Billy Ho Hung Cheung

Introduction: This cross‐sectional study aims to evaluate the association between experience in musical instruments and surgical skills in medical students. Methods: Online questionnaires were distributed to 243 final year students for their baseline demographic data and exposure to musical instrument training. A two‐hour surgical skills training was conducted, and students were assessed for their surgical skills by two blinded assessors 4 weeks after the teaching using the objective structured assessment of technical skills (OSATS) score. Results: Two hundred three final year medical students were recruited. The median age was 24 years old (range 23–34). 126 (62.3%) had experience in playing musical instruments. 101 (80.2%) students mainly played keyboard, 23 (18.3%) played strings, and 2 (1.5%) played brass/wind. The mean time for task completion was 249.3 s (SD = 45.9) in the control group (no musical experience), while the case group (with musical experience) was 223.5 s (SD = 28.8), p < 0.001. The mean OSATS score in the control group was 7.79 (SD = 0.78) while the case group was 8.28 (SD = 0.59), p < 0.001. The mean time for task completion was 223.8 s (SD = 30.8) in the keyboard group, while that in the strings group was 223.2 s (SD = 18.6), p = 0.926. The mean OSATS score was 8.3 (SD = 0.59) in the keyboard group and 8.26 in the strings group (SD = 0.54), p = 0.789. Conclusion: Experience with musical instruments is associated with quicker time of basic surgical tasks completion with better technique.

Cheung BH, et al. J Breast Cancer. 2026 ;29:e38. https://doi.org/10.4048/jbc.2026.0196

Cheung BH, et al. J Breast Cancer. 2026 ;29:e15. https://doi.org/10.4048/jbc.2025.0077

Introduction: Chylous leakage is a rare complication following breast cancer surgery, characterized by milky, lipid-rich fluid collection in surgical drains. While well documented in thoracic and abdominal surgeries, its occurrence after breast procedures remains poorly understood with limited literature. This study evaluates the incidence, characteristics, and management of this complication. Methods: A retrospective analysis was conducted, and seven patients with confirmed chyle leakage were identified among 1,441 breast cancer patients who underwent breast cancer surgery at two Hong Kong surgical centres within a 5-year period. Patients with prolonged drainage or milky fluid underwent laboratory analysis to confirm chylous leakage. Demographics, tumour characteristics, surgical details, management strategies, and outcomes were analysed. Results: Seven patients (0.49%) developed chylous leakage. The median age was 67 years, and the median BMI was 22.2 kg/m2. Four patients had right-sided, and three had left-sided breast cancer. Most tumours (85.7%) were located in the upper outer quadrant. All patients underwent mastectomy with various axillary procedures. Chylous drainage was identified between postoperative days 2 and 15 in 6 patients, with 1 late presentation at 6 months. Six patients (85.7%) were successfully managed with dietary modifications (medium-chain triglyceride or low-fat diet), with resolution within 3–11 days. One patient with late presentation required surgical intervention as definitive treatment. No recurrences or delays in adjuvant therapy occurred. Conclusion: Chylous leakage after breast cancer surgery can occur on either side and can occur in patient with sentinel lymph node biopsy. Conservative management with dietary modification is highly effective as first-line treatment. This study highlights the need for increased awareness of this complication and provides foundation for further investigation into its incidence, pathophysiology, and optimal management.

Introduction: Large language models, in particular ChatGPT, have showcased remarkable language processing capabilities. Given the substantial workload of university medical staff, this study aims to assess the quality of multiple-choice questions (MCQs) produced by ChatGPT for use in graduate medical examinations, compared to questions written by university professoriate staffs based on standard medical textbooks. Methods: 50 MCQs were generated by ChatGPT with reference to two standard undergraduate medical textbooks (Harrison’s, and Bailey & Love’s). Another 50 MCQs were drafted by two university professoriate staff using the same medical textbooks. All 100 MCQ were individually numbered, randomized and sent to five independent international assessors for MCQ quality assessment using a standardized assessment score on five assessment domains, namely, appropriateness of the question, clarity and specificity, relevance, discriminative power of alternatives, and suitability for medical graduate examination. Results: The total time required for ChatGPT to create the 50 questions was 20 minutes 25 seconds, while it took two human examiners a total of 211 minutes 33 seconds to draft the 50 questions. When a comparison of the mean score was made between the questions constructed by A.I. with those drafted by humans, only in the relevance domain that the A.I. was inferior to humans (A.I.: 7.56 +/- 0.94 vs human: 7.88 +/- 0.52; p = 0.04). There was no significant difference in question quality between questions drafted by A.I. versus humans, in the total assessment score as well as in other domains. Questions generated by A.I. yielded a wider range of scores, while those created by humans were consistent and within a narrower range. Conclusion: ChatGPT has the potential to generate comparable-quality MCQs for medical graduate examinations within a significantly shorter time.