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Education/Clinical Care into
Scholarship
or
Water 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
– (PUT EVERYTHING ON YOUR CV!)
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, QI, HSR (IRB?)
• Present abstract or poster descriptively:
institutionally, locally, regionally, nationally
• Evaluate-the double helix
• Write about it: publish
• Show that others are using it: citations, adoption
Education Example: CRIT
• Developed
• Conducted
• Evaluated
• Abstract to Evans Day, AGS
• Poster: Evans Day, annual Reynold’s meeting
• Paper Session: AGS
• Publication in peer-reviewed journal
• Dissemination at other institutions
• Citations by others
• POGOe
0%
10%
20%
30%
40%
50%
60%
70%
80%
2005 2006
Pre
Post
Chief Resident Immersion Training (CRIT) in the Care of Older
Adults Levine SA, Chao S, Brett B, Jackson A, Goldman L, Burrows AB, Caruso LB
Geriatrics Section, Boston Medical Center and Boston University School of Medicine Supported by the Donald W. Reynolds Foundation Evaluation to
Date
Self-Reported Knowledge Gains (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”)
Extent to which Connections Made with Others
(n=number answering 4 or 5 on 5-pt scale, with 5 high)
Most Important Gains
2005
Knowledge/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
2005 & 2006 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)
Chief Residents: n=28
(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)
Topic 2005 2006
Retr
o
Pre-
mea
n
Post
-
mea
n
P-
value
Retr
o
Pre-
mea
n
Post-
mea
n
P-
value
Insurance
coverage
2.0 3.3 <.000 2.0 3.5 <.000
Functional
assessment
2.3 3.8 <.000 2.6 3.9 <.000
Long-term care
services
2.3 3.8 <.000 2.5 3.8 <.000
Principles of
geri-rehab
2.5 3.9 <.000 2.5 3.8 <.000
Discharge
planning
2.7 3.8 <.000 2.9 3.9 <.000
Pre-op
assessment
2.7 4.0 .001 3.0 4.1 <.000
Assessment of
living
arrangements /
support
2.9 4.1 .001 2.8 4.1 <.000
Decision-
making
capacity
3.3 4.4 .004 3.1 4.2 <.000
Value of
interdisciplinar
y, collaborative
teams
3.6 4.5 .002 3.5 4.5 <.000
Topic 2005 2006
Pre-
mea
n
Post
-
mea
n
P-
valu
e
Pre-
mea
n
Post
-
mea
n
P-
valu
e
Assessment of decision-making
capacity
3.2 4.3 .001 2.7 4.0 <.00
0
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 interdiscipl.,
collaborative teams
3.7 4.4 .02 3.0 4.5 .001
Functional assessment 3.4 3.8 NS 2.3 3.9 <.00
0
Principles of geri-rehab 2.8 3.5 NS 2.3 3.7 <.00
0
Long-term care services 3.0 3.3 NS 2.3 3.8 <.00
0
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) 2006
Recognition and
management of delirium
(n=10)
Discharge planning
Polypharmacy
Skills of being a CR
Teaching skills
14 of 15 agreed that CRIT
increased their interest in
geriatrics
2005 & 2006 Pre- and Post- Knowledge Test
4.0 4.1 4.2 4.3 4.4 4.5 4.6
Practice geri
Manage multi-tasks
Teach geri-skills
Deal w/reluctant learner
Resolve conflicts
Teach geri-issues
Feedback skills
Lead a team
Teach w/cases
2006
2005
Background Chief 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
Goals To 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 skills
To develop a do-able project related to resident
education or patient care in geriatrics
To have fun and foster collegiality
Curriculum Methods Interdisciplinary Planning Team
•Internal medicine, family medicine, geriatrics
Curriculum 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 skills
Small group exercises and brainstorms
Action plan development sessions
Evaluation Methods Pre- 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 retreat
Six month follow-up interviews
Eleven month final survey/interview
Anonymous Program Director post-retreat survey
Examples of CR Project Action Plans
Neurology: 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’ conference
Ophtho: Functional outcomes of cataract surgery
Rehabilitation: Polypharmacy on a rehab unit
2005 Eleven-month Follow-up Action 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
Conclusions
A 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
Implications CRs 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 “The retreat tackled a finite amount
of information in sufficient detail to
be useful in a cross-disciplinary way
and did a wonderful job of
highlighting the need for
collaboration among different
services.“ 2005 CRIT Participant
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
80%
70%
60%
50%
40%
30%
20%
10%
0%
2005
2006
Pre
Post
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
Chief Resident Immersion Training (CRIT)
National Demonstration
Sharon A. Levine, MD
Lisa Caruso, MD, MPH
Belle Brett, EdD
Heidi Auerbach, MD
Angela Jackson, MD
Adam Burrows, MD
Serena Chao, MD, MSc
AGS, May 5, 2012
Total # of Chief Residents (CRs) Trained = 1022
Total # of Faculty Mentors (FMs) Trained = 317
Chief Resident Immersion Training (CRIT) List of Participating Institutions and Total Number Trained: 2005-2013
Medstar
UT San Antonio
Beaumont
BU/BMC
160 CRs/54 FMs
Hartford Cohort-1 Hartford Cohort-2 Hartford Cohort-3
Denver Yale Baystate
Reynolds 1-3
Hearst 1-3
Cincinnati Rochester
Nebraska
Kansas
USC
Wisconsin
Marshall
Cooper
Wake Forest
UMass
UPenn
Arizona
Duke
Emory
Mt. Sinai
Texas Tech
UPenn
UT – Southwestern
Utah
NEOMED
Stony Brook
Brown
UMass
U of Hawaii
UNC - Chapel Hill
Louisville
EVMS
Lifebridge/Sinai
A Clinical Example • Home care/clinical responsibilities (80% time!)
• Lecture to/precept trainees about home care
• SGIM Geriatrics Interest Group: Like-minded
colleagues (American Academy Home Care
Physicians) FUN. FRIENDS FOR LIFE. NATIONAL
• Home Care workshops/symposia at CDIM, SGIM,
AGS, etc, etc
• Survey of program directors re: home care
• Development and publication of HC curriculum
guidelines
• JAMA Contempo Update: Home Care
Impact of A Post-Hospitalization Patient
Visit on Residents’ Discharge Planning
Skills
M. Young, V. Parker, SA. Levine, SH. Chao
Section of Geriatrics, Department of Medicine,
Boston University School of Medicine
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 a priority for you
The 2 x 2 table
xx
X0
XX 00
IMPACT
E
F
F
O
R
T
High Low
High
Low
-------------------------------------------------------------------
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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
• Partners should be outside your institution
• 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
• Outcomes
The W’s
• What ?
• Who?
• When?
• Where?
• HoW?
• (Why?)