All Publications

  • A Multicenter Observational Study Comparing Virtual with In-Person Morning Reports during the COVID-19 Pandemic SOUTHERN MEDICAL JOURNAL Bradley, J. M., Redinger, J. W., Tuck, M. G., Sweigart, J. R., Smeraglio, A. C., Mitchell, C. A., Laudate, J. D., Kwan, B. K., Jagannath, A. D., Heppe, D. B., Guidry, M. M., Ehlers, E. T., Cyr, J. E., Cornia, P. B., Chun, J. W., Caputo, L. M., Arundel, C., Albert, T. J., Gunderson, C. G. 2023; 116 (9): 745-749


    The coronavirus disease 2019 (COVID-19) pandemic disrupted how educational conferences were delivered, leaving programs to choose between in-person and virtual morning report formats. The objective of our study was to describe morning reports during the COVID-19 pandemic, including the use of virtual formats, attendance, leadership, and content.A prospective observational study of morning reports was conducted at 13 Internal Medicine residency programs between September 1, 2020 and March 30, 2021, including a follow-up survey of current morning report format in January 2023.In total, 257 reports were observed; 74% used virtual formats, including single hospital, multiple hospital, and a hybrid format with both in-person and virtual participants. Compared with in-person reports, virtual reports had more participants, with increased numbers of learners (median 21 vs 7; P < 0.001) and attendings (median 4 vs 2; P < 0.001), and they were more likely to involve medical students (83% vs 40%; P < 0.001), interns (99% vs 53%; P < 0.001), and program directors (68% vs 32%; P < 0.001). Attendings were less likely to lead virtual reports (3% vs 28%, P < 0.001). Virtual reports also were more likely to be case based (88% vs 69%; P < 0.001) and to use digital presentation slides (91% vs 36%; P < 0.001). There was a marked increase in the number of slides (median 20 vs 0; P < 0.001). As of January 2023, all 13 programs had returned to in-person reports, with only 1 program offering an option to participate virtually.During the COVID-19 pandemic, virtual morning report formats predominated. Compared with traditional in-person reports, virtual report increased attendance, favored resident leadership, and approached a similar range of patient diagnoses with a greater number of case-based presentations and slides. In spite of these characteristics, all programs returned to an in-person format for morning report as pandemic restrictions waned.

    View details for DOI 10.14423/SMJ.0000000000001597

    View details for Web of Science ID 001052870900004

    View details for PubMedID 37657781

  • What internal medicine attendings talk about at morning report: a multicenter study. BMC medical education Redinger, J. W., Heppe, D. B., Albert, T. J., Cornia, P. B., Gordon, K. S., Arundel, C., Bradley, J. M., Caputo, L. M., Chun, J. W., Cyr, J. E., Ehlers, E. T., Guidry, M. M., Jagannath, A. D., Kwan, B. K., Laudate, J. D., Mitchell, C. A., Smeraglio, A. C., Sweigart, J. R., Tuck, M. G., Gunderson, C. G. 2023; 23 (1): 84


    Morning report is a core educational activity in internal medicine resident education. Attending physicians regularly participate in morning report and influence the learning environment, though no previous study has described the contribution of attending physicians to this conference. This study aims to describe attending comments at internal medicine morning reports.We conducted a prospective, observational study of morning reports conducted at 13 internal medicine residency programs between September 1, 2020, and March 30, 2021. Each attending comment was described including its duration, whether the comment was teaching or non-teaching, teaching topic, and field of practice of the commenter. We also recorded morning report-related variables including number of learners, report format, program director participation, and whether report was scripted (facilitator has advance knowledge of the case). A regression model was developed to describe variables associated with the number of attending comments per report.There were 2,344 attending comments during 250 conferences. The median number of attendings present was 3 (IQR, 2-5). The number of comments per report ranged across different sites from 3.9 to 16.8 with a mean of 9.4 comments/report (SD, 7.4). 66% of comments were shorter than one minute in duration and 73% were categorized as teaching by observers. The most common subjects of teaching comments were differential diagnosis, management, and testing. Report duration, number of general internists, unscripted reports, and in-person format were associated with significantly increased number of attending comments.Attending comments in morning report were generally brief, focused on clinical teaching, and covered a wide range of topics. There were substantial differences between programs in terms of the number of comments and their duration which likely affects the local learning environment. Morning report stakeholders that are interested in increasing attending involvement in morning report should consider employing in-person and unscripted reports. Additional studies are needed to explore best practice models of attending participation in morning report.

    View details for DOI 10.1186/s12909-023-04057-y

    View details for PubMedID 36732763

    View details for PubMedCentralID PMC9893973

  • Development and Validation of a Machine Learning Model for Automated Assessment of Resident Clinical Reasoning Documentation. Journal of general internal medicine Schaye, V., Guzman, B., Burk-Rafel, J., Marin, M., Reinstein, I., Kudlowitz, D., Miller, L., Chun, J., Aphinyanaphongs, Y. 2022


    BACKGROUND: Residents receive infrequent feedback on their clinical reasoning (CR) documentation. While machine learning (ML) and natural language processing (NLP) have been used to assess CR documentation in standardized cases, no studies have described similar use in the clinical environment.OBJECTIVE: The authors developed and validated using Kane's framework a ML model for automated assessment of CR documentation quality in residents' admission notes.DESIGN, PARTICIPANTS, MAIN MEASURES: Internal medicine residents' and subspecialty fellows' admission notes at one medical center from July 2014 to March 2020 were extracted from the electronic health record. Using a validated CR documentation rubric, the authors rated 414 notes for the ML development dataset. Notes were truncated to isolate the relevant portion; an NLP software (cTAKES) extracted disease/disorder named entities and human review generated CR terms. The final model had three input variables and classified notes as demonstrating low- or high-quality CR documentation. The ML model was applied to a retrospective dataset (9591 notes) for human validation and data analysis. Reliability between human and ML ratings was assessed on 205 of these notes with Cohen's kappa. CR documentation quality by post-graduate year (PGY) was evaluated by the Mantel-Haenszel test of trend.KEY RESULTS: The top-performing logistic regression model had an area under the receiver operating characteristic curve of 0.88, a positive predictive value of 0.68, and an accuracy of 0.79. Cohen's kappa was 0.67. Of the 9591 notes, 31.1% demonstrated high-quality CR documentation; quality increased from 27.0% (PGY1) to 31.0% (PGY2) to 39.0% (PGY3) (p < .001 for trend). Validity evidence was collected in each domain of Kane's framework (scoring, generalization, extrapolation, and implications).CONCLUSIONS: The authors developed and validated a high-performing ML model that classifies CR documentation quality in resident admission notes in the clinical environment-a novel application of ML and NLP with many potential use cases.

    View details for DOI 10.1007/s11606-022-07526-0

    View details for PubMedID 35710676

  • NOTESENSE: DEVELOPMENT OF A MACHINE LEARNING ALGORITHM FOR FEEDBACK ON CLINICAL REASONING DOCUMENTATION Schaye, V., Guzman, B., Rafel, J., Kudlowitz, D., Reinstein, I., Miller, L., Cocks, P., Chun, J., Aphinyanaphongs, Y., Marin, M. SPRINGER. 2021: S110
  • Internal Medicine Residents' Perceptions of Virtual Morning Report: a Multicenter Survey. Journal of general internal medicine Albert, T. J., Bradley, J., Starks, H., Redinger, J., Arundel, C., Beard, A., Caputo, L., Chun, J., Gunderson, C. G., Heppe, D., Jagannath, A., Kent, K., Krug, M., Laudate, J., Palaniappan, V., Pensiero, A., Sargsyan, Z., Sladek, E., Tuck, M., Cornia, P. B. 2021


    IMPORTANCE: The COVID-19 pandemic disrupted graduate medical education, compelling training programs to abruptly transition to virtual educational formats despite minimal experience or proficiency. We surveyed residents from a national sample of internal medicine (IM) residency programs to describe their experiences with the transition to virtual morning report (MR), a highly valued core educational conference.OBJECTIVE: Assess resident views about virtual MR content and teaching strategies during the COVID-19 pandemic.DESIGN: Anonymous, web-based survey.PARTICIPANTS: Residents from 14 academically affiliated IM residency programs.MAIN MEASURES: The 25-item survey on virtual MR included questions on demographics; frequency and reason for attending; opinions on who should attend and teach; how the virtual format affects the learning environment; how virtual MR compares to in-person MR with regard to participation, engagement, and overall education; and whether virtual MR should continue after in-person conferences can safely resume. The survey included a combination of Likert-style, multiple option, and open-ended questions.RESULTS: Six hundred fifteen residents (35%) completed the survey, with a balanced sample of interns (39%), second-year (31%), and third-year (30%) residents. When comparing their overall assessment of in-person and virtual MR formats, 42% of residents preferred in-person, 18% preferred virtual, and 40% felt they were equivalent. Most respondents endorsed better peer-engagement, camaraderie, and group participation with in-person MR. Chat boxes, video participation, audience response systems, and smart boards/tablets enhanced respondents' educational experience during virtual MR. Most respondents (72%) felt that the option of virtual MR should continue when it is safe to resume in-person conferences.CONCLUSIONS: Virtual MR was a valued alternative to traditional in-person MR during the COVID-19 pandemic. Residents feel that the virtual platform offers unique educational benefits independent of and in conjunction with in-person conferences. Residents support the integration of a virtual platform into the delivery of MR in the future.

    View details for DOI 10.1007/s11606-021-06963-7

    View details for PubMedID 34173198

  • Experience and Education in Residency Training: Capturing the Resident Experience by Mapping Clinical Data. Academic medicine : journal of the Association of American Medical Colleges Rhee, D. W., Chun, J. W., Stern, D. T., Sartori, D. J. 2021


    PROBLEM: Internal medicine training programs operate under the assumption that the three-year residency training period is sufficient for trainees to achieve the depth and breadth of clinical experience necessary for independent practice; however, the medical conditions to which residents are exposed in clinical practice are not easily measured. As a result, residents' clinical educational experiences are poorly understood.APPROACH: A crosswalk tool (a repository of international classification of diseases [ICD]-10 codes linked to medical content areas) was developed to query routinely collected inpatient principal diagnosis codes and translate them into an educationally meaningful taxonomy. This tool provides a robust characterization of residents' inpatient clinical experiences.OUTCOMES: This pilot study has provided proof of principle that the crosswalk tool can effectively map one year of resident-attributed diagnosis codes to both the broad content category level (for example "Cardiovascular Disease") and to the more specific condition category level (for example "Myocardial Disease"). The authors uncovered content areas in their training program that are overrepresented and some that are underrepresented relative to material on the American Board of Internal Medicine (ABIM) Certification Exam.NEXT STEPS: The crosswalk tool introduced here translated residents' patient care activities into discrete, measurable educational content and enabled one internal medicine residency training program to characterize residents' inpatient educational experience with a high degree of resolution. Leaders of other programs seeking to profile the clinical exposure of their trainees may adopt this strategy. Such clinical content mapping drives innovation in the experiential curriculum, enables comparison across practice sites, and lays the groundwork to test associations between individual clinical exposure and competency-based outcomes, which, in turn, will allow medical educators to draw conclusions regarding how clinical experience reflects clinical competency.

    View details for DOI 10.1097/ACM.0000000000004162

    View details for PubMedID 33983144

  • Development of a Clinical Reasoning Documentation Assessment Tool for Resident and Fellow Admission Notes: a Shared Mental Model for Feedback. Journal of general internal medicine Schaye, V., Miller, L., Kudlowitz, D., Chun, J., Burk-Rafel, J., Cocks, P., Guzman, B., Aphinyanaphongs, Y., Marin, M. 2021


    BACKGROUND: Residents and fellows receive little feedback on their clinical reasoning documentation. Barriers include lack of a shared mental model and variability in the reliability and validity of existing assessment tools. Of the existing tools, the IDEA assessment tool includes a robust assessment of clinical reasoning documentation focusing on four elements (interpretive summary, differential diagnosis, explanation of reasoning for lead and alternative diagnoses) but lacks descriptive anchors threatening its reliability.OBJECTIVE: Our goal was to develop a valid and reliable assessment tool for clinical reasoning documentation building off the IDEA assessment tool.DESIGN, PARTICIPANTS, AND MAIN MEASURES: The Revised-IDEA assessment tool was developed by four clinician educators through iterative review of admission notes written by medicine residents and fellows and subsequently piloted with additional faculty to ensure response process validity. A random sample of 252 notes from July 2014 to June 2017 written by 30 trainees across several chief complaints was rated. Three raters rated 20% of the notes to demonstrate internal structure validity. A quality cut-off score was determined using Hofstee standard setting.KEY RESULTS: The Revised-IDEA assessment tool includes the same four domains as the IDEA assessment tool with more detailed descriptive prompts, new Likert scale anchors, and a score range of 0-10. Intraclass correlation was high for the notes rated by three raters, 0.84 (95% CI 0.74-0.90). Scores ≥6 were determined to demonstrate high-quality clinical reasoning documentation. Only 53% of notes (134/252) were high-quality.CONCLUSIONS: The Revised-IDEA assessment tool is reliable and easy to use for feedback on clinical reasoning documentation in resident and fellow admission notes with descriptive anchors that facilitate a shared mental model for feedback.

    View details for DOI 10.1007/s11606-021-06805-6

    View details for PubMedID 33945113

  • Gastric Diospyrobezoar Dissolution with Ingestion of Diet Soda and Cellulase Enzyme Supplement. ACG case reports journal Chun, J., Pochapin, M. 2017; 4: e90


    Diospyrobezoars are a subtype of phytobezoars caused by excessive consumption of persimmons, which contain large amounts of tannins. In contrast to phytobezoars, diospyrobezoars have a harder consistency than other bezoars, making them more difficult to break up both chemically and endoscopically. We have previously reported successful dissolution of phytobezoars with diet soda and cellulase. A review of the literature found low efficacy of soda in dissolving diospyrobezoars compared to other phytobezoars. We report a case of successful dissolution of a diospyrobezoar after a failed attempt with diet soda alone.

    View details for DOI 10.14309/crj.2017.90

    View details for PubMedID 28761893

    View details for PubMedCentralID PMC5519403