Free-text Answers Research Articles

Automatic grading for Arabic short answer questions using optimized deep learning model.

Auto-grading of short answer questions is considered a challenging problem in the processing of natural language. It requires a system to comprehend the free text answers to automatically assign a grade for a student answer compared to one or more model answers. This paper suggests an optimized deep learning model for grading short-answer questions automatically by using various sizes of datasets collected in the Science subject for students in seventh grade in Egypt. The proposed system is a hybrid approach that optimizes a deep learning technique called LSTM (Long Short Term Memory) with a recent optimization algorithm called a Grey Wolf Optimizer (GWO). The GWO is employed to optimize the LSTM by selecting the best dropout and recurrent dropout rates of LSTM hyperparameters rather than manual choice. Using GWO makes the LSTM model more generalized and can also avoid the problem of overfitting in forecasting the students’ scores to improve the learning process and save instructors’ time and effort. The model’s performance is measured in terms of the Root Mean Squared Error (RMSE), the Pearson correlation coefficient, and R-Square. According to the simulation results, the hybrid GWO with the LSTM model ensured the best performance and outperformed the classical LSTM model and other compared models such that it had the highest Pearson correlation coefficient value, the lowest RMSE value, and the best R square value in all experiments, but higher training time than the traditional deep learning model.

Dental education during the pandemic – cross-sectional lecturer-side evaluation for the use of digital teaching concepts

Background: The COVID-19 pandemic resulted in significant restrictions on dental teaching. The aim of this investigation was to evaluate the attitudes of faculty members towards digital teaching formats and the effort creating digital lectures. We hypothesized that on the lecturer side there is no difference between the various digital teaching concepts in terms of workload and effort and that there is no increase in workload and effort when switching to digital teaching concepts. Methods: All German dental faculties were invited to the online survey by an anonymous voluntary questionnaire from January to April 2021. The questionnaire consisted of 27 questions that could be answered with a visual analog scale, free text answers, or with fixed answer options. Data was analyzed using the Kolmogorov-Smirnov test and an exploratory data analysis (α=0.05). Results: Before the pandemic, 24.8% of the participating lecturers were using digital teaching and 64.4% had no previous experience. After the outbreak of the pandemic 100% of the dental teaching was initially held online. More than 80% of the lecturers stated that they offer online lectures (86.1%), online seminars (81.2%), and/or online bedside teaching (33.7%). 88.1% see face-to-face teaching as the preferred teaching format. The lecturers also see the greatest opportunities for interaction in the area of analog teaching and significantly worse in synchronous and asynchronous digital teaching. In the course of the pandemic, respondents' attitudes towards online teaching improved in the median of 24.0 to a median of 50.0. Conclusions: Faculty members have positively changed their attitudes towards online teaching formats over the course of the pandemic. Although they see the greatest learning success in conventional face-to-face teaching formats and the creation of digital lectures is associated with a higher effort, they want more online lessons in the future.

One year of general practice during the COVID-19 pandemic - presentation and evaluation of digital medical education.

Background and teaching situation: The SARS-CoV-2 pandemic had a substantial didactic impact on medical teaching. In Erlangen, the lecture “General Practice” was offered asynchronously and digitally in an inverted-classroom concept. Contents were available via a learning platform. The lecture was presented using annotated videos, consolidation materials and control questions. A forum encouraged for discussions and feedback and collected in-depth aspects for a case-based video consultation. The aim of this work is to evaluate and critically examine the digital teaching concept during the SARS-CoV-2 pandemic.Methodology: Two semester cohorts evaluated the lecture. Overall impression of the lecture, didactic elements, suitability and the desired future lecture format were surveyed quantitatively. Free text answers were evaluated by means of qualitative content synthesis.Results: In terms of overall impression, the students (N=199) rated the lecture on average as “very good” (M=1.41, SD=.57). Digital methods were perceived as suitable for supporting self-study, and digital usage was rated as unproblematically (M=1.18, SD=.50). Desired future teaching formats were blended learning concepts (79.4%). Organisation, structure and content presentation were highly appreciated. The time for completing the course was perceived critically. The students urged for more practical and consolidating lecture work.Discussion and implications: The results illustrate high acceptance of digital teaching and underline the demand for future blended learning concepts. It is particularly important to better consider the students’ time investment and practical relevance of digital self-learning mechanisms.

Is There Gender (In)Equality in Pediatric Surgery? An Online Survey on Gender-Related Career Opportunities.

The highest percentage of female surgeons is found in pediatric surgery but most departments are led by men. The aim of this study is to evaluate gender-related career goals, perceived career opportunities, and reasons for differences. An online questionnaire was created and distributed to pediatric surgeons in Germany, Switzerland, and Austria between July and September 2020. Participants were asked to state current position, career goals, and perceived career opportunities in comparison to a colleague of the opposite gender. Reasons for gender-related differences were asked for as free-text comments. A total of 182 questionnaires were analyzed. The overall gender ratio was balanced but junior positions were predominantly held by women, while there were more men in leading positions. Most women pursued a position as a consultant, while the majority of men aimed for a leading position. Men mostly regard both genders to have the same career opportunities, whereas most women believe the chances of men to be better. From the free-text answers, three following categories for gender-related differences in career chances were derived: (1) absences due to maternity, (2) differing support and bias arising from gender-related stereotypes, and (3) assumed personality traits. There are gender-related differences in career opportunities in pediatric surgery. Gender equality is needed not only to overcome injustice but also to maximize team efficiency and collaboration. Career support needs to be gender-independent and (unconscious) bias needs to be recognized and eradicated.

Dental education during the pandemic - cross-sectional lecturer-side evaluation for the use of digital teaching concepts.

Background: The COVID-19 pandemic resulted in significant restrictions on dental teaching. The aim of this investigation was to evaluate the attitudes of faculty members towards digital teaching formats and the effort creating digital lectures. We hypothesized that on the lecturer side there is no difference between the various digital teaching concepts in terms of workload and effort and that there is no increase in workload and effort when switching to digital teaching concepts. Methods: All German dental faculties were invited to the online survey by an anonymous voluntary questionnaire from January to April 2021. The questionnaire consisted of 27 questions that could be answered with a visual analog scale, free text answers, or with fixed answer options. Data was analyzed using the Kolmogorov-Smirnov test and an exploratory data analysis (α=0.05). Results: Before the pandemic, 24.8% of the participating lecturers were using digital teaching and 64.4% had no previous experience. After the outbreak of the pandemic 100% of the dental teaching was initially held online. More than 80% of the lecturers stated that they offer online lectures (86.1%), online seminars (81.2%), and/or online bedside teaching (33.7%). 88.1% see face-to-face teaching as the preferred teaching format. The lecturers also see the greatest opportunities for interaction in the area of analog teaching and significantly worse in synchronous and asynchronous digital teaching. In the course of the pandemic, respondents' attitudes towards online teaching improved in the median of 24.0 to a median of 50.0. Conclusions: Faculty members have positively changed their attitudes towards online teaching formats over the course of the pandemic. Although they see the greatest learning success in conventional face-to-face teaching formats and the creation of digital lectures is associated with a higher effort, they want more online lessons in the future.

Taking open answers seriously: gaining insights into the perilous undercurrent of organizational change

PurposeThis study aims to discuss the usefulness of free-text comments to gain insights into participants' opinions about an organizational change project.Design/methodology/approachA secondary analysis of 152 free-text answers to an open question in a questionnaire evaluating the implementation of lean facility design was conducted.FindingsThe authors identified three categories of responses to change: (1) dismissive – lean unrelated, (2) dismissive – lean related and (3) supporting – lean related. Notably, the large majority of the comments were dismissive by nature and unrelated to lean. Furthermore, critical responses also emanate from the most supportive group (critical friends).Practical implicationsQuintessential to change management is understanding how those involved perceive the changes. Free-text comments offer an opportunity to gain a view on these perceptions, particularly perceptions that often stay covert whilst having the potential to undermine change initiatives. At the same time, the comments may also be used to capitalize on constructive criticisms.Originality/valueThis study delivers a unique view on how free comments allow developing a broader understanding of hospital staff's responses to an organizational change initiative and particularly its “undercurrent” that may potentially have significant implications to change processes.

Developing a Mobile Health Application to Communicate Adverse Drug Reactions - Preconditions, Assessment of Possible Functionalities and Barriers for Patients and Their General Practitioners.

PurposeMobile health (mHealth) applications offer structured and timely communication between patients and general practitioners (GPs) about adverse drug reactions (ADR). Preconditions, functionalities and barriers should be studied to ensure safe implementation.MethodsWe performed a cross-sectional questionnaire survey addressing (i) preconditions, (ii) users’ assessment of functionalities and (iii) barriers to mHealth managing ADR communication.ResultsA total of 480 patients and 31 GPs completed the survey. (i) A total of 269 (56%) patients and 13 (42%) GPs were willing to use mHealth for ADR communication. Willingness was negatively correlated with age for both patients (r = −0.231; p < 0.001) and GPs (r = −0.558; p = 0.002). (ii) Most useful functionalities mentioned by patients (>60%) included “Rapid feedback on urgency of face-to-face consultations.” GPs valued information on “Patient’s difficulties in medication administration.” (iii) In free-text answers, the barrier reported most frequently by patients was “preferred personal GP contact” (6%), whereas GPs claimed, “uncomplicated use with low expenditure of time and personnel” (19%).ConclusionOlder patients and GPs mainly show reservations about mHealth for ADR communication but recognize possible benefits. mHealth implementation should avoid a negative effect on GPs’ time budgets; the primary goal should not be to reduce the number of GP-patient contacts but to optimize them.

Child Protective Services Reports in the Context of Intimate Partner Violence: A Delphi Process Examining Best Practices.

Child protective services (CPS) reporting for families experiencing intimate partner violence (IPV) is complex. The goal of this study was to develop expert-driven best practices for pediatric providers filing CPS reports in the context of IPV. We conducted a Delphi study with experts in IPV and child abuse and neglect (CAN) through 3 rounds of surveys. In Round 1, participants selected clinical scenarios for which they would file, as well as best practices when CPS reporting is indicating. In Round 2, participants described how strongly they agreed that a provider should file for each clinical scenario and how important each best practice was on a 5-point Likert scale. Finally, in Round 3 participants reviewed Round 1 and 2 results, then reported their final determination by selecting yes or no for each option. Consensus was achieved in Round 3 if >80% of participants agreed. In each round, participants could provide further detail via free-text answers. Twenty-three (40%) of the invited experts participated. Consensus was not achieved for children directly witnessing IPV or experiencing health symptoms due to IPV exposure. Participants were in consensus regarding need for CPS reporting when CAN was present and that reporting should not occur for exposure to IPV only. Best practices included supporting IPV survivors, developing healthcare-based IPV advocacy programs, and optimizing the child welfare system. This study provides expert-driven recommendations for filing CPS reports in the context of IPV and highlights the inherent complexity of filing and the need for further guidelines.

Discrimination in an “equal country”—a survey amongst Swedish final-year medical students

BackgroundDiscrimination due to gender and ethnicity has been found to be widespread in medicine and healthcare. Swedish and European legislation list seven discrimination grounds (age, sex, ethnicity, religion, sexuality, non-binary gender identity, and disability) which may intersect with each other; yet these have only been sparsely researched. The aim of this study was to assess the extent of discrimination, based on these seven discrimination grounds, amongst final-year medical students in Sweden.MethodsA web-based survey, based on the CHERRIES-checklist, was disseminated to course coordinators and program directors in charge of final year medical students at all seven medical schools in Sweden. Quantitative data were analyzed using descriptive statistics, Fisher’s exact test, and logistic regression. Free-text answers were analyzed thematically using the “Master Suppression techniques” conceptual framework.ResultsOf the 1298 medical students contacted, 247 (19%) took part in the survey. Almost half (n = 103, 42%) had experienced some form of discrimination, and this difference was statistically significant by gender (p = 0.012), self-perceived ethnicity (p < 0.001), country of birth other than Scandinavia (p < 0.001) and visible religious signs (p = 0.037). The most common type of discrimination was gender-based (in 83% of students who had experienced discrimination), followed by age (48%), and ethnicity (42%). In the logistic regression, women/non-binary gender (p = 0.001, OR 2.44 [95% CI 1.41–4.22]), country of birth not in Scandinavia (p < 0.001, OR 8.05 [2.69–24.03]), non-Caucasian ethnicity (p = 0.04, OR 2.70 [1.39–5.27]), and disability (p = 0.02, OR 13.8 [1.58–12040]) were independently associated with discrimination. Half of those who had experienced religion-based discrimination and nearly one-third of victims of ethnicity-based discrimination reported “large” or “extreme” impact of this. Clinical staff or supervisors were the most common offenders (34%), closely followed by patients and their relatives (30%), with non-Caucasian respondents significantly more likely to experience discrimination by patients (p < 0.001).ConclusionsDiscrimination appears to be frequent in medical school, even in one of the world’s “most equal countries”. Discrimination is most commonly gender- or ethnicity-based, with ethnicity- and religion-based discrimination appearing to have the largest impact. Future research should continue to evaluate discrimination from an intersectional perspective, adapted for local contexts and legislations.

Coping strategies during legally enforced quarantine and their association to psychological distress level: a cross-sectional study

ObjectivesThe non-pharmacological measures to contain the COVID-19 pandemic may lead to considerable psychological distress. The aim of the CoCo-Fakt study was to investigate possible coping strategies and their effects on psychological distress during legally enforced quarantine of infected persons (IPs) and their close contacts (CPs). Study designThis was a cross-sectional cohort study. MethodsFrom 12 December 2020 to 6 January 2021, all IPs and their CPs (n = 8232) registered by the public health department (Cologne, Germany) were surveyed online. Psychosocial distress and coping were measured using sum scores; free-text answers related to specific strategies were subsequently categorised. ResultsPsychosocial distress was higher in IPs than in CPs (P < .001). Although the mean coping score did not differ between both groups, it was influenced by the reason for quarantine (IP vs CP) besides gender, age, socio-economic status, living situation, psychological distress, resilience, physical activity and eating behaviour. This final regression model explained 25.9% of the variance. Most participants used active coping strategies, such as contact with the social environment, a positive attitude and hobbies. ConclusionsAlthough psychological distress was higher in IPs than in CPs during the quarantine period, the mean coping score did not differ. The strategies most frequently used by IPs and CPs were activating social networks, a healthy lifestyle and professional support systems, such as the health department helpline. Appropriate advice should be implemented to prevent long-term psychological consequences when supporting affected people.

Opening up the University for a Multi-directed Lifelong Professional Development

In a time when most countries are facing a rapidly emerging knowledge society, the investment in human resources is essential for companies and organisations. In parallel, technology enhanced learning has enabled more flexible forms of professional development with work-integrated learning, an interesting shift that also challenges the traditional university model. An interesting concept for realising the work-integrated learning principle of solving practical problems in the industry with the use of theory from academia, is to let participants and companies to bring their own data (BYOD). This study was based on the BUFFL project, where BYOD activities have been an essential part of course design and learning activities for bank and insurance company staff. A project that is a cross-disciplinary collaboration between six companies, three universities, and researchers from different university departments. The aim of this study is to present, analyse and discuss the design and implementation of a pilot project for a technology enhanced and multi-directed lifelong professional development. The main research question to answer was: "What are the bank and insurance company staff perceptions of the BUFFL project design of technology enhanced professional development, and the idea of bringing their own data to course activities?" &#x0D; Data for a preliminary project evaluation has been gathered by course evaluation questionnaires from 14 instances of 9 course modules. Questionnaires comprised 30 questions with a mix of Likert-scale questions and questions with open-ended free-text answers. In a strive to find the data that have a potential to answer the research question 10 Likert-scale questions and 4 free-text questions were selected. Results from the Likert-scale questions were presented as a descriptive statistical analysis that discusses frequency, central tendency and variation. Open-ended free-text answers have been categorised in an deductive thematic analysis and compared to the results from the Likert-scale questions. Findings indicate that a technology enhanced and workplace integrated course design is appreciated, when information and communication technologies work. On the other hand, technology incidents have caused irritation and the provisional support model needs a further development that also could survive the project span. The earlier complaints on too theoretical course literature, and that course design lacks adaption to the participants actual workplace situations are contradicted by the result of the quantitative analysis. However, there are also indications that universities have to open up further, in a shift to a more multi-directed communication and knowledge sharing between academia, industry and society. Finally, even if course modules are given on a 25% pace, the current workload can be demanding for full-time working participants.

Patients’ and relatives’ perspectives on best possible care in the context of developing a multidisciplinary center for endometriosis and adenomyosis: findings from a national survey

BackgroundEndometriosis and adenomyosis are common benign conditions compromising both physical and psychological health, with a negative impact on quality of life. This survey aimed to establish what the users’ perspectives are on best possible care in the context of developing a multidisciplinary center for endometriosis and adenomyosis in Norway.MethodsAn electronic questionnaire was developed in collaboration between the Norwegian Patient’s Endometriosis Society (NPES) and gynecologists with special interest in endometriosis and adenomyosis. The questionnaire was distributed digitally to the members of NPES in May 2021.Results938 participants answered the questionnaire. Better patient information, long term therapeutic plans and integration of their partners into their care were the main concerns. Multidisciplinary care was a key issue for the majority, with (n = 775) 89% stating a need for a consultation with a psychologist, (n = 744) 86% at least one consultation with a nutritionist, (n = 733) 85% a physiotherapist, and (n = 676) 78% needing a sex therapist and (n = 935) 99,7% consider research and (n = 934) 99,8% consider quality assurance initiated by the endometriosis center to be important. The qualitative analysis of free text answers revealed a great need for updated and easily accessible information, meeting competent health care professionals and being taken seriously/listened to.ConclusionsThis survey shows similar perceptions and a high level of agreement regarding their needs amongst people with endometriosis and/or adenomyosis. This survey supports recommendations by the experts that endometriosis/adenomyosis care should be centralized in specialized, multidisciplinary centers. The results of the present work will be valuable for the future planning and development of a multidisciplinary endometriosis center.

Nursing Students’ Learning and Issues in Gerontological Nursing in Online Practical Training

The aim of this research is to clarify student learning and the issues they faced in the practice of gerontological nursing that our students completed online from home during the COVID-19 pandemic. A survey was conducted involving 71 third-year students who completed practical training in October 2020, and their choice of answers regarding "students' online learning environment" and free text answers regarding "what they have learned through practical training" were investigated through e-Learning systems. A total of 68 valid responses were analyzed, and the following 5 categories regarding students' learning were extracted: 1. the pleasure of experiencing that their understanding about patients can improve the care and the pleasure experienced from interacting with the elderly; 2. the importance of verbalizing and transmitting information in a way that others can understand; 3. the reconfirmation of records to avoid mixing facts with assessment and discussion, and the development of behavioral goals for personal growth: 4. the multidisciplinary cooperation and care necessary to support the lives of patients; and 5. the importance of maintaining independence during the online practice and increasing the motivation to learn. This study revealed that the benefits of learning from on-site training could be obtained in part, by providing opportunities for students to be connected with both clinical practice instructors and patients. The results suggest the possibility that online practical training, where more time is shared among teachers and students, may help students understand the importance of learning behavior and independence generated from teacher-student interactions. It was suggested that there is a need for the improvement of the student's online learning environment and practical training goals.

Multisource feedback in medical students’ workplace learning in primary health care

BackgroundIn medical students’ workplace learning, feedback is important for effective learning regarding communication and clinical skills. The provision of multisource feedback (MSF) in clinical practice with focus on the patient’s perspective is rarely addressed in the literature. The overall objective was to explore the experience of MSF in medical students’ clinical learning in primary healthcare (PHC).MethodsIn the study, patients provided feedback by use of the Patient Feedback in Clinical Practice (PFCP) questionnaire. By use of adapted PFCP questionnaire versions peers and clinical supervisors provided feedback and students performed a self-evaluation. The MSF learning activity was evaluated using surveys (4-point Likert scale/open-ended questions), (students (n = 26), peers (n = 9) and clinical supervisors (n = 7)). Data were analysed using descriptive and qualitative content analysis.ResultsResults (mean 4-point Likert scale) from participants evaluation of the MSF learning activity visualises the value of feedback in terms of patient-centred communication (students 3.50, peers 2.44 and clinical supervisors 3.57), guidance for further training (students 3.14, peers 2.89 and clinical supervisors 3.00) and clarification of pedagogical assignment (students 3.14, peers 2.89 and clinical supervisors 3.00). Thematic analysis of participants’ free-text answers in the evaluation surveys resulted in three themes: (1) applicability of the MSF, (2) MSF – collaborative learning process and (3) MSF as a facilitator in students’ clinical skills development. The participants experienced that the written MSF provided multi-facetted perspectives, which contributed to students’ and peers’ clinical and communication learning. MSF experience also enhanced clinical supervisors’ feedback regarding communication skills, targeting the supervisors’ pedagogical assignment.ConclusionOur findings indicate that MSF provided directly after a patient encounter, using the PFCP questionnaire as feedback provider, could be an adequate learning activity for medical students’ workplace learning. The MSF, provided through the PFCP questionnaire, was experienced to neutralise and operationalise the provision of concrete feedback, facilitating peers’ learning and clinical supervisors’ tuition. The results visualise the importance of patients in MSF, as a valuable resource in students’ workplace learning. Our study implies that this learning activity could be an applicable tool to facilitate learning and pedagogic development in clinical education in PHC.

Visual identifier systems for patients with cognitive impairment in healthcare settings: A survey of practice in UK hospitals.

People with dementia and other forms of cognitive impairment form a substantial proportion of patients admitted to hospitals, but problems in their care are persistent. One widely proposed improvement approach involves the use of systems using visual identifiers to help staff quickly recognise people with suspected dementia, with the goal of supporting more personalised care. The aim of this paper is to identify the identifier systems in use and staff perceptions of their strengths and weaknesses. We undertook an online survey of staff providing care for people with dementia in acute and mental health hospitals across the United Kingdom. The questionnaire covered different types of visual identifier systems for dementia. It used categorical and open-response questions to access staff views of their use in practice. Responses were analysed using descriptive statistics, and the Framework approach for free-text answers. 162 responses were received from staff in at least 48 hospitals. Of these, 128 had direct experience of using visual identifier systems. They reported that multiple identifier systems are in use, including schemes with national scope and locally developed approaches. Most respondents reported that more than one system is in use in their hospital. Different types of identifier were seen to have different strengths and weaknesses. Respondents had a broadly positive view of identifiers, but highlighted risks including lack of reliable and consistent use (linked to competing pressures on staff time), lack of staff training, uncertainty about patient and family views, and unclear consent processes. Our study suggests that a wide range of identifier systems is in use in UK hospitals, with many hospitals using more than one. Further consideration should be given to ensuring that multiple perspectives-including those of patients and carers-are drawn on in optimising their design, resolving ethical issues and supporting implementation.

Improving team dynamics for project based learning in pharmacy: A multimodal approach

Background and purposeStudents taking a research elective with project-based course components have shown aversion to group activities. We aimed to minimize group participation hesitancy and give students autonomy in choice of team formation approach in order to examine the effects of team formation approaches on successful team dynamics. Educational activity and settingLearners chose either a student self-selected (SS) or an instructor randomized (IR) team formation approach for two activities (a brief intervention role-play and a review of reviews research symposia presentation). Group development for the different team approaches was studied using the Tuckman model. Using this model, team dynamics was evaluated over five stages of group development: forming, norming, storming, performing, and adjourning. Student reports for each of the phases were evaluated using a project evaluation rubric. For the adjourning phase we used an open-ended survey embedded in the course learning management system. Free text answers from open-ended questions were analyzed for themes related to team dynamics concepts. FindingsStudents rated their satisfaction with team performance higher for SS than for IR teams. In terms of individual learning and satisfaction with individual's roles and tasks, they indicated greater satisfaction with the IR approach. SummaryTeam formation methods impacted group dynamics and individual attitudes with favorable team dynamics leading to better individual task and overall team performance. Higher team performance corresponds to higher grades for group projects and for courses with group projects, favorable team dynamics could impact students' evaluation of the course.

Joining the Navy to Become a Physician: The Typical Experience.

The decision to enter the Navy as a physician is a major career choice. However, there are no published studies that address the typical Navy physician's experience in the Health Professions Scholarship Program (HPSP) and Uniformed Services University of the Health Sciences (USUHS) programs. The purpose of this qualitative study is to describe the typical Navy physician's experience in the HPSP and USUHS programs. An anonymous online survey containing 47 questions was distributed to 63 Navy HPSP and USUHS physicians who started internships from 2008 to 2015. Participants were chosen by using purposeful, criterion, and snowball sampling methods with whom the author had a professional relationship during his military experience. The survey data were plotted in Excel spreadsheets and graphs according to six sub-research questions. Mean, SD, Likert scale 1-5, and grouping of free text responses were recorded. A total of 54 out of 63 Navy physicians (85.7%) responded to the survey. Navy physicians got their first-choice residency selection of 67.3% of the time, 34.6% went straight through residency without interruptions, 44.2% answered definitely or probably that military match changed their residency selection compared to them applying for civilian residency, and 46.2% answered definitely or probably that it was more difficult to get into military versus civilian residency. Participants answered definitely or probably that military experience puts them ahead of civilians in terms of leadership (82.7%), prior medical experience (46.2%), and applying for civilian residency (76.2%). Common positive themes of free-text answers included having financial stability, unique life experiences, and serving their country. Common negative themes included lack of career control, lack of knowledge regarding HPSP/USUHS programs, and delay in residency and career. The principal findings in this study are that most Navy physicians favored paid medical school/financial support, working overseas and in unique operational climates, having unique life experiences, leadership skills, and prior military experience put them ahead of their civilian colleagues, thought the Navy experience was worth it, and would join again if given the opportunity. However, most Navy physicians had a lack of career control due to needs of the Navy, lack of knowledge regarding residency selection, operational billets, and active duty service obligation, had more difficulty getting into a military residency of their choice versus civilians, and had interrupted residency training/training delays. The Navy would possibly benefit from a nationwide HPSP/USUHS physician mentorship program and an educational seminar to increase medical student applicant knowledge, which may improve recruiting and retention.

Using artificial intelligence to support rapid, mixed-methods analysis: Developing an automated qualitative assistant (AQUA).

Context: Qualitative research - crucial for understanding human behavior - remains underutilized, in part due to the time and cost of annotating qualitative data (coding). Artificial intelligence (AI) has been suggested as a means to reduce those burdens. Older AI techniques (Latent Semantic Indexing / Latent Dirichlet Allocation (LSI/LDA)) have fallen short, in part because qualitative data is rife with idiom, non-standard expressions, and jargon. Objective: To develop an AI platform using updated techniques to augment qualitative data coding. Study Design and Analysis: We previously completed traditional qualitative analysis of a large dataset, with 11 qualitative categories and 72 subcategories (categories), and a final Cohen's kappa ≥ 0.65 as a measure of human inter-coder reliability (ICR) after coding. We built our Automated Qualitative Assistant (AQUA) using a semi-classical approach, replacing LSI/LDA with a graph-theoretic topic extraction and clustering method. AQUA was given the previously-identified qualitative categories and tasked with coding free-text data into those categories. Item coding was scored using cosine-similarity. Population Studied: Pennsylvanian adults. Instrument: Free-text responses to five open ended questions related to the COVID-19 pandemic (e.g. "What worries you most about the COVID-19 pandemic?"). Outcome Measures: AQUA's coding was compared to human coding using Cohen's kappa. This was done on all categories in aggregate, and also on category clusters to identify category groups amenable to AQUA support. AQUA's time to complete coding was compared to the time taken by the human coding team. Dataset: Five unlimited free-text survey answers from 538 responders. Results: AQUA's kappa for all categories was low (kappa~0.45), reflecting the challenge of automated analysis of diverse language. However, for several 3-category combinations (with less linguistic diversity), AQUA performed comparably to human coders, with an ICR kappa range of 0.62 to 0.72 based on test-train split. AQUA's analysis (including human interpretation) took approximately 5 hours, compared to approximately 30 person hours for traditional coding. Conclusions: AQUA enables qualitative researchers to identify categories amenable to automated coding, and to rapidly conduct that coding on the entirety of very large datasets. This saves time and money, and avoids limitations inherent in limiting qualitative analysis to limited samples of a given dataset.

Feasibility study on collecting patient-reported outcomes from breast cancer patients using the LINE-ePRO system.

Due to the increasing complexity of cancer treatment, ensuring safety and maintaining the quality of life during treatment are important issues. Patient‐reported outcomes (PROs) in oncology are essential for assessing patient symptoms. A feasibility study was undertaken on breast cancer patients by building a PRO data collection system based on LINE, one of the most popular social network service applications in Japan. In this study, one or more predefined PRO questions for each breast cancer patient's clinical situation were sent to the patient’s LINE application daily. The patient selected a predefined answer by tapping the screen, but no free‐text answers were allowed. Seventy‐three patients were enrolled. The median observation period was 435 days (84‐656 days), and the total number of PROs collected was 16,417, with a mean of 224.9 reports per patient. Patients on adjuvant endocrine therapy were notified of 2.5 questions per week, and the median number of responses per week and response rate were 2.387 (1.687‐11.627) and 95.5%, respectively. Analyzing the results by age group, the number of responses from those aged 60 and above was equal to or higher than that of the younger age group. It was also possible to track each patient’s PROs accurately. These results suggested that the design of the system, based on an application used daily, instead of using specifically prepared applications for collecting electronic PROs, was the reason for the favorable acceptance from patients and the satisfactory response rate from all age groups, including the elderly.

No man is an island: management of the emergency response to the SARS-CoV-2 (COVID-19) outbreak in a large public decentralised service delivery organisation

BackgroundWe wanted to better understand whether and how agility can be achieved in a decentralised service delivery organisation in Sweden. The pandemic outbreak of SARS-Cov-2 (Covid-19) provided an opportunity to assess decentralisation as a strategy to improve the responsiveness of healthcare and at the same time handle an unpredictable and unexpected event.MethodsData from in-depth interviews with a crisis management team (n = 23) and free text answers in a weekly survey to subordinated clinical directors, i.e. unit managers, (n = 108) were scrutinised in a directed content analysis. Dynamic capabilities as a prerequisite for dynamic effectiveness, understood as reaching strategic and operative effectiveness simultaneously, were explored by using three frameworks for dynamic effectiveness, dynamic capabilities and delegated authority in a decentralised organisation.ResultsUnpredictable events, such as the pandemic Covid-19 outbreak, demand a high grade of ability to be flexible. We find that a high degree of operational effectiveness, which is imperative in an emergency situation, also is a driver of seeking new strategic positions to even better meet new demands. The characteristics of the dynamic capabilities evolving from this process are described and discussed in relation to decentralisation, defined by decision space, organisational and individual capacity as well as accountability. We present arguments supporting that a decentralised management model can facilitate the agility required in an emergency.ConclusionsThis study is, to our knowledge, the first of its kind where a decentralised management model in a service delivery organisation in healthcare is studied in relation to crisis management. Although stemming from one organisation, our findings indicating the value of decentralisation in situations of crisis are corroborated by theory, suggesting that they could be relevant in other organisational settings also.