James Tomlinson’s research while affiliated with The University of Sheffield and other places

Aims The use of artificial intelligence (AI) in spinal surgery is expanding, yet its ability to match the diagnostic and treatment planning accuracy of human surgeons remains unclear. This study aims to compare the performance of AI models—ChatGPT-3.5, ChatGPT-4, and Google Bard—with that of experienced spinal surgeons in controversial spinal scenarios. Methods A questionnaire comprising 54 questions was presented to ten spinal surgeons on two occasions, four weeks apart, to assess consistency. The same questionnaire was also presented to ChatGPT-3.5, ChatGPT-4, and Google Bard, each generating five responses per question. Responses were analyzed for consistency and agreement with human surgeons using Kappa values. Thematic analysis of AI responses identified common themes and evaluated the depth and accuracy of AI recommendations. Results Test-retest reliability among surgeons showed Kappa values from 0.535 to 1.00, indicating moderate to perfect reliability. Inter-rater agreement between surgeons and AI models was generally low, with nonsignificant p-values. Fair agreements were observed between surgeons’ second occasion responses and ChatGPT-3.5 (Kappa = 0.24) and ChatGPT-4 (Kappa = 0.27). AI responses were detailed and structured, while surgeons provided more concise answers. Conclusions AI large language models are not yet suitable for complex spinal surgery decisions but hold potential for preliminary information gathering and emergency triage. Legal, ethical, and accuracy issues must be addressed before AI can be reliably integrated into clinical practice.

Aim Can Large Language Models (LLMs) provide the answers to common controversial spinal surgery scenarios and answer the dilemmas that we can’t? Method 54 highly detailed questions were developed on 18 scenarios, for example, ‘Management of Painless Foot Drop’. 9 Consultant Spinal Surgeons answered the questions on 2 separate occasions. The questions were submitted to 4 LLMs and the answers regenerated 5 times for each. Response reproducibility and consistency was compared, and a thematic analysis of the AI answers was undertaken. Results Bing Chat was excluded from the study. ChatGPT3.5 refused to give a definitive answer in 14% of its answers, ChatGPT4 in 29% and Bard in 11%. ChatGPT3.5 suggested the user seek medical advice in 60% of its answers, ChatGPT4 99% and Bard 45%. Surgeons stated they were confident in their answers in 96%. AI answers were deemed decisive: ChatGPT3.5 71%, ChatGPT4 24% and Bard 92%. Reproducibility of Consultants answers averaged 63%, and 64% for AI overall. Agreement between the Consultants for each question averaged 66%, and 64% between AI. Thematic analysis of the AI answers revealed themes including surgical and conservative management, individualised approach, risks and benefits, consideration of severity and duration of symptoms, and decision-making processes. Conclusions ChatGPT and Bard provide detailed answers to common controversial spinal surgery scenarios, however, they are not as decisive as consultants, and agreed on fewer management plans. Many of these scenarios remained unanswered.

Background Imposter Phenomenon (IP) is a subjective feeling of intellectual fraudulence and self-doubt experienced by individuals in goal-orientated high-achieving professions. The impact of IP within healthcare has been associated with individual physical and mental health and concerns around training, career progression and DEI at an institutional level. To effectively address IP in healthcare, this scoping review aims to explore educational interventions designed to empower high-achieving individuals with the tools needed to confront and overcome IP. Methods The scoping review adhered to a predetermined protocol informed by the JBI methodology and PRISMA-ScR guidelines in order to identify educational interventions addressing IP in high-achieving industries. Articles were searched across multiple databases, including MEDLINE (Ovid), PsychINFO, SCOPUS, and Web of Science, alongside grey literature, without imposing any time constraints. A systematic approach including a thematic analysis allowed for a nuanced exploration and interpretation of the identified educational interventions and their impact on addressing IP. Results Seventeen articles were incorporated into the review, with the majority originating from the USA and majority being published since 2020. Ten studies targeted healthcare professionals, undergraduate and postgraduate healthcare students. Majority of studies aimed at addressing IP, featured a larger number of female participants than males. Workshops with self-reflection and group-guided exercises to overcome IP were the most popular educational interventions. Coaching and structured supervision were also suggested. Across all papers, three themes emerged for coping strategies: individual, peer-to-peer, and institutional. Conclusions This scoping review suggests how group and individual interventions such as workshops, small group discussions and coaching can be used to overcome IP in healthcare. Institutional changes like diversity promotion, supervisor education, and support networks are crucial in addressing IP. Further long term and speciality specific assessments are needed to measure impact. Overall, the review highlights how educational awareness and a variety of strategies can be implemented to create a supportive environment for professionals dealing with IP, promoting their well-being and success.

INTRODUCTION In the NHS the structure of a “regular healthcare team” is no longer the case. The NHS is facing a workforce crisis where cross-covering of ward-based health professionals is at an all-time high, this includes nurses, doctors, therapists, pharmacists and clerks. Comprehensive post-operative care documentation is essential to maintain patient safety, reduce information clarification requests, delays in rehabilitation, treatment, and investigations. The value of complete surgical registry data is emerging, and in the UK this has recently become mandated, but the completeness of post-operative care documentation is not held to the same importance, and at present there is no published standard. This project summarises a 4-stage approach, including 6 audit cycles, >400 reviewed operation notes, over a 5 year period. OBJECTIVE To deliver a sustainable change in post operative care documentation practices through quality improvement frameworks. METHODS Stage 1: Characterise the problem and increase engagement through: SMART aims, process mapping, hybrid action-effect and driver diagram and stakeholder analysis. Multi disciplinary stakeholders were involved in achieving a consensus of evidence-based auditable criteria. Stage 2: Baseline audit to assess current practice. Stage 3: Intervention planning by stakeholders. Stage 4: Longitudinal monitoring through run charts and iterative refinement. RESULTS Stage 1: Process mapping identified numerous downstream effects of the absence of critical information from operation notes, and the action-effect diagram highlighted the multiple unnecessary mitigating actions performed by ward staff. An MDT consensus was achieved on 15 essential criteria for complete documentation, including important negative fields. Interest-influence matrix identified stakeholder groups with high influence but low interest who needed engagement to deliver change. Stage 2: Baseline audit demonstrated unexpectedly poor documentation: >75% compliance in 4 criteria, and <50% compliance in 10 criteria, which elevated the interest of key stakeholders. Stage 3: A post-operative care template based on the 15 criteria was embedded within the existing IT software. It allowed use of existing operative templates, with a non-overwriting suffix requiring only two mouse clicks. Stage 4: Re-audit at 3 and 12 months showed improved and sustained compliance. At 24 months compliance had declined. Questionnaire of template usage identified problems of criteria response options, and lack of awareness of template by newly appointed staff. Template update improved compliance over the next 6 months (>75% compliance in 11 criteria). Finally, a further reaudit conducted 12 months after the template update (5 years post baseline audit) showed a sustained improvement in compliance (>75% compliance in 13 criteria). CONCLUSIONS Simple innovation through quality improvement frameworks has changed documentation practices by 1) achieving a consensus from stakeholders, 2) a “shock and awe” moment to highlight existing poor documentation and increase engagement 3) implementing change which fit easily into existing systems, 4) respecting autonomy rather than enforcing change and 5) longitudinal monitoring using run charts and an iterative process to ensure the template remains fit for purpose. This model has now successfully been translated to other subspecialities within the orthopaedic department. Declaration of Interest (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Background Imposter Phenomenon (IP) is a subjective feeling of intellectual fraud and self-doubt experienced by individuals in goal-orientated high-achieving professions, regardless of gender. The impact of IP within healthcare has been associated with individual physical and mental health and concerns around training, career progression and DEI at an institutional level. To effectively address IP in healthcare, this scoping review aims to explore educational interventions designed to empower high-achieving individuals with the tools needed to confront and overcome IP. Methods The scoping review adhered to a predetermined protocol informed by the JBI methodology and PRISMA-ScR guidelines in order to identify educational interventions addressing IP in high-achieving industries. Articles were searched across multiple databases, including MEDLINE (Ovid), PsychINFO, SCOPUS, and Web of Science, alongside grey literature, without imposing any time constraints. Results Seventeen articles were incorporated into the review, with the majority originating from the USA and majority being published since 2020. Ten studies targeted healthcare professionals, undergraduate and postgraduate healthcare students. Majority of studies aimed at addressing IP, featured a larger number of female participants than males. Workshops with self-reflection and group-guided exercises to overcome IP were the most popular educational interventions. Coaching and structured supervision were also suggested. Across all papers, three themes emerged for coping strategies: individual, peer-to-peer, and institutional. Conclusions This scoping review suggests how group and individual interventions such as workshops, small group discussions and coaching can be used to overcome IP in healthcare. Institutional changes like diversity promotion, supervisor education, and support networks are crucial in addressing IP. Further long term and speciality specific assessments are needed to measure impact. Overall, the review highlights how educational awareness and a variety of strategies can be implemented to create a supportive environment for professionals dealing with IP, promoting their well-being and success.

Background Higher surgical training (HST) in the UK focuses on delivery of clinical knowledge to pass FRCS exams, technical skills to fulfil CCT requirements, and clinical preparedness for a day-one consultants. Aim To identify specific professional capabilities deficient in HST which may inform new training objectives to aid transition between HST and T&O consultant practice. Study Design PRISMA Scoping Review. Review of existing courses and interviews with course directors. Semi-structured interviews with newly appointed consultants (< 5 years) exploring non-clinical attributes necessary for new consultants. Interactive questionnaire with senior trainers and with post-FRCS trainees exploring timeframe for current trainees to gain non-clinical experience compared to the ideal timing of developing these skills. Results PRISMA-ScR papers identified n = 434, screened n = 276, eligible n = 105, included n = 50, of which surgical = 7, T&O = 0; demonstrating limited literature characterising the gap in preparedness during this specific surgical transition-point. Specialities with dedicated courses include paediatrics and ophthalmology; programmes reviewed demonstrated a wide array of topics. Interviews identified strong themes of lack of understanding of NHS structure, job planning, procuring specialist equipment, handling complaints and human factors. The interactive survey undertaken by both senior trainers and post-FRCS trainees demonstrated a similar trend with a clear shift towards pre-FRCS delivery of skills. Conclusions Differences in trainees’ perceived needs and those identified by consultants pose a potential challenge in HST. Across all groups involved, deficiencies were identified in acquiring non-clinical skills and knowledge. This mixed methods approach identified key topics to cover in transition to consultant course to improve challenges during transition.

Background Higher surgical training (HST) focuses on delivering clinical knowledge and technical skills to fulfil day-one consultant clinical competencies. Introduction of capabilities in practice (CiPs), shifts curricula to outcome-based assessment related to direct clinical care. To aid the transition into consultant surgical practice, we must identify deficiencies in HST related to wider professional capabilities outside of direct clinical care. Aim To identify deficiencies in HST by exploring challenges faced by recently appointed T&O consultants. Method The experience of T&O consultants, appointed in the last five years, was explored using a phenomenological approach. Field notes from unstructured interviews with five consultants (convenience sampling), was used to develop a topic guide for semi-structured interviews with six new consultants (purposive sampling). Interviews were transcribed and thematically analysed. Results Consultants transitioning into the new role emphasized comprehensive clinical knowledge, technical and non-technical skills as attributes required to be a good day-one consultant. Further identifying various deficiencies in their non-clinical training; categorised into two themes and further sub-themes: Adapting identity Practice management, Building a reputation, Leadership identity, Trainer identity, Awareness of limitations, Independence vs support Discovering responsibilities Job planning, Management structure, Service provision and procurement, Complaints and complications. Conclusions This study provides an in-depth account of deficiencies in professional capabilities outside of direct clinical care required by day-one consultants. Furthermore, highlighting the pressing need to equip trainees for transition to consultant-surgical practice. We make recommendations on how stakeholders such as surgical-trainees, newly appointed consultants and employing organisations can modify identified deficiencies at different training levels.

Background Higher surgical training (HST) focuses on delivery of clinical knowledge to pass FRCS exams, technical skills to fulfil CCT requirements, and clinical preparedness in the UK. The lack of good quality evidence to characterise the non-clinical challenges during transition from HST to consultant surgical practice, makes it challenging to develop a well-structured intervention to address this gap. Aim To identify the gap in current literature, methodologies and analysis of inventions trialled to address the transition from surgical trainee to consultant surgeon. Method PRISMA-ScR structured scoping review of literature. Search terms were wider than the specific research question of surgery in the UK. Other medical specialities and overseas healthcare training programmes were included to focus the gap analysis for translatable content and sub analysis to highlight the paucity of literature in surgery. Results Databases interrogated: Medline, HMIC, Pubmed, Google Scholar. Papers: identified n = 434, screened n = 276, eligible n = 105, included n = 50. Majority of papers were of poor to moderate quality. The moderate-quality papers included those adopting a mixed methods approach to both characterise the gap in training and utilised this to structure interventional programmes. Conclusions This review highlights the need for a mixed methods approach alongside a stakeholder analysis to identify target population for qualitative semi-structured interview (most likely to be newly appointed consultants) for characterising the gap in HST for trainees making the transition to UK NHS consultant practice. The topic guide for interviews would be informed by the deficiencies in training identified in this scoping review.

Background: IP is a subjective feeling of intellectual fraud that is predominant in high-achieving individuals regardless of gender. IP is associated with physical and mental health at the individual level. Literature suggests various hypothetical strategies to overcome IP, with limited research on how these strategies are being implemented in healthcare systems. To confront the possible impact of IP within healthcare, it is essential to explore existing educational interventions and understand how these equip individuals and institutions with skills to overcome the effects of IP across a wide variety of professional settings. Aim: This scoping review aims to understand the educational interventions developed to equip high-performance individuals with skills to manage imposter phenomenon (IP). Methods: The scoping review will comprise articles found by searching the MEDLINE (Ovid), Psych INFO, SCOPUS, and Web of Science databases, along with gray literature searched through Google Scholar. Studies will be assessed by two independent reviewers and screened against the inclusion criteria for eligibility to be included in the review. All published studies and gray literature, such as reports, commentaries, website content describing an educational intervention to IP, will be included in the scoping review. Interventions not addressing IP such as mimicking syndromes: Capgras syndrome, or isolated symptoms such as burnout will be excluded from the study. Furthermore, studies detailing prevalence of IP without any educational intervention will also be excluded. Discussion: At an institutional level, IP threatens inclusion and diversity. This is due to the debilitating self-doubt that limits professionals from applying to leadership and management roles within healthcare. This review will provide healthcare professionals with a wider understanding of educational interventions available to tackle IP in their workplace. Further the review will highlight gaps for future research and innovation.