Papers by Anderson Spickard
Journal of biomedical informatics, 2015
Assessment of medical trainee learning through pre-defined competencies is now commonplace in sch... more Assessment of medical trainee learning through pre-defined competencies is now commonplace in schools of medicine. We describe a novel electronic advisor system using natural language processing (NLP) to identify two geriatric medicine competencies from medical student clinical notes in the electronic medical record: advance directives (AD) and altered mental status (AMS). Clinical notes from third year medical students were processed using a general-purpose NLP system to identify biomedical concepts and their section context. The system analyzed these notes for relevance to AD or AMS and generated custom email alerts to students with embedded supplemental learning material customized to their notes. Recall and precision of the two advisors were evaluated by physician review. Students were given pre and post multiple choice question tests broadly covering geriatrics. Of 102 students approached, 66 students consented and enrolled. The system sent 393 email alerts to 54 students (82%)...
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2014
Competence is essential for health care professionals. Current methods to assess competency, howe... more Competence is essential for health care professionals. Current methods to assess competency, however, do not efficiently capture medical students' experience. In this preliminary study, we used machine learning and natural language processing (NLP) to identify geriatric competency exposures from students' clinical notes. The system applied NLP to generate the concepts and related features from notes. We extracted a refined list of concepts associated with corresponding competencies. This system was evaluated through 10-fold cross validation for six geriatric competency domains: "medication management (MedMgmt)", "cognitive and behavioral disorders (CBD)", "falls, balance, gait disorders (Falls)", "self-care capacity (SCC)", "palliative care (PC)", "hospital care for elders (HCE)" - each an American Association of Medical Colleges competency for medical students. The systems could accurately assess MedMgmt, SCC, HCE,...
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2007
Traditional methods allowing medical students and residents to review their work and receive feed... more Traditional methods allowing medical students and residents to review their work and receive feedback are lacking. We developed a web-based portfolio system that collects all clinical documentation and allows teachers to give feedback electronically. In a randomized control trial, we found that this system significantly increased feedback to students, often exceeding clerkship expectations. Seventy-five percent of students found the system a "valuable teaching tool". Students in control and portfolio groups agreed that the system increased feedback.
Sexual Addiction & Compulsivity, 2002
Physicians who cross sexual boundaries with patients pose a serious problem for themselves, the p... more Physicians who cross sexual boundaries with patients pose a serious problem for themselves, the patient and the medical profession. The role of healer is compromised when the physician becomes romantically involved with a patient. In repsonse to the need for ...
Medical Teacher, 2014
Educators need efficient and effective means to track students&am... more Educators need efficient and effective means to track students' clinical experiences to monitor their progress toward competency goals. To validate an electronic scoring system that rates medical students' clinical notes for relevance to priority topics of the medical school curriculum. The Vanderbilt School of Medicine Core Clinical Curriculum enumerates 25 core clinical problems (CCP) that graduating medical students must understand. Medical students upload clinical notes pertinent to each CCP to a web-based dashboard, but criteria for determining relevance of a note and consistent uploading practices by students are lacking. The Vanderbilt Learning Portfolio (VLP) system automates both tasks by rating relevance for each CCP and uploading the note to the student's electronic dashboard. We validated this electronic scoring system by comparing the relevance of 265 clinical notes written by third year medical students to each of the 25 core patient problems as scored by VLP verses an expert panel of raters. We established the threshold score which yielded 75% positive prediction of relevance for 16 of the 25 clinical problems to expert opinion. Automated scoring of student's clinical notes provides a novel, efficient and standardized means of tracking student's progress toward institutional competency goals.
Journal of the American Medical Informatics Association, 2003
To describe the development and evaluation of computational tools to identify concepts within med... more To describe the development and evaluation of computational tools to identify concepts within medical curricular documents, using information derived from the National Library of Medicine's Unified Medical Language System (UMLS). The long-term goal of the KnowledgeMap (KM) project is to provide faculty and students with an improved ability to develop, review, and integrate components of the medical school curriculum. The KM concept identifier uses lexical resources partially derived from the UMLS (SPECIALIST lexicon and Metathesaurus), heuristic language processing techniques, and an empirical scoring algorithm. KM differentiates among potentially matching Metathesaurus concepts within a source document. The authors manually identified important "gold standard" biomedical concepts within selected medical school full-content lecture documents and used these documents to compare KM concept recognition with that of a known state-of-the-art "standard"-the National Library of Medicine's MetaMap program. The number of "gold standard" concepts in each lecture document identified by either KM or MetaMap, and the cause of each failure or relative success in a random subset of documents. For 4,281 "gold standard" concepts, MetaMap matched 78% and KM 82%. Precision for "gold standard" concepts was 85% for MetaMap and 89% for KM. The heuristics of KM accurately matched acronyms, concepts underspecified in the document, and ambiguous matches. The most frequent cause of matching failures was absence of target concepts from the UMLS Metathesaurus. The prototypic KM system provided an encouraging rate of concept extraction for representative medical curricular texts. Future versions of KM should be evaluated for their ability to allow administrators, lecturers, and students to navigate through the medical curriculum to locate redundancies, find interrelated information, and identify omissions. In addition, the ability of KM to meet specific, personal information needs should be assessed.
Journal of the American Medical Informatics Association, 2009
Clinical notes, typically written in natural language, often contain substructure that divides th... more Clinical notes, typically written in natural language, often contain substructure that divides them into sections, such as "History of Present Illness" or "Family Medical History." The authors designed and evaluated an algorithm ("SecTag") to identify both labeled and unlabeled (implied) note section headers in "history and physical examination" documents ("H&P notes"). The SecTag algorithm uses a combination of natural language processing techniques, word variant recognition with spelling correction, terminology-based rules, and naive Bayesian scoring methods to identify note section headers. Eleven physicians evaluated SecTag's performance on 319 randomly chosen H&P notes. The primary outcomes were the algorithm's recall and precision in identifying all document sections and a predefined list of twenty-nine major sections. A secondary outcome was to evaluate the algorithm's ability to recognize the correct start and end boundaries of identified sections. The SecTag algorithm identified 16,036 total sections and 7,858 major sections. Physician evaluators classified 15,329 as true positives and identified 160 sections omitted by SecTag. The recall and precision of the SecTag algorithm were 99.0 and 95.6% for all sections, 98.6 and 96.2% for major sections, and 96.6 and 86.8% for unlabeled sections. The algorithm determined the correct starting and ending text boundaries for 94.8% of labeled sections and 85.9% of unlabeled sections. The SecTag algorithm accurately identified both labeled and unlabeled sections in history and physical documents. This type of algorithm may assist in natural language processing applications, such as clinical decision support systems or competency assessment for medical trainees.
Journal of General Internal Medicine, 1996
OBJECTIVE: To determine whether a short, 3-hour teaching skills workshop could improve residents’... more OBJECTIVE: To determine whether a short, 3-hour teaching skills workshop could improve residents’ teaching performances and attitudes toward teaching. DESIGN: Controlled study. PARTICIPANTS AND SETTING: Forty-four second- and third-year residents in a university-based internal medicine residency program. INTERVENTIONS: Twenty-two residents were assigned to a nonparticipant (control) group, and 22 residents were assigned to a 3-hour teaching skills workshop designed to
Journal of General Internal Medicine, 2008
To determine whether the integration of an automated electronic clinical portfolio into clinical ... more To determine whether the integration of an automated electronic clinical portfolio into clinical clerkships can improve the quality of feedback given to students on their patient write-ups and the quality of students' write-ups. The authors conducted a single-blinded, randomized controlled study of an electronic clinical portfolio that automatically collects all students' clinical notes and notifies their teachers (attending and resident physicians) via e-mail. Third-year medical students were randomized to use the electronic portfolio or traditional paper means. Teachers in the portfolio group provided feedback directly on the student's write-up using a web-based application. Teachers in the control group provided feedback directly on the student's write-up by writing in the margins of the paper. Outcomes were teacher and student assessment of the frequency and quality of feedback on write-ups, expert assessment of the quality of student write-ups at the end of the clerkship, and participant assessment of the value of the electronic portfolio system. Teachers reported giving more frequent and detailed feedback using the portfolio system (p = 0.01). Seventy percent of students who used the portfolio system, versus 39% of students in the control group (p = 0.001), reported receiving feedback on more than half of their write-ups. Write-ups of portfolio students were rated of similar quality to write-ups of control students. Teachers and students agreed that the system was a valuable teaching tool and easy to use. An electronic clinical portfolio that automatically collects students' clinical notes is associated with improved teacher feedback on write-ups and similar quality of write-ups.
Journal of General Internal Medicine, 2008
To help authors design rigorous studies and prepare clear and informative manuscripts, improve th... more To help authors design rigorous studies and prepare clear and informative manuscripts, improve the transparency of editorial decisions, and raise the bar on educational scholarship, the Deputy Editors of the Journal of General Internal Medicine articulate standards for medical education submissions to the Journal. General standards include: (1) quality questions, (2) quality methods to match the questions, (3) insightful interpretation of findings, (4) transparent, unbiased reporting, and (5) attention to human subjects' protection and ethical research conduct. Additional standards for specific study types are described. We hope these proposed standards will generate discussion that will foster their continued evolution.
Journal of General Internal Medicine, 2008
Journal of General Internal Medicine, 2005
BACKGROUND: Often, medical educators and students do not know where important concepts are taught... more BACKGROUND: Often, medical educators and students do not know where important concepts are taught and learned in medical shcool. Manual efforts to identify and track concepts covered across the curriculum are inaccurate and resource intensive. OBJECTIVE: To test the ability of a web-based application called KnowledgeMap (KM) to automatically locate where broad biomedical concepts are covered in lecture documents in
Journal of General Internal Medicine, 2002
OBJECTIVE: To determine the impact of an online lecture versus a live lecture on screening given ... more OBJECTIVE: To determine the impact of an online lecture versus a live lecture on screening given to medical students who are participating in an outpatient clerkship.
Journal of Clinical Investigation, 1963
Four strains of an unclassified human virus were isolated in 1958by Lennette, Fox, Schmidt, and C... more Four strains of an unclassified human virus were isolated in 1958by Lennette, Fox, Schmidt, and Culver and given the name Coe virus (1). This agent multiplied in tissues of human but not of simian origin, and could not be adapted to serial propagation of suckling mice. ...
Academic Medicine, 2000
To clarify the use of outpatient morning report in internal medicine residency programs, we condu... more To clarify the use of outpatient morning report in internal medicine residency programs, we conducted a national survey of internal medicine residency directors and a local survey of a cohort of residents at a large teaching hospital. The program directors reported a 24% prevalence of outpatient morning report. The cohort of residents reported that the conference contributed much to their education by meeting specific learning needs and covering topics not covered elsewhere in their residency training.
The American Journal of Medicine, 1979
Abstract An outbreak of acute histoplasmosis occurred among 42 people who gathered for two days i... more Abstract An outbreak of acute histoplasmosis occurred among 42 people who gathered for two days in May 1977 to cut and clear a fallen oak tree near Nashville (Williamson County), Tennessee. Thirty-two (76 per cent) of the participants had serologic evidence of infection; ...
Journal of Biomedical Informatics, 2009
Graduate medical students must demonstrate competency in clinical skills. Current tracking method... more Graduate medical students must demonstrate competency in clinical skills. Current tracking methods rely either on manual efforts or on simple electronic entry to record clinical experience. We evaluated automated methods to locate 10 institution-defined core clinical problems from three medical students' clinical notes (n = 290). Each note was processed with section header identification algorithms and the KnowledgeMap concept identifier to locate Unified Medical Language System (UMLS) concepts. The best performing automated search strategies accurately classified documents containing primary discussions to the core clinical problems with area under receiver operator characteristic curve of 0.90-0.94. Recall and precision for UMLS concept identification was 0.91 and 0.92, respectively. Of the individual note section, concepts found within the chief complaint, history of present illness, and assessment and plan were the strongest predictors of relevance. This automated method of tracking can provide detailed, pertinent reports of clinical experience that does not require additional work from medical trainees. The coupling of section header identification and concept identification holds promise for other natural language processing tasks, such as clinical research or phenotype identification.
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Papers by Anderson Spickard