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Tessler I, Wolfovitz A, Alon EE, Gecel NA, Livneh N, Zimlichman E, Klang E. ChatGPT's adherence to otolaryngology clinical practice guidelines. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08634-9. [PMID: 38647684 DOI: 10.1007/s00405-024-08634-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Large language models, including ChatGPT, has the potential to transform the way we approach medical knowledge, yet accuracy in clinical topics is critical. Here we assessed ChatGPT's performance in adhering to the American Academy of Otolaryngology-Head and Neck Surgery guidelines. METHODS We presented ChatGPT with 24 clinical otolaryngology questions based on the guidelines of the American Academy of Otolaryngology. This was done three times (N = 72) to test the model's consistency. Two otolaryngologists evaluated the responses for accuracy and relevance to the guidelines. Cohen's Kappa was used to measure evaluator agreement, and Cronbach's alpha assessed the consistency of ChatGPT's responses. RESULTS The study revealed mixed results; 59.7% (43/72) of ChatGPT's responses were highly accurate, while only 2.8% (2/72) directly contradicted the guidelines. The model showed 100% accuracy in Head and Neck, but lower accuracy in Rhinology and Otology/Neurotology (66%), Laryngology (50%), and Pediatrics (8%). The model's responses were consistent in 17/24 (70.8%), with a Cronbach's alpha value of 0.87, indicating a reasonable consistency across tests. CONCLUSIONS Using a guideline-based set of structured questions, ChatGPT demonstrates consistency but variable accuracy in otolaryngology. Its lower performance in some areas, especially Pediatrics, suggests that further rigorous evaluation is needed before considering real-world clinical use.
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Affiliation(s)
- Idit Tessler
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel.
- School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel.
| | - Amit Wolfovitz
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran E Alon
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir A Gecel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Livneh
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Zimlichman
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel
- The Sheba Talpiot Medical Leadership Program, Ramat Gan, Israel
- Hospital Management, Sheba Medical Center, Ramat Gan, Israel
| | - Eyal Klang
- The Division of Data-Driven and Digital Medicine (D3M), Icahn School of Medicine at Mount Sinai, New York, USA
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Alessandri Bonetti M, Giorgino R, Gallo Afflitto G, De Lorenzi F, Egro FM. How Does ChatGPT Perform on the Italian Residency Admission National Exam Compared to 15,869 Medical Graduates? Ann Biomed Eng 2024; 52:745-749. [PMID: 37490183 DOI: 10.1007/s10439-023-03318-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE The study aims to assess ChatGPT performance on the Residency Admission National Exam to evaluate ChatGPT's level of medical knowledge compared to graduate medical doctors in Italy. METHODS ChatGPT3 was used in June 2023 to undertake the 2022 Italian Residency Admission National Exam-a 140 multiple choice questions computer-based exam taken by all Italian medical graduates yearly, used to assess basic science and applied medical knowledge. The exam was scored using the same criteria defined by the national educational governing body. The performance of ChatGPT was compared to the performance of the 15,869 medical graduates who took the exam in July 2022. Lastly, the integrity and quality of ChatGPT's responses were evaluated. RESULTS ChatGPT answered correctly 122 out of 140 questions. The score ranked in the top 98.8th percentile among 15,869 medical graduates. Among the 18 incorrect answers, 10 were evaluating direct questions on basic science medical knowledge, while 8 were evaluating candidates' applied clinical knowledge and reasoning under the form of case presentation. Errors were logical (2 incorrect answers) and informational in nature (16 incorrect answers). Explanations to the correct answers were all evaluated as "appropriate." Comparison to national statistics related to the minimal score needed to match into each specialty, demonstrated that the performance of ChatGPT would have granted the candidate a match into any specialty. CONCLUSION ChatGPT proved to be proficient in basic science medical knowledge and applied clinical knowledge. Future research should assess the impact and reliability of ChatGPT in clinical practice.
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Affiliation(s)
- Mario Alessandri Bonetti
- Residency Program in Plastic Surgery, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Gabriele Gallo Afflitto
- Residency Program in Ophthalmology, Università di Roma "Tor Vergata", Via Cracovia 50, 00133, Rome, Italy
| | - Francesca De Lorenzi
- Department of Plastic Surgery, European Institute of Oncology, Via Giuseppe Ripamonti 345, 20122, Milan, Italy
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street 6B Scaife Hall, Pittsburgh, PA, 15261, USA.
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Lehut T, Lambert C, Mortier R, Futier E, Chabanne R, Bauer U, Verdier P, Ravan R, Ocquidant P, Mourgues C, Lautrette A. Cost awareness among intensivists in their daily clinical practice: a prospective multicentre study. Eur J Health Econ 2024:10.1007/s10198-024-01686-y. [PMID: 38472725 DOI: 10.1007/s10198-024-01686-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/13/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Better cost-awareness is a prerogative in achieving the best benefit/risk/cost ratio in the care. We aimed to assess the cost-awareness of intensivists in their daily clinical practice and to identify factors associated with accurate estimate of cost (50-150% of the real cost). METHODS We performed a prospective observational study in seven French ICUs. We compared the estimate of intensivists of the daily costs of caring with the real costs on a given day. The estimates covered five categories (drugs, laboratory tests, imaging modalities, medical devices, and waste) whose sum represented the overall cost. RESULTS Of the 234 estimates made by 65 intensivists, 70 (29.9%) were accurate. The median overall cost estimate (€330 [170; 620]) was significantly higher than the real cost (€178 [124; 239], p < 0.001). This overestimation was found in four categories, in particular for waste (€40 [15; 100] vs. €1.1 [0.6; 2.3], p < 0.001). Only the laboratory tests were underestimated (€65 [30; 120] vs. €106 [79; 138], p < 0.001). Being aware of the financial impact of prescriptions was factor associated with accurate estimate (OR: 5.05, 95%CI:1.47-17.4, p = 0.01). However, feeling able to accurately perform estimation was factor negatively associated with accurate estimate (OR: 0.11, 95%CI: 0.02-0.71, p = 0.02). CONCLUSION French intensivists have a poor awareness of costs in their daily clinical practice. Raising awareness of the financial impact of prescriptions, and of the cost of laboratory tests and waste are the main areas for improvement that could help achieve the objective of the best care at the best cost.
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Affiliation(s)
- Timothée Lehut
- Department of Anaesthesiology and Critical Care Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Romain Mortier
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Anaesthesiology and Critical Care Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Russell Chabanne
- Department of Anaesthesiology and Critical Care Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Ulrich Bauer
- Intensive Care Unit, Cancer Center Jean Perrin, Clermont-Ferrand, France
| | - Philippe Verdier
- Intensive Care Unit, Centre Hospitalier de Montluçon, Montluçon, France
| | - Ramin Ravan
- Intensive Care Unit, Centre Hospitalier Jacques Lacarin, Vichy, France
| | | | - Charline Mourgues
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandre Lautrette
- Intensive Care Unit, Cancer Center Jean Perrin, Clermont-Ferrand, France.
- Intensive Care Medicine, CHU Clermont-Ferrand,Intensive Care Unit, Cancer Centre Jean Perrin, Clermont-Ferrand, 54 rue Montalembert BP69, Cedex 1, 63003, France.
- LMGE (Laboratoire Micro-organismes: Génome et Environnement), UMR CNRS 6023, Université Clermont Auvergne, Clermont-Ferrand, France.
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Aksoy C, Reimold P, Schumann A, Schneidewind L, Karschuck P, Flegar L, Leitsmann M, Heers H, Huber J, Zacharis A, Ihrig A. Enhancing Human Papillomavirus Vaccination Rates through Better Knowledge? Insights from a Survey among German Medical Students. Urol Int 2024; 108:153-158. [PMID: 38246131 PMCID: PMC10994630 DOI: 10.1159/000536257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Vaccination against human papillomavirus (HPV) significantly reduces the risk for malignant diseases like cervix, anal, or penile cancer. However, although vaccination rates are rising, they are still too low mirroring a lack of disease awareness in the community. This study aims to evaluate knowledge about HPV vaccination as well as the vaccination rate among German medical students. MATERIAL AND METHODS Medical students were surveyed during a German medical students' sports event. The self-designed survey on HPV vaccination consisted of 24 items. The data collection was anonymous. RESULTS Among 974 participating medical students 64.9% (632) were women, 335 (34.4%) were male and 7 (0.7%) were nonbinary. Mean age was 23.1 ± 2.7 (± standard deviation; range 18-35) years. Respondents had studied mean 6.6 ± 3.3 (1-16) semesters and 39.4% (383) had completed medical education in urology. 613 (64%) respondents reported that HPV had been discussed during their studies. 7.6% (74) had never heard of HPV. In a multivariate model female gender, the knowledge about HPV, and having worked on the topic were significantly associated with being HPV-vaccinated. Older students were vaccinated less likely. CONCLUSIONS Better knowledge and having worked on the topic of HPV were associated with a higher vaccination rate. However, even in this highly selected group the knowledge about HPV vaccination was low. Consequently, more information and awareness campaigns on HPV vaccination are needed in Germany to increase vaccination rates.
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Affiliation(s)
- Cem Aksoy
- Department of Urology, University Hospital Marburg, Marburg, Germany
| | - Philipp Reimold
- Department of Urology, University Hospital Marburg, Marburg, Germany
| | - Annika Schumann
- Department of Nuclear Medicine, Philipps-University Marburg, Marburg, Germany
| | - Laila Schneidewind
- Department of Urology, University Medical Center Rostock, Rostock, Germany
| | - Philipp Karschuck
- Department of Urology, University Hospital Marburg, Marburg, Germany
| | - Luka Flegar
- Department of Urology, University Hospital Marburg, Marburg, Germany
| | - Marianne Leitsmann
- Department of Urology, Medical University Graz, Graz, Austria
- Institute for Applied Quality Improvement and Research in Health Care GmbH, Goettingen, Germany
| | - Hendrik Heers
- Department of Urology, University Hospital Marburg, Marburg, Germany
| | - Johannes Huber
- Department of Urology, University Hospital Marburg, Marburg, Germany
| | | | - Andreas Ihrig
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany
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Lario R, Kawamoto K, Sottara D, Eilbeck K, Huff S, Del Fiol G, Soley R, Middleton B. A method for structuring complex clinical knowledge and its representational formalisms to support composite knowledge interoperability in healthcare. J Biomed Inform 2023; 137:104251. [PMID: 36400330 DOI: 10.1016/j.jbi.2022.104251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/08/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The use and interoperability of clinical knowledge starts with the quality of the formalism utilized to express medical expertise. However, a crucial challenge is that existing formalisms are often suboptimal, lacking the fidelity to represent complex knowledge thoroughly and concisely. Often this leads to difficulties when seeking to unambiguously capture, share, and implement the knowledge for care improvement in clinical information systems used by providers and patients. OBJECTIVES To provide a systematic method to address some of the complexities of knowledge composition and interoperability related to standards-based representational formalisms of medical knowledge. METHODS Several cross-industry (Healthcare, Linguistics, System Engineering, Standards Development, and Knowledge Engineering) frameworks were synthesized into a proposed reference knowledge framework. The framework utilizes IEEE 42010, the MetaObject Facility, the Semantic Triangle, an Ontology Framework, and the Domain and Comprehensibility Appropriateness criteria. The steps taken were: 1) identify foundational cross-industry frameworks, 2) select architecture description method, 3) define life cycle viewpoints, 4) define representation and knowledge viewpoints, 5) define relationships between neighboring viewpoints, and 6) establish characteristic definitions of the relationships between components. System engineering principles applied included separation of concerns, cohesion, and loose coupling. RESULTS A "Multilayer Metamodel for Representation and Knowledge" (M*R/K) reference framework was defined. It provides a standard vocabulary for organizing and articulating medical knowledge curation perspectives, concepts, and relationships across the artifacts created during the life cycle of language creation, authoring medical knowledge, and knowledge implementation in clinical information systems such as electronic health records (EHR). CONCLUSION M*R/K provides a systematic means to address some of the complexities of knowledge composition and interoperability related to medical knowledge representations used in diverse standards. The framework may be used to guide the development, assessment, and coordinated use of knowledge representation formalisms. M*R/K could promote the alignment and aggregated use of distinct domain-specific languages in composite knowledge artifacts such as clinical practice guidelines (CPGs).
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Affiliation(s)
- Robert Lario
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | | | - Karen Eilbeck
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Stanley Huff
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States; Graphite Health, Salt Lake City, UT, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
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Duane M, Martinez V, Berry M, Manhart MD. Evaluation of a fertility awareness-based shared decision-making tool part 1: Study design and impact on clinician knowledge. PEC Innov 2022; 1:100061. [PMID: 37213746 PMCID: PMC10194193 DOI: 10.1016/j.pecinn.2022.100061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 05/23/2023]
Abstract
Objective To assess the impact of a Shared Decision-Making (SDM) tool for fertility awareness-based methods (FABMs) of family planning. Methods Clinicians familiar with at least one FABM were randomly invited to participate in a prospective cross-over study to compare usual practice to the use of the SDM tool when discussing FABMs with patients. Patients completed surveys pre- and post-office visit and six months later. The primary outcome explored the effect of online education on use of the SDM tool on clinicians' knowledge of FABMs. Results Of 278 clinicians contacted, 54% could not be reached, and 15% did not provide women's health services. The 26 clinicians enrolled were experienced, with more than half recommending FABMs for ≥10 years, and 73% recommending more than one FABM to patients. Knowledge scores significantly improved after online training and use of the SDM tool (baseline mean score = 9.54 (scale of 0-12); post-training mean score = 10.73, p < 0.002). Conclusions Education about FABMs and training on use of the SDM tool improved knowledge scores even among an experienced cohort of clinicians. Innovation The novel SDM tool can better equip clinicians to meet the rising patient interest in FABMs.
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Affiliation(s)
- Marguerite Duane
- FACTS, 1020 Kearny St NE, Washington DC 20017, USA
- Corresponding author.
| | | | - Meghan Berry
- FACTS, 1020 Kearny St NE, Washington DC 20017, USA
| | - Michael D. Manhart
- FACTS, 1020 Kearny St NE, Washington DC 20017, USA
- Couple to Couple League International, 5440 Moeller Avenue Suite 149, Cincinnati, OH 45212, USA
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McNeely MM, Chang KWC, Smith BW, Justice D, Daunter AK, Yang LJS, McGillicuddy JE. Knowledge of neonatal brachial plexus palsy among medical professionals in North America. Childs Nerv Syst 2021; 37:3797-3807. [PMID: 34406450 DOI: 10.1007/s00381-021-05310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Early referral of neonatal brachial plexus palsy (NBPP) patients to multidisciplinary clinics is critical for timely diagnosis, treatment, and improved functional outcomes. In Saudi Arabia, inadequate knowledge regarding NBPP is a reason for delayed referral. We aimed to evaluate the knowledge of North American healthcare providers (HCPs) regarding the diagnosis, management, and prognosis of NBPP. METHODS A 12-question survey regarding NBPP was distributed via electronic and paper formats to North American providers from various referring and treating specialties. NBPP knowledge was compared between Saudi Arabian vs. North American providers, referring vs. treating specialties, academic vs. community hospitals, and providers with self-reported confidence vs. nonconfidence in NBPP knowledge. RESULTS Of the 273 surveys collected, 45% were from referring providers and 55% were from treating providers. Saudi Arabian and North American HCPs demonstrated similar NBPP knowledge except for potential etiologies for NBPP and surgery timing. In North America, referring and treating providers had similar overall knowledge of NBPP but lacked familiarity with its natural history. A knowledge gap existed between academic and community hospitals regarding timing of referral/initiation of physical/occupational therapy (PT/OT) and Horner's syndrome. Providers with self-reported confidence in treating NBPP had greater knowledge of types of NBPP and timing for PT/OT initiation. CONCLUSIONS Overall, North American providers demonstrated adequate knowledge of NBPP. However, both eastern and western physicians remain overly optimistic in believing that most infants recover spontaneously. This study revealed a unique and universal knowledge gap in NBPP diagnosis, referral, and management worldwide. Continuous efforts to increase NBPP knowledge are indicated.
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Affiliation(s)
- Molly M McNeely
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Brandon W Smith
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Denise Justice
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Alecia K Daunter
- Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Lynda J-S Yang
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
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Chick RC, Adams AM, Peace KM, Kemp Bohan PM, Schwantes IR, Clifton GT, Vicente D, Propper B, Newhook T, Grubbs EG, Bednarski BK, Vreeland TJ. Using the Flipped Classroom Model in Surgical Education: Efficacy and Trainee Perception. J Surg Educ 2021; 78:1803-1807. [PMID: 34210646 DOI: 10.1016/j.jsurg.2021.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/03/2021] [Accepted: 05/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe the feasibility, efficacy, and learner perception of the flipped classroom model for teaching conferences within surgical training programs. DESIGN For the flipped classroom conferences, video lectures were prepared by a faculty member, and sent to all attendees at least 2 days prior to lecture. The conference time was then spent going over cases and questions, rather than traditional lecture. We conducted a qualitative survey to assess learner's perceptions and pre-lecture quizzes to assess trainee preparedness. SETTING The comparison of pre-conference quizzes between flipped classroom and traditional models was carried out at Brooke Army Medical Center (BAMC) in San Antonio, TX, a tertiary care facility with a general surgery residency program. The survey was conducted at BAMC and within the Complex General Surgical Oncology fellowship program at University of Texas MD Anderson Cancer Center, where a flipped classroom model was similarly employed. PARTICIPANTS Surgical residents BAMC participated in pre-lecture quizzes. BAMC residents and MD Anderson fellows were invited to complete the online survey. RESULTS Lecture videos did not increase mean preparation time (1.53 vs. 1.46 hours without vs. with video, p = 0.858), but did increase mean quiz scores from 67% to 80% (p = 0.031) with 32/35 learners utilizing videos. Videos increased the proportion of learners who self-reported preparing at all from 42% to 95% (p = 0.28), and preparing for at least one hour for conference from 23% to 49% (p = 0.014). Of survey respondents, 90% said videos were very helpful, 90% would use them weekly if available, and 90% prefer this format to traditional lecture. CONCLUSIONS Utilization of a flipped classroom method was well received and preferred by surgical trainees, and it increased performance on pre-conference quizzes without increasing preparation time. Although creation of video lectures is work-intensive for lecturers, these results suggest it is more effective for learner preparation. These results could be generalizable to surgical residents nationwide as technology utilization increases in surgical education.
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Affiliation(s)
- R C Chick
- US Army Brooke Army Medical Center, San Antonio, Texas
| | - A M Adams
- US Army Brooke Army Medical Center, San Antonio, Texas.
| | - K M Peace
- US Army Brooke Army Medical Center, San Antonio, Texas
| | | | - I R Schwantes
- Carver College of Medicine, University of Iowa, Iowa City, Lowa
| | - G T Clifton
- US Army Brooke Army Medical Center, San Antonio, Texas
| | - D Vicente
- Naval Medical Center San Diego, San Diego, California
| | - B Propper
- US Army Brooke Army Medical Center, San Antonio, Texas
| | - T Newhook
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - E G Grubbs
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - B K Bednarski
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - T J Vreeland
- US Army Brooke Army Medical Center, San Antonio, Texas
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Qi T, Qiu S, Shen X, Chen H, Yang S, Wen H, Zhang Y, Wu Y, Huang Y. KeMRE: Knowledge-enhanced medical relation extraction for Chinese medicine instructions. J Biomed Inform 2021; 120:103834. [PMID: 34119692 DOI: 10.1016/j.jbi.2021.103834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
Medicine instructions usually contain rich medical relations, and extracting them is very helpful for many downstream tasks such as medicine knowledge graph construction and medicine side-effect prediction. Existing relation extraction (RE) methods usually predict relations between entities from their contexts and do not consider medical knowledge. However, understanding a part of medical relations may need some expert knowledge in the medical field, making it challenging for existing methods to achieve satisfying performances of medical RE. In this paper, we propose a knowledge-enhanced framework for medical RE, which can exploit medical knowledge of medicines to better conduct medical RE on Chinese medicine instructions. We first propose a BERT-CNN-LSTM based framework for text modeling and learn representations of characters from their contexts. Then we learn representations of each entity by aggregating representations of their characters. Besides, we propose a CNN-LSTM based framework for entity modeling and learn entity representations from their relatedness. In addition, there are usually many different instructions for the same medicine, which usually share general knowledge on this medicine. Thus, to obtain medical knowledge of medicines, we annotate relations on a randomly-sampled instruction of each medicine. Then we build knowledge embeddings to represent potential relations between entities from knowledge of medicines. Finally, we use an MLP network to predict relations between entities from their representations and knowledge embeddings. Extensive experiments on a real-world dataset show that our method can significantly outperform existing methods.
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Affiliation(s)
- Tao Qi
- Department of Electronic Engineering & BNRist, Tsinghua University, Beijing 100084, China.
| | - Shan Qiu
- Department of Electronic Engineering & BNRist, Tsinghua University, Beijing 100084, China.
| | - Xiaoqian Shen
- College of Computer Science and Technology, Jilin University, Jilin 130012, China
| | - Haopu Chen
- International School, Beijing University of Posts and Telecommunications, Beijing 100876, China.
| | - Shuai Yang
- Beijing Jingdong Jiankang Co., Ltd., Beijing 101111, China.
| | - Hao Wen
- Beijing Jingdong Jiankang Co., Ltd., Beijing 101111, China.
| | - Ya Zhang
- Beijing Jingdong Jiankang Co., Ltd., Beijing 101111, China.
| | - Yuanqing Wu
- Beijing Jingdong Jiankang Co., Ltd., Beijing 101111, China.
| | - Yongfeng Huang
- Department of Electronic Engineering & BNRist, Tsinghua University, Beijing 100084, China.
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Bußenius L, Harendza S. Are different medical school admission tests associated with the outcomes of a simulation-based OSCE? BMC Med Educ 2021; 21:263. [PMID: 33962606 PMCID: PMC8103591 DOI: 10.1186/s12909-021-02703-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Medical school admission procedures have the common goal to select applicants with the greatest potential of becoming successful physicians. Hamburg Medical Faculty selects medical students by grade point average (GPA) and employs a two-step selection process of a natural sciences test (HAM-Nat), in some cases followed by multiple mini-interviews (HAM-Int). Multiple mini-interviews can predict non-cognitive outcomes, while GPA has predictive validity for cognitive outcomes. The aim of our study was to explore communication skills and clinical knowledge of advanced medical students according to their respective admission procedure. METHODS In July 2019, 146 students grouped according to their admission procedure into GPA-only (19.2 %), HAM-Nat (33.6 %), HAM-Int (30.8 %), and Waiting List (16.4 %) participated in four OSCE stations which equally assessed students' communication skills (OSCE part 1) and clinical knowledge (OSCE part 2) in simulated patient encounters, rated by physicians with checklists. Additionally, psychosocial assessors ranked communication skills with a global rating scale (GR). The students also participated in a multiple choice (MC) exam testing clinical knowledge. Kruskal-Wallis analyses of variance of test performance and Spearman correlation of instruments were calculated. RESULTS Students from the Waiting List group performed significantly worse on the MC exam compared to GPA-only and HAM-Int (adjusted p = .029 and 0.018, respectively). No significant differences were found between the admission groups with respect to communication skills. Global Rating and OSCE part 1 (communication) correlated significantly (ρ = 0.228, p = .006) as did OSCE part 2 (clinical knowledge) and MC exam (ρ = 0.242, p = .003), indicating criterion validity. Constructs did not overlap, indicating divergent validity. CONCLUSIONS Advanced medical students selected for undergraduate studies by multiple mini-interviews assessing psychosocial skills showed similar communication skills compared to students admitted to medical school by other entryways. It is unclear whether these similarities are due to an effective undergraduate longitudinal communication curriculum. Assessing baseline communication skills of all medical students at entry-level may aid with this question.
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Affiliation(s)
- Lisa Bußenius
- Department of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrid Harendza
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Mullen JT, Cassidy DJ. Let's Not Throw the Baby Out with the Bath Water - Keep the ABSITE a Numerically Scored Exam. J Surg Educ 2021; 78:714-716. [PMID: 32958423 DOI: 10.1016/j.jsurg.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/05/2020] [Indexed: 06/11/2023]
Abstract
The American Board of Surgery In-Training Examination (ABSITE) is a low-stakes, validated, objective measure of the medical knowledge of our surgical residents and is an important predictor of ABS Qualifying Exam (QE) passage. It was never intended to serve as a global assessment of resident performance or aptitude, to assess any competency other than medical knowledge, or to serve as the sole criterion by which to judge resident promotion to the next PGY level. Though the scoring of the ABSITE and the use of the exam by some PDs and fellowship directors may be imperfect, let's not throw the baby out with the bath water and destroy the utility of the ABSITE by changing its grading to pass/fail. Rather, let's set rigorous, high standards for our residents in preparation for the ABSITE, as well as for PDs and fellowship directors in the proper interpretation of the ABSITE as a formative assessment of resident knowledge progression as opposed to a high-stakes summative exam.
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Affiliation(s)
- John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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12
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Farkhondehzadeh M, Gohari Fakhrabad M. Ab -10%υ¯ Man s .-10%υ¯r ῌasan Qamar ī: Promoter of the Medical School of Rāz ī (Rhazes). J Med Biogr 2021; 29:19-23. [PMID: 30382792 DOI: 10.1177/0967772018799857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The medical history of Iran and Islam is marked by the presence of renowned physicians, some of whom are not well known outside Iran. Abυ¯ Man⋅υ¯r ῌasan ibn Nυ¯ḥ Qamarī Bukhārā 'ī was an Iranian physician living in the fourth century AH (10th century CE). The scientific works of this sage indicate his skill and expertise in medical science. He was a man of such scientific stature that the renowned Iranian philosopher and physician, Avicenna, use may have been one of his disciples. Qamarī may be credited as one of the promoters of the medical school of Muḥammad Ibn Zakarīyyā Rāzī. Some of his works, including Al-Tanwīr Fī 'Isṭilāḥāt Al-Ṭibbīyyah and Al-Ghinā and Al-Munā are still extant. In this paper, his scientific life and works, based on primary sources, have been studied in order to shed light on his role in formation of the Muslim Medical School.
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Affiliation(s)
| | - Mostafa Gohari Fakhrabad
- Department of Islamic Sciences, Faculty of Theology, Ferdowsi University of Mashhad, Mashhad, Iran
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13
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Abstract
BACKGROUND Professional knowledge aims at improving practice. It reduces uncertainty in decision-making, improves effectiveness in action and relevance in evaluation, stimulates reflexivity, and subjects practice to ethical standards. Heuristics is an approach to problem-solving, learning, and discovery employing a practical methodology that, although not optimal, is sufficient for achieving immediate goals. This article identifies the desirable, heuristic particularities of research in professional, medical practice; and it identifies what distinguishes this research from scientific research. MAIN TEXT We examine the limits of biomedical and sociological research to produce professional knowledge. Then, we derive the heuristic characteristics of professional research from a meta-analysis of two action-research projects aimed at securing access to essential generic drugs in Senegal and improving physicians' self-assessment and healthcare coordination in Belgium. To study healthcare, biomedical sciences ignore how clinical decisions are implemented. Decisions are built into an articulated knowledge system, such as (clinical) epidemiology, where those studied are standardisable - while taking care of patients is an idiosyncratic, value-based, person-to-person process that largely eludes probabilistic methodologies. Social sciences also reach their limits here because descriptive, interpretative methods cannot help with gesture and speech quality, while the management of the patient's suffering and risks makes each of them unique. Research into medical professionalism is normative as it is intended to formulate recommendations. Scientific data and descriptions are useful to the practitioner randomly, only from the similarities in the environment of the authors and their readers. Such recommendations can be conceived of as strategies, i.e., multi-resource and multi-stage action models to improve clinical and public health practice. Action learning and action-research are needed to design and implement these strategies, because their complexity implies trial and error. To validate a strategy, repeated experiences are needed. Its reproducibility assumes the description of the context. To participate in medical action-research, the investigator needs professional proficiency - a frequent difficulty in academic settings. CONCLUSION Some criteria to assess the relevance of publicly funded clinical and public health research can be derived from the difference between scientific and professional knowledge, i.e. the knowledge gained with real-life experience in the field.
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Affiliation(s)
- Jean-Pierre Unger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium
| | - Ingrid Morales
- Office de la Naissance et de l’Enfance, French Community of Belgium, Chaussée de Charleroi 95, B-1060 Brussels, Belgium
| | - Pierre De Paepe
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium
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14
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Ducey A, Donoso C, Ross S, Robert M. From anatomy to patient experience in pelvic floor surgery: Mindlines, evidence, responsibility, and transvaginal mesh. Soc Sci Med 2020; 260:113151. [PMID: 32738706 DOI: 10.1016/j.socscimed.2020.113151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022]
Abstract
Beginning in the late 1990s, surgeons around the world widely adopted the transvaginal placement of permanent synthetic mesh for the treatment of several common pelvic floor disorders in women. By 2012 it had become the subject of extensive litigation, including one of the biggest mass-tort cases in U.S. history, with litigants reporting debilitating and unexpected complications. Based on qualitative research that includes interviews with surgeons, observations of medical conferences, and analysis of archival materials, we argue the adoption of transvaginal mesh cannot be fully explained without recognizing the role of mindlines, or collective moral-epistemological ways of knowing and acting responsibly. The adoption of mesh was anchored in a mindline focused on repairing anatomy. The harms that resulted from transvaginal mesh necessitated a shift to a focus on patient experience. We analyze the role of evidence-based medicine (EBM) in the re-organization of these surgeons' mindlines, showing that mindlines are not reducible to evidence as defined by EBM and that evidence thus defined facilitated the adoption of transvaginal mesh.
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Affiliation(s)
- Ariel Ducey
- Department of Sociology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| | - Claudia Donoso
- Graduate International Relations, St. Mary's University, San Antonio, TX, USA
| | - Sue Ross
- Women's Health Research, Department of Obstetrics and Gynaecology, Royal Alexandra Hospital, University of Alberta, Canada
| | - Magali Robert
- Cumming School of Medicine, Department of Obstetrics and Gynecology, University of Calgary, Canada
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15
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Tarrada A, Hingray C, Sachdev P, Le Thien MA, Kanemoto K, de Toffol B. Epileptic psychoses are underrecognized by French neurologists and psychiatrists. Epilepsy Behav 2019; 100:106528. [PMID: 31654941 DOI: 10.1016/j.yebeh.2019.106528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 11/17/2022]
Abstract
This study evaluates the knowledge about psychotic disorders associated with epilepsy among medical practitioners in France. A self-report questionnaire was sent, and responses of 486 participants were collected. Results showed the rate of correct responses being higher among neurologists compared to psychiatrists, respectively 70.6% and 58.3% (p < 10-11). The highest rate of correct responses was found for the participants trained in epileptology (71%), and a regression analysis confirmed that epilepsy-training was the most influential variable. However, we found that knowledge about epileptic psychosis was imprecise among all participants: current classification was not known to most participants (77%), there were false beliefs concerning postictal confusion and psychosis (41%), and both prevalence and duration of postictal psychosis were not well-known. There is the first survey to highlight such gaps of knowledge, and hopefully lead to measures to remedy this, especially specialists such as psychiatrists, neurologists, and epileptologists who may be called upon to treat such patients.
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Affiliation(s)
- Alexis Tarrada
- Department of neurology, University Hospital of Nancy, 54000 Nancy, France; Psychiatry department, psychotherapeutic center of Nancy, CPN, 54520 Laxou, France
| | - Coraline Hingray
- Department of neurology, University Hospital of Nancy, 54000 Nancy, France; Psychiatry department, psychotherapeutic center of Nancy, CPN, 54520 Laxou, France
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - My-Anh Le Thien
- Hospices civils de Lyon, Direction des Systèmes D'information, 69003 Lyon, France
| | - Kousuke Kanemoto
- Aichi Medical University, Neuropsychiatric Department, Nagakute, Japan
| | - Bertrand de Toffol
- Service de Neurologie & Neurophysiologie Clinique, CHU Bretonneau, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, France.
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16
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Beltran-Aroca CM, Labella F, Font-Ugalde P, Girela-Lopez E. Assessment of Doctors' Knowledge and Attitudes Towards Confidentiality in Hospital Care. Sci Eng Ethics 2019; 25:1531-1548. [PMID: 30604354 DOI: 10.1007/s11948-018-0078-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 11/30/2018] [Indexed: 06/09/2023]
Abstract
The physician's duty of confidentiality is based on the observance of the patient's privacy and intimacy and on the importance of respecting both of these rights, thus creating a relationship of confidence and collaboration between doctor and patient. The main objective of this work consists of analyzing the aspects that are related to the confidentiality of patients' data with respect to the training, conduct and opinions of doctors from different Clinical Management Units of a third-level hospital via a questionnaire. The present study aimed to define the problem and determine whether the opinions of these professionals correspond to those observed in a previous work conducted at the same center. Of the 200 questionnaires that were collected, 62.5% were from consultants and the rest were from residents (37.5%) with an average of 14.4 ± 12.5 years in professional practice. The respondents noted habitual situations in which confidentiality was breached in the reference hospital (74%). The section on their attitudes and behaviors towards situations related to confidentiality showed a slightly lower average score than that of their medical knowledge; significant differences in these scores were observed between the consultants and residents as well as between the extreme age groups (≤ 30 vs. ≥ 51 years) and years of professional practice, thus more inadequate attitudes were consistently noted in younger doctors who had fewer years of experience. Finally, the respondents answered that the training of doctors in the aspects of healthcare law and ethics was the most important measure that the hospital could adopt regarding confidentiality practices.
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Affiliation(s)
- Cristina M Beltran-Aroca
- Sección de Medicina Legal y Forense, Facultad de Medicina y Enfermería, Universidad de Córdoba, Avda Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Fernando Labella
- Sección de Oftalmología, Departamento de Especialidades Médico-Quirúrgicas, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004, Córdoba, Spain
| | - Pilar Font-Ugalde
- Sección de Bioestadística, Departamento de Medicina, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004, Córdoba, Spain
| | - Eloy Girela-Lopez
- Sección de Medicina Legal y Forense, Facultad de Medicina y Enfermería, Universidad de Córdoba, Avda Menéndez Pidal s/n, 14004, Córdoba, Spain
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Brateanu A, Strang TM, Garber A, Mani S, Spencer A, Spevak B, Thomascik J, Mehta N, Colbert CY. Using an Adaptive, Self-Directed Web-Based Learning Module to Enhance Residents' Medical Knowledge Prior to a New Clinical Rotation. Med Sci Educ 2019; 29:779-786. [PMID: 34457542 PMCID: PMC8368484 DOI: 10.1007/s40670-019-00772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND The effect of self-directed adaptive learning on internal medicine residents' knowledge prior to a new clinical rotation is not known. METHODS We developed an adaptive, online, self-directed spaced repetition module and determined the effect on medical knowledge acquisition. We randomized postgraduate year 1 internal medicine residents into two groups. The intervention group (n = 27) received an electronic version of the clinical rotation curriculum as portable document format (PDF) files and participated in the online module, delivered via Moodle, a free, open-source learning management system. The non-intervention group (n = 27) only received the PDF files. All residents participated in a medical knowledge test at baseline and 3 months later. RESULTS Both groups were similar at study baseline in terms of age, trainee type, years since graduation, results at United States Medical Licensing Examination (USMLE) Step 1, 2, In-Training Examination (ITE), and pre-intervention evaluation. There was a statistically significant improvement in scores on the post-intervention medical knowledge assessment for the intervention group when compared with the non-intervention group (24.2 ± 15.4% vs. 8.6 ± 9.9%, p < 0.001). CONCLUSION An online, self-directed, adaptive spaced repetition-learning module can offer a simple and effective method to increase the medical knowledge present at the start of residents' clinical rotations.
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Affiliation(s)
- Andrei Brateanu
- Internal Medicine Residency Program, Cleveland Clinic, NA10, 9500 Euclid, Cleveland, OH 44195 USA
| | - Tara M. Strang
- Internal Medicine Residency Program, Cleveland Clinic, NA10, 9500 Euclid, Cleveland, OH 44195 USA
| | - Ari Garber
- Internal Medicine Residency Program, Cleveland Clinic, NA10, 9500 Euclid, Cleveland, OH 44195 USA
| | | | - Abby Spencer
- Internal Medicine Residency Program, Cleveland Clinic, NA10, 9500 Euclid, Cleveland, OH 44195 USA
| | - Bruce Spevak
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - James Thomascik
- Internal Medicine Residency Program, Cleveland Clinic, NA10, 9500 Euclid, Cleveland, OH 44195 USA
| | - Neil Mehta
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Colleen Y. Colbert
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH USA
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Manolescu LSC, Boeru C, Căruntu C, Dragomirescu CC, Goldis M, Jugulete G, Marin M, Popa GL, Preda M, Radu MC, Popa MI. A Romanian experience of syphilis in pregnancy and childbirth. Midwifery 2019; 78:58-63. [PMID: 31374436 DOI: 10.1016/j.midw.2019.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/22/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE to establish the incidence of syphilis in a group of childbearing women and their newborn babies in Romania and to identify the major risk factors of materno-fetal transmission in order for midwives to develop strategies to help prevent congenital syphilis. MATERIAL AND METHODS a descriptive study of a group of 982 childbearing women who gave birth during a three-month period at an Obstetrics and Gynaecology Hospital in Romania. The women completed a questionnaire, which consisted of three sections: general data, general knowledge of syphilis and birth and pregnancy data. After admission to hospital, the women were investigated for syphilis using serological tests. RESULTS there was a syphilis frequency of 0.91649% (n = 9) among the surveyed women. Among the nine infected women, two were not aware that they had a syphilis infection when initially admitted to hospital. The maternal profile with the highest risk of being diagnosed with syphilis was a young woman who had not had adequate prenatal care, who had elementary sex education and who lacked knowledge of personal health and hygiene. A significant percentage of the respondents, namely 11.9% (n = 117), were aged 15 to 20. CONCLUSIONS in certain population groups, syphilis is still an important health care problem, especially in vulnerable individuals, such as childbearing women and newborns babies. More attention needs to be paid to primary prevention; the number of cases of congenital syphilis could be reduced by more involvement of midwifes and family doctors in antenatal care.
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Affiliation(s)
| | - Calin Boeru
- Obstetrics and Gynaecology Hospital, Str. Mihai Bravu nr. 106, 100409, Ploieşti, Romania
| | - Constantin Căruntu
- "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, Sector 5, 050474 Bucharest, Romania; Department of Dermatology, Prof. N.C. Paulescu National Institute of Diabetes, Nutrition and Metabolic Diseases, Str. Grigore Manolescu nr. 22-24, 030167, Bucharest, Romania.
| | - Cristiana Cerasella Dragomirescu
- "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, Sector 5, 050474 Bucharest, Romania; Cantacuzino National Medico-Military Institute for Research and Development, Splaiul Independentei nr. 103, 050096, Sector 5, Bucharest, Romania
| | - Mirela Goldis
- Obstetrics and Gynaecology Hospital, Str. Mihai Bravu nr. 106, 100409, Ploieşti, Romania
| | - Gheorghiţă Jugulete
- "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, Sector 5, 050474 Bucharest, Romania; Clinical Section IX - Pediatrics, "Prof. Dr. Matei Balş" National Institute for Infectious Diseases, Str. Dr. Calistrat Grozovici 1, 021105, Bucharest, Romania
| | - Mihaela Marin
- Obstetrics and Gynaecology Hospital, Str. Mihai Bravu nr. 106, 100409, Ploieşti, Romania
| | - Gabriela Loredana Popa
- "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, Sector 5, 050474 Bucharest, Romania; Colentina Clinical Hospital (CDPC), Sos. Stefan cel Mare nr. 19-21, Sector 2, 020125, Bucharest, Romania
| | - Mădălina Preda
- "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, Sector 5, 050474 Bucharest, Romania; Cantacuzino National Medico-Military Institute for Research and Development, Splaiul Independentei nr. 103, 050096, Sector 5, Bucharest, Romania
| | - Mihaela Corina Radu
- "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, Sector 5, 050474 Bucharest, Romania; Obstetrics and Gynaecology Hospital, Str. Mihai Bravu nr. 106, 100409, Ploieşti, Romania
| | - Mircea Ioan Popa
- "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii Sanitari nr. 8, Sector 5, 050474 Bucharest, Romania; Cantacuzino National Medico-Military Institute for Research and Development, Splaiul Independentei nr. 103, 050096, Sector 5, Bucharest, Romania
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Khasha R, Sepehri MM, Mahdaviani SA. An ensemble learning method for asthma control level detection with leveraging medical knowledge-based classifier and supervised learning. J Med Syst 2019; 43:158. [PMID: 31028489 DOI: 10.1007/s10916-019-1259-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 03/27/2019] [Indexed: 12/25/2022]
Abstract
Approximately 300 million people are afflicted with asthma around the world, with the estimated death rate of 250,000 cases, indicating the significance of this disease. If not treated, it can turn into a serious public health problem. The best method to treat asthma is to control it. Physicians recommend continuous monitoring on asthma symptoms and offering treatment preventive plans based on the patient's control level. Therefore, successful detection of the disease control level plays a critical role in presenting treatment plans. In view of this objective, we collected the data of 96 asthma patients within a 9-month period from a specialized hospital for pulmonary diseases in Tehran. A new ensemble learning algorithm with combining physicians' knowledge in the form of a rule-based classifier and supervised learning algorithms is proposed to detect asthma control level in a multivariate dataset with multiclass response variable. The model outcome resulting from the balancing operations and feature selection on data yielded the accuracy of 91.66%. Our proposed model combines medical knowledge with machine learning algorithms to classify asthma control level more accurately. This model can be applied in electronic self-care systems to support the real-time decision and personalized warnings on possible deterioration of asthma control level. Such tools can centralize asthma treatment from the current reactive care models into a preventive approach in which the physician's therapeutic actions would be based on control level.
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Affiliation(s)
- Roghaye Khasha
- Group of Information Technology, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, 1411713116, Iran
| | - Mohammad Mehdi Sepehri
- Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, 1411713116, Iran.
| | - Seyed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Martínez-Parra AG, Pinilla-Alfonso MY, Abadía-Barrero CE. Sociocultural dynamics that influence Chagas disease health care in Colombia. Soc Sci Med 2018; 215:142-150. [PMID: 30236829 DOI: 10.1016/j.socscimed.2018.09.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 11/25/2022]
Abstract
Chagas disease (CD) is a Latin America endemic and neglected tropical disease that affects primarily poor people living in rural areas. Its current low profile leads to many diagnostic, treatment, and control challenges. This study aimed to identify and characterize the sociocultural dynamics that influence CD health care in Colombia. Data for our ethnographic study was collected in 2013 and included participant observation in two main endemic areas in Colombia. In addition, 81 people belonging to four groups (patients and family members; health care workers; researchers; and officers) were recruited through snowball sampling technique and participated in informal and semi-structured interviews. People from the first two groups also participated in social cartography excercises. Data analysis resulted in the identification of three main sociocultural dynamics. Local Understandings: Patients reported confusions around disease transmission, treatment effectiveness and development of future complications. Providers' Knowledge and Training: Failures in professional's knowledge and training mostly affect the primary level of care in rural areas. Professionals undergo minimal training during medical school and lack access to continuous education. In contrast, clinicians working at tertiary university hospitals or at the CD unit of the Colombian National Institute of Health (NIH) exhibited great knowledge and competency. Health Care System Barriers: The Colombian market-based health care reform augmented access barriers, which impacted CD care greatly. We identified geographic and bureaucratic itineraries that depended on type of insurance plan, insurance contracts with service providing institutions, and levels of care. This study shows that people's experience of these sociocultural dynamics vary depending on their mobility from rural to urban contexts. It unveils the importance of analyzing the structure of the health care system. In the Colombian case, its for-profit orientation has become one of the most important obstacles for comprehensive, integrated, and timely health care responses.
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Gibson D, Drabkin A, Krantz MJ, Mascolo M, Rosen E, Sachs K, Welles C, Mehler PS. Critical gaps in the medical knowledge base of eating disorders. Eat Weight Disord 2018; 23:419-430. [PMID: 29681012 DOI: 10.1007/s40519-018-0503-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/22/2018] [Indexed: 12/14/2022] Open
Abstract
Eating disorders are unique in that they inherently have much medical comorbidity both as a part of restricting-type eating disorders and those characterized by purging behaviors. Over the last three decades, remarkable progress has been made in the understanding and treatment of the medical complications of eating disorders. Yet, unfortunately, there is much research that is sorely needed to bridge the gap between current medical knowledge and more effective and evidence-based medical treatment knowledge. These gaps exist in many different clinical areas including cardiology, electrolytes, gastrointestinal and bone disease. In this paper, we discuss some of the knowledge gap areas, which if bridged would help develop more effective medical intervention for this population of patients.
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Affiliation(s)
- Dennis Gibson
- ACUTE, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA
| | - Anne Drabkin
- ACUTE, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA
| | - Mori J Krantz
- Division of Cardiology, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA
| | | | - Elissa Rosen
- ACUTE, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA
| | - Katherine Sachs
- ACUTE, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA
| | - Christine Welles
- ACUTE, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA
| | - Philip S Mehler
- ACUTE, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA.
- Eating Recovery Center, Denver, 7351E Lowry Blvd, Denver, CO, 80230, USA.
- , Denver, USA.
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Wu V, Sattar J, Cheon S, Beyea JA. Ear Disease Knowledge and Otoscopy Skills Transfer to Real Patients: A Randomized Controlled Trial. J Surg Educ 2018; 75:1062-1069. [PMID: 29371080 DOI: 10.1016/j.jsurg.2017.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To determine which teaching method-otoscopy simulation (OS), web-based module (WM), or standard classroom instruction (SI)-produced greater translation of knowledge and otoscopy examination skills to real patients. DESIGN In a prospective randomized controlled nonclinical trial, medical students were randomized to 1 of 3 interventional arms: (1) OS, (2) WM, or (3) SI. Students were assessed at baseline for diagnostic accuracy and otoscopy skills on 5 volunteer patients (total of 10 ears), followed by the intervention. Testing was repeated immediately after intervention on the same patients. Student reported confidence in diagnostic accuracy and otoscopy examination were also captured. Assessors were blinded to the intervention group, and whether students were pre- or post-intervention. SETTING Clinical Teaching Centre, Queen's University. PARTICIPANTS Twenty-nine participants were initially randomized. Two students were unable to attend their specific intervention sessions and withdrew. Final group sizes were: OS-10, WM-9, SI-8. Five patients with external/middle ear pathologies were voluntarily recruited to participate as testing subjects. RESULTS Baseline diagnostic accuracy and otoscopy clinical skills did not differ across the groups. Post-intervention, there were improvements in diagnostic accuracy from all groups: OS (127.78%, 2.30 ± 1.42, p = 0.0006), WM (76.40%, 1.44 ± 1.88, p = 0.0499), and SI (100.00%, 1.50 ± 1.20, p = 0.0093). For otoscopy skills, post-intervention improvements were noted from OS (77.00%, 3.85 ± 2.55, p < 0.0001) and SI (22.20%, 1.25 ± 1.20, p = 0.0011), with no significant improvement from WM (13.46%, 0.78 ± 1.92, p = 0.1050). Students across all groups reported significantly improved confidence in diagnostic accuracy (p < 0.0001) and otoscopy skill (p < 0.0001) after the intervention. CONCLUSION All 3 teaching modalities showed an improvement in diagnostic accuracy immediately post-intervention. Otoscopy clinical skills were found to have increased only in OS and SI, with the OS group demonstrating the largest improvement. Simulation-based medical education in Otolaryngology may provide the greatest transfer of medical knowledge and technical skills when evaluated with real patients.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology, Hotel Dieu Hospital, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Joobin Sattar
- Department of Otolaryngology, Hotel Dieu Hospital, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Stephanie Cheon
- Department of Otolaryngology, Hotel Dieu Hospital, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Jason A Beyea
- Department of Otolaryngology, Hotel Dieu Hospital, Queen's University School of Medicine, Kingston, Ontario, Canada.
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23
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Collichio FA, Hess BJ, Muchmore EA, Duhigg L, Lipner RS, Haist S, Hawley JL, Morrison CA, Clayton CP, Raymond MJ, Kayoumi KM, Gitlin SD. Medical Knowledge Assessment by Hematology and Medical Oncology In-Training Examinations Are Better Than Program Director Assessments at Predicting Subspecialty Certification Examination Performance. J Cancer Educ 2017; 32:647-654. [PMID: 26897634 DOI: 10.1007/s13187-016-0993-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The Accreditation Council for Graduate Medical Education's Next Accreditation System requires training programs to demonstrate that fellows are achieving competence in medical knowledge (MK), as part of a global assessment of clinical competency. Passing American Board of Internal Medicine (ABIM) certification examinations is recognized as a metric of MK competency. This study examines several in-training MK assessment approaches and their ability to predict performance on the ABIM Hematology or Medical Oncology Certification Examinations. Results of a Hematology In-Service Examination (ISE) and an Oncology In-Training Examination (ITE), program director (PD) ratings, demographic variables, United States Medical Licensing Examination (USMLE), and ABIM Internal Medicine (IM) Certification Examination were compared. Stepwise multiple regression and logistic regression analyses evaluated these assessment approaches as predictors of performance on the Hematology or Medical Oncology Certification Examinations. Hematology ISE scores were the strongest predictor of Hematology Certification Examination scores (β = 0.41) (passing odds ratio [OR], 1.012; 95 % confidence interval [CI], 1.008-1.015), and the Oncology ITE scores were the strongest predictor of Medical Oncology Certification Examination scores (β = 0.45) (passing OR, 1.013; 95 % CI, 1.011-1.016). PD rating of MK was the weakest predictor of Medical Oncology Certification Examination scores (β = 0.07) and was not significantly predictive of Hematology Certification Examination scores. Hematology and Oncology ITEs are better predictors of certification examination performance than PD ratings of MK, reinforcing the effectiveness of ITEs for competency-based assessment of MK.
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Affiliation(s)
- Frances A Collichio
- Division of Hematology and Oncology, University of North Carolina-Chapel Hill, Physicians Office Building, 3rd Floor 170 Manning Drive, CB# 7305, Chapel Hill, NC, 27599, USA
| | - Brian J Hess
- Hess Consulting, 272 Rue du Replat, Lévis, Quebec, G7A 5E4, Canada
| | - Elaine A Muchmore
- Division of Hematology/Oncology, University of California-San Diego School of Medicine and Veterans Affairs San Diego Healthcare System, 9500 Gilman Drive #9111-E, La Jolla, CA, 92093, USA
| | - Lauren Duhigg
- American Board of Internal Medicine, 510 Walnut St, Suite 1700, Philadelphia, PA, 19106, USA
| | - Rebecca S Lipner
- American Board of Internal Medicine, 510 Walnut St, Suite 1700, Philadelphia, PA, 19106, USA
| | - Steven Haist
- Test Development Services, National Board of Medical Examiners, 3750 Market St, Philadelphia, PA, 19104, USA
| | - Janine L Hawley
- National Board of Medical Examiners, 3750 Market St, Philadelphia, PA, 19104, USA
| | - Carol A Morrison
- National Board of Medical Examiners, 3750 Market St, Philadelphia, PA, 19104, USA
| | - Charles P Clayton
- Education and Training, American Society of Hematology, 2021 L Street NW, Suite 900, Washington, DC, 20036, USA
| | - Marilyn J Raymond
- American Society of Clinical Oncology, 2318 Mill Road, Suite 800, Alexandria, VA, 22314, USA
| | - Karen M Kayoumi
- Education and Training, American Society of Hematology, 2021 L Street NW, Suite 900, Washington, DC, 20036, USA
| | - Scott D Gitlin
- Division of Hematology/Oncology, University of Michigan Health System and Veterans Affairs Ann Arbor Health System, C345 Med Inn Building/SPC 5848, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- University of Michigan Health System, C345 Med Inn Building/SPC 5848, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5848, USA.
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24
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Zuin M, Rigatelli G, Del Favero G, Roncon L. Why modern internists should be also researchers? Eur J Intern Med 2017; 39:e14. [PMID: 28117196 DOI: 10.1016/j.ejim.2017.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Marco Zuin
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy; Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Department of Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Giuseppe Del Favero
- Department of Gastroenterology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
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25
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Gostlow H, Marlow N, Babidge W, Maddern G. Systematic Review of Voluntary Participation in Simulation-Based Laparoscopic Skills Training: Motivators and Barriers for Surgical Trainee Attendance. J Surg Educ 2017; 74:306-318. [PMID: 27836238 DOI: 10.1016/j.jsurg.2016.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/06/2016] [Accepted: 10/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine and report on evidence relating to surgical trainees' voluntary participation in simulation-based laparoscopic skills training. Specifically, the underlying motivators, enablers, and barriers faced by surgical trainees with regard to attending training sessions on a regular basis. DESIGN A systematic search of the literature (PubMed; CINAHL; EMBASE; Cochrane Collaboration) was conducted between May and July 2015. Studies were included on whether they reported on surgical trainee attendance at voluntary, simulation-based laparoscopic skills training sessions, in addition to qualitative data regarding participant's perceived barriers and motivators influencing their decision to attend such training. Factors affecting a trainee's motivation were categorized as either intrinsic (internal) or extrinsic (external). RESULTS Two randomised control trials and 7 case series' met our inclusion criteria. Included studies were small and generally poor quality. Overall, voluntary simulation-based laparoscopic skills training was not well attended. Intrinsic motivators included clearly defined personal performance goals and relevance to clinical practice. Extrinsic motivators included clinical responsibilities and available free time, simulator location close to clinical training, and setting obligatory assessments or mandated training sessions. The effect of each of these factors was variable, and largely dependent on the individual trainee. The greatest reported barrier to attending voluntary training was the lack of available free time. CONCLUSION Although data quality is limited, it can be seen that providing unrestricted access to simulator equipment is not effective in motivating surgical trainees to voluntarily participate in simulation-based laparoscopic skills training. To successfully encourage participation, consideration needs to be given to the factors influencing motivation to attend training. Further research, including better designed randomised control trials and large-scale surveys, is required to provide more definitive answers to the degree in which various incentives influence trainees' motivations and actual attendance rates.
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Affiliation(s)
- Hannah Gostlow
- Division of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Nicholas Marlow
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Wendy Babidge
- Division of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Guy Maddern
- Division of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia.
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26
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Freund O, Reychav I, McHaney R, Goland E, Azuri J. The ability of older adults to use customized online medical databases to improve their health-related knowledge. Int J Med Inform 2017; 102:1-11. [PMID: 28495336 DOI: 10.1016/j.ijmedinf.2017.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/04/2017] [Accepted: 02/18/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Patient compliance with medical advice and recommended treatment depends on perception of health condition, medical knowledge, attitude, and self-efficacy. This study investigated how use of customized online medical databases, intended to improve knowledge in a variety of relevant medical topics, influenced senior adults' perceptions. METHOD Seventy-nine older adults in residence homes completed a computerized, tablet-based questionnaire, with medical scenarios and related questions. Following an intervention, control group participants answered questions without online help while an experimental group received internet links that directed them to customized, online medical databases. RESULTS Medical knowledge and test scores among the experimental group significantly improved from pre- to post-intervention (p<0.0001) and was higher in comparison with the control group (p<0.0001). No significant change occurred in the control group. CONCLUSION Older adults improved their knowledge in desired medical topic areas using customized online medical databases. The study demonstrated how such databases help solve health-related questions among older adult population members, and that older patients appear willing to consider technology usage in information acquisition.
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27
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Monaghan SA, Felgar RE, Kelly MA, Ali AM, Anastasi J, Bellara AP, Rinder HM, Sargent RL, Wagner J, Swerdlow SH, Johnson RL. Does Taking the Fellowship In-Service Hematopathology Examination and Performance Relate to Success on the American Board of Pathology Hematology Examination? Am J Clin Pathol 2016; 146:107-12. [PMID: 27357289 DOI: 10.1093/ajcp/aqw085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The biannual Fellow In-Service Hematopathology Examination (FISHE) assesses knowledge in five content areas. We examined the relationship between taking the FISHE and performance on it with outcomes on the first attempted American Board of Pathology Hematology subspecialty certifying examination (ABP-HE). METHODS The pass rate between the ABP-HE candidates who took the spring FISHE and those who did not were compared. The likelihood of fellows passing the ABP-HE based on their percentiles on the FISHE was also assessed. RESULTS ABP-HE candidates who took the spring FISHE had a higher pass rate (96.4%) than those who did not (76.1%, P < .001). Spring FISHE performance, including total percentile and percentiles in four of five FISHE content areas, was only a weak predictor of passing the ABP-HE. CONCLUSIONS Candidates who take the spring FISHE do better on the ABP-HE than those who do not. Most fellows passed the first attempted ABP-HE regardless of FISHE performance. Whether this is due to fellows making use of the FISHE as a self-evaluation tool to help identify and then correct their knowledge deficiencies remains to be determined.
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Affiliation(s)
- Sara A Monaghan
- From the Department of Pathology, University of Texas Southwestern Medical Center, Dallas
| | - Raymond E Felgar
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Melissa A Kelly
- Department of Evaluation, Measurement, and Assessment, American Society for Clinical Pathology, Chicago, IL
| | - Asma M Ali
- Department of Evaluation, Measurement, and Assessment, American Society for Clinical Pathology, Chicago, IL
| | - John Anastasi
- Department of Pathology, University of Chicago Medical Center, Chicago, IL
| | - Aarti P Bellara
- American Board of Pathology, Tampa, FL Department of Educational Psychology, University of Connecticut, Storrs
| | - Henry M Rinder
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Rachel L Sargent
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Jay Wagner
- Department of Evaluation, Measurement, and Assessment, American Society for Clinical Pathology, Chicago, IL
| | - Steven H Swerdlow
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA American Board of Pathology, Tampa, FL
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28
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Willis RE, Dent DL, Love JD, Kempenich JW, Uecker J, Brown KM, Thomas JS, Gomez PP, Adams AJ, Admire JR, Sprunt JM, Kahrig KM, Wiggins-Dohlvik K. Predicting and enhancing American Board of Surgery In-Training Examination performance: does writing questions really help? Am J Surg 2015; 211:361-8. [PMID: 26687960 DOI: 10.1016/j.amjsurg.2015.08.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/20/2015] [Accepted: 08/19/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The generative learning model posits that individuals remember content they have generated better than materials created by others. The goals of this study were to evaluate question generation as a study method for the American Board of Surgery In-Training Examination (ABSITE) and determine whether practice test scores and other data predict ABSITE performance. METHODS Residents (n = 206) from 6 general surgery programs were randomly assigned to one of the two study conditions. One group wrote questions for practice examinations. All residents took 2 practice examinations. RESULTS There was not a significant effect of writing questions on ABSITE score. Practice test scores, United States Medical Licensing Examination Step 1 scores, and previous ABSITE scores were significantly correlated with ABSITE performance. CONCLUSIONS The generative learning model was not supported. Performance on practice tests and other data can be used for early identification of residents at risk of performing poorly on the ABSITE.
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Affiliation(s)
- Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Daniel L Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Joseph D Love
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - John Uecker
- University of Texas Southwestern at Austin, Austin, TX, USA
| | | | | | - Pedro P Gomez
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Andrew J Adams
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - John R Admire
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Julie M Sprunt
- University of Texas Southwestern at Austin, Austin, TX, USA
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29
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McHugh HM, Walker ST. "Personal Knowledge" in Medicine and the Epistemic Shortcomings of Scientism. J Bioeth Inq 2015; 12:577-585. [PMID: 26615541 DOI: 10.1007/s11673-015-9661-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 10/10/2015] [Indexed: 06/05/2023]
Abstract
In this paper, we outline a framework for understanding the different kinds of knowledge required for medical practice and use this framework to show how scientism undermines aspects of this knowledge. The framework is based on Michael Polanyi's claim that knowledge is primarily the product of the contemplations and convictions of persons and yet at the same time carries a sense of universality because it grasps at reality. Building on Polanyi's ideas, we propose that knowledge can be described along two intersecting "dimensions": the tacit-explicit and the particular-general. These dimensions supersede the familiar "objective-subjective" dichotomy, as they more accurately describe the relationship between medical science and medical practice. Scientism, we argue, excludes tacit and particular knowledge and thereby distorts "clinical reality" and impairs medical practice and medical ethics.
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Affiliation(s)
| | - Simon Thomas Walker
- Bioethics Centre, University of Otago, 71 Frederick St, Dunedin, New Zealand
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30
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Ferreira AM, Bettencourt N, Matos P, Oliveira L, Almeida AG; Grupo de Estudo de Cardiologia Nuclear, Ressonância Magnética e TC Cardíaca da Sociedade Portuguesa de Cardiologia. [Familiarity and perceptions of Portuguese cardiologists concerning cardiac magnetic resonance and cardiac computed tomography: the extent of the task ahead]. Rev Port Cardiol 2013; 32:601-8. [PMID: 23827417 DOI: 10.1016/j.repc.2012.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 11/01/2012] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Rapid advances in cardiac magnetic resonance (CMR) and cardiac computed tomography angiography (CCTA) pose challenges for practicing physicians in terms of awareness of their indications, contraindications, advantages and pitfalls. METHODS We conducted a nationwide online survey assessing the familiarity, perceptions and patterns of use concerning these imaging modalities based on a questionnaire sent to all physician members of the Portuguese Society of Cardiology. RESULTS The responses from 205 physicians (21% response rate) were analyzed. Roughly half of them requested less than one CMR (51%) or CCTA (52%) per week. Suspected coronary artery disease in symptomatic patients with intermediate pretest probability was considered a good or excellent indication for CCTA by 59% of respondents when performed as a second-line exam, and by 29% as a first-line exam. Cardiac masses, congenital heart disease and cardiomyopathies were considered good or excellent indications for CMR by over 90% of respondents, while assessment of myocardial viability and acute myocardial infarction with normal coronary arteries were considered good or excellent indications by 75% and 65% of respondents, respectively. Less than half (39%) answered all the questions regarding contraindications for CMR correctly, and 15% were unaware that CMR does not involve ionizing radiation. The main reasons for not referring a patient for CMR were limited availability (45%) and cost (36%). CONCLUSIONS Portuguese cardiologists appear to be moderately aware of the indications, contraindications and advantages of these new imaging modalities. Greater efforts should be made to improve physician education on this subject in order to improve patient care.
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Abstract
BACKGROUND Graduate medical education has moved towards competency-based training. The aim of this study was to assess hand surgery program directors' opinions of exposure gaps in core competencies rated as essential for hand surgery training. METHODS We surveyed the 74 ACGME hand surgery fellowship program directors. Respondents rated their opinion of 9 general areas of practice, 97 knowledge topics, and 172 procedures into one of three categories: essential, exposure needed, or unnecessary. Program directors also rated trainee exposure of each component at their respective program. Moderate and large exposure gaps were respectively defined as presence of at least 25 and 50 % of programs rating trainees as not having proficiency in the component at the end of training. RESULTS Sixty-two of 74 program directors (84 %) responded to the survey. For the 76 knowledge topics and 98 procedures rated as essential, a majority of the knowledge topics (61 %; n = 46) and procedures (72 %; n = 71) had at least a moderate exposure gap. In addition, 22 % (n = 17) of the essential knowledge topics and 26 % (n = 25) of the essential procedures had a large exposure gap. CONCLUSION This study illuminates the discrepancies between what is believed to be important for practicing hand surgeons and graduates' proficiency as perceived by program directors. The field of hand surgery must work to determine if program directors have unrealistic expectations for what is essential for practicing hand surgeons or if reforms are needed to improve exposure to essential skills in hand surgery training.
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