Assessing clinical frailty scale scoring by junior medical learners on an inpatient geriatrics consultation service
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
The Clinical Frailty Scale (CFS) is incorporated into our institution's comprehensive geriatric assessment (CGA). CGAs and CFS scoring are completed by junior medical trainees on the Geriatric consult service. The agreement between CFS score assignment by junior trainees and Geriatrics trained individuals in this setting is unknown. Importantly, these scores assign a frailty level that impacts care pathways. We conducted a retrospective chart review from April-June 2019. A Geriatric medicine subspecialty resident assigned retrospective CFS scores based on data from the CGA. We compared scores to determine the level of agreement using the Cohen and Conger's Kappa inter-rater agreement metric and assessed whether patient characteristics influenced the likelihood of agreement between raters using a generalized linear model. Medical students assessed 43% (46/108) of patients (n = 13), and 57% (62/108) were assessed by PGY1s (n = 10). Inter-rater agreement measures showed substantial agreement overall and for PGY1s, but dropped to a moderate agreement for medical students. The retrospective inter-rater agreement of the CFS showed substantial agreement overall and decreased when limited to medical students, highlighting the need for interventions to improve the understanding of frailty early in medical training.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it