High-stakes examinations are an integral part of medical education. To practice in the United States (U.S.), students must pass the U.S. Medical Licensing Examinations (USMLE). With the transition of USMLE Step 1 to pass/fail scoring on January 26, 2022, a worldwide debate regarding how residency program directors will view the Step 2 Clinical Knowledge (CK) test emerged. Here, the authors explore the role of formal, informal, and hidden curricula related to USMLE, with broader implications for high-stakes examinations. Six focus groups of fourth-year students who recently took Step 2 CK and a supplemental curricular content analysis were conducted to explore students’ decision-making and emotions regarding the exam, including how the formal, informal, and hidden curricula influence their perspectives. Participants highlighted how informal and hidden curricula drive the belief that high-stakes examinations are the single most important factor in medical school. Prior experience with Step 1 drives behaviors and attitudes when preparing for Step 2 CK. Pressures from these examinations have unintended consequences on burnout, professional identity, specialty choice, and interpersonal interactions. Both interpersonal interactions within medical education as well as subconscious, unintended messaging can influence medical student approaches to and perspectives about high-stakes examinations. Within the context of U.S. medical training, with the transition to a new era of a pass/fail Step 1 examination, careful consideration to prevent shifting the current “Step 1 mania” to a “Step 2 CK mania” is warranted. More broadly, medical educators must examine the unintended yet potentially damaging pressures institutions generate in their medical trainees in relation to high-stakes examinations.
Copyright: © 2023 Geraghty et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

In the three months since artificial intelligence tool ChatGPT was introduced to the world, workers have already harnessed it to make their lives easier. Professionals in fields including real estate, health care and finance say they save time and work more efficiently using AI.

Here's how these workers described using the tool in their day-to-day jobs.

Write me a real estate listing

Mala Sander, a top real estate agent for the Corcoran Group who focuses on the Hamptons, has been using ChatGPT regularly for the past couple of weeks to help her write real estate listings and devise marketing strategies for properties. 

"I asked it to write me ad copy about a house in Bridgehampton with a pool and tennis court on two acres and I listed the other features I wanted to highlight," she told CBS MoneyWatch. "And it would weave this fantastic copy into something that you could actually use." 

She uses ChatGPT to change the tone of listings too. "I'll say things like, 'write this toward a millennial audience' or 'make it funny.'"

Her routine these days is to have her team write the first draft of a listing "and crunch it through to see if ChatGPT can edit it down and make it more concise," she said.

On a whim, she asked the bot to write her a marketing plan for one of her listings. It delivered. It gave her a breakdown of a campaign that would include digital, print and social outreach, she told CBS MoneyWatch. 

"It talked about everything from direct mail to online digital advertising to social media, and it even came up with some percentages that might be ideal," Sander said.

Having worked as an agent for the last 20 years, Sander is quite capable and efficient without ChatGPT. 

"But it is useful," she said. "It's like talking to another person, almost like having work therapist to say, 'Am I moving in the right direction with this or should be looking at some other things?'"

Elia Mazor, marketing manager for The Glazer Team at Corcoran, said he also uses ChatGPT to write listings and create other content.

"Sometimes you get writer's block, so I use ChatGPT for a bit of inspiration and to provide a different tone," he said.

Financial planner's assistant

Certified financial planner Michael Reynolds uses the chatbot to help him draft blog posts that educate his clients about financial documents like wills and trusts. 

He tells ChatGPT the syllabu he wants to address, and enters a prompt like: "ChatGPT, create an introduction on why estate planning is important." 

It spits out paragraphs that Reynolds then edits in his own voice.

In a accurate article on estate planning, Reynolds relied on ChatGPT to hook readers by driving home the message that "estate planning is an act of love for those you leave behind."

"I asked ChatGPT to explain that and it put together a few paragraphs on why it's thoughtful and considerate to do these things," Reynolds said.

The process took about 20 minutes. If he'd worked on the article alone, it would have taken closer to two hours, he said.

He doesn't use the tool to help clients make financial decisions — that's still a job exclusively for humans, according to Reynolds. 

"Financial planning is so nuanced, individualized and personal. It is hard to envision using ChatGPT to spit out recommendations without it knowing the client. I see it being more valuable in generating educational material to supplement what I am doing," he said. "We don't just crunch numbers; we coach people, listen to their concerns and help them talk through emotional situations. The creative, empathetic work we do as humans is irreplaceable as of today."

Nick Meyer, another financial planner who produces shortform videos on TikTok, said he uses it as a starting point to come up with ideas for new content. 

"I use it instead of Google search to get syllabu ideas, or to edit what I have already written," he said. It also helps him make his videos funny.  

"I can insert a couple lines of a script and say, 'Make this more comedic, insert a joke on this line, or make it more concise," Meyer said.

"Gobs" of medical information

Board-certified emergency physician Harvey Castro is advising digital health companies on how to best integrate ChatGPT into the health care sector. 

He says one good application is creating and translating patient discharge instructions — rules for them to follow after a medical visit. 

An expert in emergency medicine, if he were asked a dermatology-related question he was unsure about, Castro said he'd enter the query into ChatGPT for more information. In the past, he relied on other clinical search engines and resources like MDConsult, now called ClinicalKey. 

"I could type it in and it would supply me gobs of information. So it's a supplement," Castro said. 

Doctors are also using it to enter a patient's symptoms and have it return a differential diagnosis — a list of possible conditions related to the presenting symptoms, according to Castro. 

"That is already happening today," he said. 

Study buddy

Rushabh Doshi, a second-year medical student at Yale University School of Medicine, likes to use ChatGPT to create demo questions while he studies for the U.S. Medical Licensing Examination. 

Test prep services have limited practice questions, and ChatGPT can generate new ones on any syllabu based on the prompt he feeds it. 

It helps him prepare for some patient interactions, too, but uses it strictly for medical education and not patient care.

"If there is a patient coming in with a disease I am not familiar with, I can go to ChatGPT and read up on it," he said. 

It also gives him information that helps him conduct more thorough patient evaluations. "I ask it to supply me a guide of the types of questions to ask to make sure I am doing a comprehensive patient interview."

ChatGPT - a recently released AI with the uncanny ability to mimic human writing - has passed some of America's most challenging professional exams, studies have shown, raising concerns it could soon put many white collar workers out of a job.

The artificially intelligent content creator, whose name is short for 'Chat Generative Pre-trained Transformer,' was released two months ago by OpenAI, and has since taken the world by storm.

Praised by figures such as Elon Musk - one of OpenAI's founders - the AI-powered chatbot, however, has raised alarms in regards to ethics as students use it to cheat on writing assignments and experts warn it could have lasting effects on the US economy.

Its results, though, are inarguable - with accurate research showing it the chatbot could successfully achieve an MBA, and soon pass notoriously difficult tests like the United States Medical Licensing test and the Bar.

© Provided by Daily Mail Ethan Mollick, associate professor at Wharton School of the University of Pennsylvania, touted ChatGPT's increasingly impressive capabilities in a accurate post to Twitter 

© Provided by Daily Mail accurate research shared by the professor showed that the AI-powered chatbot, release two months ago, can already  successfully achieve an MBA, and may soon be able to pass notoriously difficult tests like the United States Medical Licensing test and the Bar Exam

Ethan Mollick, associate professor at Wharton School of the University of Pennsylvania, highlighted these reports in a accurate post on social media, one of which was carried out by one of his colleagues at the prestigious school.

The report, by Wharton professor Christian Terwiesch, found that ChatGPT, while still in its infancy, received a grade varying from a B to B- on the final test of a typical MBA core course.

Additionally, the research, done to see what the release of the AI tool could mean for MBA programs, found that ChatGPT also 'performed well in the preparation of legal documents.'

'The next generation of this technology might even be able to pass the bar exam,' the report notes.

Mollick, who requires students to use the AI during his courses covering innovation and entrepreneurship, touted the findings Sunday in a post to social media, in which he remarked on their potential implications. 

© Provided by Daily Mail Mollick, who allows students in his class to use the technology highlighted these reports in a accurate post on social media, one of which was carried out by one of his colleagues

'I think we haven't fully absorbed the fact that careful academic papers have found ChatGPT clearly passes some of the most challenging American professional exams,' Mollick wrote.

The post saw the professor share another study carried out by researchers ay Yale that saw the chatbot earn a passing grade United States Medical Licensing Exam.

Another praised the AI bot's performances on the professional license exam, commonly referred to as 'the Bar Exam', which professors at the Michigan State and Chicago Kent colleges of law found could also be conquered by ChatGPT.

Other posts from the professor similarly tout the progress recently seen from the still young AI, which early adopters have already begun using to draft assignments and write work emails, all in specific tones and styles.

While 'still in its infancy,' as billionaire crypto enthusiast Mark Cuban said in an interview touting the technology this week, the accomplishments of ChatGPT in the few months since its release cannot be ignored.

© Provided by Daily Mail The post saw the professor share another study carried out by researchers ay Yale that saw the chatbot earn a passing grade United States Medical Licensing Exam

Andrew Karolyi, dean of Cornell University's SC Johnson College of Business, told the Financial Times this week that while many may have their reservations over the technology -  which has become a burgeoning internet fad in accurate weeks - he believes ChatGPT is here to stay. 

'One thing we all know for sure is that ChatGPT is not going away. If anything, these AI techniques will continue to get better and better. Faculty and university administrators need to invest to educate themselves.'

As the technology gains popularity, it has reportedly raised alarms within companies like Google, which has sought to adopt the AI to enhance the capabilities of its popular search engine.

Late last week,  The New York Times reported that Google execs are engaged in plans to 'demonstrate a version of its search engine with chatbot features this year' and unveil more than 20 projects powered by artificial intelligence.

However, sources have since alleged that brass at the company have embraced the AI technology too fast for its own good, with the search giant on Friday announcing layoffs of more than 12,000 employees amid plans to shift to AI as a domain of primary importance.

The nixing, the largest in the company's 25-year history, stoked fears that services like ChatGPT could copywriters, journalists, customer-service agents, and now even lawyers and doctors, out of a job.

© Provided by Daily Mail Another praised the AI bot's performances on the professional license exam, commonly referred to as 'the Bar Exam', which professors at the Michigan State and Chicago Kent colleges of law found could also be conquered by the now viral AI bot

As students and others on social media become the first to embrace the technology, Kara McWilliams, who heads a nonprofit which that offers a tool that can identify AI-generated answers, warns that others will soon need to follow suit or risk being left in the dust by those who embrace such tools, which likely will become more commonplace in the coming years.

ETS Product Innovation Labs' Williams told the Times last week: 'I’m of the mind that AI isn’t going to replace people, but people who use AI are going to replace people.' 

While introducing his paper, Terwiesch, noted liken affect ChapGPT will have on the world to that of electronic calculators on the corporate world in the late 60s and 70s.

'Prior to the introduction of calculators and other computing devices, many firms employed hundreds of employees whose task it was to manually perform mathematical operations such as multiplications or matrix inversions,' he wrote. 

'Obviously, such tasks are now automated, and the value of the associated skills has dramatically decreased. In the same way any automation of the skills taught in our MBA programs could potentially reduce the value of an MBA education.' 

Medical schools are highly competitive. The national acceptance rate is 43 percent, according to data compiled by the Association of American Medical Colleges. Use these top 10 tips from doctors and medical students to help you prepare for your pre-health profession.

1. Get Some Medical Experience on Your Résumé

Job shadow with doctors and other medical professionals. Admissions committees don't expect applicants to have real experience actually treating patients. After all, you're not a doctor yet. But they do want to know that you've spent time getting to know what your future job would be like. Job shadowing is a great way to get some medical experience but there are other non-shadowing opportunities that may be available to you.

"Med school admissions committees want students to have realistic expectations for what a career in medicine will be like. says Dr. Sarah Carlson, a vascular surgery resident at Dartmouth Hitchcock Medical Center, who has also served on a medical school admissions committee. As an undergraduate, she volunteered to file x-rays at the local hospital, then parlayed that into an opportunity to talk with the radiologist. He explained both how to read x-ray films, and why he chose his profession. "It's those types of interactions that are important to have under your belt," she says. "Quite frankly, medicine isn't for everyone, so it's best if you do some soul-searching and spend some time with the people who have the job you want. Most doctors are happy to sit down with students who are considering a career in medicine."

Other ways to get medical experience include becoming a Certified Nursing Assistant (CNA), a volunteer emergency medical technician (EMT), or as a hospital scribe doing data entry. Some applicants are able to gain clinical experience by helping to care for family members.

2. Do Research Projects

3. Put in Time Serving Others

Dr. Carlson volunteered with the Big Brothers-Big Sisters organization. So did Joseph. Rake leaves, build an accessibility ramp, clean the beach, walk a dog. There are lots of non-clinical options for volunteering that demonstrate your willingness to pay it forward and supply back.

"They have many different programs and services." Joseph, accepted into Central Michigan University's College of Medicine, was part of the Forever Friends program, matched with an elderly woman she visited a few times each month. "I 've formed a great friendship with her, and hopefully, helped alleviate some loneliness. It 's a win-win!"

"Doctors are generally pretty altruistic people, and med schools want to see that you care about your community or have some drive to contribute to the greater good," says Dr. Carlson. "Community service comes in many forms, and really anything qualifies, from trash cleanup and mentorship programs to working the concession stand at a fund-raiser for a charity—anything that requires some unpaid time for a good cause."

Ask your pre-health professions advisor about volunteering opportunities on campus or in your community, which could include helping at local food banks or blood drives, local shelters for the homeless or those dealing with domestic violence. You could tutor, deliver good companionship and Meals on Wheels, or walk the dogs at a local animal shelter. Take an alternative spring break and work with Habitat for Humanity or on developing clean water sources for Third World countries. Check with your school for a list of community and global partners it works with who can use your time and talents. The mentors you develop will come in handy when it's time to gather recommendation letters—most schools ask for at least three—and the friendships you develop will last a lifetime.

4. Choose a Major You Will Excel In

Grades aren't everything, but they're extremely important. Choose a field of study that will yield a competitive GPA (grade point average). The recommended GPA for medical school applicants is 3.7 for MDs (medical doctors), 3.5 for DOs (doctors of osteopathy), and 3.4 for NDs (Doctor of Naturopathic). While many students who are planning careers in medicine decide to major in biology, Dr. Carlson earned her bachelor's in chemistry. Many of her colleagues majored in even more unexpected fields, including engineering, English, music, and classics.

"It 's OK if you 're not on the pre-med track right away when you start college; pursue experiences that genuinely interest you and rely on guidance from your faculty mentors to navigate your path"Carly Joseph

There is no such thing as a pre-med major, says pre-health professions advisor Nicole Seigneurie, who works with students preparing for medical careers at Michigan Technological University. "There are so many different programs students can apply to." You will still need to do well in both your cumulative and your science GPA, classes like biology, physics, chemistry, and math, that are required for medical school admission. If you are struggling in any classes, get help right away.

During her fourth year, Joseph had to take many of the medical school prerequisite classes that were not part of her engineering curriculum and build a Medical College Admission Test (MCAT) study plan into her schedule.

5. Apply to Multiple Schools

Improve your odds by not placing all your hopes on one school. Do individual research on each school, says Seigneurie; application requirements can vary from school to school and from year-to-year.

She also notes that you can reach out to admission committees with specific questions about the program and expectations. And, she says, don't be bummed if at first you don't succeed. Try again. "If you don 't get accepted into the school of your dreams, it 's OK! Schools have many applicants and can 't take everyone," says McKenzie, who was accepted into the Michigan State University College of Human Medicine. "My dad, who has been a family physician for 29 years, often tells me, "An MD is an MD, it doesn't matter where you go to school."

"Don't take it personally when you get some rejections—they happen at every stage of the game. If you cast a wide net, you'll increase your likelihood of getting an acceptance."Dr. Carlson

Other ways to get noticed among the hundreds or even thousands of medical school applications submitted each year: send supplemental materials beyond your application. For example, "if you've published a paper, consider sending a copy of the publication with a handwritten note to the director of admissions, indicating you really hope to be considered for acceptance," she says.

6. Study Early and Often for the Medical College Admission Test, or MCAT

MCAT scores range from 472-528. Accepted medical students average around 508. Recommended study time: 300-350 hours.

Take a course and buy books and study on your own. Find the method that works for you. Take practice questions many times and don't let your practice scores spook you, says McKenzie. "I used the Kaplan book series, and studied by reading, highlighting, and taking notes. The real MCAT was not as hard as the Kaplan test, in my opinion." The pre-health professions advisor can help you find the resources you need.

You can also join a pre-health professions club or association at your school, including Alpha Epsilon Delta, the national honor society for health pre-professionals. Members help each other get ready for tests, along with hosting speakers and events to help gain knowledge and experience.

7. Learn Another Language

"I speak Spanish almost every day at work," says Dr. Carlson. "It 's what I use the most from my premed education." Joseph spent a semester in Chile. "Focusing on language, culture, and people challenged me in a me in ways that technical classes couldn't and was critical in my preparation for medical school. If you 're thinking about studying abroad, do it. Communication and understanding different cultures are crucial skills for anyone entering the medical field, and medical schools look for applicants who make the effort to broaden their horizons culturally."

Medical volunteer programs abroad are another option to gain both life and health-care related experiences. Students are placed in hospitals and clinics in both rural and urban settings where staff is inadequate. Work, with professional guidance, can include giving vaccinations and other tasks interacting directly with patients, as well as helping to make facilities cleaner and more accessible. Programs are normally for people aged 18 and older

8. Don't Skimp on Extracurricular Activities

Show that you're interested in other things besides schoolwork. Dr. Carlson says having outside interests makes you stand out (she plays violin in an orchestra). "It's OK to indicate some of these personal interests on your med school applications—they supply the interviewers something to relate to you with," she says. "I interviewed one applicant who only got a C in biochemistry, but he wrote lots of letters to the admissions committee highlighting his other strengths. We accepted him, and he turned out to be a star."

"Medical schools like to see commitment in their applicants, be it to sports, work, or extracurricular activities," says McKenzie. "It 's easier to not join clubs and just do homework and relax, but devoting time now to extracurricular commitments is worth it in the long run. These experiences also supply you good opportunities to get to know people who can write the letters of recommendation."

Joseph says to choose activities based on what works best for you. Aim for quality rather than quantity.

"There 's a lot of pressure to have as many leadership roles as possible and be involved in tons of student organizations. For me though, having a few deep and lasting experiences was the way to go. I chose to invest my time in research, improving my Spanish, and volunteering," she says.

9. Be Polite and Be Yourself at Interviews

Research the schools you're interested in and look at mission statements, so you know something about the institution that you can share at the interview. Practice answering interview questions. When you arrive, be courteous to everyone you meet at the interview, including the receptionist.

"Schools are interested in learning what kind of student and person you are," says McKenzie. Schools invest in students and are looking for a good fit.

If you need help with effective body language, knowing how to dress professionally or for other tips, check out your school's Career Services office, which may offer mock interview opportunities and other techniques to help you present your best self.

10. Be Ready to Explain Why You Want to be a Doctor

Bonus Tips for Getting into Medical School

Dr. Carlson has two more important suggestions to help you successfully apply to medical school:

Ask a Mentor or Advisor to Pick Up the Phone and Make a Call for You

"This is an unwritten rule that everyone does and nobody ever told me until I was several years into my training," says Dr. Carlson. "If you want to go to a particular school, find a way to have one of your mentors or advisors reach out to the admissions committee on your behalf."

For example, if you wanted to go to the University of Michigan ask your advisor or another mentor to call the director of admissions or any other person they know and advocate for you. Email can also be effective, she says. "It's a bonus if your mentor/advisor actually has a personal contact at the medical school you're interested in. "There is a culture of 'I can vouch for this person' that goes very far in the medical world. A phone call won't get you in if your application is terrible, but if you're on the cusp of acceptance and someone makes a call on your behalf, it can supply you the push you need to be accepted."

Don't Be Afraid to Self-Promote (In a Humble Way).

"It's OK to highlight the accomplishments you're proud of; put these in your required personal statement or find a way to work them into conversation during interviews. The key is to do it humbly but confidently: 'I was fortunate enough to win a teaching award from my time as a chemistry lab TA, and that's something I'm really proud of.' It's OK to be proud of your own achievements! Selectively highlighting a few make your application stand out from the rest."

Pre-Health Professions at Michigan Tech

Michigan Tech's placement rate into medical school is 60 to 70 percent (well above the national average) and is nearly 100 percent for physical therapy school. Choose a pre-health profession and prepare for your future today.

“Clinicians do not — and would never be expected to — implement all of the suggested screenings, counseling services, and preventive medications in a single patient visit,” Dr. Mangione wrote in an email. “When caring for patients, clinicians use both their judgment and the information obtained during conversations with each patient to prioritize which preventive services should be offered during each visit.”

Even that is not easy, said Dr. Daniel Jonas, director of the division of general internal medicine at Ohio State University.

Guidelines can serve a purpose, Dr. Jonas said. “I think they’re incredibly helpful,” he added. But, he said, “deciding what to prioritize in a busy primary care practice is a big challenge.”

Dr. Montori added another complication.

“To assume that patients and clinicians can sort and prioritize recommendations over multiple visits,” he said, “wishes away the fundamental problem that many patients cannot get primary care, see the same clinician or have unhurried consultations.”

Dr. Pignone said that some of the burden should be shared with other professionals, like nutritionists, who can talk to patients about healthy diets. But, he said, that is only a partial solution. He’d like to see current recommendations prioritized by their impact on health and on their cost effectiveness. As examples, he said, childhood immunizations would rank high but existing guidelines to supply tetanus boosters to adults who already had tetanus shots would rank lower.

Dr. Guyatt said guidelines should be held to the same standard as new drugs. Before they are implemented, there should be evidence that they are helpful.

“Somebody might say, ‘Oh, a new drug has side effects but what harm is there in this guideline?’” he said. “But yes, there is real harm. There is a trade-off between doing things that are actually useful and spending time on things that are useless.”