Since 2022, generative artificial intelligence (AI) use has grown rapidly across many sectors, including medical education. While prior research has explored perceptions of AI, the understanding of AI use amongst medical trainees has been limited. This study surveyed medical trainees to better identify the patterns of generative AI use. Results showed varying patterns based on the phase of training, with ChatGPT emerging as the predominantly used platform across all phases. While awareness of AI policies was limited, the majority reported efforts for responsible use of AI. Implications include understanding of equitable access and onboarding regarding AI use policies.

Strokes are a leading cause of death worldwide, with a majority being ischemic. Treatments include intravenous thrombolytics and mechanical thrombectomy (MT) for large vessel occlusions. With both being time-sensitive, there has been a focus on emergency transport decisions; however, there is a deficit of large, multi-institutional studies to support the use of a bypass transport system where patients suspected of large vessel occlusion are transported directly to a comprehensive stroke center (CSC) even if they bypass other centers. A query was completed of PubMed, Scopus, and Web of Science for articles related to clinical outcomes with the bypass transport method. Patients directly transported to a CSC were compared to patients transferred from a peripheral stroke center. A mixed-effect meta-regression model was used to investigate the effect of patient and treatment variables on 90-day mortality and functional outcome rates. Two hundred sixty articles were included in the final analysis. The time to tissue plasminogen activator treatment was insignificantly but slightly delayed in the direct group (132.1 vs. 130.6 minutes; P value: 0.8823), while the time to MT was significantly faster in the direct group (225.6 vs. 275.4 minutes; P value: 0.0114). Mortality and good neurological outcome rates were not significantly different in these groups (odds ratio=0.7060; 95% confidence interval 0.4802-1.0379 and odds ratio=1.1305; 95% confidence interval 0.8830-1.4473). This meta-analysis compares the 90-day mortality and functional outcomes between patients, and we found a statistically significant improvement in time to MT for those directly transported to a CSC; however, there was not a significant difference in clinical outcomes.

Study Design: Retrospective cohort study. Objective: To evaluate the association between psychiatric comorbidity and in-hospital outcomes in traumatic spinal fracture patients, as well as the dose-response relationship between psychiatric burden and outcomes. Summary of Background Data: Psychiatric comorbidities are prevalent among trauma patients and associated with worse acute outcomes, yet few studies have examined this relationship in spinal fracture patients specifically, and none have assessed the cumulative effect of multiple psychiatric conditions. Methods: Traumatic spinal fracture patients were identified from the 2018 to 2023 National Trauma Data Bank using ICD-10 codes. Psychiatric comorbidity was characterized as a binary indicator and a Psychiatric Burden score reflecting the number of distinct diagnostic categories. Propensity score matching (1:2) was performed to compare patients with and without psychiatric comorbidity on length of stay (LOS), ventilator use, ventilator duration, mortality, and severe sepsis. Dose-response analyses were conducted in the psychiatric subgroup using multivariate regression with Psychiatric Burden as a continuous predictor. Results: Of 940,733 analytic patients, 4731 (0.50%) had ≥1 psychiatric comorbidity. After matching, psychiatric comorbidity was associated with 22.8% longer LOS (95% CI: 19.2–26.5%, P <0.001) and higher odds of ventilator use (OR: 1.11, 95% CI: 1.01–1.22, P =0.025). Each additional psychiatric diagnostic category was associated with 8.6% longer LOS (95% CI: 4.7–12.7%, P <0.001) and lower odds of ventilator use (OR: 0.87, 95% CI: 0.76–0.98, P =0.024). Conclusion: Psychiatric comorbidity is an independent and dose-dependent predictor of prolonged hospitalization in traumatic spinal fracture patients, with higher psychiatric burden associated with less invasive respiratory management. A count of psychiatric diagnoses at admission may serve as a low-cost criterion for prioritizing early behavioral health involvement. Prospective evaluation is needed to determine whether such an intervention alters in-hospital outcomes. Levels of Evidence: Level III.

Background: Spinal tumors are neoplasms occurring in or around the spinal cord and can be classified based on tissue type and location within the spine. These lesions can lead to spinal cord compression and neurologic deficit. Low- and middle-income countries (LMICs) often face a significant burden of disease due to limited access to healthcare and advanced treatments. We investigate surgical and adjunctive therapies for spinal column tumors in LMICs. Methods: A systematic search was completed to identify articles related to spinal tumors in LMICs. Data were extracted for study parameters and patient outcomes. Country-specific variables were collected for each country. A pooled meta-analysis was completed with this data. Results: Of 99 included articles, 67 provided data on gross total resection (GTR), while 39 articles reported use of adjunctive therapies. Since 1990, there has been an increase in the use of both treatments in LMICs; however, there were significant correlations between the use of adjunctive therapy, life expectancy, and access to healthcare. Conclusion: While treatment and outcomes of spinal column tumors vary within the United States based on socioeconomic factors, including income and gender, this has not been studied on a global scale and in relation to accessibility of specific treatments in LMICs. In this study, we found that specific diagnoses and country income levels were significant drivers of GTR or adjunctive therapy rates. The poor accessibility of these treatments may be overcome with targeted investment, and this should be explored in future research.

The proliferation of digital platforms has transformed how knowledge is created, shared, and evaluated in academic medicine. Although Boyer’s framework of scholarship has long guided academic recognition, digital scholarship challenges traditional paradigms centered on print publications and conferences. This commentary argues that digital scholarship satisfies Boyer’s framework and should be recognized in promotion and tenure. Digital-first creation, interactivity, and flexibility enable engagement, collaboration, and dissemination, yet institutional recognition remains limited. We propose a framework to evaluate quality, reach, and impact using traditional and alternative metrics, including peer review and engagement analytics, while addressing challenges of literacy, ethics, and intellectual property.

Background: Minimally invasive spine surgery (MISS) has become increasingly common, but there are barriers to its adoption in acute trauma. To investigate these barriers, clinical data on preoperative factors and outcomes were compared between patients undergoing percutaneous and open spinal trauma procedures. Methods: In this retrospective cohort study of the National Trauma Data Bank, we analyzed trauma patients nationwide who underwent spine procedures from 2017 to 2023. Using International Classification of Diseases, Tenth Revision codes, index procedures classified as “open”, “percutaneous/MISS”, or “converted.” Comorbidities, demographic data, and adverse events were analyzed and compared between groups. Results: Of the 187,382 patients included, 13.2% underwent MISS. Open surgery correlated with males, older patients, and major comorbidities, including diabetes mellitus, congestive heart failure, and chronic obstructive pulmonary disease. MISS correlated with smoking and greater injury severity. Except for surgical site infections, all adverse events were more prevalent following open procedures. Conclusion: From 2017 to 2023, traumatic spinal surgery increased significantly, and the percentage approached percutaneously procedures increased from 11.7% to 15.2%, while adverse events were more common after open surgery.