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Previous work has suggested that gender and geographical distribution (affiliation) of Editors-in-Chief (EiC) and Editorial Board (EB) members are inequitable in representation of scientific communities, and could benefit from increasing diversity of representation. Specifically, previous studies suggest that male and ethnically white (or non-minoritized groups) are overrepresented. Such differences in representation may potentially influence the scientific and scholarly record. This paper aims to build on pre-existing literature by examining the diversity of representation among EiCs and EB members in the top (Q1) journals in the "Medicine-Health Informatics" category (ranked by SCImago Journal and Country Rank, or SJR) in terms of gender as assessed by genderize.io) and geographical distribution of affiliations. Preliminary findings are consistent with those of previous work on the topic: only 25% (8/32) of the EiCs in the selected journals are female, while females only represent 32.7% (426/1303) of the EB members across journals. Furthermore, the US is highly represented in EBs, with more than half of the members, i.e., 52.2% (698/1337), being US-affiliated. Present results suggest the need for an intentional approach to diversifying representation on editorial boards of medical informatics journals. Such intention can be seen as part of a call to action from important stakeholders, including medical informatics leaders and programs, journal management and publishers, and the medical informatics and scientific community more generally.
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Informática Médica , Publicaciones Periódicas como Asunto , Publicaciones Periódicas como Asunto/estadística & datos numéricos , Femenino , Masculino , Humanos , Políticas EditorialesRESUMEN
OBJECTIVE: Understanding and quantifying biases when designing and implementing actionable approaches to increase fairness and inclusion is critical for artificial intelligence (AI) in biomedical applications. METHODS: In this Special Communication, we discuss how bias is introduced at different stages of the development and use of AI applications in biomedical sciences and health care. We describe various AI applications and their implications for fairness and inclusion in sections on 1) Bias in Data Source Landscapes, 2) Algorithmic Fairness, 3) Uncertainty in AI Predictions, 4) Explainable AI for Fairness and Equity, and 5) Sociological/Ethnographic Issues in Data and Results Representation. RESULTS: We provide recommendations to address biases when developing and using AI in clinical applications. CONCLUSION: These recommendations can be applied to informatics research and practice to foster more equitable and inclusive health care systems and research discoveries.
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The number of papers presenting machine learning (ML) models that are being submitted to and published in the Journal of Medical Internet Research and other JMIR Publications journals has steadily increased. Editors and peer reviewers involved in the review process for such manuscripts often go through multiple review cycles to enhance the quality and completeness of reporting. The use of reporting guidelines or checklists can help ensure consistency in the quality of submitted (and published) scientific manuscripts and, for example, avoid instances of missing information. In this Editorial, the editors of JMIR Publications journals discuss the general JMIR Publications policy regarding authors' application of reporting guidelines and specifically focus on the reporting of ML studies in JMIR Publications journals, using the Consolidated Reporting of Machine Learning Studies (CREMLS) guidelines, with an example of how authors and other journals could use the CREMLS checklist to ensure transparency and rigor in reporting.
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Aprendizaje Automático , Humanos , Guías como Asunto , Pronóstico , Lista de VerificaciónRESUMEN
The ethics of generative artificial intelligence (AI) use in scientific manuscript content creation has become a serious matter of concern in the scientific publishing community. Generative AI has computationally become capable of elaborating research questions; refining programming code; generating text in scientific language; and generating images, graphics, or figures. However, this technology should be used with caution. In this editorial, we outline the current state of editorial policies on generative AI or chatbot use in authorship, peer review, and editorial processing of scientific and scholarly manuscripts. Additionally, we provide JMIR Publications' editorial policies on these issues. We further detail JMIR Publications' approach to the applications of AI in the editorial process for manuscripts in review in a JMIR Publications journal.
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Inteligencia Artificial , Programas Informáticos , Humanos , Autoria , Políticas Editoriales , LenguajeRESUMEN
Letters of recommendation play a significant role in higher education and career progression, particularly for women and underrepresented groups in medicine and science. Already, there is evidence to suggest that written letters of recommendation contain language that expresses implicit biases, or unconscious biases, and that these biases occur for all recommenders regardless of the recommender's sex. Given that all individuals have implicit biases that may influence language use, there may be opportunities to apply contemporary technologies, such as large language models or other forms of generative artificial intelligence (AI), to augment and potentially reduce implicit biases in the written language of letters of recommendation. In this editorial, we provide a brief overview of existing literature on the manifestations of implicit bias in letters of recommendation, with a focus on academia and medical education. We then highlight potential opportunities and drawbacks of applying this emerging technology in augmenting the focused, professional task of writing letters of recommendation. We also offer best practices for integrating their use into the routine writing of letters of recommendation and conclude with our outlook for the future of generative AI applications in supporting this task.
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Physical distancing requirements due to the coronavirus (COVID-19) pandemic has increased the need for broadband internet access. The World Health Organization defines social determinants of health as non-medical factors that impact health outcomes by affecting the conditions in which people are born, grow, work, live, and age. By this definition broadband internet access is a social determinant of health. Digital redlining-the systematic process by which specific groups are deprived of equal access to digital tools such as the internet-creates inequities in access to educational and employment opportunities, as well as healthcare and health information. Although it is known that internet service providers systematically exclude low-income communities from broadband service, little has been done to stop this discriminatory practice. In this paper, we seek to amplify the call to action against the practice of digital redlining in the United States, describe how it contributes to health disparities broadly and within the context of the COVID-19 pandemic, and use a socio-ecological framework to propose short- and long-term actions to address this inequity.
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The Journal of Medical Internet Research is pleased to offer "Research Letter" as a new article type. Research Letters are similar to original and short paper types in that they report the original results of studies in a peer-reviewed, structured scientific communication. The Research Letter article type is optimal for presenting new, early, or sometimes preliminary research findings, including interesting observations from ongoing research with significant implications that justify concise and rapid communication.
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Investigación Biomédica , Edición , Comunicación , Humanos , Revisión por ParesRESUMEN
BACKGROUND: Women physicians face unique obstacles while progressing through their careers, navigating career advancement and seeking balance between professional and personal responsibilities. Systemic changes, along with individual and institutional changes, are needed to overcome obstacles perpetuating physician gender inequities. Developing a deeper understanding of women physicians' experiences during important transition points could reveal both barriers and opportunities for recruitment, retention, and promotion, and inform best practices developed based on these experiences. OBJECTIVE: The aim is to learn from the experiences and perspectives of women physicians as they transition from early to mid-career, then develop best practices that can serve to support women physicians as they advance through their careers. METHODS: Semistructured interviews were conducted with women physicians in the United States in 2020 and 2021. Eligibility criteria included self-identification as a woman who is in the process of transitioning or who recently transitioned from early to mid-career stage. Purposeful sampling facilitated identification of participants who represented diversity in career pathway, practice setting, specialty, and race/ethnicity. Each participant was offered compensation for their participation. Interviews were audio-recorded and professionally transcribed. Interview questions were open-ended, exploring participants' perceptions of this transition. Qualitative thematic analysis will be performed. We will use an open coding and grounded theory approach on interview transcripts. RESULTS: The Ethics Review Committee of the Faculty of Health, Medicine, and Life Sciences at Maastricht University approved the study; Stanford University expedited review approved the study; and the University of California, San Diego certified the study as exempt from review. Twelve in-depth interviews of 50-100 minutes in duration were completed. Preliminary analyses indicate one key theme is a tension resulting from finite time divided between demands from a physician career and demands from family needs. In turn, this results in constant boundary control between these life domains that are inextricable and seemingly competing against each other within a finite space; family needs impinge on planned career goals, if the boundary between them is not carefully managed. To remedy this, women sought resources to help them redistribute home responsibilities, freeing themselves to have more time, especially for children. Women similarly sought resources to help with career advancement, although not with regard to time directly, but to first address foundational knowledge gaps about career milestones and how to achieve them. CONCLUSIONS: Preliminary results provide initial insights about how women identify or activate a career shift and how they marshaled resources and support to navigate barriers they faced. Further analyses are continuing as of March 2022 and are expected to be completed by June 2022. The dissemination plan includes peer-reviewed open-access journal publication of the results and presentation at the annual meeting of the American Medical Association's Women Physicians Section.
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Telehealth visits have become an integral model of healthcare delivery since the COVID-19 pandemic. This rapid expansion of telehealthcare delivery has forced faculty development and trainee education in telehealth to occur simultaneously. In response, academic medical institutions have quickly implemented clinical training to teach digital health skills to providers across the medical education continuum. Yet, learners of all levels must still receive continual assessment and feedback on their skills to align with the telehealth competencies and milestones set forth by the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME). This paper discusses key educational needs and emerging areas for faculty development in telehealth teaching and assessment of telehealth competencies. It proposes strategies for the successful integration of the AAMC telehealth competencies and ACGME milestones into medical education, including skills in communication, data gathering, and patient safety with appropriate telehealth use. Direct observation tools in the paper offer educators novel instruments to assess telehealth competencies in medical students, residents, and peer faculty. The integration of AAMC and ACGME telehealth competencies and the new assessment tools in this paper provide a unique perspective to advance clinical practice and teaching skills in telehealthcare delivery.
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COVID-19 , Educación Médica , Internado y Residencia , Telemedicina , COVID-19/epidemiología , Competencia Clínica , Educación de Postgrado en Medicina , Docentes Médicos , Humanos , PandemiasRESUMEN
OBJECTIVE: This study sought to describe gender representation in leadership and recognition within the U.S. biomedical informatics community. MATERIALS AND METHODS: Data were collected from public websites or provided by American Medical Informatics Association (AMIA) personnel from 2017 to 2019, including gender of membership, directors of academic informatics programs, clinical informatics subspecialty fellowships, AMIA leadership (2014-2019), and AMIA awardees (1993-2019). Differences in gender proportions were calculated using chi-square tests. RESULTS: Men were more often in leadership positions and award recipients (P < .01). Men led 74.7% (n = 71 of 95) of academic informatics programs and 83.3% (n = 35 of 42) of clinical informatics fellowships. Within AMIA, men held 56.8% (n = 1086 of 1913) of leadership roles and received 64.1% (n = 59 of 92) of awards. DISCUSSION: As in other STEM fields, leadership and recognition in biomedical informatics is lower for women. CONCLUSIONS: Quantifying gender inequity should inform data-driven strategies to foster diversity and inclusion. Standardized collection and surveillance of demographic data within biomedical informatics is necessary.
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Distinciones y Premios , Liderazgo , Becas , Femenino , Humanos , Informática , MasculinoRESUMEN
Physician suicide is a growing public health crisis that affects the medical community and patients. Literature on physician suicide has been published since 1903. However, the epidemiology of physician suicide including incidence is unclear due to a lack of accurate data. Lack of reliable data can lead to barriers in developing effective physician suicide prevention programs and creating policies to address the issue. Data are often collected from multiple data sources that each have limitations resulting in crude estimates of incidence and persistent barriers to surveillance. The aim of this study was to survey the medical community to determine the perceived usefulness of a physician suicide registry, with an accompanying data warehouse, to collect and store information about suicides reported from the community. Physicians at all stages of their training and careers would be key stakeholders contributing information to the registry and therefore their perception of such a tool to track physician suicides is important. Results show that 70.0% of respondents expressed that they somewhat to strongly agree with the approach; and 74.2% agreed with a statement that more research is needed on physician suicide. The proposed registry to better track physician suicide is a possible solution to better address physician suicide that has garnered initial support from the medical community as reflected by the survey results.
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Médicos/psicología , Médicos/estadística & datos numéricos , Sistema de Registros , Suicidio/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Encuestas y Cuestionarios , Prevención del SuicidioRESUMEN
OBJECTIVES: Overuse of telemetry among hospitalized patients results in poor patient care and wasted health care dollars. Guidelines addressing telemetry use have been developed by the American Heart Association (AHA) and are effective when applied to specific clinical practices and high-value care. The purpose of our intervention was to facilitate more effective utilization of telemetry in our hospital. We aimed to reduce patient days on telemetry through use of AHA guideline criteria for telemetry. STUDY DESIGN: We used Plan-Do-Study-Act cycles with chart review for pre- and postintervention measurement collection. METHODS: We included patients hospitalized at The Brooklyn Hospital Center on inpatient general medical wards from January 1, 2017, through July 31, 2018. The intervention consisted of a standard process of reviewing patients on telemetry based on AHA guidelines, educating teams on the guidelines, and changes to telemetry order sets. The primary outcome measured was the total number of days that patients remained on telemetry. Secondary measures included the daily number of telemetry downgrades and total number of patients on telemetry. Diagnosis-related group and case mix index were also noted. RESULTS: Patient average days on telemetry changed from 7.20 days preintervention to 3.51 days post intervention (P < .0001). The number of patients on telemetry with a diagnosis meeting AHA guidelines for telemetry increased. CONCLUSIONS: The stated intervention resulted in more effective use of telemetry, evidenced by fewer patient days on telemetry and increased numbers of patients on telemetry meeting AHA guidelines for telemetry.
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Pacientes Internos , Telemetría , American Heart Association , Humanos , Estados UnidosRESUMEN
CONTEXT: Physicians who migrate globally face a daunting series of time-consuming, labor- and resource-intensive procedures to prove their clinical competency before being allowed to practice medicine in a new country. ISSUES: In this commentary, we describe licensing barriers faced by physician-migrants based on the authors' experiences, and reflect also on rapidly implemented measures to address COVID-19 pandemic related workforce shortages. We offer recommendations for potential reductions in bureaucratic regulatory barriers that prohibit mobilization of international medical graduate talent. LESSONS LEARNED: Licensing boards and authorities should strive for standardized, competency-based basic professional recognition. Professional medical societies are well-positioned to guide such competency-based recognition as a more organized, international collaborative effort across specialties. The COVID-19 pandemic facilitated cross-state and international licensing in some regions, highlighting a key opportunity: streamlining professional recognition requirements is achievable.