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Using ChatGPT-Generated Practice Exam Questions in Medical Education
Full text linkBackground: As artificial intelligence expands in medical education, large language models like ChatGPT have shown potential for efficiently generating practice questions (PQs). A 2023 needs assessment at our institution found that all first-year medical students used PQs, with 75% reporting they always use them when available. To support active learning and exam preparation, we utilized ChatGPT to generate PQs for the historically challenging Circulatory and Respiratory Blocks of the M1 year. Our pilot study aimed to (1) examine the process of developing PQs using ChatGPT, (2) evaluate the impact of ChatGPT-generated PQs on exam performance, and (3) assess student satisfaction.
Methods: A senior medical student used ChatGPT to develop USMLE-style PQs for the Class of 2027 (\u2727) based on faculty-provided learning objectives. Faculty reviewed each question to ensure clarity and accuracy. In total, 211 PQs were distributed ahead of five exams between the two Blocks. Students could complete questions multiple times and view explanations. We compared exam scores of \u2727 with those of the Class of 2026 (\u2726), who had no access to PQs but received identical instruction. Within \u2727, we compared scores between students who used the PQs at least once and those who did not. Two-sample t-tests (p≤0.05) assessed statistical significance, and satisfaction was measured through a Likert-type survey.
Results: PQ usage grew from 12.1% (n=16) to 36.4% (n=48) across exams. After standardizing ChatGPT prompts, question quality improved, and fewer revisions were needed. Compared to \u2726, students in \u2727 scored significantly higher on two of the five exams (p=0.02, p\u3c 0.01). Within \u2727, PQ users had higher average scores on all five exams, though differences were not statistically significant. Among students who used PQs (n=35), 68.6% and 65.7% agreed or strongly agreed that PQs improved their performance on the Circulatory and Respiratory exams, respectively.
Conclusions: Further research across multiple institutions and diverse curricula with larger sample sizes is needed, but one takeaway is clear: standardized prompting workflow and expert review are essential to ensure accuracy and clarity of ChatGPT-generated PQs.https://digitalcommons.unmc.edu/com_msrs/1001/thumbnail.jp
Human Papillomavirus Vaccine Uptake Among U.S. Medical Residents in High-Exposure-Risk Specialties – A National Study
No full textBackground. HPV vaccination is not required for the United States (U.S.) medical residents, despite their potentially high risk of iatrogenic exposure to the virus. We aim to evaluate vaccination status, patterns of HPV vaccine uptake, and perceived risk of iatrogenic infection among residents in high-exposure-risk specialties.
Methods. In spring 2023, an anonymous online survey was distributed via program directors and coordinators of all Accreditation Council for Graduate Medical Education (ACGME)-accredited Obstetrics & Gynecology, Family Medicine, Otolaryngology, and Dermatology training programs to assess residents’ vaccination status, HPV exposure, and HPV vaccine knowledge.
Results. Responses from 537 residents at programs located in 42/52 U.S. states/territories showed that 91% of females and 62% of males were at least partially vaccinated (p \u3c 0.01), and 77% who were unvaccinated would consider vaccination in the future. Overall, 47% of residents estimated treating ≥ 26 cases/year of HPV-related disease, and 85% perceived a mild to high risk of iatrogenic exposure. Finally, 90% were familiar with the CDC’s HPV vaccination schedule, 92% felt comfortable counseling patients about the vaccine, and 99% agreed the vaccine provides protection to male and female patients.
Conclusion. This study found a 16% rate of non-vaccination, with men much less likely to be vaccinated, despite most residents feeling at risk of iatrogenic exposure. Additionally, despite nearly unanimous agreement that the HPV vaccine provides protection to patients, only 60% of residents routinely recommended vaccination to all eligible patients. These findings demonstrate potential opportunities to increase HPV vaccine uptake among residents who treat HPV-related diseases and to improve vaccination counseling for their patients
Implementation of an Adolescent Women’s Health and Wellness Education Program
Full text linkObjectives: The goal of this research study was to provide scientific evidence supporting the importance and effectiveness of implementing a women’s health and wellness education course and its effect on (1) adolescent knowledge of sexual health and hygiene, (2) self-efficacy in menstrual management, and (3) self-empowerment in managing their own reproductive health.
Design: This was a mixed methods pilot study utilizing a pre/post-test single intervention efficacy trial. Quantitative and qualitative data were obtained.
Setting: The setting included two different sites including one outpatient ambulatory obstetrics/gynecology clinic and one community outreach center. Both sites were located within a midwestern metropolitan city.
Participants: The study included a convenience sample of 11 adolescent women, ages 13 to 18, who attended the women’s health and wellness education program. Participants ranged from 13 to 18 years old, with a median age of 14, and the majority were between 13 and 15 years old. Seven participants were recruited from the outpatient obstetrics/gynecology clinic in the Midwest, and four were recruited from the community outreach center.
Measurements: Data were analyzed using descriptive statistics and paired t-tests. Correlational and chi-square analyses were conducted to explore relationships between demographic variables, groups, and outcomes. Three different instruments were used to evaluate the study\u27s aims of knowledge, self-efficacy, and self-empowerment. Additionally, a qualitative tool was utilized to gather participant feedback on the educational content and course.
Results: The relationship between the adolescent women’s health and wellness education course and the measurable outcomes of knowledge (Aim 1), self-efficacy (Aim 2), and self-empowerment (Aim 2) were evaluated.
Conclusions: The findings support the initiation of an adolescent women’s health and wellness education course to help increase knowledge, self-efficacy, and self-empowerment. More standardized, evidence-based education programs are necessary to enhance the knowledge and over-all wellbeing of adolescent females
Navigating Lipid Nanoparticle Design: From Microfluidic Optimization for RNA Delivery in Pancreatic Cancer to Extended-release Formulations for HIV-1 Therapy.
Full text linkLipid nanoparticles (LNPs) have emerged as a powerful platform for the delivery of RNA and small-molecule therapeutics, enabling improved drug stability, biodistribution, and cellular uptake. This study explores the formulation and optimization of LNPs for two distinct therapeutic applications: (1) mRNA-based therapy for pancreatic cancer (PC) and (2) extended-action fostemsavir (FTR) delivery for HIV-1 treatment. For PC therapy, a library of 48 mRNA-LNP formulations was developed for intraperitoneal (IP) administration in an orthotopic pancreatic tumor mouse model. Using microfluidic assembly, LNPs were engineered with varying lipid compositions and characterized based on size, zeta potential, and cytotoxicity. Biodistribution and mRNA expression were tracked using fluorescence-based labeling (RhB-DHPE) and firefly Luciferase mRNA (fLuc mRNA), respectively. Results revealed that specific lipid compositions exhibited preferential accumulation in pancreatic tumors, with distinct correlations between biodistribution and mRNA expression levels. Statistical analyses using JMP software identified key formulation parameters influencing delivery efficiency and therapeutic potential. For HIV-1 therapy, an extended-action FTR-LNP formulation was developed to serve as a long-acting antiretroviral drug depot within monocyte-derived macrophages. The formulation aimed to enhance plasma drug residence time by optimizing physicochemical properties, including PEGylated lipid composition, flow rate ratios, size, polydispersity, shape, and zeta potential. These parameters influenced the LNP’s ability to withstand fluid flow forces, cellular internalization, and antiretroviral efficacy. The FTR-LNP formulation demonstrated stability, efficient macrophage uptake, and extended drug release, highlighting its potential for long-acting HIV-1 therapy. Both studies underscore the critical role of lipid composition and formulation parameters in optimizing LNP-based drug delivery. By mapping the formulation space for both mRNA and small-molecule therapeutics, this research provides insights into the rational design of LNPs for targeted and extended-action drug delivery. These findings contribute to advancing precision nanomedicine for cancer and infectious disease treatments
Navigating the Divide: COVID-19 Vaccine Access, Uptake, and Persistent Vaccine Refusal in Nebraska
Full text linkBarriers to equitable access and uptake of Coronavirus 2019 (COVID-19) vaccines remain of critical importance to public health. This dissertation evaluated geographical disparities in vaccine access in Chapter Two, assessed individual- and community-level determinants of vaccine uptake in Chapter Three, and examined persistent vaccine refusal in Chapter Four.
In Chapter Two, a cross-sectional ecological study was conducted to evaluate geospatial accessibility to provider sites at four timepoints. An accessibility score was created using the Two Step Floating Catchment Area method and a spatial autoregressive model was used to identify indicators of vaccine access. Census tract level determinants for low vaccine accessibility included rurality, no internet access, overcrowded housing, and low educational attainment. Vulnerable populations, including low socioeconomic status (SES), minority, and elderly populations, exhibited a mostly positive association with accessibility.
In Chapter Three, a retrospective cohort study evaluating vaccine uptake of primary, monovalent booster, and bivalent booster series doses was performed using multilevel analysis. At the individual level, lower vaccination uptake was consistently observed among minorities and those with prior COVID-19 infection. Community-level factors associated with low uptake include county-level Republican partisanship and the Social Vulnerability Index (SVI) theme related to low SES. Older age and female sex positively predicted vaccine uptake, as did the county-level SVI theme related to the household characteristics.
In Chapter Four, a cohort of unvaccinated individuals with prior COVID-19 infection were asked for their reason for non-vaccination during case investigation. A modified Poisson regression was used to estimate the risk of unvaccinated status at follow-up against predictors. Ideology-based reasons for non-vaccination (including religious exemption and philosophical objection), older age, non-adherence to mitigation measures, and rural populations were at greater risk of persistent non-vaccination; minority status and hospitalization were correlated with vaccination.
Our study documented the urgency for equitable, accessibility focused vaccination efforts towards specific disadvantaged communities. Special consideration on community-level and individual-level barriers is necessary to curate context specific strategies to improve vaccine uptake. Vaccination patterns within unvaccinated and under vaccinated populations require further research and distinguishing sources of misinformation among ideologically similar communities could instigate reconsideration for vaccination
An Extension of a Break-to-Choice Intervention with Isolated Contingency Tests for Children with Multiply Maintained Challenging Behavior
Full text linkResearch on functional communication training has shown it to be a highly effective treatment for socially maintained challenging behavior. Challenging behavior multiply maintained by social variables is often addressed with isolated treatments for each function. While this approach has been shown to be efficacious, it may be more time-consuming and less efficient. A more efficient option may be to synthesize the isolated treatments. One such approach, break-to-choice, utilizes a chained schedule of reinforcement that allows the individual to request a break, followed by the selection (choice) of a functional reinforcer to consume. Although this procedure has been shown to be effective, it is unclear whether effects of the synthesized treatment will generalize to isolated contingencies of each functional reinforcer. In this study, a break-to-choice treatment was implemented with children determined to exhibit multiply maintained challenging behavior. Additionally, this study extended previous research by implementing isolated contingency tests following schedule thinning criteria being met in the break-to-choice condition. The results of the study showed the break-to-choice intervention was effective in decreasing multiply maintained challenging behavior and increasing functional communication responses for three out of four participants. These effects generalized to all isolated contingencies for two participants
Optimizing Case Management Manuals: A Ryan White Quality Improvement Project for Northwest Missouri
Full text linkThe Ryan White HIV/AIDS Act, established in 1990, has played a critical role in providing essential services for individuals living with HIV, including medication access, adherence support, health coverage, housing, and transportation. In rural Missouri, particularly in the northwest region, HIV case management under the Ryan White program is guided by four separate manuals, creating inefficiencies and burdens for case managers. This paper presents a process evaluation plan utilizing the Plan-Do-Study-Act (PDSA) framework to address these challenges and improve service delivery. The aim of this quality improvement project is to enhance the efficiency and effectiveness of HIV case management in Northwest Missouri. The planning phase involved in-depth interviews with staff from the Andrew County Health Department to identify existing operational barriers. In the do phase, a unified document was developed to simplify case management processes and serve as a comprehensive reference for the HIV case management team. The study phase involved follow-up interviews, which confirmed the document’s positive impact in reducing confusion and improving adherence to procedures. The act phase is ongoing, with continuous feedback being collected to further refine the document
Investigating the Role of Androgen Deprivation on AXL Regulation in Prostate Cancer
No full textEarly prostate cancer (PC) is androgen-dependent and is often treated with androgen deprivation therapy (ADT) or castration. As PC progresses to a castration-resistant state (CRPC), patients continue to receive ADT through second-generation AR antagonists like Enzalutamide. Despite therapeutic advancements, resistance to Enzalutamide poses a significant challenge in treating metastatic CRPC. Insights from multi-omics profiling in single cells have revealed complex drug resistance mechanisms and the emergence of drug-tolerant persister cells (DTPs). The receptor tyrosine kinase AXL drives DTP survival and evolution and is a drug resistance marker in various cancers. However, in PC, the relationship between AXL and drug resistance remains unclear. To address this gap, this thesis investigates the impact of ADT on Axl expression in Ar+Axl+PC cells. Data revealed a significant reduction in Axl expression following “acute ADT” (24-72 hours). Conversely, cells undergoing “chronic ADT” (\u3e10 passages), or Enzalutamide-resistant cells, maintained Axl expression. Multi-omics studies of PCa patient samples highlight AXL gene expression exclusively in the AP-1 and YAP/TAZ-driven CRPC stem cell-like (SCL) subtype. Mechanistically, we combined ADT with small-molecule inhibitors of Hippo or AP-1 signaling pathway transcription factors to examine their impact on Axl expression. This combination treatment reduced Axl expression in Ar+Axl+ PC cells. Finally, using a syngeneic xenograft model, we aimed to evaluate the therapeutic efficacy of the GnRH antagonist Degarelix in targeting AXL-expressing CRPC cells. Our in vivo data indicated a significant reduction in tumor burden in Enzalutamide-resistant cells under Degarelix treatment, suggesting that Degarelix provides a therapeutic advantage against the CRPC-SCL subtype
Investing in Embedded Practitioners: Lessons from the Region VII Public Health Expansion Program
Full text linkPublic health systems in the United States face mounting challenges, including workforce shortages, skill gaps, and increasing demands on practitioners. These issues are particularly acute in rural and Tribal communities, where systemic barriers and health disparities persist. The Region VII Public Health Expansion Program (PHES) addresses these challenges by investing in practitioners already embedded in their communities. Through fully funded public health degree programs, the PHES aims to enhance workforce retention, strengthen skills, and support the delivery of essential public health services in Missouri, Iowa, Nebraska, and Kansas. This study evaluates the program\u27s innovative approach, which departs from traditional recruitment models by focusing on those already committed to rural and Tribal health. Findings will offer insights into workforce development strategies that can improve public health capacity, equity, and resilience