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
– (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, HSR (IRB?)
• Present abstract or poster descriptively: institutionally, locally, regionally, nationally
• Evaluate-the double helix • 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
0%
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80%
2005 2006
PrePost
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 Gains2005 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
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
4.0 4.1 4.2 4.3 4.4 4.5 4.6
Teach w/casesLead a team
Feedback skillsTeach geri-issuesResolve conflicts
Deal w/reluctant learnerTeach geri-skills
Manage multi-tasksPractice geri
2005 2006
80%
70%
60%
50%
40%
30%
20%
10%
0%
20052006
PrePost
Chief Resident Immersion Training in Geriatrics
Sharon A. Levine, MDSerena Chao, MD, MSc
Belle Brett, EdDAngela Jackson, MDLaura Goldman, MDAdam 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
BUMC7
123 CRs/42 FMs
Hartford Cohort-1 Hartford Cohort-2 Hartford Cohort-3
Denver2
49 CRs/10 FMsYale3
54 CRs/8 FMsBaystate2
26 CRs/14 FMs
Reynolds Other
Cincinnati3
57 CRs/22 FMsRochester2
25 CRs/10 FMs
Nebraska2
23 CRs/8 FMs
Kansas2
23 CRs/2 FMs
USC3
17 CRs/2 FM
Wisconsin2
33 CRs/15 FMs
Marshall2
18 CRs/4 FMs
Cooper2
31 CRs/9 FMs
Wake Forest2
28 CRs/6 FMs
UMass2
25 CRs/6 FMs
UPenn2
18 CRs/9 FMs
Arizona2
56 CRs/9 FMs
Chief Resident Immersion Training (CRIT) 2005-2011Number of Chief Residents (CRs) & Faculty Mentors (FMs)
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
important to you
The 2 x 2 table
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X0 XX 00
IMPACT
EFFORT
High LowHigh
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
The W’s
•What ?•Who?•When?•Where?•HoW?•(Why?)