It’s Not Just Size That Matters: Small Language Models Are Also Few-Shot Learners

When scaled to hundreds of billions of parameters, pretrained language models such as GPT-3 (Brown et al., 2020) achieve remarkable few-shot performance. However, enormous amounts of compute are required for training and applying such big models, resulting in a large carbon footprint and making it difficult for researchers and practitioners to use them. We show that performance similar to GPT-3 can be obtained with language models that are much “greener” in that their parameter count is several orders of magnitude smaller. This is achieved by converting textual inputs into cloze questions that contain a task description, combined with gradient-based optimization; exploiting unlabeled data gives further improvements. We identify key factors required for successful natural language understanding with small language models

Senior medical student attitudes towards patient communication and their development across the clinical elective year – A Q-methodology study

To be proficient in communicating with patients, physicians need specified knowledge, skills and attitudes. Until now, medical educators have mostly focused on undergraduate students’ communication knowledge and skills in training and assessment. Attitudes towards communication with patients have been researched less frequently, but it is plausible that they also influence physicians’ behaviours in many ways. The present study investigates the communication-focused attitudes of senior medical students and their development through the clinical elective year using an innovative approach based on Q-methodology. We conducted a Q-methodology study using statements from the Kalamazoo Communication Skills Assessment Form. A total of 47 final-year medical students documented their attitudes towards communication by sorting these statements in regard to their importance into a normal distribution grid in medical interviews. Our innovative approach included three time points during the elective year at which these statements were sorted, with only a slight decrease of participants. We applied a Q-factor analysis and found three attitude profiles that were structurally stable over time. Attitude profile #1 focused on providing information and fostering shared decision making; profile #2 focused on the patients’ concerns and emotions while meeting the patients’ demands for sufficient information. Finally, the focus of attitude profile #3 was on using appropriate conversation techniques to structure communication and gather sufficient information. Overall, the respondents assigned increasing importance to building good relationships and making shared decisions with patients over time. Statements about structuring conversations and communication techniques were evaluated as less important by the end of the clinical elective year

The Aging Enteric Nervous System

The gut and the brain communicate via the nervous system, hormones, microbiota-mediated substances, and the immune system. These intricate interactions have led to the term 'gut-brain axis'. Unlike the brain-which is somewhat protected-the gut is exposed to a variety of factors throughout life and, consequently, might be either more vulnerable or better adapted to respond to these challenges. Alterations in gut function are common in the elder population and associated with many human pathologies, including neurodegenerative diseases. Different studies suggest that changes in the nervous system of the gut, the enteric nervous system (ENS), during aging may result in gastrointestinal dysfunction and initiate human pathologies of the brain via its interconnection with the gut. This review aims at summarizing the contribution of normal cellular aging to the age-associated physiological changes of the ENS. Morphological alterations and degeneration of the aging ENS are observed in different animal models and humans, albeit with considerable variability. The aging phenotypes and pathophysiological mechanisms of the aging ENS have highlighted the involvement of enteric neurons in age-related diseases of the central nervous system such as Alzheimer's or Parkinson's disease. To further elucidate such mechanisms, the ENS constitutes a promising source of material for diagnosis and therapeutic predictions, as it is more accessible than the brain

Implementing a logbook on entrustable professional activities in the final year of undergraduate medical education in Germany – a multicentric pilot study

Objectives: The final year of undergraduate medical education (practical year) should foster the transition from undergraduate medical education to graduate medical education. Medical students in the practical year should be able to assume professional tasks, and supervisors should assign these tasks to them. In this pilot study, a curriculum based on the concept of entrustable professional activities (EPAs) was implemented and evaluated in the disciplines of internal medicine, surgery and general practice at four university hospitals.Methods: n =37 medical students and n =17 supervising physicians at four German university hospitals participated in the implementation study for one trimester. For evaluation purposes, we conducted focus group discussions and telephone interviews and analyzed them following qualitative content analysis.Results: We identified five different aspects as important for implementing the EPA curriculum in undergraduate medical education in the German context: Implementation process of the EPA curriculum and required resources, Entrustment process, Feedback sessions with supervisors, Students' and supervisors' role perception Overall impact of EPAs on training conditions in the practical year. Conclusion: The study presents a practical implementation of the EPA curriculum in Germany's undergraduate medical education. Besides the need for time and resources, the concept shows good feasibility and fosters a competence-oriented undergraduate medical education in the practical year.Hintergrund: Das letzte Jahr der medizinischen Ausbildung (Praktisches Jahr) soll den Übergang zwischen dem Medizinstudium und der ärztlichen Weiterbildung fördern. Medizinstudierende im Praktischen Jahr sollten befähigt werden, professionelle Aufgaben zu übernehmen. Diese sollten ihnen von Supervisor/innen auch übertragen werden. In dieser Pilotstudie wird ein Curriculum-basiertes Konzept zu anvertraubaren professionellen Tätigkeiten (APT) eingeführt und an vier Universitätskliniken für die Fachbereiche Innere Medizin, Chirurgie und Allgemeinmedizin evaluiert.Methode: N =37 Medizinstudierende und N =17 supervidierende Ärzt/Ärztinnen an vier deutschen Universitätskliniken nahmen an der Implementierungsstudie für ein Tertial teil. Zur Evaluationszwecken führten wir Fokusgruppen und Telefoninterviews durch und analysierten dessen Transkripte nach einem qualitativ inhaltsanalytischen Ansatz.Ergebnisse: Wir konnten fünf Aspekte identifizieren, die sich als wichtig für die Implementierung eines APT-Curriculums im Medizinstudium im deutschsprachigen Kontext herausgestellt haben: Der Implementationsprozess des APT-Curriculums und die dafür benötigten Ressourcen, Prozess des Anvertrauens, Feedbackgespräche mit Supervisor/innen, Rollenwahrnehmung der Medizinstudierenden und der Supervisor/innen, Gesamteinfluss der APTs auf die Trainingsbedingungen im Praktischen Jahr. Schlussfolgerung: Die Studie zeigt eine praktische Implementierung des APT-Curriculums im deutschsprachigen Medizinstudium. Neben dem Bedarf an Zeit und Ressourcen, zeigt das Konzept gute Durchführbarkeit und fördert eine kompetenzorientierte medizinische Ausbildung im Praktischen Jahr

Measuring informal workplace learning outcomes in residency training: a validation study

Abstract Background Informal workplace learning (WPL) has no concrete learning objective and takes place without a responsible supervisor, which makes it difficult to assess its learning outcomes. Formal learning situations, as they are known from universities or schools, do not exist in this context and make a conventional assessment of learning goals and achievements impossible. Informal learning in the workplace is of central importance, and the assessment of informal learning outcomes in medical education is an under-researched area. The aim of our study was to adapt and validate an informal WPL questionnaire (originally developed for social workers) to assess learning outcomes due to informal WPL in residency training. Methods A total of 528 residents (n = 339 female; age: M = 29.79; SD = 3.37 years) completed an adapted questionnaire on informal WPL outcomes and the Freiburg Questionnaire to Assess Competencies in Medicine (i.e. medical knowledge, communication, and scholarship). Exploratory factor analysis was used to determine the underlying factor structure. The reliability of the factors was tested using McDonald’s omega, and the correlation between the factors and the three subscales of the Freiburg questionnaire was tested using Spearman’s rho correlation coefficient. To investigate construct validity, a structural equation model was calculated to examine the relationships between medical competencies and informal learning outcomes. Results The exploratory factor analysis yielded a four-factor solution that best fit the data. The scores of all four factors (GLO-CD: generic learning outcomes—competence development, GLO-R: generic learning outcomes—reflection, JSLO: job-specific learning outcomes, and OLLO: organisational learning outcomes) showed good internal consistency (Ω ≥ .69). The structural equation model showed that "medical expertise" had an impact on all four factors of informal learning at work. “Scholarship” seemed to predict GLO-CD and GLO-R. Conclusions Our four-factor model reveals meaningful determinants of informal WPL in relation to residency training. The instrument is therefore the first promising attempt to assess informal WPL in the broader context of medical education during residency, thus supporting its construct validity

Competencies for first year residents – physicians’ views from medical schools with different undergraduate curricula

Abstract Background Frameworks like the CanMEDS model depicting professional roles and specific professional activities provide guidelines for postgraduate education. When medical graduates start their residency, they should possess certain competencies related to communication, management and professionalism while other competencies will be refined during postgraduate training. Our study aimed to evaluate the relevance of different competencies for a first year resident required for entrustment decision from the perspective of physicians from medical faculties with different undergraduate medical curricula. Methods Nine hundred fifty-two surgeons and internists from three medical schools with different undergraduate medical curricula were invited to rank 25 competencies according to their relevance for first year residents. The rankings were compared between universities, specialties, physicians’ positions, and gender. Results Two hundred two physicians participated, 76 from Hamburg University, 44 from Oldenburg University, and 82 from Technical University Munich. No significant differences were found regarding the top 10 competencies relevant for first year residents between the universities. ‘Responsibility’ was the competency with the highest rank overall. Internists ranked ‘Structure, work planning and priorities’ higher while surgeons ranked ‘Verbal communication with colleagues and supervisors’ higher. Consultants evaluated ‘Active listening to patients’ more important than department directors and residents. Female physicians ranked ‘Verbal communication with colleagues and supervisors’ and ‘Structure, work planning and priorities’ significantly higher while male physicians ranked ‘Scientifically and empirically grounded method of working’ significantly higher. Conclusions Physicians from universities with different undergraduate curricula principally agreed on the competencies relevant for first year residents. Some differences between physicians from different positions, specialties, and gender were found. These differences should be taken into account when planning competence-based postgraduate education training programs

Validation of a competence-based assessment of medical students performance in the physicians role

Assessing competence of advanced undergraduate medical students based on performance in the clinical context is the ultimate, yet challenging goal for medical educators to provide constructive alignment between undergraduate medical training and professional work of physicians. To assess different facets of competence expressed in performance, we designed a 360-degree assessment for undergraduate medical students, which simulates a first day of residency in three phases: a consultation hour, a patient management phase, and a patient handover. Different rater groups assessed the participants with four main instruments, which are based on ten facets of competence needed by beginning residents