Developing Research Capacity Within A Division or Program Focus on Academic General Pediatrics Peter Szilagyi and Janet Serwint

Developing Research Developing Research Capacity Within A Division or Capacity Within A Division or

ProgramProgramFocus on Academic General PediatricsFocus on Academic General Pediatrics

Peter Szilagyi and Janet SerwintPeter Szilagyi and Janet Serwint

Learning ObjectivesLearning Objectives

Improve my leadership skills in enhancing Improve my leadership skills in enhancing the research productivity of my division or the research productivity of my division or programprogram

Enhance my ability to mentor facultyEnhance my ability to mentor faculty

Broaden my understanding of research Broaden my understanding of research opportunitiesopportunities

AgendaAgenda Introduction and Background (30 minutes)Introduction and Background (30 minutes)

Research in General Academic PediatricsResearch in General Academic Pediatrics A Framework to evaluate and improve research A Framework to evaluate and improve research

capacity within your divisioncapacity within your division

Break into 2 groups (60 minutes)Break into 2 groups (60 minutes) Discuss the framework and common case Discuss the framework and common case

scenariosscenarios

Reconvene and Summarize (30 minutes)Reconvene and Summarize (30 minutes)

Major Goals of General Major Goals of General Pediatrics Academic Pediatrics Academic

Development ProgramDevelopment ProgramIn May, 1978, RWJ Foundation implemented In May, 1978, RWJ Foundation implemented

fellowship training in academic general fellowship training in academic general pediatrics to:pediatrics to: Improve the health of children and youthImprove the health of children and youth Conduct exciting research on common health Conduct exciting research on common health

problemsproblems Develop new methods of patient care to deal Develop new methods of patient care to deal

with major health problemswith major health problems Translate the findings of research into clinical Translate the findings of research into clinical

practicepractice

RJ Haggerty, The Academic Generalist: An Endangered Species Revived. RJ Haggerty, The Academic Generalist: An Endangered Species Revived. PediatricsPediatrics. 1990; 83(3):413-420.. 1990; 83(3):413-420.

Unique Perspectives of Unique Perspectives of Academic General Academic General

Pediatric ResearchersPediatric Researchers Understand clinical diseaseUnderstand clinical disease Confront research questions in Confront research questions in

practicepractice Poised to answer relevant research Poised to answer relevant research

questionsquestions Able to bring research back to Able to bring research back to

practice or back to the communitypractice or back to the community Bridges research and education Bridges research and education

Challenges to do Challenges to do ResearchResearch

Funding supportFunding support Protected timeProtected time Lack of research mentorsLack of research mentors Lack of clinical service reformLack of clinical service reform Little effort to translate findings Little effort to translate findings

into practiceinto practiceRJ Haggerty, The Academic Generalist: An Endangered RJ Haggerty, The Academic Generalist: An Endangered Species Revived. Species Revived. PediatricsPediatrics, 1990; 83(3): 413-420., 1990; 83(3): 413-420.

Spectrum of researchSpectrum of research Clinical: Clinical trials- treatment & preventionClinical: Clinical trials- treatment & prevention Health ServicesHealth Services EpidemiologicalEpidemiological EducationalEducational QualitativeQualitative Translating research into clinical and Translating research into clinical and

community practicecommunity practice S Ludwig, Academic General Pediatrics: From Endangered Species to S Ludwig, Academic General Pediatrics: From Endangered Species to

Advanced Scholars of General Pediatrics: The Report of a Consensus Advanced Scholars of General Pediatrics: The Report of a Consensus Conference. Conference. Amb PediatrAmb Pediatr. 2004; 4 (5):407-410.. 2004; 4 (5):407-410.

Efforts to Sustain Academic Efforts to Sustain Academic General PediatricsGeneral Pediatrics

““Tree whose branches and flowers are robust, but trunk Tree whose branches and flowers are robust, but trunk somewhat tenuous.”somewhat tenuous.”

Define, strengthen and expand fellowship training Define, strengthen and expand fellowship training programsprograms

APA needs to take major role in standardizing the APA needs to take major role in standardizing the fellowship programsfellowship programs

Consider certification for achievement of competencies for Consider certification for achievement of competencies for fellowship experiencefellowship experience

Research enterprise critical element of fellowship trainingResearch enterprise critical element of fellowship training

S Ludwig, Academic General Pediatrics: From Endangered S Ludwig, Academic General Pediatrics: From Endangered Species to Advanced Scholars of General Pediatrics: The Report Species to Advanced Scholars of General Pediatrics: The Report of a Consensus Conference. of a Consensus Conference. Amb PediatrAmb Pediatr. 2004;4(5):407-409.. 2004;4(5):407-409.

Benefits to Conducting Benefits to Conducting ResearchResearch

Improve the health of children & Improve the health of children & familiesfamilies

Contribute to entity bigger than selfContribute to entity bigger than self Intellectual satisfactionIntellectual satisfaction Personal gratificationPersonal gratification National/international recognitionNational/international recognition PromotionPromotion Collaborations with others Collaborations with others

Faculty Involvement in Faculty Involvement in ResearchResearch

1990s1990sSurvey of division directors:Survey of division directors:

32% = mean percentage time conducting 32% = mean percentage time conducting researchresearch

2.1 2.1 (2.25)(2.25) = mean # of faculty as principal = mean # of faculty as principal investigatorinvestigator

100/114 - presented at national meetings100/114 - presented at national meetings 97/112 - published peer reviewed articles97/112 - published peer reviewed articles

CI Dungy, BP Dreyer, Academic General Pediatrics Divisions CI Dungy, BP Dreyer, Academic General Pediatrics Divisions in the 1990s. in the 1990s. Amb Child HealthAmb Child Health. 1999.5(1):53-60.. 1999.5(1):53-60.

Missions of DivisionsMissions of Divisions

TL Cheng. The Status of academic General Pediatrics. No Longer Endangered? Pediatrics 2007, 119:46-52

Division Grants and Division Grants and ContractsContracts

0

5

10

15

20

25

0 1K -50K

50K-250K

250K-500K

500K-1m

1m-5m

>5m


# Program

s

Total Directs

Director’s Top 3 Successes Director’s Top 3 Successes in Past 5 Yearsin Past 5 Years

Clinical

Education

Research

Advocacy

AdministrationEndowment

Other


NIH Roadmap for Medical NIH Roadmap for Medical ResearchResearch

Currently 36% of NIH funding committed to Currently 36% of NIH funding committed to clinical research and trainingclinical research and training

New emphasis on translating research into New emphasis on translating research into practicepractice

Clinical and Translational Science Awards Clinical and Translational Science Awards (CTSAs)(CTSAs)

Academic homes for original clinical and Academic homes for original clinical and translational sciencetranslational science

Novel interdisciplinary approaches Novel interdisciplinary approaches

E Zerhouni, Translational and Clinical Science-Time for a New E Zerhouni, Translational and Clinical Science-Time for a New Vision. Vision. NEJMNEJM, 2005; 353:1621-1623., 2005; 353:1621-1623.

NIH RoadmapNIH RoadmapPractice-Based ResearchPractice-Based Research

Increased attention to translate Increased attention to translate research findings into practiceresearch findings into practice

Average of 17 years for 14% of new Average of 17 years for 14% of new scientific findings to enter practice.scientific findings to enter practice.

Individualize the delivery of right Individualize the delivery of right treatment to right patient to improve treatment to right patient to improve health in ambulatory carehealth in ambulatory care

Test feasibility in real world of daily Test feasibility in real world of daily practicepractice

JM Westfall, Practice-Based Research-”Blue Highways” on the JM Westfall, Practice-Based Research-”Blue Highways” on the NIH Roadmap. NIH Roadmap. JAMAJAMA. 2007; 297(4):403-406.. 2007; 297(4):403-406.

Translating Research Translating Research Into PracticeInto Practice

National Pediatric Research National Pediatric Research NetworksNetworks PROSPROS CORNETCORNET PRISPRIS

Regional networksRegional networks Current networksCurrent networks CTSA regional networks (being formed)CTSA regional networks (being formed)

PBRN = Practice-based research network

Ways to be Involved in Ways to be Involved in PBRNsPBRNs

Serve as a co-investigator and Serve as a co-investigator and site data collectorsite data collector

Serve as a co-authorServe as a co-author Serve as the principal Serve as the principal

investigator and utilize sites to investigator and utilize sites to enhance sample size and enhance sample size and demonstrate feasibilitydemonstrate feasibility

A Framework to Evaluate and Improve A Framework to Evaluate and Improve the Research Capacity in a Programthe Research Capacity in a ProgramProgram Program

ComponentsComponentsStrengthsStrengths WeaknesseWeaknesse

ssSimple Simple

ImprovementsImprovementsComplex Complex

ImprovementsImprovements



ssSimple Simple


ImprovementsImprovementsCulture of DeptCulture of Dept



ssSimple Simple



Culture of DivisnCulture of Divisn

OrganizationOrganization



ssSimple Simple





Time AllocationTime Allocation

MentorshipMentorship



ssSimple Simple







Research Areas Research Areas

Faculty #, TypesFaculty #, Types



ssSimple Simple









FundingFunding



ssSimple Simple









FundingFunding

Collaborations- InCollaborations- In

Collaborations-Collaborations-OutOut

Program ComponentsProgram Components(Refer to Handouts)(Refer to Handouts)

1.1. Culture of the DepartmentCulture of the Department2.2. Culture of the Division or ProgramCulture of the Division or Program3.3. Organization of the divisionOrganization of the division4.4. Time Allocation and Skill Sets of Faculty Time Allocation and Skill Sets of Faculty 5.5. Mentoring of facultyMentoring of faculty6.6. Content areas of current research Content areas of current research 7.7. Number and types of faculty (recruitment)Number and types of faculty (recruitment)8.8. FundingFunding9.9. Collaborations within the institutionCollaborations within the institution10.10. Collaborations- externallyCollaborations- externally

Culture of the Department Culture of the Department (the only component that refers to the department)(the only component that refers to the department)

What are the expectations for research from the chair and the What are the expectations for research from the chair and the department?department?

What are the departmental priorities for research in comparison What are the departmental priorities for research in comparison to other missions of clinical care and education?to other missions of clinical care and education?

To what extent are other activities (clinical, teaching, To what extent are other activities (clinical, teaching, administration) conflicting with research expectations?administration) conflicting with research expectations?

How effective is the department’s infrastructure (e.g., statistician, How effective is the department’s infrastructure (e.g., statistician, programmers, fieldwork experts, small-grant program) to support programmers, fieldwork experts, small-grant program) to support research and does this include clinical research?research and does this include clinical research?

How well does the department support general pediatric How well does the department support general pediatric research (e.g., health services, clinical, community, behavioral?research (e.g., health services, clinical, community, behavioral?

How knowledgeable is your IRB concerning clinical research?How knowledgeable is your IRB concerning clinical research?

Culture of the Division or ProgramCulture of the Division or Program How much is research expected, emphasized, discussed at How much is research expected, emphasized, discussed at

division meetings? division meetings? Does your division have a research agenda, a strategic plan?Does your division have a research agenda, a strategic plan? What are expectations concerning research for individual What are expectations concerning research for individual

faculty? faculty? Is your division in agreement on how to judge effectiveness of Is your division in agreement on how to judge effectiveness of

research performance as well as mentoring?research performance as well as mentoring? Is unfunded research encouraged, and how effectively is it Is unfunded research encouraged, and how effectively is it

being done (e.g., small projects)? being done (e.g., small projects)? What is the emphasis on PAS abstracts, regional abstracts, What is the emphasis on PAS abstracts, regional abstracts,

and publications?and publications? What is the incentive for research (publications) that come What is the incentive for research (publications) that come

from projects that are not independently funded?from projects that are not independently funded?

Organization of the Division or Organization of the Division or Program with Respect to Research-1Program with Respect to Research-1

Does a research “champion” exist? Does a research “champion” exist? How adequate is the support structure for research How adequate is the support structure for research

(programmers, data, fieldwork, stats, grant writing support)? (programmers, data, fieldwork, stats, grant writing support)? Can these be found outside the division?Can these be found outside the division?

Could the division better use summer, medical, and MPH Could the division better use summer, medical, and MPH and PhD students?and PhD students?

To what extent are the clinical areas (e.g. Continuity Clinic) To what extent are the clinical areas (e.g. Continuity Clinic) set up for research? Is it happening?set up for research? Is it happening?

To what extent are data sets available to do research, e.g. To what extent are data sets available to do research, e.g. electronic patient records, billing data, quality measures, etc.electronic patient records, billing data, quality measures, etc.

Organization of the Division or Organization of the Division or Program with Respect to Research-2Program with Respect to Research-2

How frequent and effective are research meetings, practice How frequent and effective are research meetings, practice sessions (for PAS) and other venues to share ideas and sessions (for PAS) and other venues to share ideas and critique?critique?

How well trained are the faculty in the core areas of How well trained are the faculty in the core areas of research? Is more needed?research? Is more needed?

What opportunities are available within your What opportunities are available within your division/institution to enhance research methodology skills?division/institution to enhance research methodology skills?

By characteristic of the division:By characteristic of the division: For divisions with intent to improve research - how do you re-organize most For divisions with intent to improve research - how do you re-organize most

effectively / efficiently?effectively / efficiently? For divisions with many junior faculty - is the structure adequate for them to For divisions with many junior faculty - is the structure adequate for them to

move to the next level?move to the next level? For mature research divisions - how do you maintain momentum, hold the For mature research divisions - how do you maintain momentum, hold the

line, prevent burn-out?line, prevent burn-out?

Time Allocation and Time Allocation and Skill Sets of FacultySkill Sets of Faculty

How adequate (on paper and in practice) is the time allotted to How adequate (on paper and in practice) is the time allotted to research for the faculty?research for the faculty?

How much time is provided to junior faculty to jump-start research How much time is provided to junior faculty to jump-start research efforts? What about mid-level and senior faculty?efforts? What about mid-level and senior faculty?

To what extent are junior faculty “protected” from committee work, To what extent are junior faculty “protected” from committee work, inpatient attending responsibilities?inpatient attending responsibilities?

How effectively is time utilized by faculty who are doing research?How effectively is time utilized by faculty who are doing research? Are the skill sets of faculty adequate for their content areas?Are the skill sets of faculty adequate for their content areas? Could courses, programs and workshops locally, regionally, or Could courses, programs and workshops locally, regionally, or

nationally help individual faculty members improve their skills?nationally help individual faculty members improve their skills? How effectively are PAS and other meetings utilized to improve How effectively are PAS and other meetings utilized to improve

specific skills of faculty?specific skills of faculty? What is the availability of other disciplines/consultants for specific What is the availability of other disciplines/consultants for specific

research areas?research areas?

Mentorship of FacultyMentorship of Faculty Does each research-oriented faculty have a mentor? Is adequate Does each research-oriented faculty have a mentor? Is adequate

mentoring available?mentoring available? How effective is the mentoring of faculty (junior, mid-level, and How effective is the mentoring of faculty (junior, mid-level, and

senior faculty)?senior faculty)? How effectively are senior faculty members utilized and How effectively are senior faculty members utilized and

“incentivized” for mentoring?“incentivized” for mentoring? How effective is the mentorship specifically for obtaining grants—to How effective is the mentorship specifically for obtaining grants—to

relevant institutions (e.g., NIH, CDC, AHRQ, MCHB) and to relevant institutions (e.g., NIH, CDC, AHRQ, MCHB) and to foundations (local and national)?foundations (local and national)?

To what extent are career development awards being promoted; To what extent are career development awards being promoted; how effective is mentorship for this pursuit?how effective is mentorship for this pursuit?

Are clear expectations delineated for research mentors?Are clear expectations delineated for research mentors? Do you need to pursue mentors outside your division, department, Do you need to pursue mentors outside your division, department,

school of medicine, university?school of medicine, university?

Content Areas of Content Areas of Current ResearchCurrent Research

To what extent are the research topics being investigated To what extent are the research topics being investigated critical for the health of children?critical for the health of children?

How well do the current research topics capitalize on How well do the current research topics capitalize on strengths of the division, department, and community?strengths of the division, department, and community?

Has the division found a unique niche for research? A Has the division found a unique niche for research? A division unifying research theme?division unifying research theme?

How well integrated are the research topics with the How well integrated are the research topics with the department’s or institution’s research priorities / strengths?department’s or institution’s research priorities / strengths?

What types of research are priorities in your division?What types of research are priorities in your division?

Number and Types of FacultyNumber and Types of Faculty

Is the number of faculty adequate for research? Is the number of faculty adequate for research? Would a targeted recruitment help? Would a targeted recruitment help? Does targeted recruitment take place to “fill in” gaps in Does targeted recruitment take place to “fill in” gaps in

skills?skills? How adequate are recruitment packages?How adequate are recruitment packages? To what extent are PhDs integrated into research activities To what extent are PhDs integrated into research activities

of the division? Could they be?of the division? Could they be?

FundingFunding

To what extent do small grants exist within the department or To what extent do small grants exist within the department or division? How effectively are your faculty obtaining these division? How effectively are your faculty obtaining these grants?grants?

To what extent do small grants exist within your community? To what extent do small grants exist within your community? How effectively are your faculty obtaining these grants?How effectively are your faculty obtaining these grants?

Does the division chief have some discretionary money to fund Does the division chief have some discretionary money to fund small projects (or personnel)?small projects (or personnel)?

To what extent are faculty in a “catch-22” with having so many To what extent are faculty in a “catch-22” with having so many other responsibilities that they can’t compete for funding?other responsibilities that they can’t compete for funding?

How effectively can (and do) faculty piggy-back research onto How effectively can (and do) faculty piggy-back research onto larger existing research efforts within the institution?larger existing research efforts within the institution?

How adequate are the grant-writing skills of faculty, and are How adequate are the grant-writing skills of faculty, and are there mechanisms to improve these skills?there mechanisms to improve these skills?

CollaborationsCollaborationsWithin the InstitutionWithin the Institution

How adequately are research projects linked with other How adequately are research projects linked with other specialties within the department, capitalizing on specialties within the department, capitalizing on strengths?strengths?

To what extent are strengths from other departments To what extent are strengths from other departments (e.g., the medical school, undergraduate campus, school (e.g., the medical school, undergraduate campus, school of public health, other disciplines) utilized?of public health, other disciplines) utilized?

CollaborationsCollaborationsExternallyExternally

How effective are collaborations within the community How effective are collaborations within the community (beyond the institution) – e.g., DOH, community (beyond the institution) – e.g., DOH, community organizationsorganizations

Are community collaborations a priority?Are community collaborations a priority? Are collaborations adequate with networks (E.g., Are collaborations adequate with networks (E.g.,

CORNET, PRIS, PROS, regional practice-based CORNET, PRIS, PROS, regional practice-based research networks)? research networks)?

Do you take advantage of potential “mentorship” from Do you take advantage of potential “mentorship” from the APA, (e-Connections, APA members, APA SIGs and the APA, (e-Connections, APA members, APA SIGs and groups)?groups)?

Break Into Small GroupsBreak Into Small Groups(60 minutes)(60 minutes)

GoalsGoals Review:Review:

Components of the framework orComponents of the framework or Case scenariosCase scenarios

Discuss your program’s strengths / weaknessesDiscuss your program’s strengths / weaknesses Develop ideas for improving research capacityDevelop ideas for improving research capacity

In your division or program and generallyIn your division or program and generally Simple improvements (little or no funding needed)Simple improvements (little or no funding needed) More complex and long-term improvementsMore complex and long-term improvements

ReconveneReconvene(30 minutes)(30 minutes)

GoalsGoals Review:Review:

Ideas for improving research capacity in our Ideas for improving research capacity in our own divisions or programsown divisions or programs

Ideas for improved use of APA resourcesIdeas for improved use of APA resources Next stepsNext steps

Homework assignment Homework assignment Fill in the framework grid for your programFill in the framework grid for your program

Simple improvementsSimple improvements More complex or long-term improvementsMore complex or long-term improvements

Never doubt that a small group of thoughtful, Never doubt that a small group of thoughtful, committed citizens can change the world; committed citizens can change the world;

Indeed, it's the only thing that ever hasIndeed, it's the only thing that ever has..

Margaret MeadeMargaret Meade

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Developing Research Capacity Within A Division or Program Focus on Academic General Pediatrics Peter Szilagyi and Janet Serwint