Biomedical subjects

Charles P Friedman

Publications and source records attributed to Charles P Friedman.

11 recordsLinked to original sources

PubMed2006

Creating an infrastructure for training in the responsible conduct of research: the University of Pittsburgh's experience.

In response to public concerns about the consequences of research misconduct, academic institutions have become increasingly cognizant of the need to implement comprehensive, effective training in the responsible conduct of research (RCR) for faculty, staff, students, and external collaborators. The ability to meet this imperative is challenging as universities confront declining financial resources and increasing complexity of the research enterprise. The authors describe the University of Pittsburgh's design, implementation, and evaluation of a Web-based, institution-wide RCR training program called Research and Practice Fundamentals (RPF). This project, established in 2000, was embedded in the philosophy, organizational structure, and technology developed through the Integrated Advanced Information Management Systems grant from the National Library of Medicine. Utilizing a centralized, comprehensive approach, the RPF system provides an efficient mechanism for deploying content to a large, diverse cohort of learners and supports the needs of research administrators by providing access to information about who has successfully completed the training. During its first 3 years of operation, the RPF served over 17,000 users and issued more than 38,000 training certificates. The 18 modules that are currently available address issues required by regulatory mandates and other content areas important to the research community. RPF users report high levels of satisfaction with content and ease of using the system. Future efforts must explore methods to integrate non-RCR education and training into a centralized, cohesive structure. The University of Pittsburgh's experience with the RPF demonstrates the importance of developing an infrastructure for training that is comprehensive, scalable, reliable, centralized, affordable, and sustainable.

Academic Medical Centers↗

PubMed2005

Do physicians know when their diagnoses are correct? Implications for decision support and error reduction.

OBJECTIVE: This study explores the alignment between physicians' confidence in their diagnoses and the "correctness" of these diagnoses, as a function of clinical experience, and whether subjects were prone to over-or underconfidence. DESIGN: Prospective, counterbalanced experimental design. SETTING: Laboratory study conducted under controlled conditions at three academic medical centers. PARTICIPANTS: Seventy-two senior medical students, 72 senior medical residents, and 72 faculty internists. INTERVENTION: We created highly detailed, 2-to 4-page synopses of 36 diagnostically challenging medical cases, each with a definitive correct diagnosis. Subjects generated a differential diagnosis for each of 9 assigned cases, and indicated their level of confidence in each diagnosis. MEASUREMENTS AND MAIN RESULTS: A differential was considered "correct" if the clinically true diagnosis was listed in that subject's hypothesis list. To assess confidence, subjects rated the likelihood that they would, at the time they generated the differential, seek assistance in reaching a diagnosis. Subjects' confidence and correctness were "mildly" aligned (kappa=.314 for all subjects, .285 for faculty, .227 for residents, and .349 for students). Residents were overconfident in 41% of cases where their confidence and correctness were not aligned, whereas faculty were overconfident in 36% of such cases and students in 25%. CONCLUSIONS: Even experienced clinicians may be unaware of the correctness of their diagnoses at the time they make them. Medical decision support systems, and other interventions designed to reduce medical errors, cannot rely exclusively on clinicians' perceptions of their needs for such support.

Clinical Competence↗

PubMed2005

"Smallball" evaluation: a prescription for studying community-based information interventions.

OBJECTIVES: This paper argues that focused evaluation studies of community-based informational interventions conducted over the life-cycle of the project ("smallball" studies) are more informative and useful than randomized experiments conducted only at the project's conclusion ("powerball" studies). METHOD: Based on two contrasting strategies in baseball, smallball and powerball studies are compared and contrasted, emphasizing how the distinctive features of community-based interventions lend advantage to smallball approaches. RESULTS: Smallball evaluations have several important advantages over powerball evaluations: before system development, they ensure that information resources address real community needs; during deployment, they ensure that the systems are suited to the capabilities of the users and to community constraints; and, after deployment, they enable as much as possible to be learned about the effects of the intervention in environments where randomized studies are usually impossible. IMPLICATIONS: Many in informatics see powerball studies as the only legitimate form of evaluation and so expect powerball studies to be done. These expectations should be revised in favor of smallball studies.

Community Health Planning↗

PubMed2004

Training the next generation of informaticians: the impact of "BISTI" and bioinformatics--a report from the American College of Medical Informatics.

In 2002-2003, the American College of Medical Informatics (ACMI) undertook a study of the future of informatics training. This project capitalized on the rapidly expanding interest in the role of computation in basic biological research, well characterized in the National Institutes of Health (NIH) Biomedical Information Science and Technology Initiative (BISTI) report. The defining activity of the project was the three-day 2002 Annual Symposium of the College. A committee, comprised of the authors of this report, subsequently carried out activities, including interviews with a broader informatics and biological sciences constituency, collation and categorization of observations, and generation of recommendations. The committee viewed biomedical informatics as an interdisciplinary field, combining basic informational and computational sciences with application domains, including health care, biological research, and education. Consequently, effective training in informatics, viewed from a national perspective, should encompass four key elements: (1). curricula that integrate experiences in the computational sciences and application domains rather than just concatenating them; (2). diversity among trainees, with individualized, interdisciplinary cross-training allowing each trainee to develop key competencies that he or she does not initially possess; (3). direct immersion in research and development activities; and (4). exposure across the wide range of basic informational and computational sciences. Informatics training programs that implement these features, irrespective of their funding sources, will meet and exceed the challenges raised by the BISTI report, and optimally prepare their trainees for careers in a field that continues to evolve.

Computational Biology↗

PubMed2003

Is medical informatics a mature science? A review of measurement practice in outcome studies of clinical systems.

OBJECTIVE: To determine the extent of explicit attention to formal issues of 'measurement' in studies examining outcomes of the deployment of clinical information systems. METHODS: A structured literature review identified 27 published studies reporting quantitative outcomes including attitudes, clinician behavior, quality of care, and cost of care. These studies were analyzed for types of outcome reported, evidence of 'reuse' of measurement methodology, and evidence of formal study of the reliability and validity of these measures. RESULTS: The 27 studies meeting the inclusion criteria were published between 1976 and 2002. Several of the studies addressed multiple outcome types. Nine examined clinician attitudes; 22 examined health care behaviors; 15 examined patient health status/quality of care; and four examined economic indicators. There were eight examples of reuse of measurement methods, five of which represented reuse within a single research group. Reliability indices were reported in three studies. There were no reported validity indices. CONCLUSION: Based on this sample of studies, specific attention to issues of measurement is sparse in outcome studies of deployed clinical information systems. As such, medical informatics does not appear to be on a par with more mature sciences in its approaches to measurement of key outcome variables.

Hospital Information Systems↗

PubMed2002

An experiment in graduate medical education: combined residency training in pediatrics, psychiatry, and child and adolescent psychiatry.

As an experiment in graduate medical education, a 5-year curriculum in pediatrics, psychiatry, and child and adolescent psychiatry was developed and evaluated over a 10-year period. The evaluation results suggested that the program's goal to create a cadre of specialists was achieved in terms of recruitment, performance during training, fostering of clinical reasoning ability, board certification rates, and postgraduate activities. As a result, the American Boards of Pediatrics and of Psychiatry and Neurology decided to make the combined training track permanent, and the numbers of training sites and residents have since been expanded.

Journal Article↗

PubMed2002

Exploring the boundaries of plausibility: empirical study of a key problem in the design of computer-based clinical simulations.

All clinical simulation designers face the problem of identifying the plausible diagnostic and management options to include in their simulation models. This study explores the number of plausible diagnoses that exist for a given case, and how many subjects must work up a case before all plausible diagnoses are identified. Data derive from 144 residents and faculty physicians from 3 medical centers, each of whom worked 9 diagnostically challenging cases selected from a set of 36. Each subject generated up to 6 diagnostic hypotheses for each case, and each hypothesis was rated for plausibility by a clinician panel. Of the 2091 diagnoses generated, 399 (19.1%), an average of 11 per case, were considered plausible by study criteria. The distribution of plausibility ratings was found to be statistically case dependent. Averaged across cases, the final plausible diagnosis was generated by the 28th clinician (sd = 8) who worked the case. The results illustrate the richness and diversity of human cognition and the challenges these pose for creation of realistic simulations in biomedical domains.

Computer Simulation↗

PubMed2002

Use of a MeSH-based index of faculty research interests to identify faculty publications: an IAIMSian study of precision, recall, and data reusability.

OBJECTIVE: To determine whether MEDLINE searches based on an existing automated faculty research interest index or on author name entities can be used to automate construction of accurate online lists of faculty publications. METHODS: Curricula vitae (CVs) for 36 faculty members were selected at random. Their lists of journal publications were used to determine recall and precision of two MEDLINE search strategies. OUTCOME: Most faculty publications in the CVs (86%) were indexed in MEDLINE. The research-interest-enhanced MEDLINE searches retrieved citations in the CVs that were also in MEDLINE with a recall of 0.53 and precision of 0.85. For every 10 citations in the research interest-enhanced search, on average 8.5 were in the CVs. The name entity searches retrieved a higher proportion of citations in the CVs (recall 0.94, precision 0.59) with a higher rate of citations not in the CVs: For every 10 citations in the faculty name searches, 7.3 citations were in the CVs. Name commonness or clinical or basic sciences appointment did not change these results. CONCLUSION: MEDLINE searches, especially those based on research interests, can be used to populate faculty publication lists with high rates of accuracy. Author based searches can also be used, but they retrieve a higher proportion of irrelevant citations. This study confirms a successful instance of data reusability and integration at a large health academic sciences institution.

Abstracting and Indexing↗

PubMedDate not supplied

Medical errors as a result of specialization.

Errors in medicine result in over 44,000 preventable deaths annually. Some of these errors are made by specialized physicians at the time of diagnosis. Building on error frameworks proposed in the literature, we tested the experimental hypothesis that physicians within a given specialty have a bias in diagnosing cases outside their own domain as being within that domain. Thirty-two board-certified physicians from four internal medicine subspecialties worked four patient cases each. Verbal protocol analysis and general linear modeling of the numerical data seem to confirm the experimental hypothesis, indicating that specialists try to "pull" cases toward their specialty. Specialists generate more diagnostic hypotheses within their domain than outside, and assign higher probabilities to diagnoses within that domain.

Decision Making↗

PubMedDate not supplied

Factors associated with success in searching MEDLINE and applying evidence to answer clinical questions.

OBJECTIVES: This study sought to assess the ability of medical and nurse practitioner students to use MEDLINE to obtain evidence for answering clinical questions and to identify factors associated with the successful answering of questions. METHODS: A convenience sample of medical and nurse practitioner students was recruited. After completing instruments measuring demographic variables, computer and searching attitudes and experience, and cognitive traits, the subjects were given a brief orientation to MEDLINE searching and the techniques of evidence-based medicine. The subjects were then given 5 questions (from a pool of 20) to answer in two sessions using the Ovid MEDLINE system and the Oregon Health & Science University library collection. Each question was answered using three possible responses that reflected the quality of the evidence. All actions capable of being logged by the Ovid system were captured. Statistical analysis was performed using a model based on generalized estimating equations. The relevance-based measures of recall and precision were measured by defining end queries and having relevance judgments made by physicians who were not associated with the study. RESULTS: Forty-five medical and 21 nurse practitioner students provided usable answers to 324 questions. The rate of correctness increased from 32.3 to 51.6 percent for medical students and from 31.7 to 34.7 percent for nurse practitioner students. Ability to answer questions correctly was most strongly associated with correctness of the answer before searching, user experience with MEDLINE features, the evidence-based medicine question type, and the spatial visualization score. The spatial visualization score showed multi-colinearity with student type (medical vs. nurse practitioner). Medical and nurse practitioner students obtained comparable recall and precision, neither of which was associated with correctness of the answer. CONCLUSIONS: Medical and nurse practitioner students in this study were at best moderately successful at answering clinical questions correctly with the assistance of literature searching. The results confirm the importance of evaluating both search ability and the ability to use the resulting information to accomplish a clinical task.

Adult↗

PubMedDate not supplied

Development of visual diagnostic expertise in pathology -- an information-processing study.

OBJECTIVE: To identify key features contributing to trainees' development of expertise in microscopic pathology diagnosis, a complex visual task, and to provide new insights to help create computer-based training systems in pathology. DESIGN: Standard methods of information-processing and cognitive science were used to study diagnostic processes (search, perception, reasoning) of 28 novices, intermediates, and experts. Participants examined cases in breast pathology; each case had a previously established gold standard diagnosis. Videotapes correlated the actual visual data examined by participants with their verbal "think-aloud" protocols. MEASUREMENTS: Investigators measured accuracy, difficulty, certainty, protocol process frequencies, error frequencies, and times to key diagnostic events for each case and subject. Analyses of variance, chi-square tests and post-hoc comparisons were performed with subject as the unit of analysis. RESULTS: Level of expertise corresponded with differences in search, perception, and reasoning components of the tasks. Several discrete steps occur on the path to competence, including development of adequate search strategies, rapid and accurate recognition of anatomic location, acquisition of visual data interpretation skills, and transitory reliance on explicit feature identification. CONCLUSION: Results provide the basis for an empirical cognitive model of competence for the complex tasks of microscopic pathology diagnosis. Results will inform the development of computer-based pedagogy tools in this domain

Analysis of Variance↗