Education/Clinical Care 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; clinical practice guidelines; editorials; book chapters; dissemination: www; pop writing; lay press

– (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

Basic Scientist Educator

• Scientists involved in educational activities

• Scholarly activities resulting in communication of new knowledge

• New courses/curricula; course syllabi; lectures; other teaching materials; scholarly reviews of scientific subjects

At BUSM:Teaching/Administration ≠ Scholarship!!

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 via grants• Citations by others• ->POGOe

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80%

2005 2006

Pre

Post

Chief Resident Immersion Training (CRIT) Chief Resident Immersion Training (CRIT) in thein the Care Care ofof Older Older AdultsAdults

Levine 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 LBGeriatrics Section, Boston Medical Center and Boston University School of MedicineGeriatrics Section, Boston Medical Center and Boston University School of Medicine

Supported by the Donald W. Reynolds FoundationSupported by the Donald W. Reynolds FoundationEvaluation 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

Retro Pre- mean

Post- mean

P-value

Retro Pre- mean

Post- mean

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 interdisciplinary, collaborative teams

3.6 4.5 .002 3.5 4.5 <.000

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 interdiscipl., 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

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

BackgroundChief Residents (CRs) play a crucial part in training

residents and studentsCRs 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 skillsTo develop a do-able project related to resident

education or patient care in geriatricsTo have fun and foster collegiality

Curriculum Methods Interdisciplinary 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 studentsCRs 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 skillsTo develop a do-able project related to resident

education or patient care in geriatricsTo have fun and foster collegiality

Curriculum Methods Interdisciplinary 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 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’ 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 educationCRs can be a source of cross fertilization across

departments at an institutionCRs 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 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’ 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 educationCRs can be a source of cross fertilization across

departments at an institutionCRs 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 The retreat tackled a finite amount

of information in sufficient detail to of information in sufficient detail to be useful in a cross-disciplinary be useful in a cross-disciplinary way and did a wonderful job of way and did a wonderful job of

highlighting the need for highlighting the need for collaboration among different collaboration among different

services.services.“ “ 2005 CRIT Participant2005 CRIT Participant

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

be useful in a cross-disciplinary be useful in a cross-disciplinary way and did a wonderful job of way and did a wonderful job of

highlighting the need for highlighting the need for collaboration among different collaboration among different

services.services.“ “ 2005 CRIT Participant2005 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%

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30%

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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)Chief Resident Immersion Training (CRIT)National DemonstrationNational Demonstration

Sharon A. Levine, MDLisa Caruso, MD, MPHLisa Caruso, MD, MPH

Belle Brett, EdDBelle Brett, EdDHeidi Auerbach, MDHeidi Auerbach, MDAngela Jackson, MDAngela Jackson, MDAdam Burrows, MDAdam Burrows, MD

Serena Chao, MD, MScSerena Chao, MD, MSc

AGS, May 5, 2012AGS, May 5, 2012

CRIT Program TimelineCRIT Program Timeline

4 yr (2009-2013) Reynolds grants to UMass and UPenn – BMC CRIT Faculty consult. 

 4 yr (2007-2011) grant awarded to ADGAP/BMC from Hartford Foundation.

4 yr (2011-2015) grants from both Hearst (via ADGAP) and Reynolds (via Duke) foundations 

 ADGAP develops website featuring CRIT

 First 4 yr (2003-2007) grant to BUSM from Reynolds Foundation.

CRCRIT manuscript published in JAGS

Hearst/Reynolds funding ends. Future plans under consideration.

Grand TotalsGrand Totals> 1200 CRs at 86 CRITs in 33 > 1200 CRs at 86 CRITs in 33 institutionsinstitutions

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

PROFESSIONAL IMPACT/YIELD

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

• 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?)