Resuscitating the Socratic Method: Student and Faculty Perspectives on Posing Probing Questions During Clinical Teaching

Why Pimping Works: The Neurophysiology of Emotional Memories

A time-honored medical ritual that combines emotion and cognition into a seamless consolidation of lucid memories is a feared teaching method in medical education. The resulting neurophysiology is explained from a neurosurgeon's perspective - equal parts guilt and dread as a prescription for an improved and sustained trainee fund of knowledge. Much of the available literature published with regard to pimping explores its pedagogy and use in medical practice. This review aims to explore the neurobehavioral and biological aspects of pimping in why it remains a popular teaching model. We describe the neuromodulatory process of integrating emotions and memory as observed during pimping. Additionally, we explore the neuronal pathways and circuits involved in memory encoding, consolidation, and retrieval. Finally, we explored the effects of this methodology as it is currently used in the United States medical education system.

Large language models in health care: Development, applications, and challenges

Recently, the emergence of ChatGPT, an artificial intelligence chatbot developed by OpenAI, has attracted significant attention due to its exceptional language comprehension and content generation capabilities, highlighting the immense potential of large language models (LLMs). LLMs have become a burgeoning hotspot across many fields, including health care. Within health care, LLMs may be classified into LLMs for the biomedical domain and LLMs for the clinical domain based on the corpora used for pre-training. In the last 3 years, these domain-specific LLMs have demonstrated exceptional performance on multiple natural language processing tasks, surpassing the performance of general LLMs as well. This not only emphasizes the significance of developing dedicated LLMs for the specific domains, but also raises expectations for their applications in health care. We believe that LLMs may be used widely in preconsultation, diagnosis, and management, with appropriate development and supervision. Additionally, LLMs hold tremendous promise in assisting with medical education, medical writing and other related applications. Likewise, health care systems must recognize and address the challenges posed by LLMs.

Medical Faculty and Medical Student Opinions on the Utility of Questions to Teach and Evaluate in the Clinical Environment

Objectives

We sought to report medical student and faculty perceptions of the purpose and utility of questions on clinical rounds.

Methods

We developed and administered a survey to third and fourth-year medical students and teaching physicians. The survey elicited attitudes about using questions to teach on rounds in both benign and malignant learning environments.

Results

Ninety-seven percent of faculty and 85% of students predicted they will use questions to teach. Nine percent of students described learning-impairing stress during benign bedside teaching. Fifty-nine percent of faculty felt questions were mostly for teaching; 74% of students felt questions were mostly for evaluation. Forty-six percent of students felt questions underestimated their knowledge. Students felt questions were more effective for classroom teaching than bedside teaching. Faculty and students agreed that a malignant environment detrimentally affected learning and performance.

Conclusions

Students and faculty supported the use of questions to teach and evaluate, especially in benign teaching environments. Many students described stress severe enough to affect their learning and performance, even when questioned in benign teaching environments. Faculty underestimated the degree to which students experience stress-related learning impairment and the degree to which students see questions as evaluation rather than teaching. Nearly half of students felt that questions underestimated their own knowledge. Students feel more stress and less learning when questioned with a patient present. Faculty must realize that even in the best learning environment some students experience stress-impaired learning and performance, perhaps because of the conflict between learning and evaluation.

Performance of ChatGPT on USMLE: Potential for AI-assisted medical education using large language models

We evaluated the performance of a large language model called ChatGPT on the United States Medical Licensing Exam (USMLE), which consists of three exams: Step 1, Step 2CK, and Step 3. ChatGPT performed at or near the passing threshold for all three exams without any specialized training or reinforcement. Additionally, ChatGPT demonstrated a high level of concordance and insight in its explanations. These results suggest that large language models may have the potential to assist with medical education, and potentially, clinical decision-making.

What Aspects of Supervised Patient Encounters Affect Students' Perception of Having an Excellent Learning Outcome? A Survey Among European Medical Students

Background

To investigate whether supervisor behavior, students' participation and approach, and psychological safety were associated with self-reported excellent learning outcome from supervised encounters with patients among European medical students.

Methods

A cross-sectional, online survey among European medical students asking about their latest clinical supervision experience. Associations were examined with logistic regression.

Results

Students (N=908) from >25 countries reported on experiences from supervised patient encounters in most types of hospital departments and general practice. One out of six (17%) students perceived the learning outcome as excellent. In the multivariable logistic regression, this was independently associated with supervisor role modelling (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.5-3.0) and addressing learning goals (OR 1.4, 95% CI 1.1-1.7), students' approach to learning (OR 1.7, 95% CI 1.0-3.0) and psychological safety (OR 1.5, 95% CI 1.1-2.0). Supervisors being present during the patient encounter, coaching students or asking questions to have students express their thinking, and student participation in examination and/or history taking was not associated with perceived excellent learning outcome.

Conclusion

We encourage supervisors to recognize that students are beginners in most supervised clinical settings and often appreciate having learning goals addressed, behavior and thinking role modelled, and psychological safety established before they participate more fully.

A Narrative Review of Key Studies in Medical Education in 2021: Applying Current Literature to Educational Practice and Scholarship

To remain at the forefront of clinical practice and pedagogy, pediatric medical educators must stay informed of the latest research. Yet familiarization with the growing body of literature in both pediatrics and medical education is a near-impossible task for the busy medical educator. The purpose of this annotated bibliography is to summarize key manuscripts in medical education published in 2021 that have the potential to significantly influence a pediatric medical educator's practice. Using a 2-staged iterative process, discrete author pairs reviewed 1599 abstracts from 16 medical education and specialty journals. In summary, 16 manuscripts were selected and grouped into the following 6 domains: assessment and feedback, USMLE Step 1 changes, communication, wellness, diversity and inclusion, and professional development. The authors provide abridged summaries and high-yield take-aways from these manuscripts that may impact educational practices in pediatrics. This year, we also provide a 6-year retrospective review of the journals that have had selected articles for this annotated bibliography since inception.

Revisiting the Socratic method of teaching to improve third-year pharmacy students critical thinking and advanced pharmacy practice experience readiness in a critical care elective

BACKGROUND

One of the most important abilities we look to nurture and develop in pharmacy students is critical thinking. A critical care elective course was re-designed to optimize high-pressure situations to engage and target critical thinking, clinical reasoning, and advanced pharmacy practice experience (APPE) readiness using the Socratic method of teaching.

EDUCATIONAL ACTIVITY

Pharmacy students at Loma Linda University School of Pharmacy were selected and exposed to a high-pressure classroom environment with each day structured around the Socratic method of teaching. Pass/fail grades were earned daily based solely on verbal responses and discussions. The assessment tools used were: Health Sciences and Reasoning Test (HSRT) to measure critical thinking, an APPE-readiness survey of the entire third-year class for peer comparison, and a survey of the style and pedagogies used.

CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY

The elective students showed noteworthy gains on their HSRT results in an eight-week critical care elective course. They also had significantly more positive responses on the APPE-readiness survey relative to their classmates and rated this teaching style higher than a typical course. Revisiting and applying the Socratic method of teaching in a high-pressure course is an effective way to engage pharmacy students, producing substantial improvements in critical thinking, clinical reasoning, and APPE readiness in a short time. Lastly, it offers one way to incorporate a validated tool to measure critical thinking in pharmacy students for institutional assessment and accreditation that is widely available, easy to use, and cost friendly.