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Heinke A, Radgoudarzi N, Huang BB, Baxter SL. A review of ophthalmology education in the era of generative artificial intelligence. Asia Pac J Ophthalmol (Phila) 2024:100089. [PMID: 39134176 DOI: 10.1016/j.apjo.2024.100089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/18/2024] Open
Abstract
PURPOSE To explore the integration of generative AI, specifically large language models (LLMs), in ophthalmology education and practice, addressing their applications, benefits, challenges, and future directions. DESIGN A literature review and analysis of current AI applications and educational programs in ophthalmology. METHODS Analysis of published studies, reviews, articles, websites, and institutional reports on AI use in ophthalmology. Examination of educational programs incorporating AI, including curriculum frameworks, training methodologies, and evaluations of AI performance on medical examinations and clinical case studies. RESULTS Generative AI, particularly LLMs, shows potential to improve diagnostic accuracy and patient care in ophthalmology. Applications include aiding in patient, physician, and medical students' education. However, challenges such as AI hallucinations, biases, lack of interpretability, and outdated training data limit clinical deployment. Studies revealed varying levels of accuracy of LLMs on ophthalmology board exam questions, underscoring the need for more reliable AI integration. Several educational programs nationwide provide AI and data science training relevant to clinical medicine and ophthalmology. CONCLUSIONS Generative AI and LLMs offer promising advancements in ophthalmology education and practice. Addressing challenges through comprehensive curricula that include fundamental AI principles, ethical guidelines, and updated, unbiased training data is crucial. Future directions include developing clinically relevant evaluation metrics, implementing hybrid models with human oversight, leveraging image-rich data, and benchmarking AI performance against ophthalmologists. Robust policies on data privacy, security, and transparency are essential for fostering a safe and ethical environment for AI applications in ophthalmology.
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Affiliation(s)
- Anna Heinke
- Division of Ophthalmology Informatics and Data Science, The Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Drive, La Jolla, CA 92037, USA; Jacobs Retina Center, 9415 Campus Point Drive, La Jolla, CA 92037, USA
| | - Niloofar Radgoudarzi
- Division of Ophthalmology Informatics and Data Science, The Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Drive, La Jolla, CA 92037, USA; Division of Biomedical Informatics, Department of Medicine, University of California San Diego Health System, University of California San Diego, La Jolla, CA, USA
| | - Bonnie B Huang
- Division of Ophthalmology Informatics and Data Science, The Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Drive, La Jolla, CA 92037, USA; Division of Biomedical Informatics, Department of Medicine, University of California San Diego Health System, University of California San Diego, La Jolla, CA, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sally L Baxter
- Division of Ophthalmology Informatics and Data Science, The Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Drive, La Jolla, CA 92037, USA; Division of Biomedical Informatics, Department of Medicine, University of California San Diego Health System, University of California San Diego, La Jolla, CA, USA.
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Perkons M, Wickersham A, Bharel S, Kuchera T, Jaffe R. Early Immersion in Team-Based Event Review: Experiential Patient Safety Education for PGY 1 Internal Medicine Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11376. [PMID: 38264238 PMCID: PMC10803640 DOI: 10.15766/mep_2374-8265.11376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/23/2023] [Indexed: 01/25/2024]
Abstract
Introduction In recent years, there has been a national push to incorporate high-fidelity quality improvement and patient safety (QIPS) education into physician training programs. In fact, integration of robust patient safety education became an Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirement for residency programs in 2017. We developed a curriculum to not only fulfill the ACGME's requirement but also provide PGY 1 internal medicine residents with the skills needed to become active participants in ongoing patient safety work throughout their training and careers. Methods Our patient safety curriculum was woven into residents' existing protected educational time and supported by a standardized facilitator guide and participant workbook. It combined didactic prework with the review of recent near-miss or low-harm patient safety events, empowering residents to identify root causes and propose interventions. Results We successfully delivered our patient safety curriculum to 80 PGY 1 residents over the course of 2 academic years. Residents rated the curriculum as a valuable educational experience, and the event reviews they completed met most of the criteria for high-quality patient safety reviews according to the Strong String Assessment. Discussion Implementation of this standardized curriculum has allowed us to reliably and consistently incorporate experiential patient safety education into the first year of training for internal medicine residents. Unlike purely didactic sessions, our curriculum encourages active learning, building muscle memory for event reviews that enables future engagement in patient safety activities.
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Affiliation(s)
- Michelle Perkons
- Assistant Professor, Department of Medicine, Duke University School of Medicine
| | - Alexis Wickersham
- Clinical Associate Professor, Department of Medicine, Thomas Jefferson University Hospitals
| | - Sonia Bharel
- Clinical Assistant Professor, Department of Medicine, Thomas Jefferson University Hospitals
| | - Timothy Kuchera
- Clinical Assistant Professor, Department of Medicine, Thomas Jefferson University Hospitals
| | - Rebecca Jaffe
- Associate Professor, Department of Medicine, Thomas Jefferson University Hospitals
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3
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Mendoza J, Hampton E, Singleton L. A theoretical and practical approach to quality improvement education. Curr Probl Pediatr Adolesc Health Care 2023; 53:101459. [PMID: 37980237 DOI: 10.1016/j.cppeds.2023.101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Quality Improvement (QI) knowledge and skills are required at all levels of physician training. System improvement efforts need to include understanding of health disparities and design of interventions to reduce those disparities, thus health equity needs to be integrated into QI education. Payors, accreditation bodies and health systems' emphases on QI result in the need for QI curricula that meet the needs of diverse learners. This article presents a theoretical background and practical tools for designing, implementing, and evaluating a QI educational program across the spectrum of physician training with an emphasis on competency-based education and a goal of continuous practice improvement. Practice-based learning and improvement and systems-based practice are two core domains of competencies for readiness to practice. These competencies can be met through the health systems science framework for studying improvement in patient care and health care delivery coupled with QI science. Curricula should incorporate interactive learning of theory and principles of QI as well as mentored, experiential QI project work with multidisciplinary teams. QI projects often develop ideas and implement changes but are often inconsistent in studying intervention impacts or reaching the level of patient outcomes. Curriculum design should incorporate adult learning principles, competency based medical education, environmental and audience factors, and formats for content delivery. Key QI topics and how they fit into the clinical environment and teaching resources are provided, as well as options for faculty development. Approaches to evaluation are presented, along with tools for assessing learner's beliefs and attitudes, knowledge and application of QI principles, project evaluation, competency and curriculum evaluation. If the goal is to empower the next generation of change agents, there remains a need for development of scientific methodology and scholarly work, as well as faculty development and support by institutions.
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Affiliation(s)
- Joanne Mendoza
- Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Virginia, USA.
| | - Elisa Hampton
- Department of Pediatrics, University of Virginia School of Medicine, University of Virginia Children's, Virginia, USA
| | - Lori Singleton
- Department of Pediatrics, Morehouse School of Medicine, Children's Healthcare of Atlanta, Georgia, USA
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Durham ML, Diegel-Vacek L, Sparbel KJH, Rugen KW, Hershberger PE. Strategies for developing faculty confidence and competencies to mentor quality improvement DNP projects. J Prof Nurs 2023; 47:56-63. [PMID: 37295913 DOI: 10.1016/j.profnurs.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/01/2023] [Accepted: 04/10/2023] [Indexed: 06/12/2023]
Abstract
DNP faculty who mentor students in quality improvement (QI) DNP projects often lack essential knowledge of QI principles. The purpose of this article is to guide DNP programs in developing confident and competent faculty mentors for QI DNP projects, facilitating DNP student success. At a multi-campus practice- and research-intensive university, strategies employed to teach College of Nursing faculty essential knowledge of QI principles comprise structural and process components. Structural supports standardize faculty workload, promote potential for collaborative scholarship, and provide instructional and resource support for faculty mentors. Organizational processes facilitate identification of practice sites and meaningful projects. A College of Nursing and university Institutional Review Board collaboration established policy to guide human subjects protection regarding DNP project activity, streamlining and standardizing the process. Library support mechanisms, access to ongoing faculty QI training and resources, and faculty feedback processes to improve QI faculty development are ongoing and sustained. Peer coaching provides continued support for faculty development. Initial process outcomes indicate that implemented strategies are well-received by faculty. The transition to competency-based education provides opportunities to create tools to measure multiple student quality and safety competencies highlighted in Domain 5 of The Essentials: Core Competencies for Professional Nursing Education and inform future directions for faculty development essential to support student success.
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Affiliation(s)
- Marianne L Durham
- College of Nursing, University of Illinois Chicago, United States of America.
| | - Lauren Diegel-Vacek
- College of Nursing, University of Illinois Chicago, United States of America
| | | | - Kathryn Wirtz Rugen
- College of Nursing, University of Illinois Chicago, United States of America
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5
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Marcdante K, Wali S, Wilkerson L, Simpson D. Demonstrating Clinician Educator Value. J Grad Med Educ 2023; 15:383-384. [PMID: 37363654 PMCID: PMC10286926 DOI: 10.4300/jgme-d-23-00199.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Affiliation(s)
- Karen Marcdante
- Karen Marcdante, MD, is Professor Emerita (Pediatrics) and an Executive Coach, Medical College of Wisconsin
| | - Soma Wali
- Soma Wali, MD, is Chair, Department of Medicine, Olive View-University of California, Los Angeles (UCLA) Medical Center, Executive Vice Chair of Medicine and Professor of Clinical Medicine, David Geffen School of Medicine at UCLA
| | - Luann Wilkerson
- Luann Wilkerson, EdD, is Associate Dean, Evaluation and Faculty Development, and Professor, Department of Medical Education, University of Texas, Austin's Dell Medical School
| | - Deborah Simpson
- Deborah Simpson, PhD, is Education Director, Academic Affairs, Advocate Aurora Health, Adjunct Clinical Professor Family and Community Medicine, School of Medicine and Public Health and Medical College of Wisconsin, and Deputy Editor, Journal of Graduate Medical Education
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Chen A, Kwendakwema N, Vande Vusse LK, Narayanan M, Strizich L, Albert T, Wu C. Outcomes in quality improvement and patient safety training: moving from in-person to synchronous distance education. BMJ Open Qual 2023; 12:bmjoq-2022-002176. [PMID: 36927629 PMCID: PMC10030926 DOI: 10.1136/bmjoq-2022-002176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated increased synchronous distance education (SDE) in graduate medical education, presenting challenges for Quality Improvement and Patient Safety (QIPS) best practices, which call for integration with daily clinical care and investigation of real patient safety events. OBJECTIVE To evaluate educational outcomes for QIPS training after conversion of a mature, in-person curriculum to SDE. METHODS 68 postgraduate year (PGY)-1 residents were surveyed before and after the SDE Culture of Patient Safety training in June 2020, and 59 PGY-2s were administered the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) before and after the SDE QIPS seminar series in July-August 2020. Values before and after training were compared using sign tests for matched pairs (PGY-1) and Wilcoxon signed-rank tests (PGY-2). RESULTS 100% (68 of 68) of PGY-1s and 46% (27 of 59) of PGY-2s completed precourse and postcourse surveys. Before the course, 55 PGY-1s (81%) strongly agreed that submitting patient safety event reports are a physician's responsibility, and 63 (93%) did so after (15% increase, p=0.004). For PGY-2s, the median composite QIKAT-R score was 17 (IQR 14.5-20) before and 22.5 (IQR 20-24.5) after the seminars, with a median difference of 4.5 (IQR 1.5-7), a 32% increase in QIPS competency (p=0.001). CONCLUSIONS Patient safety attitudes and quality improvement knowledge increased after SDE QIPS training at comparable levels to previously published results for in-person training, supporting SDE use in future hybrid curricula to optimise educational value and reach.
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Affiliation(s)
- Anders Chen
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Medicine, Veterans Affairs Puget Sound Heathcare System, Seattle, Washington, USA
| | - Natasha Kwendakwema
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa K Vande Vusse
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Maya Narayanan
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lindee Strizich
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tyler Albert
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Medicine, Veterans Affairs Puget Sound Heathcare System, Seattle, Washington, USA
| | - Chenwei Wu
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Medicine, Veterans Affairs Puget Sound Heathcare System, Seattle, Washington, USA
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Fedoruk KA, Chan YK, Williams CE. Scholarship in anesthesiology: the role of critical appraisal, literature review, quality improvement, journal club, and presentation skills. Int J Obstet Anesth 2023; 54:103639. [PMID: 36841065 DOI: 10.1016/j.ijoa.2023.103639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/27/2022] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
If asked to describe the term "anesthesiologist scholar", one may receive a variety of definitions depending on the individual's area of practice, location in the world, and the generation in which they trained. In this article, we review the roles of five core elements that make an anesthesiologist a "scholar": skills in critical appraisal, literature review, quality improvement, journal club participation, and presentation delivery. Although this list of scholarly components is not comprehensive, review of each element's role in the everyday practice and training of physicians will offer insight into their evolution and may offer a glimpse into the future of anesthesiologist scholars. Overall, through the dissemination, recognition, and support of scholarship through these practices, we will continue to achieve meaningful outcomes for our patients and promote a culture of collaboration worldwide. We should ensure that these topic areas become a bedrock of medical education globally, and we must foster opportunities for those who have already completed training to develop and master these skills as a part of their clinical and academic practice.
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Affiliation(s)
- K A Fedoruk
- Center for Academic Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Y K Chan
- Department of Anaesthesiology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - C E Williams
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge, UK
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Tucker CM, Jaffe R, Goldberg A. Supporting a culture of patient safety: Resident-led patient safety event reviews in a pathology residency training program. Acad Pathol 2023; 10:100069. [PMID: 36873567 PMCID: PMC9982285 DOI: 10.1016/j.acpath.2023.100069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/22/2022] [Accepted: 01/08/2023] [Indexed: 03/05/2023] Open
Abstract
Patient safety is a critical component of quality patient care at any healthcare institution. In order to support a culture of patient safety, and in the context of a hospital-wide patient safety initiative at our institution, we have created and implemented a new patient safety curriculum within our training program. The curriculum is embedded in an introductory course for first-year residents, in which residents gain an understanding of the multifaceted role of the pathologist in patient care. The patient safety curriculum is a resident-centered event review process and includes 1) identification and reporting of a patient safety event, 2) event investigation and review, and 3) presentation of findings to the residency program including core faculty and safety champions for the consideration of implementation of the identified systems solution. Here we discuss the development of our patient safety curriculum, which was trialed over a series of seven event reviews conducted between January 2021 and June 2022. Resident involvement in patient safety event reporting and patient safety event review outcomes were measured. All event reviews conducted thus far have resulted in the implementation of the solutions discussed during event review presentations based on cause analysis and identification of strong action items. Ultimately this pilot will serve as the basis by which we implement a sustainable curriculum in our pathology residency training program centered on supporting a culture of patient safety, and in line with ACGME requirements.
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Affiliation(s)
- Catherine M Tucker
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rebecca Jaffe
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Allison Goldberg
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Clemo R, Parsons AS, Boggan JC, Shieh L, Miller BP. Learning by Doing: Practical Strategies to Integrate Resident Education and Quality Improvement Initiatives. J Grad Med Educ 2021; 13:631-634. [PMID: 34721789 PMCID: PMC8527936 DOI: 10.4300/jgme-d-21-00381.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rebecca Clemo
- Rebecca Clemo, MD, is Chief Resident, Internal Medicine Residency Program, University of Virginia School of Medicine
| | - Andrew S. Parsons
- Andrew S. Parsons, MD, MPH, is Associate Program Director, Internal Medicine Residency Program, and Assistant Professor, Department of Medicine and Public Health Sciences, Section of Hospital Medicine, University of Virginia School of Medicine
| | - Joel C. Boggan
- Joel C. Boggan, MD, MPH, is Associate Program Director, Internal Medicine Residency Program, and Assistant Professor, Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine
| | - Lisa Shieh
- Lisa Shieh, MD, PhD, is Clinical Professor of Medicine, Associate Chief Quality Officer, Medical Director of Quality, Department of Medicine, and Medical Director of GME QI programs, Stanford University School of Medicine
| | - Bahnsen P. Miller
- Bahnsen P. Miller, MD, is Assistant Professor, Department of Medicine, Section of Hospital Medicine, University of Virginia School of Medicine
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