Education/Research into Scholarship

orWater into Wine

Sharon Levine,MD

Outline

• What is scholarship?

• What is scholarship at BU?

• How to make it count (x 4)

• Getting to “yes” and getting to “no”

• 2 x 2 table

• Going national

• Exercise

Scholarship-Glassick’s Criteria

• Clear Goals

• Adequate Preparation

• Appropriate Methods

• Significant Results

• Effective Presentation

• Reflective Critique

Glassick et al.Scholarship Assessed—Evaluation of the Professoriate. San Francisco. CA: Jossey-Bass. 1997

Scholarship at BU

• Clinician Scholar/Educator– Focus and identity in educational scholarship– New or revised courses/curricula: syllabi, admin– Innovative teaching materials/strategies: eg

video, web-based modules, simulation, etc– Educational research projects-disseminated– Clinical practice applications: written reports of

organizational innovations; pt ed materials; clinical reviews and reports; editorials; book chapters; dissemination

Scholarship at BU

• Clinician Scientist

– Clinical and educational activities PLUS focused basic science, health services, or clinical research

– General goals as scientist track, although scholarly activities similar to those listed for clinical scholars can also be taken into account for promotion.

Scholarship at BU

• Basic Scientist– Scientific investigation– Developing well-focused area and identity– Publication in peer-reviewed journals– Acquisition of extramural funding: fed/pvt– Building a research team– Training others at pre- and post-doctoral level– Participation in intra-departmental research

How to Make it Count x 4

• Use what you are already doing: teaching, curriculum development, HSR (IRB?)

• Present abstract or poster descriptively: institutionally, locally, regionally, nationally

• Evaluate • Present abstract or poster complete:

institutionally, locally, regionally, nationally• Write about it: publish• Show that others are using it: citations, adoption

Example: CRIT

• Developed• Conducted• Evaluated• Abstract to Evans, AGS• Poster: Evans Day, annual Reynold’s meeting• Paper Session: AGS• Publication in peer-reviewed journal• Dissemination at other institutions• Citations by others• POGOe

Chief Resident Immersion Training (CRIT) in the Care of Older AdultsChief Resident Immersion Training (CRIT) in the Care of Older AdultsLevine SA, Chao S, Brett B, Jackson A, Goldman L, Burrows AB, Caruso LBLevine SA, Chao S, Brett B, Jackson A, Goldman L, Burrows AB, Caruso LB

Geriatrics Section, Boston Medical Center and Boston University School of MedicineGeriatrics Section, Boston Medical Center and Boston University School of MedicineSupported by the Donald W. Reynolds FoundationSupported by the Donald W. Reynolds Foundation

BackgroundChief Residents (CRs) play a crucial part in training residents and students

CRs are often responsible for resolving conflicts regarding patient care

CRs typically have variable formal training in education or teaching

Chief Resident Immersion Training GoalsTo foster collaboration among disciplines in the management of complex older patients

To incorporate geriatrics into teaching and administrative roles as CRs

To develop leadership and teaching skillsTo develop a do-able project related to resident education or patient care in geriatrics

To have fun and foster collegiality

Curriculum MethodsInterdisciplinary Planning Team

•Internal medicine, family medicine, geriatricsCurriculum based on a needs assessment of CRs via focus group (n=5)

Unfolding case over 2 days: 3 modules (2 hrs)Mini-lectures: geriatrics topics/CR skillsSmall group exercises and brainstormsAction plan development sessions

Evaluation MethodsPre- and Post- 10 item knowledge test (12-item ’06)Pre- and Post- self report surveys

•Knowledge gained•Confidence to teach•For validity: added items not in CRIT content

Focus group to obtain feedback on retreatSix month follow-up interviewsEleven month final survey/interview Anonymous Program Director post-retreat survey

BackgroundChief Residents (CRs) play a crucial part in training residents and students

CRs are often responsible for resolving conflicts regarding patient care

CRs typically have variable formal training in education or teaching

Chief Resident Immersion Training GoalsTo foster collaboration among disciplines in the management of complex older patients

To incorporate geriatrics into teaching and administrative roles as CRs

To develop leadership and teaching skillsTo develop a do-able project related to resident education or patient care in geriatrics

To have fun and foster collegiality

Curriculum MethodsInterdisciplinary Planning Team

•Internal medicine, family medicine, geriatricsCurriculum based on a needs assessment of CRs via focus group (n=5)

Unfolding case over 2 days: 3 modules (2 hrs)Mini-lectures: geriatrics topics/CR skillsSmall group exercises and brainstormsAction plan development sessions

Evaluation MethodsPre- and Post- 10 item knowledge test (12-item ’06)Pre- and Post- self report surveys

•Knowledge gained•Confidence to teach•For validity: added items not in CRIT content

Focus group to obtain feedback on retreatSix month follow-up interviewsEleven month final survey/interview Anonymous Program Director post-retreat survey

Examples of CR Project Action PlansNeurology: Functional assessment enhancements to the EHR in neurology

ENT: Grand Rounds “Dysphagia- Diagnosis and Practical Management”

Psychiatry: Interdisciplinary/Community Resources for caregiver stress in psychiatry

IM: Dementia and Delirium interns’ conferenceOphtho: Functional outcomes of cataract surgeryRehabilitation: Polypharmacy on a rehab unit

2005 Eleven-month Follow-upAction Plan Completion: 9 of 12 had completed at least 50% of action plans by 10 months. One pair was not able to implement their plan.

Impact of CRIT on Overall Ability to Carry out Work as a CR: (5 point scale, with 5 a great deal) Mean=3.9, with 9/11 rating it 4 or 5

Better administrative and personnel management of residents and staff, especially conflict resolution skills

More and better teaching about geriatrics to residents and students

Meeting and cross-talk with other CRs from other specialties

ConclusionsA two day case-based interactive educational program aimed at Chief Residents was effective in •Relaying new knowledge with respect to geriatrics•Enhancing skills related to being a CR •Increasing confidence in teaching skills•Offering valuable opportunities for collaboration in the care of older patients

•Fostering the development of educational projects around care of older patients

ImplicationsCRs are an untapped resource for changing geriatrics practice and education

CRs can be a source of cross fertilization across departments at an institution

CRs are eager learners who often become leaders at other institutions and take knowledge and skills with them

Make this a nationwide effort for CRs, who can bring back new knowledge and skills to their own institutions

Examples of CR Project Action PlansNeurology: Functional assessment enhancements to the EHR in neurology

ENT: Grand Rounds “Dysphagia- Diagnosis and Practical Management”

Psychiatry: Interdisciplinary/Community Resources for caregiver stress in psychiatry

IM: Dementia and Delirium interns’ conferenceOphtho: Functional outcomes of cataract surgeryRehabilitation: Polypharmacy on a rehab unit

2005 Eleven-month Follow-upAction Plan Completion: 9 of 12 had completed at least 50% of action plans by 10 months. One pair was not able to implement their plan.

Impact of CRIT on Overall Ability to Carry out Work as a CR: (5 point scale, with 5 a great deal) Mean=3.9, with 9/11 rating it 4 or 5

Better administrative and personnel management of residents and staff, especially conflict resolution skills

More and better teaching about geriatrics to residents and students

Meeting and cross-talk with other CRs from other specialties

ConclusionsA two day case-based interactive educational program aimed at Chief Residents was effective in •Relaying new knowledge with respect to geriatrics•Enhancing skills related to being a CR •Increasing confidence in teaching skills•Offering valuable opportunities for collaboration in the care of older patients

•Fostering the development of educational projects around care of older patients

ImplicationsCRs are an untapped resource for changing geriatrics practice and education

CRs can be a source of cross fertilization across departments at an institution

CRs are eager learners who often become leaders at other institutions and take knowledge and skills with them

Make this a nationwide effort for CRs, who can bring back new knowledge and skills to their own institutions

Evaluation to Date

Most Important Gains2005Knowledge/tools/practice related to dementia and delirium (n=6)Networking/new relationships with other CRs (n=6)New and improved skills for work as a CR (n=6)10 of 12 agreed that CRIT increased their interest in geriatrics

2006Recognition and management of delirium (n=10)Discharge planningPolypharmacySkills of being a CR Teaching skills14 of 15 agreed that CRIT increased their interest in geriatrics

0%

10%

20%

30%

40%

50%

60%

70%

80%

2005 2006

PrePost

(2005) Increase of 66.6% correct responses on pre-test to 72.4% correct on post-test

(2006) With more difficult test (12 items), increase from 48% correct on pre-test to 70% correct on post test (p=.001)

2005 & 2006 Pre- and Post- Knowledge Test

2005 2006

80%

70%

60%

50%

40%

30%

20%

10%

0%

Pre

Post

Gains in Self-Reported Knowledge (1=low, 5=high)

Self-reported Confidence to Teach (Low=1, High=5)

Extent to Which CRIT Enhanced Skills Related to Being a CR (on scale from 1-5, with 5 as “very much”)

4.0 4.1 4.2 4.3 4.4 4.5 4.6

Teach w/cases

Lead a team

Feedback skills

Teach geri-issues

Resolve conflicts

Deal w/reluctant learner

Teach geri-skills

Manage multi-tasks

Practice geri

2005

2006““The retreat tackled a finite amount of The retreat tackled a finite amount of information in sufficient detail to be information in sufficient detail to be

useful in a cross-disciplinary way and useful in a cross-disciplinary way and did a wonderful job of highlighting the did a wonderful job of highlighting the need for collaboration among different need for collaboration among different

services.services.“ “ 2005 CRIT Participant2005 CRIT Participant

““The retreat tackled a finite amount of The retreat tackled a finite amount of information in sufficient detail to be information in sufficient detail to be

useful in a cross-disciplinary way and useful in a cross-disciplinary way and did a wonderful job of highlighting the did a wonderful job of highlighting the need for collaboration among different need for collaboration among different

services.services.“ “ 2005 CRIT Participant2005 CRIT Participant

2005 Extent

Realized n/N (mean)

2006 Extent

Realized n/N (mean)

With CRs from other areas 12/12 (4.6) 12/15 (4.1)

With geriatrics faculty 12/12 (4.5) 12/15 (4.2)

With faculty outside my area 9/12 (4.2) 10/15 (3.7)

With my own Program Director 5/12 (3.0) 7/10 (3.9)

Extent of Connections Made with Others (n=number answering 4 or 5 on 5-pt scale,

with 5 high))

Topic 2005 2006

Pre- mean

Post- mean

P-value Pre- mean

Post- mean

P-value

Assessment of decision-making capacity 3.2 4.3 .001 2.7 4.0 <.000

Recognizing dementia 3.6 4.3 .01 3.4 4.4 .007

Managing dementia 3.3 3.5 NS 3.0 4.3 .001

Recognizing delirium 3.8 4.6 .005 3.8 4.7 .03

Managing delirium 3.6 4.3 .005 3.6 4.4 NS

Assessment of living arrangements / support 2.9 4.0 .008 3.2 4.2 .008

Value of interdisciplinary, collaborative teams 3.7 4.4 .02 3.0 4.5 .001

Functional assessment 3.4 3.8 NS 2.3 3.9 <.000

Principles of geri-rehab 2.8 3.5 NS 2.3 3.7 <.000

Long-term care services 3.0 3.3 NS 2.3 3.8 <.000

Curriculum Topic Above line: covered formally

Below line: not covered formally

2005 2006

Retro Pre- mean

Post- mean

Retro Pre- mean

Post- mean

Insurance coverage 2.0 3.3*** 2.0 3.5***

Functional assessment 2.3 3.8*** 2.6 3.9***

Long-term care services 2.3 3.8*** 2.5 3.8***

Principles of geri-rehab 2.5 3.9** 2.5 3.8***

Discharge planning 2.7 3.8*** 2.9 3.9***

Pre-op assessment 2.7 4.0** 3.0 4.1***

Assessment of living arrangements / support

2.9 4.1** 2.8 4.1***

Decision-making capacity 3.3 4.4** 3.1 4.2***

Value of interdisciplinary, collaborative teams

3.6 4.5** 3.5 4.5***

Recognizing dementia 3.6 4.6** 3.4 4.3***

Managing dementia 2.8 3.7** 3.3 4.0**

Recognizing delirium 3.8 4.7* 3.6 4.9**

Managing delirium 3.3 4.4** 3.5 4.6**

Reviewing medications for evidence of polypharmacy

N/A N/A 3.0 4.1***

Managing diabetes 3.5 3.7 3.1 3.3

Managing coronary artery disease 3.4 3.6 2.9 3.2

Recognizing, evaluating, and treating urinary incontinence

2.6 2.9 2.7 3.1**

Assessing/reducing risk of falls 2.7 3.4** 2.9 3.7*

Accounting for cultural differences in decision making

3.3 3.6 3.3 3.5

2005 & 2006 Resident Participants

Anesthesiology (4)Cardiothoracic Surgery(1)**Family Medicine (2)*Internal Medicine (5)Neurology (3)

Ophthalmology (2)Otolaryngology (4)Psychiatry (3)Rehabilitation Medicine (2)General Surgery (1)Urology (1)

n=28

*Includes one PGY3 resident

**Includes one fellow

*=p<.05, **=p<.01, ***p=<.001

Chief Resident Immersion Training in Geriatrics

Sharon A. Levine, MD

Serena Chao, MD, MSc

Belle Brett, EdD

Angela Jackson, MD

Laura Goldman, MD

Adam Burrows, MD

Lisa B. Caruso, MD, MPH

Supported by the Donald W. Reynolds Foundation

Getting to “Yes”;Getting to “No”

• What’s your goal?• Effort• Impact• Visibility• Promotion• Say no to things that really are not going to

foster your agenda (e.g. some committees)• Say yes to things that increase your visibility or

you like to do (e.g. moderate a meeting)• If you say “no” too many times to high visibility

things or your chief, folks will give up--BEWARE• Can’t get away with doing nothing; unless it’s not

important to you

The 2 x 2 table

xx

X0 XX 00

IMPACT

EFFORT

High LowHigh

Low

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IIIIIIIIIIII

Don’t be Afraid to Fall in Love

Exercise

• Identify something you are doing now• Low hanging fruit/ something you are interested

in/someone asked you to collaborate• How can you bring it to the next level: moderate

a symposium; write a systematic review; are you doing something for a course?

• Poster for Med Ed Day, Evans Day, national meeting

• Clinical vignette (really easy)• Etc, etc, etc.

Who do you need to help you?

• Local or national colleague• Local or national mentor/friend• Which venue• What kind of support• Keep it simple. Work in the lower left

quadrant if you can• Think of challenges and how to overcome• Timeline—you may have to work at night