United States

Background: Success in transcranial microsurgery and endoscopic skull base surgery is predicated on one’s knowledge in surgical neuroanatomy. While graphic depictions aim to present the 3D anatomy, technical skills must be developed through hands-on practice. To address this, a dedicated microsurgical neuroanatomy laboratory—the first of its kind in Indiana—was established in 2025 at the Indiana University School of Medicine. Led by the senior author, the lab promotes surgical artistry through anatomical precision, repetition, and interdisciplinary collaboration. The objective of this study is to describe the inception and collaborative development of a skull base
lab at Indiana University.

Methods: The lab has been supported through personal funds and industry support. As a joint effort between the Departments of Neurological Surgery and Otolaryngology, fellows were selected from an international pool of applicants. Each fellow received a latex-injected, alcohol-preserved head and had full access to complete neurosurgical equipment, Mayfield headrests, endoscopes, microscopes, drills, aspirators, and professional photography equipment. Daily dissections followed a stepwise approach, with each step captured by high-resolution 2D/3D
images and photogrammetry. Media acquired from the lab was later combined with surgical videos so that the understanding of the microsurgical anatomy can be translated into the operating room. Weekly neuroanatomy meetings were also held to foster peer learning and mentorship.

Results: In its first year, the lab is set to train seven international fellows, with fellowships ranging from 3-12 months. The overlapping time period between the fellows facilitates international dissemination of ideas and techniques. Dissections encompassing open and endoscopic skull base approaches of the anterior, middle, and posterior fossa were performed. The present fellows report significant improvements in 3D orientation, technical confidence, and surgical fluency.

Conclusion: The IU microsurgical neuroanatomy lab offers a transformative and internationally collaborative model for neurosurgical education. The lab merges anatomical precision, simulation, and mentorship to prepare the next generation of neurosurgeons.

AMA Research Challenge 2025 

The Indiana University Microsurgical Neuroanatomy Laboratory: A Training and Innovation Center

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Background:
Medical students experience greater rates of psychological issues, including burnout and anxiety, which may have lasting effects on their future careers. To help address this increased risk, California Northstate University College of Medicine introduced a 4th year Wellness elective, which combines elements of mindfulness meditation, physician compassion and communication training, leadership training, and humanities in medicine. This study evaluated the impact of this course on the levels of burnout, self-compassion, and anxiety of medical students.

Methods:
A survey was administered to 4th year students, both those enrolled in HLT810 and those not taking the course. The survey consisted of demographic questions as well as measurements for burnout, self-compassion, and anxiety. The survey was given prior to beginning the course and again after it was completed. The Oldenburg Burnout Inventory was used to measure student burnout, exhaustion, and disengagement. The Self-Compassion Scale was used to evaluate self-compassion, self-judgment, mindfulness, and self-kindness. The General Anxiety Disorder-7 questionnaire was used to measure anxiety levels. For students who took the elective, two-tailed paired t-tests were performed to assess for differences in these metrics before and after completing the course, with p < 0.05 being significant. Unpaired t-tests were used to compare students who did not take the course to students who completed the course.

Results:
There were no significant differences in anxiety levels, self-compassion, and burnout between students who completed the HLT810 elective and those who did not. However, for the students who completed the elective, there were significantly lower total burnout and disengagement scores after taking the course (p = 0.043 and p = 0.034, respectively), as well as significantly higher self-kindness, humanity, and mindfulness scores (p = 0.00254, p = 0.0162, and p = 0.0396, respectively). These students also had significantly higher total self-compassion scores after completing the course (p = 0.0122). For students who did not take the course, engagement scores were significantly higher after the course concluded (p = 0.024) but there were no other findings of significance.

Conclusion:
Students who completed HLT810 had statistically significant decreased levels of burnout and as well as increased self-compassion after taking the course. While additional investigation is needed due to the small sample size (n = 38), these findings suggest that a 4th year wellness elective course may offer meaningful benefits for medical student well-being.

The Effects of Mindfulness and Wellness Curriculum on Burnout, Self-Compassion, and Anxiety

Background
Patients increasingly consult online resources and Artificial Intelligence (AI) chatbots for medical information. However, post pandemic aggravation of medical misinformation and recent blossom of AI has raised concerns about the quality and comprehensibility of such sources. Adequate, easy to understand, and accurate patient education is crucial in procedural outcome and prognosis, especially for procedures that warrant meticulous postoperative management, such as tracheostomy.
Methods
We evaluated five popular and high-ranking AI chatbots - ChatGPT, DeepSeek, Google Gemini, Microsoft Copilot, and Grok 3 - alongside responses from a senior otolaryngologist, addressing 12 Frequently Asked Questions (FAQs) on tracheostomy care. FAQ selection was guided by a combination of search-listening tools (Google Trends, KeywordsPeopleUse, AlsoAsked, AnswerThePublic, Kwrds.ai), manual Google searches, and clinician input to reflect authentic patient language. Three blinded, board-certified otolaryngologists independently rated each response’s accuracy, clarity, relevance, completeness, usefulness, and reference reliability using the Quality Analysis of Medical Artificial Intelligence (QAMAI), a standardized instrument developed to assess AI-generated contents. Overall preferences and reasons for suboptimal response ranking were also assessed by reviewers. Readability and descriptive text analysis were evaluated using Textstat and Natural Language Toolkit library in Python (Python Software Foundation), employing Simple Measure of Gobbledygook (SMOG), Flesch-Kincaid Grade Level (FKGL) and Reading Ease (FKRE) metrics.
Results
Across the 12 FAQs, there were no significant differences in accuracy between AI-generated and otolaryngologist-generated responses. Google Gemini has higher overall preference and QAMAI score compared to Microsoft Copilot (p<0.05). In terms of completeness, Gemini (p<0.001), DeepSeek (p<0.05), Grok 3 (p<0.05), and ChatGPT (p<0.05) outperformed the otolaryngologist, and each provided content deemed of “good quality” by QAMAI standards. However, Gemini has the reading time (p<.001), highest word (p<.001), long word (p<.001), and difficult word counts (p<.001). Readability analyses revealed that all models have high reading level of at least 10th-13th grade. Inter rater reliability among the three reviewers was 78%.
Conclusion
AI chatbots are a promising tool for accurate, on-demand, and comprehensive health information for patient and families considering or managing tracheostomy care. Google Gemini demonstrated strength in content completeness and overall preference, highlighting the potential of AI to supplement time-limited physician-patient interactions. However, all AI and otolaryngologist generated responses surpassed the American Medical Association’s recommended 6th grade reading level, indicating a need for readability optimization. Future studies should focus on refining the readability of AI-generated content and assessing patient preferences across models. 


The Role of Artificial Intelligence in Addressing Patient Inquires on Tracheostomy Care

BACKGROUND: Surgical education often relies on costly task trainers or two-dimensional surgical videos. Photogrammetry, the process of constructing three-dimensional (3D) models from two-dimensional (2D) images, offers a cost-savings solution while providing a customizable 3D surgical experience. This technique for building photogrammetry-based 3D models allows for the creation of virtual teaching modules and aimed to enhance options for surgical education. While photogrammetry has been used to build models for teaching anatomy, its application in procedural simulation remains limited. Additionally, open carpal tunnel release (OCTR) achieves outcomes comparable to the endoscopic approach, yet virtual reality (VR) training simulations for this open technique have not been explored. This study introduces a low-cost VR OCTR surgical teaching module using photogrammetry to explore production feasibility and educational value across surgical disciplines.

METHODS: A VR OCTR module was created using photogrammetry to generate virtual hand and wrist models from intraoperative cadaveric dissections. Filming was conducted in an academic anatomy lab, demonstrating a five-step OCTR procedure on cadaveric right arms. Serial photographs were captured from multiple angles using a Nikon Z8 camera, with drapes placed to minimize visual distractions. 3D models were rendered via photogrammetry software and refined with open-source tools. The models were viewed through a Meta Quest 3 headset and the teaching module was narrated by a hand surgeon using the MedicalHolodeck Surgical and Anatomical VR application. Surgical trainees and faculty from plastic surgery, orthopedics, and neurosurgery provided feedback for further model development.

RESULTS: This VR module was built using accessible tools and software. High resolution photographs resulted in the anatomically accurate 3D models used to highlight essential anatomy and surgical landmarks in the teaching module. The seven-minute module was noted to be conceptually clear and appropriately concise. Feedback emphasized its usefulness in reinforcing anatomical knowledge, visualizing operative steps, and noting structures to avoid during surgery. In-house development of the modules highlights its customizability for institutional specific learning goals, cost-effectiveness and feasibility for broader institutional adoption, compared to commercial subspecialty specific private platforms for VR surgical training. These findings support the educational potential of photogrammetry-based VR and guide further pilot studies, expansion to medical students and an upcoming randomized trial comparing VR to standard 2D training.

CONCLUSION: Photogrammetry can produce low-cost 3D models for virtual reality teaching modules in surgical education and training. By leveraging accessible technology and cadaveric dissections, this method enhances educational access and sets the stage for wider implementation and outcomes-based research.


The Novel Application of Photogrammetry in Building Virtual Reality Modules for Surgical Education

Abstract Title: Reported Levels of Student Stress and Protective Nature of Resiliency Among First Year U.S. Medical Students - A Single Institution, Pilot Study

Background:
Medical training for M.D. candidates in the United States involves four years of combined didactic and clinical learning. Medical students often experience stressors related to academics and social life that can lead to burnout and clinical depression in medical school. This study aimed to identify key problem areas pertaining to stress and wellbeing among first-year medical students at one accredited M.D. institution by administering the Medical Student Stress Scale (MSSS), a survey that was calibrated and validated by researchers at a single institution looking to identify a precise measurement tool to evaluate medical student stress.

Methods
The MSSS, a 22-item questionnaire, was administered to first year medical students twice during 2024-2025 academic calendar, in the fall and spring. The MSSS questions were administered alongside a Brief Resilience Scale (BRS) and demographic questionnaire. The MSSS measures stress with a total score determined as a summation of the responses, where higher scores indicate greater stress. The BRS measures resiliency with a total score determined as a summation of the 6 item responses and can be categorized as being low (1-2.99), normal (3-4.3), or high (4.31-5).

Results
The overall response rate was 61% (107 out of 175) in the fall and 47% (87 out of 175) in the spring. Average student stress score in the fall and spring was 34.3 and 38.8, respectfully. The resiliency score in the fall and spring was 3.6 and 3.5, respectfully. The multivariable generalized linear model showed that student stress decreased by 10 points and 13 points with every 1-point increase on the BRS in the fall and spring, respectfully (p<0.001). Additionally, at both time points, males display a significantly lower estimated stress score than females (p=0.044 and p=0.016). In the spring, compared to students of Christian faith, Jewish students displayed an estimated 10-point increase in stress (p=0.024), and Islamic students displayed an estimated 17- point increase in stress (p=0.005). Additionally, students that reported they were low-income displayed an estimated 8-point increase in stress compared to non-low-income students (p=0.009).

Conclusion
The MSSS and BRS were feasible to implement and identified clear trends in stress based on demographic factors. High levels of stress are reported even early in the academic year suggesting the need for early and ongoing support. The second time point showed compounding effects, emphasizing the importance of longitudinal support. Resiliency emerged as a potential protective factor and a possible target for future interventions.

Reported Levels of Student Stress and Protective Nature of Resiliency Among First Year Medical Students - A Single Institution, Pilot Study

Background: 

In 2023, a tragic cardiac arrest during a high school basketball game in Detroit, where a student-athlete collapsed and later died despite bystander aid and EMS intervention. This event brought national attention to the lack of consistent sideline medical coverage in underserved urban public schools. Despite widespread advocacy for the presence of certified athletic trainers, Detroit’s public schools have faced systemic under-resourcing. To address this inequity, students at Wayne State University School of Medicine developed the Detroit Public School Health Corps (DPSHC), a student-led initiative that provides consistent sideline medical care through strategic partnerships and longitudinal volunteer engagement. 



Methods: 


Our organization formed a partnership between the Detroit Public Schools Community District, Wayne Pediatrics, and the Detroit Medical Center Orthopedics and Sports Medicine. The initiative recruited over 50 medical student volunteers over the 2024-2025 academic year to volunteer as sideline sports first responders at high school athletic events. Students completed several sport specific training courses led by physicians and residents in sports medicine and pediatrics. We utilized a combined didactic and hands-on instruction, adding up to over ten hours of curriculum across an academic year. Trained volunteers were deployed to 16 high schools in the Detroit Public School Community District. Each sporting season, we provide on-site triage and acute care, with escalation protocols involving on-call physicians and EMS for higher-acuity injuries. Our hospital partners also supported logistical coordination and physician oversight. 



Results: 


During the most recent academic year, our volunteers staffed: 156 of 250 home basketball games (boys and girls), 58 of 64 home football games, 50 of 185 home baseball/softball games, 10 of 14 home girls' soccer games, and 10 of 10 track meets. This totaled 598 hours of sideline coverage across all three sports seasons in 16 public high schools. Over 50 trained student volunteers provided consistent, supervised care, directly assisting thousands of student-athletes. The collaboration with on-call physicians through Wayne Pediatrics and the Detroit Medical Center Orthopedics and Sports Medicine enabled real-time consultation and emergency triage as needed. 



Conclusion: 


DPSHC demonstrates a sustainable, scalable model for addressing the absence of sideline medical personnel in under-resourced school systems. By leveraging medical student enthusiasm, structured clinical training, and institutional partnerships, this initiative has delivered meaningful healthcare access to student-athletes in Detroit. Looking ahead, we aim to expand the program’s impact through continued systematic data collection on injuries, hydration access, and volunteer experiences. These insights will guide ongoing improvements in both student-athlete well-being and the educational value for medical students.

Medical Student-Led Model for Sideline Sports Coverage in Underserved Detroit High Schools through the Detroit Public Schools Health Corp ​

Background: Direct acting antivirals (DAAs) are over 95% effective at curing hepatitis C virus (HCV) infection, yet treatment rates remain low among people who inject drugs (PWID), a priority population for HCV treatment. Given the high prevalence of HCV among PWID, this study looks to characterize treatment uptake and completion among PWID in a safety-net healthcare system in a large city.
Methods: We conducted a retrospective study to identify individuals with evidence of HCV (detectable HCV RNA) between 11/01/2021 to 10/31/2023 and evidence of possible or definite injection drug use (IDU) who accessed care within our integrated healthcare system. We then reviewed medical records of individuals we identified with HCV and IDU to determine demographic characteristics and progression through the HCV care continuum. We compared demographic characteristics at different stages of the care continuum to assess for factors associated with completion of each stage.
Results: 1165 individuals had positive HCV RNA results in our medical system during the study period. Of those, 149 individuals had evidence of definite (n=118, 80.3 %) or possible (n=29, 19%) IDU. 34.2% (n=51) of the study population met with a HCV treatment provider, 26.8% (n=40) started treatment, 25.5% (n=38) completed treatment, and 18.1% (n=27) had evidence of SVR12. Proportions of individuals linked to care did not differ significantly by gender, housing status, IDU status (definite vs. possible), or race/ethnicity.
Conclusions: Over a two-year period, only 26.8% of the 149 individuals with IDU and HCV started HCV treatment. The largest barrier in achieving cure was linking to a medical visit for HVC care after a positive HCV RNA test. Almost three quarters (74.5%) of those who met with a treatment provider completed treatment. No statistical difference was observed in linkage to care based on gender, race/ethnicity, age or housing status. Of those who did not complete HCV treatment, most were lost to follow up without a documented reason in the electronic medical record.

Hepatitis C Care Continuum among People Who Inject Drugs in a Safety-Net Healthcare System

Introduction: Food insecurity (FI) is associated with poor health outcomes, including obesity, diabetes, hypertension, and mental illness. While food voucher programs help address FI, their clinical impact is understudied. At Prisma Health, where 1 in 5 patients face barriers to healthy eating, we implemented a voucher program at a Family Medicine clinic to improve food access and assess health outcomes. 

Materials and Methods: Between February 1 and November 1, 2024, nurses and program coordinators recruited patients during routine visits if they met ≥1 of the following criteria: (1) positive screen on a validated FI questionnaire; (2) homelessness; (3) on Medicaid; (4) uncontrolled DM (A1c ≥8.0%), or (5) HTN (≥130/90 mmHg). Participants received one to three $15 vouchers per visit, redeemable for produce at a nearby market. Voucher use was tracked at the individual level, and clinical data were obtained through manual chart review. Analyses included descriptive statistics via SAS, negative binomial regression for redemption rates, and paired t-tests or Wilcoxon tests for clinical outcomes.

Results: We distributed 4,552 vouchers to 943 participants, with a 54.6% redemption rate. After exclusions, 877 were analyzed: 78% female, 85% Black, and 78% extremely low income. Diagnoses included DM (22%), HTN (52%), depression (19%), anxiety (23%), and overweight/obesity (61%; among 710 patients with BMI data). In multivariate analysis, HTN (IRR 1.26, p = 0.0018), age ≥45 (IRR 1.42, p = 0.0002), Black vs. White race (IRR 1.37, p = 0.0009), and Latino vs. Black race (IRR 1.39, p = 0.0339) were independently associated with higher redemption. In a pre-post analysis of 535 overweight/obese patients, BMI significantly decreased (mean difference -0.44, p = 0.0006). Among 136 patients with HTN who had a pre- systolic blood pressure ≥ 140, SBP decreased on average by 11.2 mmHg. In patients with uncontrolled DM, (pre- A1c ≥ 8, n=68) there was a 1.17 decrease in A1c. Patients with a PHQ-9 ≥ 10 experienced an 8.8-point decrease (p<0.0001) in their score. No significant changes were seen in GAD-7.

Conclusion: This study identified patients likely to engage in a food access program, including those with HTN, age ≥45, and Black or Latino race. BMI improved among overweight/obese participants; other clinical outcomes remained stable. As the first study of its kind in SC – one of seven states with FI prevalence above national average – future research is indicated to evaluate whether longer-term or higher-intensity programs improve clinical outcomes.

Physicians Fighting Food Insecurity

Background
To evaluate the effectiveness of 5 Rivers Heart Association's (5RHA) street medicine initiative via medical camps and mobile healthcare outreach in advancing cardiovascular disease prevention and treatment adherence while decreasing illness burden among vulnerable populations in India and the United States.
Methods
From 2019 to 2024, 5RHA organized 1,694 health outreach events, collecting comprehensive data from 395 sessions that examined 18,750 adults (18–80 years) throughout 5 Indian states and urban U.S. underserved communities. The program addressed high blood pressure, diabetes, joint disorders, psychological wellness, and malignancy prevention through standardized risk evaluation per AHA/ACC protocols, culturally appropriate health education focusing on lifestyle changes and medication consistency, adherence monitoring via mobile messaging, and integrated community psychological support. Measured parameters included systolic/diastolic pressure, glycated hemoglobin, body mass index, treatment compliance, and life satisfaction (SF-12 scale). Statistical analysis employed paired t-tests and logistic regression for pre and post comparisons.
Results
Following intervention, blood pressure management (≤140/90 mmHg) improved 35% in India (p<0.001) and 30% in the U.S. (p=0.002), while treatment adherence increased 45% (OR 1.92; 95% CI 1.73–2.15). Glycemic management was enhanced with 25% fewer patients having HbA1c >8% (p<0.01) and 30.4% decrease in LDL among high-risk cardiovascular patients (p<0.01). Psychological intervention improved cardiac self-care in 60% of anxious/depressed participants. Malignancy screening uptake rose 40%. Integrated physiotherapy and dietary counseling produced 68% better arthritis mobility measured by walking assessments. 87% of participants represented low-income families, with 95% of U.S. participants from ethnic minorities. Patient follow-up rates rose 48% due to team-generated reminders. Community collaborations decreased hospital re-admissions by 15%.
Conclusion
5 Rivers Heart Association's mobile health program substantially improves cardiovascular prevention, enhancing blood pressure control, glucose management, and psychological health while boosting treatment adherence in marginalized communities. This expandable approach, integrating education, digital tools, and health equity initiatives, advances AHA's 2030 disparity reduction objectives. Healthcare leaders should prioritize community-centered prevention strategies to maximize similar worldwide benefits.

Strenghthening Cardiovascular Health via Mobile Outreach: 5 Rivers Heart Association's Community Impact

Background
Breastfeeding provides optimal nutrition for infants with numerous health benefits, as recommended by the World Health Organization for the first six months exclusively and up to two years or beyond with complementary foods. Not breastfeeding results in substantial global economic losses, estimated at $341.3 billion annually (0.49% of global GDP). For mothers living with HIV in low and middle-income countries (LMICs), concerns about vertical transmission via breast milk and potential interactions with antiretroviral therapy create complex challenges that impact breastfeeding initiation and sustainment. However, concerns about HIV transmission via breast milk and negative interactions with antiretroviral therapy can impact breastfeeding initiation and sustainment in these populations.

Methods
A comprehensive systematic review of nine databases was conducted in March 2024 to identify studies comparing breastfeeding versus formula feeding cost-effectiveness outcomes in LMICs. Inclusion criteria encompassed primary research with economic outcomes related to both feeding methods in HIV-affected populations. Studies lacking economic data or direct comparisons between feeding methods were excluded. The review examined both quantitative and qualitative evidence on cost-effectiveness, healthcare costs, and socioeconomic barriers to breastfeeding.

Results
From 523 initially identified articles, nine studies conducted in Sub-Saharan African countries with high HIV prevalence were included in the final analysis. Two main themes emerged: 1) mothers living with HIV often engage in suboptimal breastfeeding practices due to fears of HIV transmission, economic pressures, social norms, and lack of support; and 2) breastfeeding coupled with antiretroviral treatment is a cost-effective infant feeding strategy compared to formula feeding in resource-limited settings. Breastfeeding with appropriate antiretroviral therapy was found to be cost-effective at traditional willingness-to-pay thresholds, reducing disability-adjusted life years (DALYs) and healthcare expenses related to infant morbidity and hospitalization. However, employment status, economic determinants, and workplace commitments significantly influenced feeding decisions, often resulting in lower breastfeeding rates among HIV-positive mothers compared to their HIV-negative counterparts.

Conclusion
This systematic review highlights the complex interplay between socioeconomic factors and health outcomes in breastfeeding decisions among mothers living with HIV in LMICs. Breastfeeding promotion represents not only a health-beneficial intervention, but also a cost-effective and potentially cost-saving investment for resource-limited healthcare systems when HIV is comprehensively managed through antiretroviral treatment. Future policies should incorporate supportive measures such as evidence-based counseling, educational campaigns, paid maternal leave, and enhanced healthcare infrastructure to overcome the economic and structural barriers to successful breastfeeding in HIV-affected populations.


Economic Implications of Breastfeeding Versus Formula Feeding in the Context of HIV in Low and Middle-Income Countries: A Systematic Review

Despite significant advancements in pharmaceuticals and medical interventions, heart disease remains the leading cause of death worldwide. Although much research has been dedicated to understanding its risk factors, significant gaps persist, particularly in understudied populations. Addressing these gaps is essential to developing more effective, personalized strategies for preventing and treating heart disease. Current research often analyzes risk factors independently, without considering their potential interactions. As a result, treatments that benefit one patient may be ineffective for another, yet providers frequently adopt a one-size-fits-all approach. We can move toward a more personalized healthcare model by analyzing how risk factors, outcomes, diagnostics, and treatments vary between individuals. Understanding the complex interplay between genetic, social, and psychological determinants will help improve outcomes and bring us closer to truly individualized care on a global scale. This study aims to investigate factors that predict or protect against myocardial infarction (MI) in patients with a known risk factor of hyperlipidemia. Using regression modeling and subsets, the analysis will evaluate individual variables and their interactions. 


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