How are Chest Pain Symptoms Described in Female vs. Male Patients During Clinical Teaching of Family Medicine Residents?
Notice bibliographique
Résumé
Context: Cardiovascular disease is the leading cause of death for female patients. Despite recent clinical practice guidelines about how female patients present with chest pain, many physicians may be misclassifying female patients’ symptoms as ‘atypical’. This can result in discrepancies in care for female vs male patients and put female patients at risk for poor outcomes. It is crucial to ensure that future family physicians are getting the right teaching about appropriately diagnosing and managing female patients’ chest pain. Objective: To examine how chest pain symptoms are discussed during workplace-based clinical teaching in family medicine residency training. Study Design: Secondary data analysis. Database: Archived (July 2010 to June 2022), de-identified electronic narrative workplace-based formative assessment forms (FieldNotes) from a mid-sized Canadian family medicine residency program. FieldNotes can be used as a proxy for workplace-based clinical teaching discussions. Population studied: Family medicine preceptors and residents. Instrument: FieldNotes include a narrative of feedback shared with a resident during a clinical teaching encounter, as well as a brief description of the patient and presentation. Narratives were searched for: ‘chest pain’, ‘heart’, ‘MI’, ‘STEMI’, ‘NSTEMI’. Identified FieldNotes were then further searched for the term ‘atypical’, and to determine the sex of the patient. Outcome Measures: Numbers of FieldNotes about chest pain; percentage of chest pain FieldNotes where symptoms were described as ‘atypical’; comparison of ‘atypical’ designation by sex of patient. Chi-square goodness of fit tested the assumption that the proportion of ‘atypical’ assignment was equal across sexes Results: Of all FieldNotes (N = 64942), 677 (1.04%) included narratives about chest pain. Of those FieldNotes, 76 (11.2%) indicated that the symptoms were ‘atypical’. ‘Atypical’ classification varied by patient gender (male = 11; female = 32; unspecified = 33). A significant difference was found for female patients with ‘atypical’ chest pain (X2 = 18.24; df = 2; p = 0.00011). Expected Outcomes: Chest pain symptoms were more likely to be described as ‘atypical’ when patients were female. This finding suggests a need for faculty development about approaches to female patients with chest pain that align with best clinical practice. This should lead to improvements in how family medicine residents are taught about chest pain in female patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,035 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».