University of Chicago Medical Center

Fast-acting subperception therapy in spinal cord stimulation (FAST-SCS) uses low-frequency, subthreshold stimulation to engage the dorsal column-mediated surround inhibition mechanism and thereby relieve pain. Our study was performed to better characterize the multidimensional long-term clinical outcomes of FAST-SCS therapy in patients with chronic low back and/or leg pain. Our prospective, multicenter, single-arm, open-label trial, conducted at 12 pain management centers across the USA, included male and female patients with chronic low back pain with/without leg pain refractory to conservative therapy. All eligible patients received an SCS implant. Outcomes evaluated included pain relief, disability, mobility, health-related quality of life, sleep quality, depression, pain catastrophizing, and global impression of change. Fifty-six patients received a permanent SCS implant and 55 were activated with FAST-SCS therapy. At 12months, 89% and 59% of patients achieved ≥ 50% and ≥ 80% pain relief, respectively (p < 0.0001), and pain intensity (verbal numerical rating scale) decreased by 4.9 ± 2.2 points (p < 0.0001). Significant improvements were observed in disability (Oswestry Disability Index - 24 ± 16 points, p < 0.0001) and endurance (6-Minute Walk Test + 73 ± 96m, p < 0.0001), while mobility and balance improved without reaching statistical significance (Timed Up-and-Go test - 7.5 ± 37.5s, p = 0.17). All psychosocial measures improved significantly at 12months compared to baseline, with an increase in the EQ5D-5L index (+ 0.200 ± 0.182, p < 0.0001) and decreases in the Pittsburgh Sleep Quality index (- 3.96 ± 4.31, p < 0.0001), Pain Catastrophizing Score (- 13.3 ± 11.4, p < 0.0001), and Beck Depression Index (- 7.9 ± 10.0, p < 0.0001). At 12months, 87% of patients reported being "much" or "very much" improved. Responses to FAST-SCS were at or above the minimal clinically important differences across all measured clinical dimensions. This prospective study demonstrated that FAST-SCS provided statistically significant, multidimensional benefits across pain, disability, mobility, and psychosocial outcomes over 12months in patients with chronic low back and/or leg pain. These findings support the use of FAST-SCS in this patient population. ClinicalTrials.gov (NCT04618471). https://www. gov/study/NCT04618471 .

The Medical College Admissions Test (MCAT) remains a significant barrier for students from low socioeconomic status (SES) backgrounds, with performance disparities driven by unequal access to resources rather than by differences in aptitude. Holistic admissions practices seek to contextualize exam performance alongside other essential pre-medical competencies such as resilience, empathy, and scientific inquiry. Evidence shows that students with middle-tercile MCAT scores who demonstrate these qualities will succeed in medical school and beyond. However, only those who apply can benefit from such holistic review. Little is known about application behaviors at this pivotal stage, when examinees must decide whether to apply with their achieved MCAT score. This study examines the relationship between socioeconomic status, MCAT performance, and application probability. This study analyzed de-identified Association of American Medical Colleges (AAMC) data for all MCAT examinees between 2017 and 2019, including sociodemographic characteristics and total MCAT score. The outcome was allopathic (M.D.) medical school application status through the 2021 application cycle, allowing examinees at least two full years to apply. The AAMC parental education and occupation (EO) indicator stood as a proxy for SES – ranging from EO-1 (less than college degree, any occupation) to EO-5 (doctoral degree; executive, managerial or professional occupations). Socioeconomic disadvantage (SED) was defined as EO-1 and EO-2. Middle- or top-tercile MCAT scores were achieved by 51.8% of examinees with SED (middle, 33.2%; top, 18.6%) compared with 73.1% of examines without SED (middle, 34.4%; top, 38.7%). The probability of applying to medical school was closely tied to MCAT performance, and regardless of SES, the probability of application with any given MCAT score was similar. While most top-tercile performers (92 to 94%) applied, a much lower proportion of middle-tercile performers (78 to 80%) applied. Socioeconomically disadvantaged MCAT examinees infrequently score in the top tercile where application rates are uniformly high. Those with acceptable, middle-tercile performance may under-appreciate their academic achievements through economic adversity, as over 20% do not apply to medical school. Targeted interventions are needed to promote application and maximize the impact of holistic review.

The consultation stage of scoping reviews, originally proposed by Arksey and O'Malley and further developed by Levac et al and the Joanna Briggs Institute, remains a conceptually ambiguous and inconsistently applied component of knowledge synthesis. In this context, consultation refers to the planned, purposeful engagement with knowledge users to elicit input on priorities, interpretation and gaps and to inform dissemination strategies. Although consultation has been framed as a means to validate findings or inform dissemination, it is often treated as an optional or peripheral activity, if included at all. In this manuscript, we revisit the consultation stage as an integral, collaborative and methodologically embedded feature of scoping reviews, one that warrants the same reflexivity, rigour and transparency as other stages of the process. Drawing from recent critiques in the health professions education literature and our own experience conducting knowledge syntheses, we position consultation not as a standalone study or superfluous add-on but as a dialogical, contextually responsive strategy for engaging knowledge users meaningfully. We offer practical guidance on how to design and execute consultations with methodological intentionality, aligned with the scoping review's epistemological stance and research objectives. Through case examples from our work and additional strategies drawn from the literature, we highlight how consultation can enhance the credibility, usability and relevance of review findings. We also reflect on the ethical and epistemic considerations of consultation, including issues of authorship and the challenges that arise when feedback diverges from review findings. In doing so, we call for a shift in how the consultation stage is conceptualised, designed and reported in scoping reviews. Rather than viewing consultation as a symbolic or confirmatory gesture, we argue that it should be embraced as a dynamic, humanising process that deepens interpretation, challenges assumptions and expands the real-world applicability of scoping review findings.

With rapid expansion of artificial intelligence (AI) in clinical documentation, responsible implementation of this tool is imperative in preserving the patient-physician relationship. Orthopaedic oncologists were surveyed to assess their utilization of, and attitudes towards, ambient listening software. An anonymous, voluntary, IRB-exempt survey (Appendix) was reviewed and distributed to members of the MSTS via the society's email listserv and distributed in paper and electronic formats to attendees at the AAOS Oncology Subspeciality day from March 14 to May 22, 2025. Sixty-three orthopaedic oncologists responded to the survey. Most (93%) practiced in an academic setting. Twenty-seven percent reported using AI with a majority using Dax Copilot. Half of AI users noted a positive impact on clinical encounters, and one respondent reported a negative impact. Most AI users (86%) reported improved efficiency and accuracy in documentation and 40% reported saving 1-2 h per clinic day. Of non-users, 71% were considering implementation. Although most orthopaedic oncologists are not using AI, the majority are considering implementation. AI users reported improvements in their documentation efficiency and accuracy. Further research is needed to understand the risks and benefits of this clinical tool from both providers' and patients' perspectives to guide responsible, widespread implementation.

In academic medicine, extramural grant funding is widely regarded as a hallmark of scholarly success. Yet, in medical education (MedEd), the economics of grant funding are poorly matched to the scale and cost of most scholarly projects. Small-dollar MedEd grants, typically under $10,000, have low success rates that rival those of large clinical awards, but still require time-intensive applications. Using an illustrative economic model, the authors estimate that the faculty labor required to prepare a typical MedEd application, approximately 40 hours, often costs the institution more than the proposal's expected monetary value. These conservative estimates exclude indirect cost limitations, the added burden of reviewer time, and the applicant's opportunity cost: every hour invested in a low-probability application is an hour not spent designing studies, collecting data, analyzing results, or publishing scholarship. Thus, for most small MedEd projects, the math does not add up. Repeated applications can drain time, money, and energy, while constant grant chasing risks undermining the very scholarship that funding is intended to support. The authors encourage institutions to reconsider blanket expectations for extramural MedEd funding, shifting instead toward more sustainable support models. These include internal micro-funding to cover modest research costs, protected-time awards that address the major constraint on faculty productivity (ie, time), scholarship-first mindsets that reward contributions irrespective of external dollars, collaborative funding mechanisms that pool institutional resources, and scholarly communities of practice that offer ongoing mentorship and infrastructure. The authors further argue that institutions supported by student tuition and public funds have an ethical obligation to subsidize educational research and innovation, as the quality of educational practice is inseparable from the quality and safety of healthcare itself. Redirecting faculty efforts from low-probability, low-yield grant chasing toward scholarship can foster a more sustainable research culture that rewards quality, drives innovation, and delivers lasting educational impact.