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

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IMPACT

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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?)