MedEdTrials: Protocol registration for medical education research

A checklist for reporting, reading and evaluating Artificial Intelligence Technology Enhanced Learning (AITEL) research in medical education

Advances in Artificial Intelligence (AI) have led to AI systems' being used increasingly in medical education research. Current methods of reporting on the research, however, tend to follow patterns of describing an intervention and reporting on results, with little description of the AI in the system, or the many concerns about the use of AI. In essence, the readers do not actually know anything about the system itself. This paper proposes a checklist for reporting on AI systems, and covers the initial protocols and scoping, modelling and code, algorithm design, training data, testing and validation, usage, comparisons, real-world requirements, results and limitations, and ethical considerations. The aim is to have a systematic reporting process so that readers can have a comprehensive understanding of the AI system that was used in the research.

Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training

BACKGROUND

Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits.

METHOD

Using a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment.

RESULTS

Clinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians.

CONCLUSIONS

Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed.

TRIAL REGISTRATION

Clinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023.