Several principles have been proposed to improve use of artificial intelligence (AI) in healthcare, but the need for AI to improve longstanding healthcare challenges has not been sufficiently emphasized. We propose that AI should be designed to alleviate health disparities, report clinically meaningful outcomes, reduce overdiagnosis and overtreatment, have high healthcare value, consider biographical drivers of health, be easily tailored to the local population, promote a learning healthcare system, and facilitate shared decision-making. These principles are illustrated by examples from breast cancer research and we provide questions that can be used by AI developers when applying each principle to their work.

Biology is suffused with rhythmic behaviour, and interacting biological oscillators often synchronize their rhythms with one another. Colonies of some ant species are able to synchronize their activity to fall into coherent bursts, but models of this phenomenon have neglected the potential effects of intrinsic noise and interspecific differences in individual-level behaviour. We investigated the individual and collective activity patterns of two Leptothorax ant species. We show that in one species (Leptothorax sp. W), ants converge onto rhythmic cycles of synchronized collective activity with a period of about 20 min. A second species (Leptothorax crassipilis) exhibits more complex collective dynamics, where dominant collective cycle periods range from 16 min to 2.8 h. Recordings that last 35 h reveal that, in both species, the same colony can exhibit multiple oscillation frequencies. We observe that workers of both species can be stimulated by nest-mates to become active after a refractory resting period, but the durations of refractory periods differ between the species and can be highly variable. We model the emergence of synchronized rhythms using an agent-based model informed by our empirical data. This simple model successfully generates synchronized group oscillations despite the addition of noise to ants' refractory periods. We also find that adding noise reduces the likelihood that the model will spontaneously switch between distinct collective cycle frequencies.

Background

The COVID-19 pandemic disrupted the United States (US) medical education system with the necessary, yet unprecedented Association of American Medical Colleges (AAMC) national recommendation to pause all student clinical rotations with in-person patient care. This study is a quantitative analysis investigating the educational and psychological effects of the pandemic on US medical students and their reactions to the AAMC recommendation in order to inform medical education policy.

Methods

The authors sent a cross-sectional survey via email to medical students in their clinical training years at six medical schools during the initial peak phase of the COVID-19 pandemic. Survey questions aimed to evaluate students' perceptions of COVID-19's impact on medical education; ethical obligations during a pandemic; infection risk; anxiety and burnout; willingness and needed preparations to return to clinical rotations.

Results

Seven hundred forty-one (29.5%) students responded. Nearly all students (93.7%) were not involved in clinical rotations with in-person patient contact at the time the study was conducted. Reactions to being removed were mixed, with 75.8% feeling this was appropriate, 34.7% guilty, 33.5% disappointed, and 27.0% relieved. Most students (74.7%) agreed the pandemic had significantly disrupted their medical education, and believed they should continue with normal clinical rotations during this pandemic (61.3%). When asked if they would accept the risk of infection with COVID-19 if they returned to the clinical setting, 83.4% agreed. Students reported the pandemic had moderate effects on their stress and anxiety levels with 84.1% of respondents feeling at least somewhat anxious. Adequate personal protective equipment (PPE) (53.5%) was the most important factor to feel safe returning to clinical rotations, followed by adequate testing for infection (19.3%) and antibody testing (16.2%).

Conclusions

The COVID-19 pandemic disrupted the education of US medical students in their clinical training years. The majority of students wanted to return to clinical rotations and were willing to accept the risk of COVID-19 infection. Students were most concerned with having enough PPE if allowed to return to clinical activities.

Purpose

To assess psychological effects of the initial peak phase of the COVID-19 pandemic on United States (US) medical students in clinical training to anticipate sequelae and prepare for future outbreaks.

Methods

Authors emailed a cross-sectional survey in April-May, 2020 to students in clinical training years at six US medical schools which included validated General Anxiety Disorder (GAD-7) and Primary Care-PTSD (PC-PTSD-5) screening tools, and asked students about pandemic-related stress and specific concerns. Authors used quantitative and thematic analysis to present results.

Results

Of 2511 eligible students, 741 responded (29.5%). Most students (84.1%) reported at least "somewhat" increased levels of stress and anxiety related to the pandemic. On the GAD-7, 34.3% showed mild, 16.1% moderate, and 9.5% severe anxiety symptoms, with 39.6% demonstrating no/minimal symptoms. One quarter (25.4%) screened positive for PTSD risk symptoms. Top concerns of students chosen from a pre-populated list included inadequate COVID-19 testing, undiagnosed or asymptomatic spread and racial or other disparities in the pandemic. In thematic analysis, students' reactions to removal from clinical learning included: understanding the need to conserve PPE (32.2%), a desire to help (27.7%), worry over infectious risk to others (25.4%) and self (21.2%), and lost learning opportunities (22.5%). Female students were significantly more likely to report anxiety and PTSD risk symptoms. Asian students had a greater risk of moderate anxiety and those underrepresented in medicine (UIM) had greater risk of moderate and severe anxiety symptoms compared to white students.

Conclusions

During the initial peak phase of COVID-19, over 60% of US medical students screened positive for pandemic-related anxiety and one quarter were at risk for PTSD. Female and UIM students were significantly more affected. Medical schools should consider broad support of students, and targeted outreach to female and UIM students.