Exploiting the power of information in medical education.

The explosion of medical information demands a thorough reconsideration of medical education, including what we teach and assess, how we educate, and whom we educate. Physicians of the future will need to be self-aware, self-directed, resource-effective team players who can synthesize and apply summarized information and communicate clearly. Training in metacognition, data science, informatics, and artificial intelligence is needed.

Copy-and-Paste in Medical Student Notes: Extent, Temporal Trends, and Relationship to Scholastic Performance.

Background: Medical students may observe and subsequently perpetuate redundancy in clinical documentation, but the degree of redundancy in student notes and whether there is an association with scholastic performance are unknown.

Objectives: This study sought to quantify redundancy, defined generally as the proportion of similar text between two strings, in medical student notes and evaluate the relationship between note redundancy and objective indicators of student performance.

Methods: Notes generated by medical students rotating through their medicine clerkship during a single academic year at our institution were analyzed.

"Yes, and …" Exploring the Future of Learning Analytics in Medical Education.

This Conversations Starter article presents a selected research abstract from the 2017 Association of American Medical Colleges Northeastern Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of three experts who shared their thoughts stimulated by the study. Commentators brainstormed "what's next" with learning analytics in medical education, including advancements in interaction metrics and the use of interactivity analysis to deepen understanding of perceptual, cognitive, and social learning and transfer processes.

Formation of a New Entity to Support Effective Use of Technology in Medical Education: The Student Technology Committee.

Background: As technology in medical education expands from teaching tool to crucial component of curricular programming, new demands arise to innovate and optimize educational technology. While the expectations of today's digital native students are significant, their experience and unique insights breed new opportunities to involve them as stakeholders in tackling educational technology challenges.

Objective: The objective of this paper is to present our experience with a novel medical student-led and faculty-supported technology committee that was developed at Vanderbilt University School of Medicine to harness students' valuable input in a comprehensive fashion.

Changing Medical School IT to Support Medical Education Transformation.

Problem: Many medical schools are modifying curricula to reflect the rapidly evolving health care environment, but schools struggle to provide the educational informatics technology (IT) support to make the necessary changes. Often a medical school's IT support for the education mission derives from isolated work units employing separate technologies that are not interoperable.

Intervention: We launched a redesigned, tightly integrated, and novel IT infrastructure to support a completely revamped curriculum at the Vanderbilt School of Medicine.

Using natural language processing to provide personalized learning opportunities from trainee clinical notes.

Objective: Assessment of medical trainee learning through pre-defined competencies is now commonplace in schools of medicine. We describe a novel electronic advisor system using natural language processing (NLP) to identify two geriatric medicine competencies from medical student clinical notes in the electronic medical record: advance directives (AD) and altered mental status (AMS).

Materials And Methods: Clinical notes from third year medical students were processed using a general-purpose NLP system to identify biomedical concepts and their section context.

Spanning a Decade of Physician Boundary Violations: Are We Improving?

Sexual boundary violations can negatively impact the culture of safety within a medical practice or healthcare institution and severely compromise the covenant of care and physician objectivity. Lack of education and training is one factor associated with physician misconduct that leads to high financial and personal cost. This paper presents a follow-up study of physicians referred to a professional development course in 2001 and presents demographic data from 2001 to present.

Automated Assessment of Medical Students' Clinical Exposures according to AAMC Geriatric Competencies.

Competence is essential for health care professionals. Current methods to assess competency, however, do not efficiently capture medical students' experience. In this preliminary study, we used machine learning and natural language processing (NLP) to identify geriatric competency exposures from students' clinical notes.

Automatic scoring of medical students' clinical notes to monitor learning in the workplace.

Background: Educators need efficient and effective means to track students' clinical experiences to monitor their progress toward competency goals.

Aim: To validate an electronic scoring system that rates medical students' clinical notes for relevance to priority topics of the medical school curriculum.

Method: The Vanderbilt School of Medicine Core Clinical Curriculum enumerates 25 core clinical problems (CCP) that graduating medical students must understand.

Teaching evidence-based medicine: Impact on students' literature use and inpatient clinical documentation.

Background: Effective teaching of evidence-based medicine (EBM) to medical students is important for lifelong self-directed learning.

Aims: We implemented a brief workshop designed to teach literature searching skills to third-year medical students. We assessed its impact on students' utilization of EBM resources during their clinical rotation and the quality of EBM integration in inpatient notes.

Comparing content coverage in medical curriculum to trainee-authored clinical notes.

Accurate assessment and evaluation of medical curricula has long been a goal of medical educators. Current methods rely on manually-entered keywords and trainee-recorded logs of case exposure. In this study, we used natural language processing to compare the clinical content coverage in a four-year medical curriculum to the electronic medical record notes written by clinical trainees.

What factors create a humanistic doctor? A nationwide survey of fourth-year medical students.

Purpose: The authors sought to develop a conceptual framework of the factors that most influence medical students' development of humanism and to explore students' opinions regarding the role these factors play in developing or inhibiting humanism.

Method: In 2006-2007, the authors conducted 16 focus groups with fourth-year students and first-year residents at four universities to design a conceptual framework. They used the framework to develop a survey, which they administered to fourth-year medical students at 20 U.

Evaluation of a method to identify and categorize section headers in clinical documents.

Objective: Clinical notes, typically written in natural language, often contain substructure that divides them into sections, such as "History of Present Illness" or "Family Medical History." The authors designed and evaluated an algorithm ("SecTag") to identify both labeled and unlabeled (implied) note section headers in "history and physical examination" documents ("H&P notes").

Design: The SecTag algorithm uses a combination of natural language processing techniques, word variant recognition with spelling correction, terminology-based rules, and naive Bayesian scoring methods to identify note section headers.

Tracking medical students' clinical experiences using natural language processing.

Graduate medical students must demonstrate competency in clinical skills. Current tracking methods rely either on manual efforts or on simple electronic entry to record clinical experience. We evaluated automated methods to locate 10 institution-defined core clinical problems from three medical students' clinical notes (n=290).

Development and evaluation of a clinical note section header terminology.

Clinical documentation is often expressed in natural language text, yet providers often use common organizations that segment these notes in sections, such as history of present illness or physical examination. We developed a hierarchical section header terminology, supporting mappings to LOINC and other vocabularies; it contained 1109 concepts and 4332 synonyms. Physicians evaluated it compared to LOINC and the Evaluation and Management billing schema using a randomly selected corpus of history and physical notes.

Automated capture and assessment of medical student clinical experience.

Currently, many medical educators track trainee clinical experience using student-created manual logs. Using a web-based portfolio system that captures all notes written by trainees in the electronic medical record, we examined a graduating medical student's clinical notes to determine if we could automatically assess exposure to 10 institution-defined core clinical topics. We located all biomedical concepts in his clinical notes, divided by note section, using the KnowledgeMap concept identifier.

A randomized study of feedback on student write-ups using an electronic portfolio.

Traditional methods allowing medical students and residents to review their work and receive feedback are lacking. We developed a web-based portfolio system that collects all clinical documentation and allows teachers to give feedback electronically. In a randomized control trial, we found that this system significantly increased feedback to students, often exceeding clerkship expectations.

Automatic capture of student notes to augment mentor feedback and student performance on patient write-ups.

Objective: To determine whether the integration of an automated electronic clinical portfolio into clinical clerkships can improve the quality of feedback given to students on their patient write-ups and the quality of students' write-ups.

Design: The authors conducted a single-blinded, randomized controlled study of an electronic clinical portfolio that automatically collects all students' clinical notes and notifies their teachers (attending and resident physicians) via e-mail. Third-year medical students were randomized to use the electronic portfolio or traditional paper means.

Proposed standards for medical education submissions to the Journal of General Internal Medicine.

To help authors design rigorous studies and prepare clear and informative manuscripts, improve the transparency of editorial decisions, and raise the bar on educational scholarship, the Deputy Editors of the Journal of General Internal Medicine articulate standards for medical education submissions to the Journal. General standards include: (1) quality questions, (2) quality methods to match the questions, (3) insightful interpretation of findings, (4) transparent, unbiased reporting, and (5) attention to human subjects' protection and ethical research conduct. Additional standards for specific study types are described.

Burnout in medical school deans: an uncommon problem.

Purpose: To assess the burnout level among U.S. and Canadian medical school deans and to study how burnout relates to certain characteristics including hours worked, effectiveness, and support from family and colleagues.

A continuing medical education approach to improve sexual boundaries of physicians.

Introduction: Physician sexual boundary violations are a public health problem. Few resources exist to address physicians who behave inappropriately with patients. In response, the Center for Professional Health at Vanderbilt University developed a three-day continuing medical education (CME) course about proper professional sexual boundaries in 2000.

Can mentors prevent and reduce burnout in new chairs of departments of obstetrics and gynecology: results from a prospective, randomized pilot study.

Objective: This study assessed burnout in new chairs of obstetrics and gynecology and whether mentoring by experienced chairs would prevent or reduce burnout.

Study Design: We performed a year-long prospective, randomized trial. Questionnaires were sent to new chairs to obtain demographic information and to identify need for mentoring and level of burnout.