Objective Breaking bad news (BBN) is specified in the General Medical Council’s Generic Professional Capabilities framework, which sets out core skills to be developed alongside curricula-specified capabilities in postgraduate training. To date, a wide variety of approaches to teaching BBN have been used, however, the application of artificial intelligence (AI) to learning in this field remains in its early stages and requires further investigation. Design, setting, participants and intervention Two approaches were compared in response to the question What is the best way to break bad news?: a human-facilitated discussion versus an AI-generated response using ChatGPT-4. Both approaches produced high-level guidance condensed into short statements for online mixed methods evaluation by experienced medical educators. Outcome measures and results 41 doctors from 17 specialties and eight lay representatives provided free-text commentary as part of the assessment. Overall findings were compared with popular patient-focused BBN protocols, such as SPIKES, with qualitative analysis providing more details of skills requirements for generic and specialist levels of practice by adding more depth and nuance via three themes: patient experience, professionalism and access to support. Both approaches matched well with patient-focused protocols albeit they also addressed doctors’ debriefing after BBN. Conclusions Overall, AI produced more comprehensive, highly rated guidance suitable for early careers, but qualitative evaluation highlighted the need for more specialised skills, their nature and application, plus differences in preferred style and content between approaches. The value of tailoring communication, via a personalised approach developed from real-life experience, was also confirmed.
Background Pulmonary embolism (PE) is a condition with significant morbidity and mortality. Diagnostic imaging aims to identify patients with a PE so that they can receive anticoagulation. There is evidence, predominantly from the USA, that the number of diagnostic scans for PE has increased over time and the diagnostic yield (the percentage of positive scans) has decreased. There is limited evidence on whether this is also true in the UK. Aim To describe the pattern of diagnostic imaging for acute PE and investigate whether there has been a change in the diagnostic yield over the last 10 years. Methods All adult patients who underwent either computed tomography pulmonary angiogram (CTPA) or ventilation-perfusion (V/Q) scan as an investigation for acute PE at Cambridge University Hospitals NHS Foundation Trust (CUH) between 2015 and 2024 were included. This was a retrospective study using data extracted from the hospital electronic health record (EHR) system. Results 25,672 scans were included, comprising 23,908 CTPA and 1,764V/Q scans. The annual number of scans increased slightly over the time period, with an average increase of 1.2% per year (p < 0.05). The overall diagnostic yield was 17.0%, with no clear trend over time. There was also no clear trend in the proportion of subsegmental PE detected over time. Conclusions The overall number of scans performed and diagnostic yield for PE have remained relatively stable over the last decade. This is the largest study of its kind in the UK and, uniquely, also covers the entire timeline of the COVID-19 pandemic and its aftermath.
STUDY OBJECTIVE:Interest in medical research and clinical academic careers amongst medical students is concerningly low, posing a threat to the long-term sustainability of the clinical researcher workforce. A likely contributing factor is a lack of knowledge and teaching about medical research. To address this, we developed and evaluated the MEDICORE teaching programme; a dedicated clinical academia training programme designed to address these gaps. DESIGN:The MEDICORE programme consisted of six biweekly in-person sessions from January to March 2024, targeting UK medical students. The learning outcomes addressed educational gaps about research identified by a prior national survey and the GMC Outcomes for Graduates. MAIN OUTCOME MEASURES:Pre- and post-session assessments measured students' improvement in knowledge and attitudes towards medical research and clinical academic careers. RESULTS:534 student responses were collected overall, with on average 89 participants attending each session. Seven UK universities were represented, with 83.3% from one institution. Students reported that the MEDICORE programme addressed a curriculum gap in research training (81.5%). There was a significant increase in the number of students who felt confident completing a full research project and disseminating research through publications or presentations. Post-MEDICORE, students felt more confident in the structure of clinical academic training (mean Likert scale increase 1.45 ± 1.44, p < 0.0001). The number of students interested in pursuing a clinical academic career increased from 39.1% to 85.8% (p < 0.0001). CONCLUSION:MEDICORE demonstrates that dedicated research teaching is an effective intervention to promote research skills and the pursuit of future academic careers amongst medical students. Such efforts may help address predicted shortages in the clinical academic workforce. CLINICAL TRIAL NUMBER:Not applicable.
Foundation Year (FY) doctors consistently report feeling underprepared when applying intravenous fluid (IVF) guidelines due to inadequate training, resources and an underemphasis of evidence-based bedside assessment techniques. Given IVFs are the most commonly prescribed substance in the NHS, especially by FY doctors, inappropriate patient assessments and written prescriptions are a patient safety threat. Whilst the NICE IVF guideline exists, it is not without nuance and there remain challenges in delivering effective IVF education and sustainable learning interventions over time. From a FY doctor perspective discussed, senior clinicians demonstrating use of guidelines more explicitly may help address the gap between guidelines and clinical practice. Ultimately, given the widespread use of IVF, there is a need for improved education to develop FY doctors' clinical reasoning and ensure patient safety.
