS2s), clinical evaluations (96% vs 95% MS2s), and overall clerkship grades (89% vs 87% MS2s), all p < 0.020. There was no difference in median OSCE performance (both 92%; p = 0.499). A greater proportion of MS3 students performed in the highest 50% of weekly quiz scores (57% vs 43% MS2), NBME shelf exams (59% vs 39% MS2), and overall clerkship grades (45% vs 37% MS2), all p < 0.010. No significant difference in the proportion of students placing in the top 50% of clinical parameters including the OSCE (48% MS3 vs 46% MS2; p = 0.106) and clinical evaluations (45% MS3 vs 38%; p = 0.185) was observed. Conclusions: Although the duration of preclerkship education may correspond to examination scores, MS2s and MS3s perform similarly on clinical metrics. Future strategies to enhance available preclinical didactic time and preparation for examinations are needed.