Unprofessional faculty behaviors negatively impact the well-being of trainees yet are infrequently reported through established reporting systems. Manual review of narrative faculty evaluations provides an additional avenue for identifying unprofessional behavior but is time- and resource-intensive, and therefore of limited value for identifying and remediating faculty with professionalism concerns. Natural language processing (NLP) techniques may provide a mechanism for streamlining manual review processes to identify faculty professionalism lapses. In this retrospective cohort study of 15,432 narrative evaluations of medical faculty by medical trainees, we identified professionalism lapses using automated analysis of the text of faculty evaluations. We used multiple NLP approaches to develop and validate several classification models, which were evaluated primarily based on the positive predictive value (PPV) and secondarily by their calibration. A NLP-model using sentiment analysis (quantifying subjectivity of the text) in combination with key words (using the ensemble technique) had the best performance overall with a PPV of 49% (CI 38%-59%). These findings highlight how NLP can be used to screen narrative evaluations of faculty to identify unprofessional faculty behaviors. Incorporation of NLP into faculty review workflows enables a more focused manual review of comments, providing a supplemental mechanism to identify faculty professionalism lapses.
THE SOUND frequencies to be tested in school hearing screening programs have been and continue to be the subject of discussion. Within the past few years, new concepts of screening have developed in which the single frequency of 4,000 cycles per second, or a combination of 4,000 and 1,000 cps, or 4,000 and 2,000 cps have been used in place of the standard five-and six-frequency sweep tests. Differences of opinion exist as to the effectiveness of this technique. Glorig and House1 developed oto-check, as two\x=req-\ frequency (4,000 and 2,000 cps) screening audiometer which they stated was 99.5% as accurate in detecting hearing impairments as the standard sweep test. In a study de-signed to check the validity of oto-check, Lightfoot et al2 concluded that the t wo\ x=req-\ frequency screening procedure was inadequate for use in school programs and physicians' offices. They based their conclusions on the fact that of 552 ears capable of passing the oto check, 381 (69%) were found by otological examination to be defective. By use of the six-frequency sweep check only 78 out of the 381 defective ears would have been missed, an 80% reduction in false negatives.Siegenthaler and Sommers3 in an evalua¬ tion of sweep check procedures found that a single-frequency hearing test procedure was not appropriate for school hearing screening purposes. They found a two-frequency screening to have a greater potential but concluded that it too would fail to detect an appreciable proportion of children with hearing loss. On the other hand, Lawrence and Rubin4 found the combined 4,000 cps and 1,000 cps frequencies adequate for de¬ tecting hearing losses with medical sig¬ nificance. In order to determine if limited frequency tests would be effective in detect¬ ing those hearing losses concomitant with ear pathology, Maxwell and Davidson5 ana¬ lyzed the audiograms and otological findings of 161 ears (of 90 children) with losses in one or more of the frequencies 250, 500, 1,000, 2,000, 4,000 and 8,000 cps. They inves¬ tigated the effectiveness of screening tests using 4,000 cps, 4,000 and 1,000 cps, and 4,000 and 2,000 cps in detecting these pre¬ viously-known losses. Their results indicat¬ ed that none of the limited-frequency tests studied would detect all ear pathologies ac¬ companied by hearing loss. Norton and Lux6 evaluated the rapidity and reliability of a two-frequency (4,000 and 2,000) check as compared with the standard five-frequen¬ cy, pure-tone method. They found that the two-frequency check was simple and fast to administer but was less reliable in detecting children with hearing loss than the fivefrequency, pure-tone method.The idea of limited frequency testing orig¬ inated, no doubt, out of a desire to screen the greatest number of children with often limited available time and personnel. Most of the studies conducted to assess limited frequency methods have shown that they are inadequate for finding all children with audiogram losses. Furthermore, Siegentha-ler7 in a critical appraisal of the findings of Norton and Lux poi...
in the city of Buffalo is reported. The problems uncovered are medical, educational, and social, and involve a need for day care services. These problems are, of course, nationwide and the methods used to deal with them have equally wide applicability.
Background: Sub-Saharan Africa faces the highest relative need for health care workers in the world and the emigration of physicians significantly contributes to this deficit. Few studies have explored development of these patterns during medical education. This study investigates career aspirations of medical students in two African nations with similar Human Development Indices, but distinct differences in training structure to better inform retention strategies. Methods: A cross-sectional survey was administered in 2018 to medical students in Madagascar (University of Antananarivo, University of Mahajanga) and Tanzania (Kilimanjaro Christian Medical College, KCMC). Outcomes included emigration/career intentions, and factors influencing these decisions. Analysis utilised chi-square and Fisher's exact tests (α < 0.05, two-tailed) for statistical differences, logistic regression and qualitative content analysis of free text data. Results: A total of 439 students responded to the survey with a response rate of 12.9% from Antananarivo (n = 142/1097), 11.6% from Mahajanga (n = 43/370), and 60.0% from KCMC (n = 254/423). Significantly more Malagasy (49.7%, n = 90/181) than Tanzanian (25.2%, n = 54/214) students expressed emigration intent (P < .001). Malagasy students indicating research, possibility of working abroad, or work intensity as influencing career choice more frequently expressed a desire to emigrate. Satisfaction with computer/internet access was inversely correlated with a desire to work abroad. In comparison, Tanzanian students reporting income potential as influential in their career choice or attending a private high school were more likely to express a desire to work abroad. Qualitative content analysis of free text data demonstrated deficits in faculty availability, diversity of training locations and a particular emphasis on infrastructure challenges within Madagascar. Interpretation: A significant number of students desire to work abroad. Emigration interests are influenced by access to postgraduate training, infrastructure and opportunities in academia, which differ across countries. Efforts to retain physicians
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