BACKGROUND: Although history taking is fundamental for diagnosing medical conditions, teaching and providing feedback on the skill can be challenging due to resource constraints. Virtual simulated patients and web-based chatbots have thus emerged as educational tools, with recent advancements in artificial intelligence (AI) such as large language models (LLMs) enhancing their realism and potential to provide feedback.
OBJECTIVE: In our study, we aimed to evaluate the effectiveness of a Generative Pretrained Transformer (GPT) 4 model to provide structured feedback on medical students\' performance in history taking with a simulated patient.
METHODS: We conducted a prospective study involving medical students performing history taking with a GPT-powered chatbot. To that end, we designed a chatbot to simulate patients\' responses and provide immediate feedback on the comprehensiveness of the students\' history taking. Students\' interactions with the chatbot were analyzed, and feedback from the chatbot was compared with feedback from a human rater. We measured interrater reliability and performed a descriptive analysis to assess the quality of feedback.
RESULTS: Most of the study\'s participants were in their third year of medical school. A total of 1894 question-answer pairs from 106 conversations were included in our analysis. GPT-4\'s role-play and responses were medically plausible in more than 99% of cases. Interrater reliability between GPT-4 and the human rater showed \"almost perfect\" agreement (Cohen κ=0.832). Less agreement (κ<0.6) detected for 8 out of 45 feedback categories highlighted topics about which the model\'s assessments were overly specific or diverged from human judgement.
CONCLUSIONS: The GPT model was effective in providing structured feedback on history-taking dialogs provided by medical students. Although we unraveled some limitations regarding the specificity of feedback for certain feedback categories, the overall high agreement with human raters suggests that LLMs can be a valuable tool for medical education. Our findings, thus, advocate the careful integration of AI-driven feedback mechanisms in medical training and highlight important aspects when LLMs are used in that context.

Hysteroscopy has truly revolutionized the field of diagnostic and operative gynecology. It is presently regarded as the gold standard method for both the diagnosis and treatment of intrauterine diseases and it has fundamentally altered the way gynecologists treat patients with such conditions. These pathologies can now be diagnosed and treated in an outpatient setting, thanks to technological advancements and instrument downsizing. Two hundred years of development and notable innovation are now reflected in the present hysteroscopic practice. This review attempts to trace the boundaries-pushing history of hysteroscopy by highlighting the advancements in technology and the therapeutic and diagnostic benefits offered by this groundbreaking approach.

暂无摘要。

This commentary discusses the history of ADHD and how it can inform contemporary debates about the disorder. It critiques retrospective histories of ADHD, which propose earlier origins for the disorder than match the historical evidence. It concludes by indicating when ADHD did emerge as a distinctive disorder and why it did so.

暂无摘要。

Don\'t Panic. In the nearly 50 years since the discovery of Lyme disease, Borrelia burgdorferi has emerged as an unlikely workhorse of microbiology. Interest in studying host-pathogen interactions fueled significant progress in making the fastidious microbe approachable in laboratory settings, including the development of culture methods, animal models, and genetic tools. By developing these systems, insight has been gained into how the microbe is able to survive its enzootic cycle and cause human disease. Here, we discuss the discovery of B. burgdorferi and its development as a model organism before diving into the critical lessons we have learned about B. burgdorferi biology at pivotal stages of its lifecycle: gene expression changes during the tick blood meal, colonization of a new vertebrate host, and developing a long-lasting infection in that vertebrate until a new tick feeds. Our goal is to highlight the advancements that have facilitated B. burgdorferi research and identify gaps in our current understanding of the microbe.

暂无摘要。

Recognition of hyperactivity, impulsivity, distractibility, and emotional lability as a clinical syndrome is at the heart of identifying whether there is a discoverer of the condition of attention deficit hyperactivity disorder (ADHD). Just as clinics of children diagnosed with ADHD do not capture a homogeneous group of boys and girls, however, history does not either. What different observers/clinicians have chosen to highlight reflects what is important to them and to the times in which they lived. The child/children described by Heinrich Hoffman (of Fidgety Phil fame) and George Still (who highlighted impulsive aggression as a moral defect), for instance, did not come with a list of criteria (with which even now we cannot always agree) to prove unequivocally that they had ADHD. Who cares! It is sufficient that they recognized the importance of certain co-occurring behaviors and shared their observations with us such that we can conclude our clinic\'s children were recognized by good past observers. ADHD-like children, like the poor, have probably always been with us.

暂无摘要。

Chronic diseases are among the leading causes of mortality in the world, the subject of major regional and international efforts to tackle shared risk factors, implement prevention and control measures and set national targets as part of the drive towards universal health coverage. Yet there is a growing conviction that chronic diseases suffer an image problem. It has been suggested that the terminology \'dulls the senses\' to the problems, and in an age where the mass media affords unprecedented opportunities to inform and persuade people to care about their health and that of others, chronic disease representation remains a contested and much debated issue.This article investigates how WHO created and disseminated visual narratives to raise popular consciousness and build a visual vocabulary around chronic disease in the second half of the 20th century. It examines the measures taken to conceptualise, photograph and publicise chronic diseases, and considers who had control over their representation. In focussing predominantly on cancer, diabetes and cardiovascular disease, it reveals different narratives; the power of scientific and technological progress; individual and community action for health; promising utopian and parallel dystopian visions. It embeds these in a production context which reveals an intricate picturing process involving overcoming challenges of representation. It uses this historical background to discuss issues relating to how chronic disease and chronic pain have been narrated visually, such as the ideas of emotional response, moral failure, how people navigate the \'risk society\' and ultimately the concerns regarding the intentional and unintentional influence that the media can have on the image of disease given to society.