Category: Statistics

BMC Med Educ. 2025 Oct 2;25(1):1321. doi: 10.1186/s12909-025-07922-0.

ABSTRACT

BACKGROUND: Embryology is often a challenging subject for medical students, leading to decreased engagement and learning difficulties. Gamification has gained attention as an innovative teaching method to enhance motivation and improve educational outcomes. This study examined the impact of gamified embryology education on medical students’ reactions, learning achievements, and behaviors.

METHODS: A quasi-experimental study was conducted with 281 medical students at Jahrom University of Medical Sciences, Iran, from 2020 to 2022. Students in 2020-2021 received conventional instruction through online lectures and electronic content, while those in 2021-2022 were taught using the same routine methods supplemented by a gamification-based platform. Data collection tools included the 18-item Game User Experience Satisfaction Scale (GUESS), the 21-item Technology Acceptance Model (TAM) questionnaire, and a researcher-designed Quality of Online Learning Questionnaire (Q-OLQ). Final exam scores in embryology were compared between the groups. Statistical analysis was performed using SPSS version 21, employing descriptive statistics and Independent Samples t-tests to assess differences in academic performance.

RESULTS: All questionnaire components scored above the threshold, indicating positive responses. The highest satisfaction scores were found in Enjoyment (3.98 ± 1.02) and Visual Aesthetics (3.92 ± 1.04). For technology acceptance, Perceived Usefulness (4.06 ± 0.88), Concentration (3.96 ± 0.83), and Attitude towards Using (3.95 ± 0.90) were rated highly. Regarding online learning quality, Quality of Online Resources (3.95 ± 0.97) and Perceived Importance of Online Resources (3.90 ± 0.99) received the top scores. Importantly, students who experienced gamification alongside routine teaching scored significantly higher on final exams (p < 0.001).

CONCLUSIONS: The findings indicate that gamification effectively enhances student engagement and learning outcomes in medical education, suggesting its valuable role as a complementary teaching strategy.

PMID:41039562 | DOI:10.1186/s12909-025-07922-0

BMC Med Educ. 2025 Oct 2;25(1):1308. doi: 10.1186/s12909-025-07896-z.

ABSTRACT

BACKGROUND: Large Language Models (LLMs) are artificial intelligence (AI) systems that simulate human language processing through deep learning techniques and neural networks. They are increasingly utilized for clinical decision support, student training, and enhancing educational processes. However, the reliability of AI models, especially in answering various types of questions, remains a point of debate. Standard multiple-choice questions (MCQs) involve selecting one correct answer from five options, whereas combination-type MCQs (C-MCQs) identify all correct statements among several alternatives. This study aims to evaluate and compare the performance of various LLMs in answering MCQs and C-MCQs in endodontics.

METHODS: A total of 151 endodontic questions were identified through a comprehensive review of publicly available Dentistry Specialty Exams in Turkey conducted since 2012. The questions were presented to eight LLMs (ChatGPT-4o, ChatGPT-4, Gemini 1.5 Flash, Gemini 1.5 Pro, Gemini 2.0 Flash, Copilot, Deepseek-V3, and Qwen2.5-Max) in Turkish. Accuracy rates for both MCQs and C-MCQs were statistically analyzed using SPSS v23 (p < 0.05).

RESULTS: ChatGPT-4o achieved the highest overall accuracy rate (81.5%), while Gemini 1.5 Flash had the lowest (57%). In standard MCQs, ChatGPT-4o significantly outperformed the other models (p < 0.001), but in C-MCQs, no significant difference was observed between the models (p = 0.179). Across all models, accuracy rates for C-MCQs were significantly lower than for MCQs (p < 0.05). Deepseek-V3 maintained a more balanced performance across question types than the other models.

CONCLUSIONS: LLMs show promising potential as educational tools in endodontics. However, their accuracy varies by question type and model. They can support student learning and clinical decision-making but cannot yet be considered a fully reliable standalone source in endodontics.

PMID:41039560 | DOI:10.1186/s12909-025-07896-z

BMC Med Educ. 2025 Oct 2;25(1):1344. doi: 10.1186/s12909-025-07980-4.

ABSTRACT

BACKGROUND: Vital signs measurement is a fundamental nursing responsibility that requires cognitive and psychomotor competence. In alignment with the ethical principle of nonmaleficence, it is important to provide learning environments where students can practice and make mistakes without causing harm. This study aims to examine the effect of a 3D game-based simulation application developed for vital signs on students’ academic achievement, learning satisfaction and self-confidence levels.

METHODS: A randomized controlled experimental design was employed with 73 nursing students, assigned to either the intervention group (n = 37) or the control group (n = 36). The intervention group used a game-based simulation developed with 3D animation technology, while the control group received traditional instruction. Data were collected using the Student Introductory Characteristics Form, Academic Achievement Test of Vital Signs Measurement Skills, and the Student Satisfaction and Self-Confidence in Learning Scale. Statistical analyses were conducted using SPSS version 25, with significance set at p < 0.05.

RESULTS: The results indicated that students’ current learning satisfaction subscale scores were high in the traditional teaching group and that there was a statistically significant difference between the groups (p = 0.047). There was no statistically significant difference between the groups in terms of academic achievement (p = 0.932) and self-confidence levels in learning (p = 0.375). However, both groups had high mean scores in academic achievement, satisfaction with current learning, and self-confidence in learning.

CONCLUSIONS: The game simulation method supported by 3D animation may be insufficient for significantly improving nursing students’ academic performance, satisfaction with the learning process, and self-confidence in learning. Therefore, it is recommended that such technology-supported methods be used in blended learning environments alongside traditional teaching methods in nursing education.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT07009275; retrospectively registered.

PMID:41039559 | DOI:10.1186/s12909-025-07980-4

Scand J Trauma Resusc Emerg Med. 2025 Oct 2;33(1):159. doi: 10.1186/s13049-025-01475-3.

ABSTRACT

BACKGROUND: Large Language Models (LLMs), such as GPT-4o, are increasingly investigated for clinical decision support in emergency medicine. However, their real-world performance in disposition prediction remains insufficiently studied. This study evaluated the diagnostic accuracy of GPT-4o in predicting ED disposition-discharge, ward admission, or ICU admission-in complex emergency respiratory cases requiring pulmonology consultation and chest CT, representing a selective high-acuity subgroup of ED patients.

METHODS: We conducted a retrospective observational study in a tertiary ED between November 2024 and February 2025. We retrospectively included ED patients with complex respiratory presentations who underwent pulmonology consultation and chest CT, representing a selective high-acuity subgroup rather than the general ED respiratory population. GPT-4o was prompted to predict the most appropriate ED disposition using three progressively enriched input models: Model 1 (age, sex, oxygen saturation, home oxygen therapy, and venous blood gas parameters); Model 2 (Model 1 plus laboratory data); and Model 3 (Model 2 plus chest CT findings). Model performance was assessed using accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score.

RESULTS: Among the 221 patients included, 69.2% were admitted to the ward, 9.0% to the intensive care unit (ICU), and 21.7% were discharged. For hospital admission prediction, Model 3 demonstrated the highest sensitivity (91.9%) and overall accuracy (76.5%), but the lowest specificity (20.8%). In contrast, for discharge prediction, Model 3 achieved the highest specificity (91.9%) but the lowest sensitivity (20.8%). Numerical improvements were observed across models, but none reached statistical significance (all p > 0.22). Model 1 therefore performed comparably to Models 2-3 while being less complex. Among patients who were discharged despite GPT-4o predicting admission, the 14-day ED re-presentation rates were 23.8% (5/21) for Model 1, 30.0% (9/30) for Model 2, and 28.9% (11/38) for Model 3.

CONCLUSION: GPT-4o demonstrated high sensitivity in identifying ED patients requiring hospital admission, particularly those needing intensive care, when provided with progressively enriched clinical input. However, its low sensitivity for discharge prediction resulted in frequent overtriage, limiting its utility for autonomous decision-making. This proof-of-concept study demonstrates GPT-4o’s capacity to stratify disposition decisions in complex respiratory cases under varying levels of limited input data. However, these findings should be interpreted in light of key limitations, including the selective high-acuity cohort and the absence of vital signs, and require prospective validation before clinical implementation.

PMID:41039558 | DOI:10.1186/s13049-025-01475-3

BMC Med Educ. 2025 Oct 2;25(1):1303. doi: 10.1186/s12909-025-07899-w.

ABSTRACT

BACKGROUND: Ultrasound-guided vascular access (USGVA) is an essential clinical skill, but novice learners often face difficulties in interpreting ultrasound images and achieving spatial alignment during procedures. To address this challenge, we hypothesized that using a reversed screen orientation could facilitate the learning process. Reversed screen orientation refers to an ultrasound image flipped in the transverse plane, producing a top-to-bottom mirror image by activating the “reverse” function on the ultrasound (US) device. We assumed that this configuration might help align the visual trajectory of the needle with the user’s hand movements, potentially easing spatial perception during the early stages of learning.

METODS: The study was conducted in the Anatomy Laboratory of Ordu University Medical Faculty with 60 final-year medical students with no prior US experience. Participants were randomly divided into two groups (A and B), who performed femoral vein needle punctures on cadavers under US guidance with standard (Group A) and reverse (Group B) screen. Each group used both screen orientations across two attempts. Before the procedure, students received theoretical training. Data collected included demographic information, needle visibility, procedure duration, success rates, and complications. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS), and significance was set at p < 0.05.

RESULTS: The results showed no significant differences in age or sex distribution between groups. In the first attempt, 83.3% of participants with posterior wall penetration were in Group A (standard screen orientation). Needle visualibity score was higher in Group B (reversed screen orientation). The perceived ease of the procedure showed a significant difference in favor of Group B in the second attempt. Overall, while the success rates and time taken were similar between groups, Group B exhibited improved needle visualization and fewer complications related to posterior wall penetration.

DISCUSSION: The findings indicate that reversed screen orientation may facilitate learning and enhance procedural outcomes in USGVA. This orientation aligns better with the spatial perception of needle movement, potentially improving hand-eye coordination. The study supports the integration of reversed screen techniques in US training to improve skill acquisition and reduce complication rates in vascular access procedures. However, limitations include the study being conducted at a single center and using only one cadaver, which may affect the generalizability of results. Future research should explore long-term effects and further validate these findings in diverse clinical settings.

PMID:41039551 | DOI:10.1186/s12909-025-07899-w

BMC Med Educ. 2025 Oct 2;25(1):1302. doi: 10.1186/s12909-025-07895-0.

ABSTRACT

BACKGROUND: In today’s rapidly changing world, soft skills are essential in both academic and professional settings, as they facilitate effective interaction, clear communication, and adaptation to diverse labour markets. This study aimed to determine the relationship between the self-esteem and assertiveness of undergraduate students and the communication perceived by patients seen in the dental clinic of a Peruvian university.

METHODS: A cross-sectional study was conducted with a sample of 198 students and 198 patients. The validated questionnaires, “Rosenberg Self-Esteem Scale” and the “Rathus Assertiveness Schedule”, were used for the students. Further, the CAT Questionnaire, Communication Assessment Tool, was used for patients. Sociodemographic characteristics were recorded for both groups. Descriptive statistics were used to describe the scores of assertiveness, self-esteem, and communication variables. For inferential analysis, the relationships among self-esteem, assertiveness, and communication were assessed via Spearman’s Rho test. Comparisons with sociodemographic variables were performed via the Mann-Whitney U, Kruskal-Wallis, and Pearson chi-square tests. Poisson regression models with robust variance were applied.

RESULTS: Self-esteem, assertiveness, and communication had means ± standard deviations of 30.53 ± 5.74, -2.43 ± 22.12, and 63.69 ± 7.28, respectively. A significant relationship was found between self-esteem and assertiveness (p < 0.001, Rho = 0.598), but no significant relationships were observed for self-esteem and assertiveness with communication (p > 0.05).

CONCLUSIONS: No relationship was observed between the self-esteem and assertiveness of undergraduate students and the communication perceived by patients.

PMID:41039549 | DOI:10.1186/s12909-025-07895-0

BMC Med. 2025 Oct 2;23(1):532. doi: 10.1186/s12916-025-04311-8.

ABSTRACT

BACKGROUND: MicroRNAs (miRNAs) are short, single-stranded RNAs that function as post-transcriptional regulators of gene expression. Although circulating miRNAs have been linked to carcinogenesis, they have not yet been systematically investigated in relation to risk of colorectal cancer (CRC).

METHODS: We used Mendelian randomization (MR) and colocalization analyses to investigate the association of genetically predicted plasma miRNA concentrations (2083 miRNAs in 710 individuals) with risk of CRC (58,221 cases and 67,694 controls). For miRNAs associated with CRC risk, we also investigated their association with circulating plasma proteins (4907 proteins in 35,559 participants), bidirectionally, using MR. We performed pathway enrichment analysis (PEA) to explore downstream molecular pathways.

RESULTS: Associations of five miRNAs with CRC were found in MR and supported in colocalization analyses. Specifically, miR-146a-5p, miR-21-5p, and miR-4707-3p were positively, and miR-1908-5p and miR-6810-3p were inversely associated with CRC risk. Several protein associations were found for these miRNAs (range of proteins with P < 0.05: 78-796; 211 with FDR < 5%), and 11 pathways were identified in PEA, including regulation of Erb-B2 receptor tyrosine kinase 4 (miR-6810-3p) and insulin-like growth factor pathways (miR-1908-5p).

CONCLUSIONS: Our results support a potential implication of miR-146a-5p, miR-21-5p, miR-4707-3p, miR-1908-5p, and miR-6810-3p to CRC risk. However, their downstream effects should be elucidated before they can be utilized as preventive targets.

PMID:41039543 | DOI:10.1186/s12916-025-04311-8

BMC Vet Res. 2025 Oct 2;21(1):558. doi: 10.1186/s12917-025-05011-4.

ABSTRACT

BACKGROUND: Riding clubs face significant financial losses due to upper respiratory infections caused by Beta-hemolytic (β-hemolytic) streptococci, leading to strangles and related diseases that negatively impact the health and performance of horses. Our objective was to determine the relationship between these inflammatory cells, the presence of β-hemolytic streptococcal species, and the clinical symptoms exhibited by the horses. This study investigated the presence of β-hemolytic streptococcus in 133 tracheal lavage samples from horses exhibiting various clinical respiratory symptoms and quantified the populations of neutrophils, eosinophils, macrophages, lymphocytes, and mast cells. The horses included in this study exhibited a variety of clinical respiratory symptoms categorized into groups: (I) Horses with no apperent symptoms (Control Group), (II) Horses with only coughing, (III) Horses with only lymph node swelling, (IV) Horses with coughing and lymph node swelling, (V) Horses with all symptoms (coughing, lymph node swelling and nasal discharge). After obtaining the bacterial cultures from tracheal wash samples, additional diagnostic tests were performed to identify the suspected colonies. The cytological analysis determined the proportions of inflammatory cells, while the statistical analysis assessed the significance of differences in inflammatory cell populations and pathogen presence across the different symptom groups.

RESULTS: Among 133 horses categorized into five clinical groups, S. zooepidemicus was isolated in 18% overall, with the highest isolation rate in horses exhibiting both coughing and lymph node swelling (36%). Statistical analysis showed a significant difference in S. zooepidemicus prevalence between groups (p = 0.019), with post hoc tests confirming significance between asymptomatic horses and those with combined symptoms. Neutrophil proportions differed significantly among groups (p = 0.010), with the highest counts in symptomatic horses with both coughing and lymph node swelling. Furthermore, bacteriologically positive samples exhibited significantly higher neutrophil counts (median 83.5, IQR 76) than negatives (median 22, IQR 46, p < 0.001), suggesting an acute inflammatory response linked to infection. In contrast, macrophage, lymphocyte, and eosinophil counts showed no significant variation among groups or infection status.

CONCLUSIONS: Horses with coughing and lymph node swelling showed the highest prevalence of β-hemolytic streptococci. S. zooepidemicus infection was associated with increased neutrophils and decreased macrophages and lymphocytes, highlighting the role of neutrophils in inflammation. Asymptomatic horses may also carry the bacteria, indicating their role as carriers. Distinct inflammatory profiles correspond to clinical signs, underscoring the complexity of equine respiratory disease and the value of cytology and tracheal wash in diagnosis.

PMID:41039541 | DOI:10.1186/s12917-025-05011-4

BMC Med Educ. 2025 Oct 2;25(1):1315. doi: 10.1186/s12909-025-07887-0.

ABSTRACT

BACKGROUND: Evidence-based medicine (EBM) is an essential component of medical practice, combining the best available scientific evidence with clinical expertise to support high-quality patient care. There is limited information on how EBM is integrated into postgraduate medical education programs. This study investigates differences in EBM training between university and non-university hospitals and across specialties in Switzerland and Austria.

METHODS: Data were collected through annual nationwide surveys evaluating the quality in postgraduate medical education in Switzerland and Austria. A total of 13,659 residents (Switzerland: 9,683; Austria: 3,976) responded to a paper-based questionnaire, resulting in response rates of 71% for Switzerland and 44% for Austria. The questionnaire contains a five-item EBM-scale measuring different aspects of EBM training on a 6-point Likert scale. Residents also answered questions related to scientific publishing. Comparisons were made between university hospitals and other institutions within and between both countries, as well as across specialties within hospital types and countries. Descriptive statistics were reported, and differences were analyzed using the Mann-Whitney U and Chi-square test.

RESULTS: In both countries, residents at university hospitals gave overall significantly higher ratings on the EBM-scale than those at non-university hospitals, with more pronounced differences observed in Austria. Moreover, residents in university hospitals reported higher engagement in scientific activities. Specialty comparisons revealed that internal medicine received the highest EBM ratings among university hospitals. In both countries, there were no significant differences between the two specialities anaesthesia and pediatrics across university and non-university hospitals.

CONCLUSIONS: Data from residents of two countries indicate potential to improve EBM training in postgraduate medical education in non-university hospitals, and reveal differences across specialities, suggesting the need for further research to identify the factors underlying these differences across hospital types and clinical contexts.

PMID:41039536 | DOI:10.1186/s12909-025-07887-0

BMC Med Educ. 2025 Oct 2;25(1):1337. doi: 10.1186/s12909-025-07942-w.

ABSTRACT

BACKGROUND: Medical education is inherently demanding, often compromising students’ well-being, especially in conflict-affected regions. This study aims to 1) evaluate the burnout levels among medical students using the Maslach Burnout Inventory General Survey for Students (MBI-GSS), 2) assess quality of life (QoL) using the World Health Organization QoL scale (WHOQOL-BREF), and 3) identify predictors of burnout and QoL.

METHODS: A cross-sectional online survey was conducted in English between May and June 2024. The questionnaire included sociodemographic data, MBI-GSS subscales (emotional exhaustion, cynicism, and professional efficacy respectively), and WHOQOL-BREF domains (physical, psychological, social, and environmental respectively). Bivariate and multivariable analyses were performed with the subscales and domains as dependent variables. An alpha of 0.05 was considered statistically significant.

RESULTS: A total of 200 medical students participated in this study, yielding a 78% response rate. Participants reported relatively high levels of emotional exhaustion (Mean ± SD = 21.2 ± 8.1) and low levels of professional efficacy (22.6 ± 7.8). Lower exhaustion scores were observed among last-year medical students (adjusted (a)ß (95% CI) = -13.1 (-19.5; -6.8)) and those who reported exercising daily (-9.7 (-14.8; -4.5)). Higher cynicism scores were found among students experiencing financial problems (2.6 (0.2; 5)). Moreover, lower professional efficacy scores were observed among students reporting academic difficulties (-3.1 (-5.7; -0.4)) or social isolation (-3.1 (-5.9; -0.2)). Students reported the highest satisfaction in the environmental QoL domain (Mean ± SD = 64 ± 18). Social isolation and symptoms of anxiety and/or depression were significantly associated with poorer QoL across multiple domains.

CONCLUSION: Burnout and reduced quality of life emerged as relevant concerns among medical students. Addressing these issues requires targeted institutional support and national investment in student mental health infrastructure, particularly in conflict-affected and economically strained regions.

PMID:41039528 | DOI:10.1186/s12909-025-07942-w