Using Natural Language Processing to Evaluate the Quality of Supervisor Narrative Comments in Competency-Based Medical Education.

PURPOSE: Learner development and promotion rely heavily on narrative assessment comments, but narrative assessment quality is rarely evaluated in medical education. Educators have developed tools such as the Quality of Assessment for Learning (QuAL) tool to evaluate the quality of narrative assessment comments; however, scoring the comments generated in medical education assessment programs is time intensive. The authors developed a natural language processing (NLP) model for applying the QuAL score to narrative supervisor comments. METHOD: Samples of 2,500 Entrustable Professional Activities assessments were randomly extracted and deidentified from the McMaster (1,250 comments) and Saskatchewan (1,250 comments) emergency medicine (EM) residency training programs during the 2019-2020 academic year. Comments were rated using the QuAL score by 25 EM faculty members and 25 EM residents. The results were used to develop and test an NLP model to predict the overall QuAL score and QuAL subscores. RESULTS: All 50 raters completed the rating exercise. Approximately 50% of the comments had perfect agreement on the QuAL score, with the remaining resolved by the study authors. Creating a meaningful suggestion for improvement was the key differentiator between high- and moderate-quality feedback. The overall QuAL model predicted the exact human-rated score or 1 point above or below it in 87% of instances. Overall model performance was excellent, especially regarding the subtasks on suggestions for improvement and the link between resident performance and improvement suggestions, which achieved 85% and 82% balanced accuracies, respectively. CONCLUSIONS: This model could save considerable time for programs that want to rate the quality of supervisor comments, with the potential to automatically score a large volume of comments. This model could be used to provide faculty with real-time feedback or as a tool to quantify and track the quality of assessment comments at faculty, rotation, program, or institution levels.

Evaluation of fatty acids and carnitine as biomarkers of PFOS exposure in biota (fish and dolphin) from Galveston Bay and the northwestern Gulf of Mexico.

Perfluorooctane sulfonate (PFOS) is a ubiquitous pollutant that elicits a wide range of toxic effects in exposed biota. Coastal zones in highly urbanized or industrial areas are particularly vulnerable to PFOS pollution. At present, information is lacking on biomarkers to assess PFOS effects on aquatic wildlife. This study investigated the efficacy of l-carnitine (or carnitine) and fatty acids as biomarkers of PFOS exposure in aquatic biota. The levels of PFOS, total and free carnitine, and 24 fatty acids (measured as fatty acid methyl esters or FAMEs) were measured in the liver, and muscle or blubber, of fish and dolphins sampled from Galveston Bay and the northern Gulf of Mexico (nGoM). Overall, bottlenose dolphins (Tursiops truncatus) had the highest hepatic PFOS levels. Galveston Bay fish, gafftopsail catfish (Bagre marinus), red drum (Sciaenops ocellatus), and spotted seatrout (Cynoscion nebulosus), had hepatic PFOS levels ∼8-13× higher than nGoM pelagic fish species, red snapper (Lutjanus campechanus) and yellowfin tuna (Thunnus albacares). The multivariate analysis of PFOS liver body-burdens and biomarkers found carnitine to be a more modal biomarker of PFOS exposure than FAMEs. Significant positive correlation of hepatic PFOS levels with total carnitine was evident for biota from Galveston Bay (fish only), and a significant correlation between PFOS and total and free carnitine was evident for biota from the nGoM (fish and dolphins). Given the essential role of carnitine in mediating fatty acid ß-oxidation, our results suggest carnitine to be a likely candidate biomarker of environmental PFOS exposure and indicative of potential dyslipidemia effects.

Ready for practice? National recommendations for emergency medicine transition to practice curriculum.

BACKGROUND: Transition from residency to unsupervised practice represents a critical stage in learning and professional identity formation, yet there is a paucity of literature to inform residency curricula and emergency department transition programming for new faculty. OBJECTIVE: The objective of this study was to develop consensus-based recommendations to optimize the transition to practice phase of emergency medicine training. METHODS: A literature review and results of a survey of emergency medicine (EM) residency program directors informed focus groups of recent (within 5 years) EM graduates. Focus group transcripts were analyzed following conventional content analysis. Preliminary recommendations, based on identified themes, were drafted and presented at the 2022 Canadian Association of Emergency Physicians (CAEP) Academic Symposium on Education. Through a live presentation, symposium attendees representing the Canadian national EM community participated in a facilitated discussion of the recommendations. The authors incorporated this feedback to construct a final set of 14 recommendations, 8 targeted toward residency training programs and 6 specific to department leadership. CONCLUSION: The Canadian EM community used a structured process to develop 14 best practice recommendations to enhance the transition to practice phase of residency training as well as the transition period in the career of junior attending physicians.

ABSTRAIT: ARRIèRE-PLAN: La transition de la résidence à la pratique non supervisée représente une étape cruciale de l'apprentissage et de la formation de l'identité professionnelle, mais il y a peu de documentation pour éclairer les programmes de résidence et les programmes de transition des services d'urgence pour les nouveaux professeurs. OBJECTIF: L'objectif de cette étude était d'élaborer des recommandations consensuelles pour optimiser la transition vers la pratique de la formation en médecine d'urgence. MéTHODES: Une recension des écrits et les résultats d'un sondage auprès des directeurs des programmes de résidence en médecine d'urgence (GU) ont informé les groupes de discussion des diplômés récents (moins de cinq ans) en GU. Les transcriptions des groupes de discussion ont été analysées à la suite d'une analyse du contenu classique. Des recommandations préliminaires, fondées sur des thèmes déterminés, ont été rédigées et présentées au Symposium universitaire sur l'éducation de 2022 de l'Association canadienne des médecins d'urgence (ACMU). Au moyen d'une présentation en direct, les participants au symposium représentant la communauté nationale canadienne de la GU ont participé à une discussion dirigée sur les recommandations. Les auteurs ont intégré ces commentaires pour élaborer un ensemble final de 14 recommandations, 8 ciblant les programmes de formation en résidence et 6 ciblant le leadership ministériel. CONCLUSIONS: La communauté canadienne de la GU a utilisé un processus structuré pour élaborer 14 recommandations de pratiques exemplaires afin d'améliorer la transition à la phase de pratique de la formation en résidence ainsi que la période de transition dans la carrière des médecins traitants débutants.

Reliability of Perceptual Judgments of Phonetic Accuracy and Hypernasality Among Speech-Language Pathologists for Children With Dysarthria.

Purpose The objectives of this study were to: (a) compare interrater reliability of practicing speech-language pathologists' (SLPs) perceptual judgments of phonetic accuracy and hypernasality between children with dysarthria and those with typical development, and (b) to identify speech factors that influence reliability of these perceptual judgments for children with dysarthria. Method Ten SLPs provided ratings of speech samples from twenty 5-year-old children with dysarthria and twenty 5-year-old children with typical development on two tasks via a web-based platform: a hypernasality judgment task and a phonetic accuracy judgment task. Interrater reliability of SLPs' ratings on both tasks was compared between children with dysarthria and children with typical development. For children with dysarthria, four acoustic speech measures, intelligibility, and a measure of phonetic accuracy (percent stops correct) were examined as predictors of reliability of SLPs' perceptual judgments. Results Reliability of SLPs' phonetic accuracy judgments and hypernasality ratings was significantly lower for children with dysarthria than for children with typical development. Among children with dysarthria, interrater reliability of perceptual judgments ranged from strong to weak. Percent stops correct was the strongest predictor of interrater reliability for both phonetic accuracy judgments and hypernasality ratings. Conclusions Reliability of perceptual phonetic accuracy judgments and hypernasality ratings among practicing SLPs for children with dysarthria is reduced compared to ratings for children with typical development. Findings underscore the need for more reliable methods to assess phonetic accuracy and hypernasality for children with dysarthria.

The Clinical Ultrasonography Elective in Clerkship (CUSEC): A pilot elective for senior clerkship students at the University of Saskatchewan.

We created a clinical ultrasound (CUS) elective in clerkship, which gave medical students the opportunity to enhance their knowledge and technical skills while refining their CUS-related clinical decision making. This elective uniquely allowed medical students to integrate their CUS knowledge and skills into real patient care within the clinical environment (discipline) of their choice. As such, beyond supporting increasing technical competence, students learned to advocate for appropriate use of CUS, an important skill for trainees to develop.

Nous avons créé un stage d'externat optionnel enéchographie ciblée, laquelle offre aux étudiants en médecine l'occasion d'améliorer leurs connaissances et habiletéstechniques tout en raffinant leurs prises de décisions cliniques liées à l'échographie ciblée. Ce stage optionnel offre une occasion unique aux étudiants en médecine d'intégrer leurs connaissances et habiletésen échographie cibléeàdes soins réels aux patients dans un environnement clinique (discipline) de leur choix. Ainsi, au-delà d'un soutien au développement d'une compétence technique,les étudiants ont appris à préconiser une utilisation appropriée de l'échographie ciblée, une habiletéimportante à développer pour les apprenants.

Modeling the emission, transport and deposition of contaminated dust from a mine tailing site.

Mining operations are potential sources of airborne particulate metal and metalloid contaminants through both direct smelter emissions and wind erosion of mine tailings. The warmer, drier conditions predicted for the Southwestern US by climate models may make contaminated atmospheric dust and aerosols increasingly important, due to potential deleterious effects on human health and ecology. Dust emissions and dispersion of contaminants from the Iron King Mine tailings in Dewey-Humboldt, Arizona, a Superfund site, are currently being investigated through in situ field measurements and computational fluid dynamics modeling. These tailings are significantly contaminated with lead and arsenic with an average soil concentration of 1616 and 1420 ppm, respectively. Similar levels of these contaminants have also been measured in soil samples taken from the area surrounding the mine tailings. Using a computational fluid dynamics model, we have been able to model dust transport from the mine tailings to the surrounding region. The model includes a distributed Eulerian model to simulate fine aerosol transport and a Lagrangian approach to model fate and transport of larger particles. In order to improve the accuracy of the dust transport simulations both regional topographical features and local weather patterns have been incorporated into the model simulations.

Simulation of windblown dust transport from a mine tailings impoundment using a computational fluid dynamics model.

Mining operations are potential sources of airborne particulate metal and metalloid contaminants through both direct smelter emissions and wind erosion of mine tailings. The warmer, drier conditions predicted for the Southwestern US by climate models may make contaminated atmospheric dust and aerosols increasingly important, due to potential deleterious effects on human health and ecology. Dust emissions and dispersion of dust and aerosol from the Iron King Mine tailings in Dewey-Humboldt, Arizona, a Superfund site, are currently being investigated through in situ field measurements and computational fluid dynamics modeling. These tailings are heavily contaminated with lead and arsenic. Using a computational fluid dynamics model, we model dust transport from the mine tailings to the surrounding region. The model includes gaseous plume dispersion to simulate the transport of the fine aerosols, while individual particle transport is used to track the trajectories of larger particles and to monitor their deposition locations. In order to improve the accuracy of the dust transport simulations, both regional topographical features and local weather patterns have been incorporated into the model simulations. Results show that local topography and wind velocity profiles are the major factors that control deposition.