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Biomedical subjects

E S Berner

Publications and source records attributed to E S Berner.

At least 19 recordsLinked to original sources
PubMed2000

Comparison of measures to assess change in diagnostic performance due to a decision support system.

Little has been done to examine the relative merit of measures used to assess the impact of diagnostic decision support systems (DDSS) on physician performance. In this study, 10 different single-measures of diagnostic performance were compared empirically. The measures were of three types: rank-order, all-or-none, and appropriateness. The responsiveness (RESP) of each measure was estimated under two repeated-measures experimental conditions. RESP is the degree to which a measure could detect differences between conditions of low and high performance. The diagnostic performance of 108 physicians was compared on medical cases of varying diagnostic difficulty and with or without a high level of assistance from a DDSS. The results showed that the RESP among the measures varied nearly tenfold. The rank-order measures tended to provide the highest RESP values (maximum = 2.14) while appropriateness measures provided the lowest RESP values (maximum = 1.41). The most responsive measures were rank-orders of the correct diagnosis within the top 5 to 10 listed diagnoses.

Decision Support Systems, Clinical↗
PubMed1997

The effects of the PDQ patient information file (PIF) on patients' knowledge, enrollment in clinical trials, and satisfaction.

BACKGROUND: This study examined the outcomes of providing a copy of the PDQ Patient Information File (PIF) to cancer patients. METHODS: Patients with cervical, endometrial, and ovarian cancers were randomized to two groups: 1) verbal communication only and 2) verbal communication plus PIF. Cancer knowledge and satisfaction with the PIF and the information received were assessed with telephone interviews. Clinical trial registries were reviewed to determine enrollment in clinical trials. RESULTS: The overall reaction to the PIF was good or excellent for 92% of the patients surveyed, but there was no significant difference between the two groups in their cancer knowledge, enrollment in clinical trials, or satisfaction with the information they received from their physicians. The majority of patients from both groups lacked basic knowledge about their disease, did not use any source of information other than their physicians and/or nurses, and were satisfied with the information they received. CONCLUSIONS: Patients appreciate receiving written cancer information, although it may not increase their cancer knowledge.

Clinical Protocols↗
PubMed1994

Performance of four computer-based diagnostic systems.

BACKGROUND: Computer-based diagnostic systems are available commercially, but there has been limited evaluation of their performance. We assessed the diagnostic capabilities of four internal medicine diagnostic systems: Dxplain, Iliad, Meditel, and QMR. METHODS: Ten expert clinicians created a set of 105 diagnostically challenging clinical case summaries involving actual patients. Clinical data were entered into each program with the vocabulary provided by the program's developer. Each of the systems produced a ranked list of possible diagnoses for each patient, as did the group of experts. We calculated scores on several performance measures for each computer program. RESULTS: No single computer program scored better than the others on all performance measures. Among all cases and all programs, the proportion of correct diagnoses ranged from 0.52 to 0.71, and the mean proportion of relevant diagnoses ranged from 0.19 to 0.37. On average, less than half the diagnoses on the experts' original list of reasonable diagnoses were suggested by any of the programs. However, each program suggested an average of approximately two additional diagnoses per case that the experts found relevant but had not originally considered. CONCLUSIONS: The results provide a profile of the strengths and limitations of these computer programs. The programs should be used by physicians who can identify and use the relevant information and ignore the irrelevant information that can be produced.

Analysis of Variance↗
PubMed1993

Use of the USMLE to select residents.

Many studies have examined the relationships between students' performances on the National Board of Medical Examiners (NBME) Part I and Part II examinations and their postgraduate clinical performances. Most studies have found a positive relationship between students' NBME examination scores and the ratings of residents' clinical performances and/or scores on specialty board certification examinations. Surveys of residency directors have also shown that NBME scores are used as part of the process for selecting residents, although other data and other selection criteria are considered more useful than the NBME scores. One area of continued concern is that a large body of data on the United States Medical Licensing Examination (USMLE) is not yet available. However, the predictive validity of the NBME scores supports the use of USMLE scores as part of the review process to screen potential residents. Residency directors should continue to use a variety of criteria in their final selection decisions and are encouraged to use their own program-specific data to establish and monitor particular cutoff scores for screening applicants.

Clinical Competence↗
PubMed1993

Comparison of problem-based and traditional education on student performance in the obstetrics and gynecology clerkship.

OBJECTIVE: To evaluate the hypothesis that students trained in problem-based learning during basic sciences will have an advantage over traditionally trained students during clinical activities because of greater experience in patient care settings. METHODS: A retrospective study encompassing the academic years 1985-1990 compared students' clinical performance during an obstetrics and gynecology third-year clerkship based on the method of basic science education (problem-based 78, traditional 228). RESULTS: No statistical difference could be demonstrated in student performance based on the basic science educational method and controlling for the timing of rotation. CONCLUSIONS: Participation in a problem-based curriculum does not affect students' performance on standardized objective examinations within the clinical curriculum. Using current evaluation tools, there is no measurable difference in clinical evaluations between basic science education by traditional versus problem-based learning methods.

Clinical Clerkship↗
PubMed1991

Needs assessment for diagnostic decision support systems (DDSS).

Diagnostic decision support systems are often developed without a clear idea of how well the system will meet the needs of its users. The present study was designed to assess the information needs of clinicians. A set of questions submitted to an information service by family physicians was used to determine how much need there was for diagnostic decision support, the types of support needed, and the general content areas of their questions. Results showed that less than half of the questions were related to diagnosis and that most of those were requests for general information about a given condition. In addition, the fewest diagnosis questions were for conditions that were seen frequently in ambulatory care in a survey of family practitioners.

Alberta↗
PubMed1989

Evaluation issues in the development of expert systems in medicine.

Evaluation of medical decision support software (MDSS)--computer programs to assist health professionals with diagnostic and/or therapeutic decisions--has not kept pace with the development of such programs. This article describes the following formative evaluation issues that must be addressed by developers of MDSS to evaluate these programs properly: (1) How can systematic feedback be obtained about an evolving program? (2) How can enough data to evaluate the program be obtained? (3) How much instruction is necessary? (4) What are the most important aspects for users to evaluate? and (5) How can the appropriate use of a developing MDSS be assured? Data from an ongoing evaluation of an existing MDSS, Quick Medical Reference, are used to illustrate the issues and to suggest recommendations for addressing them.

Data Collection↗
PubMed1986

Teaching skills.

Explore the source record for details and available documents.

Faculty, Medical↗
PubMed1985

A method to determine attitudes of faculty members toward use of laboratory tests.

Investigators have suggested that attitudes of faculty members toward diagnostic testing may encourage inappropriate laboratory use. In the present paper, the authors present a method for determining faculty attitudes on laboratory tests and the results of an analysis of such attitudes at one institution. The attitudes were determined from case simulations prepared by the faculty for senior medical student examinations. At the time the examination was being constructed, the faculty members weighted each laboratory test option following the case presentation for its appropriateness as positive, zero, or negative. The investigators subsequently categorized all of the laboratory tests according to their purpose and appropriateness with respect to the likelihood of diagnostic possibilities generated by the case. The results of the analysis showed that screening tests and tests to investigate unlikely diagnoses usually received weights close to zero and rarely received negative weights. This apparent indifference to tests with limited usefulness that generate some costs may be perceived by students as permission for their continued use.

Attitude of Health Personnel↗
PubMed1984

Paradigms and problem-solving: a literature review.

Thomas Kuhn's conceptions of the influence of paradigms on the progress of science from the framework for analyzing how medical educators have approached research on medical problem-solving. Kuhn's ideas help to explain the often conflicting research results that have appeared over the last 20 years. Specifically, underlying assumptions about the problem-solving process are explored in light of data that demonstrate (a) low correlations between different measures of problem-solving, (b) inconsistent relationships between the amount of clinical experience and problem-solving ability, and (c) case specificity of performance. A new paradigm emphasizing multiple types of problems with varied solution strategies is proposed.

Clinical Competence↗
PubMed1984

A tutor programme in obstetrics and gynaecology.

A Tutor Programme was created in a third-year clerkship in obstetrics and gynaecology to remedy a student complaint of insufficient contact with teaching staff. Data obtained through the use of observational methodologies were integrated with data from questionnaires and student/teacher interviews to assess programme content, its contribution to student education, and the characteristics of student-teacher interactions. Teachers and students both expressed satisfaction at this opportunity to 'get to know each other'. A unique contribution of the programme was the discussion of a set of topics categorized as 'Medicine as a Career and Lifestyle', e.g. how to make career decisions, residency selection, etc.). These topics were not addressed elsewhere in the curriculum yet were of great importance to the students. The value of observational methods in comprehensive programme evaluation was reaffirmed.

Chicago↗