Marcos Rojas Pino

All Publications

• The Physiologic Effect of Augmented Reality Simulation Versus Traditional Simulation: A Noninferiority, Randomized Controlled Trial. The journal of education in perioperative medicine : JEPM Rama, A., Rojas-Pino, M. S., Wang, E. Y., Rodriguez, S. T., Suen, M. Y., Titzler, J. S., Zuniga-Hernandez, M., Jackson, C., Rosales, O., Collins, F., Caruso, T. J. 2025; 27 (1): E740

  Abstract

  Background: Traditional medical simulations leverage stressful scenarios to potentiate memory. Augmented reality (AR) simulations provide cost-effective experiences using holograms instead of mannequins. This study investigated the physiologic response to AR simulations.Methods: This was a noninferiority, controlled trial at an academic, pediatric hospital in Northern California among health care workers randomized to AR or traditional, in situ medical simulations. The primary outcome investigated parasympathetic tone. Biometric sensors assessed parasympathetic tone as respiratory sinus arrhythmia (RSA). A difference in RSA of less than 10% between groups was considered noninferior. Secondary outcomes explored usability, ergonomics, satisfaction, and recall with the System Usability Scale (SUS), ISO 9241-400, Simulation Design Scale (SDS), and an electronic questionnaire 5 months after the intervention, respectively.Results: A total of 111 participants were enrolled and 106 analyzed. Both groups experienced a decrease in mean RSA from baseline to during the simulation (P < .001 for both groups). Subsequently, there was an increase in RSA from the simulation period to the recovery period (P < .001 for the AR group and P = .035 for the traditional group). Regarding secondary outcomes, the mean SUS score of 70.5 suggested good usability, 65.38% of AR participants reported feeling comfortable using the headset, and satisfaction in both groups was similar except for differences in use of real-life factors. The recall assessment was completed by 12 AR and 15 traditional participants, with similar scores between the 2 groups (P = .4).Conclusions: AR simulations produced a noninferior change in parasympathetic tone compared with traditional simulations. Future investigations may explore the effectiveness of AR simulations for developing nontechnical skills during remote training. (Registration: Clinical Trials Registry NCT05674188.).

  View details for DOI 10.46374/VolXXVII_Issue1_Rama

  View details for PubMedID 40207076

• Exploring Differences in Clinical Decisions Between Medical Students and Expert Clinicians. Advances in medical education and practice Rojas, M., Price, A., Kim, C. J., Chen, S. F., Gutierrez, K., Wieman, C., Salehi, S. 2024; 15: 1285-1297

  Abstract

  Numerous challenges exist in effectively bridging theory and practice in the teaching and assessment of clinical reasoning, despite an abundance of theoretical models. This study compares clinical reasoning practices and decisions between medical students and expert clinicians using a problem-solving framework from the learning sciences, which identifies clinical reasoning as distinct, observable actions in clinical case solving. We examined students at various training stages against expert clinicians to address the research question: How do expert clinicians and medical students differ in their practices and decisions during the diagnostic process?.We developed a questionnaire about a pediatric infectious disease case based on the problem-solving framework from the learning sciences to probe clinical reasoning decisions. The questionnaire had four sections: medical history, physical examination, medical tests, and working diagnosis. The questionnaire was administered at Stanford University between January 2019 and June 2023 to collect data from 10 experts and 74 medical students. We recruited participants through maximum variation sampling. We applied deductive content analysis to systematically code responses to identify patterns in the execution of the practices and decisions across the questionnaire.This research introduces a highly detailed, empirically developed framework that holds potential to bridge theory and practice, offering practical insights for medical instructors in teaching clinical reasoning to students across various stages of their training. This framework involves nine practices, with a total of twenty-nine decisions that need to be made when carrying out these practices. Differences between experts and students centered on ten decisions across the practices: Differential diagnosis formulation, Diagnostic plan and execution, Clinical data reassessment, and Clinical solution review.We were able to identify nuanced differences in clinical reasoning between students and expert physicians under one comprehensive problem-solving framework from the learning sciences. Identifying key clinical reasoning practices and decision differences could help develop targeted instructional materials and assessment tools, aiding instructors in fostering clinical reasoning in students.

  View details for DOI 10.2147/AMEP.S492302

  View details for PubMedID 39734779

  View details for PubMedCentralID PMC11681814

• Reclaiming focus in medical education: Learning, not AI. Medical teacher Rojas, M. 2024: 1

  View details for DOI 10.1080/0142159X.2024.2394171

  View details for PubMedID 39167925

• Exploring the Performance of ChatGPT Versions 3.5, 4, and 4 With Vision in the Chilean Medical Licensing Examination: Observational Study. JMIR medical education Rojas, M., Rojas, M., Burgess, V., Toro-Pérez, J., Salehi, S. 2024; 10: e55048

  Abstract

  The deployment of OpenAI's ChatGPT-3.5 and its subsequent versions, ChatGPT-4 and ChatGPT-4 With Vision (4V; also known as "GPT-4 Turbo With Vision"), has notably influenced the medical field. Having demonstrated remarkable performance in medical examinations globally, these models show potential for educational applications. However, their effectiveness in non-English contexts, particularly in Chile's medical licensing examinations-a critical step for medical practitioners in Chile-is less explored. This gap highlights the need to evaluate ChatGPT's adaptability to diverse linguistic and cultural contexts.This study aims to evaluate the performance of ChatGPT versions 3.5, 4, and 4V in the EUNACOM (Examen Único Nacional de Conocimientos de Medicina), a major medical examination in Chile.Three official practice drills (540 questions) from the University of Chile, mirroring the EUNACOM's structure and difficulty, were used to test ChatGPT versions 3.5, 4, and 4V. The 3 ChatGPT versions were provided 3 attempts for each drill. Responses to questions during each attempt were systematically categorized and analyzed to assess their accuracy rate.All versions of ChatGPT passed the EUNACOM drills. Specifically, versions 4 and 4V outperformed version 3.5, achieving average accuracy rates of 79.32% and 78.83%, respectively, compared to 57.53% for version 3.5 (P<.001). Version 4V, however, did not outperform version 4 (P=.73), despite the additional visual capabilities. We also evaluated ChatGPT's performance in different medical areas of the EUNACOM and found that versions 4 and 4V consistently outperformed version 3.5. Across the different medical areas, version 3.5 displayed the highest accuracy in psychiatry (69.84%), while versions 4 and 4V achieved the highest accuracy in surgery (90.00% and 86.11%, respectively). Versions 3.5 and 4 had the lowest performance in internal medicine (52.74% and 75.62%, respectively), while version 4V had the lowest performance in public health (74.07%).This study reveals ChatGPT's ability to pass the EUNACOM, with distinct proficiencies across versions 3.5, 4, and 4V. Notably, advancements in artificial intelligence (AI) have not significantly led to enhancements in performance on image-based questions. The variations in proficiency across medical fields suggest the need for more nuanced AI training. Additionally, the study underscores the importance of exploring innovative approaches to using AI to augment human cognition and enhance the learning process. Such advancements have the potential to significantly influence medical education, fostering not only knowledge acquisition but also the development of critical thinking and problem-solving skills among health care professionals.

  View details for DOI 10.2196/55048

  View details for PubMedID 38686550

• Characterization of content associated with lesbian, gay, bisexual, transgender, intersex, and queer individuals in Chilean medical schools: a cross-sectional survey. BMC medical education Rojas, M., Cánepa González, J., Ortiz-López, N. 2024; 24 (1): 167

  Abstract

  Lesbian, gay, bisexual, transgender, intersex, queer, and other sexual and gender identities (LGBTIQ+) individuals face health inequities. Additionally, medical students report a lack of confidence in providing specific health care to LGBTIQ + individuals, and medical schools do not offer the breadth and depth of coverage needed to fully prepare and make them comfortable in caring for these individuals. This study aims to characterize the teaching of curricular content related to LGBTIQ + health issues in medical schools in Chile.This was a cross-sectional descriptive mixed-methods study based on a 15-question survey sent to school directors of the 24 medical schools in Chile, conducted between October 2020 and July 2021. The questions included in the study were mostly based on two pre-existing questionnaires covering content, assessment methods, and identification of barriers to teaching this content.The validated questionnaire was answered by 14 of 24 Chilean medical schools, with 11 schools (78.9%) declaring that they included some training in their curriculum. The predominant range of time allocated to LGBTIQ + training in medical programs was between 1 and 5 h. The most addressed topics were HIV (92.85%), sexual orientation (78.57%), and chronic disease risk in LGBTIQ + populations (78.57%). Most schools, accounting for 71.5%, considered the content they delivered to be "moderately insufficient" or "insufficient". Regarding the teaching methodologies, the most used were lectures (92.8%), clinical cases (42.9%), and clinical simulation (28.6%).Most surveyed medical schools reported curricular spaces dedicated to teaching health issues of LGBTIQ + individuals, primarily during the pre-internship training period. However, the time allocated is insufficient, and there is little approach to topics beyond the patient's sexual history or sexual orientation. Given the crucial role of medical schools, they must adopt both local and national strategies to enrich training focused on the care of LGBTIQ + patients.

  View details for DOI 10.1186/s12909-024-05150-6

  View details for PubMedID 38383416

  View details for PubMedCentralID 4102129

• Introducing the Problem-Solving Template as a Tool for Equity: Addressing Incoming Preparation Disparities J. Chem. Educ. Schwartz Poehlmann, J. K., Nardo, J. E., Rojas, M., Salehi, S. 2024; 101 (3): 1332–1340

  View details for DOI 10.1021/acs.jchemed.3c00732

• Impact of extracurricular activities on the self-actualization of medical students: a systematic review SPANISH JOURNAL OF MEDICAL EDUCATION Gordillo-Espinace, E., Dolz-Torres, P., Palma-Bifani, P., Rojas-Pino, M. 2024; 5 (1)

  View details for DOI 10.6018/edumed.592721

  View details for Web of Science ID 001346427200010

• Impact of 3D printing on medical students' learning: a systematic review SPANISH JOURNAL OF MEDICAL EDUCATION Zelada-Mirror, M., Segura-Beltran, F., Margas-Cavieres, F., Rojas-Pino, M. 2024; 5 (4)

  View details for DOI 10.6018/edumed.626811

  View details for Web of Science ID 001347079100001

• Well-being variations on students of health sciences related to their learning opportunities, resources, and daily activities in an online and on-crisis context: a survey-based study. BMC medical education Perez-Villalobos, C., Ventura-Ventura, J., Spormann-Romeri, C., Paredes-Villarroel, X., Rojas-Pino, M., Jara-Reyes, C., Lopez, M., Castillo-Rabanal, I., Schilling-Norman, M. J., Baquedano-Rodriguez, M., Parra-Ponce, P., Toirkens-Niklitschek, J., Briede-Westermeyer, J. C., Alvarado-Figueroa, D. 2023; 23 (1): 37

  Abstract

  BACKGROUND: Universities' training process intensely relies on face-to-face education. The COVID-19 pandemic interrupted it and forced them to reinvent their process online. But this crisis seems not to be the last we will face, and we take it as a lesson to prepare for future crises. These critical contexts are especially challenging because they imply changing teaching strategies, and students may not have the technology access or the living conditions to connect as they need. They also lived through a pandemic where the virus and the life changes added stress to their learning process and threatened their well-being. So, this study aims to analyze how well-being variations reported by Health sciences students relate to their learning opportunities, access conditions, and daily activities.METHOD: We surveyed 910 Health sciences students from six different Chilean universities at the end of the first semester of 2020, the first in pandemic conditions. Respondents answered online questionnaires about 1) Remote teaching activities, 2) Learning resources availability, 3) Daily life activities, and 4) Well-being changes. We performed descriptive analysis and Structural Equation Modelling.RESULTS: Live videoconference classes were the most frequent teaching activity; only a third of the students had quiet spaces to study online, and most had to housekeep daily. More than two third reported some well-being deterioration. The structural equation model showed a good fit.CONCLUSION: Results show an online learning scenario that tries to emulate traditional learning focusing on expositive strategies. Most students reported that their well-being deteriorated during the semester, but tutorials, workplace availability, and social support were protective factors.

  View details for DOI 10.1186/s12909-023-04011-y

  View details for PubMedID 36653767

• Remote observation of surgeries in the study of anatomy in medical students: A systematic review. SPANISH JOURNAL OF MEDICAL EDUCATION Garrido, V., Saez, M., Salinas, C., Marcos-Rojas 2023; 4 (1): 1-11

  View details for DOI 10.6018/edumed.543271

  View details for Web of Science ID 001346458200001

• Satisfaction with remote teaching during the first semester of the COVID-19 crisis: Psychometric properties of a scale for health students PLOS ONE Perez-Villalobos, C., Ventura-Ventura, J., Spormann-Romeri, C., Melipillan, R., Jara-Reyes, C., Paredes-Villarroel, X., Rojas-Pino, M., Baquedano-Rodriguez, M., Castillo-Rabanal, I., Parra-Ponce, P., Bastias-Vega, N., Alvarado-Figueroa, D., Matus-Betancourt, O. 2021; 16 (4): e0250739

  Abstract

  Due to the health crisis caused by the COVID-19 pandemic, 220 million college students in the world had to halt face-to-face teaching and migrate to what has been called Emergency Remote Teaching, using virtual media, but without adequate preparation. The way this has impacted the student body and its satisfaction with the training process is unknown and there are no instruments backed by specific validity and reliability studies for this teaching context. This is why this study aims to analyze the psychometric properties of the Remote Teaching Satisfaction Scale applied to Chilean health sciences students.Quantitative study by means of surveys. We surveyed 1,006 health careers undergraduates chosen by convenience sampling. They came from six Chilean universities, located over a distance of 3,020 kilometers and followed 7 different careers. Women comprised the 78.53%. They answered the Remote Teaching Satisfaction Scale online to evaluate their perception of the first Emergency Remote Teaching term in 2020.A descriptive analysis of the items showed a moderate to positive evaluation of the teaching. The Confirmatory Factorial Analysis showed an adequate adjustment of the theoretical four factors model to the data obtained (CFI = 0.959; TLI = 0.953; RMSEA = 0.040). Correlations among factors oscillated from r = 0.21 to r = 0.69. The measurement invariance analysis supported the Configural, Metric and a partial Scalar model. Differences were found in three of the four factors when comparing the first-year students with those of later years. Finally, the Cronbach's α and McDonald's ω coefficients were over 0.70.The results display initial psychometric evidence supporting the validity and reliability of the Remote Teaching Satisfaction Scale to assess academic satisfaction in Chilean health careers students. Likewise, it is seen that first-year students show higher satisfaction levels about the implemented teaching.

  View details for DOI 10.1371/journal.pone.0250739

  View details for Web of Science ID 000662174400072

  View details for PubMedID 33909704

  View details for PubMedCentralID PMC8081238

• Music Training and Education Slow the Deterioration of Music Perception Produced by Presbycusis in the Elderly FRONTIERS IN AGING NEUROSCIENCE Moreno-Gomez, F. N., Veliz, G., Rojas, M., Martinez, C., Olmedo, R., Panussis, F., Dagnino-Subiabre, A., Delgado, C., Delano, P. H. 2017; 9: 149

  Abstract

  The perception of music depends on the normal function of the peripheral and central auditory system. Aged subjects without hearing loss have altered music perception, including pitch and temporal features. Presbycusis or age-related hearing loss is a frequent condition in elderly people, produced by neurodegenerative processes that affect the cochlear receptor cells and brain circuits involved in auditory perception. Clinically, presbycusis patients have bilateral high-frequency hearing loss and deteriorated speech intelligibility. Music impairments in presbycusis subjects can be attributed to the normal aging processes and to presbycusis neuropathological changes. However, whether presbycusis further impairs music perception remains controversial. Here, we developed a computerized version of the Montreal battery of evaluation of amusia (MBEA) and assessed music perception in 175 Chilean adults aged between 18 and 90 years without hearing complaints and in symptomatic presbycusis patients. We give normative data for MBEA performance in a Latin-American population, showing age and educational effects. In addition, we found that symptomatic presbycusis was the most relevant factor determining global MBEA accuracy in aged subjects. Moreover, we show that melodic impairments in presbycusis individuals were diminished by music training, while the performance in temporal tasks were affected by the educational level and music training. We conclude that music training and education are important factors as they can slow the deterioration of music perception produced by age-related hearing loss.

  View details for DOI 10.3389/fnagi.2017.00149

  View details for Web of Science ID 000401658300001

  View details for PubMedID 28579956

  View details for PubMedCentralID PMC5437118