Family Physician Mentorship of the Medical Student Scholarly Project at the University of Arizona College of Medicine-Phoenix The University of Arizona College of Medicine Phoenix has a required Scholarly Project curriculum for all medical students. Longitudinal with milestones

Disclosures None

UACOM-P Scholarly Project (SP) Team Director: Matt McEchron, PhD SP Advisors: Eric vanSonnenberg, MD and Steve Stapczynski, MD Coordinator: Kristen Wagner, MS Statistician: Paul Kang, MPH mcechron@email.arizona.edu 602-827-2527

Lecture Contributors Matthew McEchron, Ph.D. Steve Stapczynski, M.D. Eric vanSonnenberg, M.D. Michelle McQuilkin (medical student) Daniel Crawford (medical student) Kristen Wagner, MS Sarah Coles, MD Jennifer Hartmark-Hill, MD

Format and objectives of this lecture List the curricular milestones and objectives for the SP and describe how they relate to the requirements of lifelong learning, critical thinking, and self-directed learning. (McEchron, 10 min content, 5 min discussion) Describe the mutually beneficial relationship of the family physician mentor and the medical student scholar. (Medical Students: Crawford and McQuilkin, 10 min content, 5 min discussion) Develop examples of family medicine quality improvement and outcomes-based research projects. (Family medicine physicians: Drs. Coles and Hartmark-Hill, 10 min content, 5 min discussion)

Some objectives of the Scholarly Project Engage in active independent learning to resolve a medically related research question Demonstrate effective teamwork, communication strategies, and critical thinking skills Evaluate the background, methods, and results using reliable medical sources Demonstrate effective verbal and written communication (e.g., prospectus, oral presentation, thesis, poster) Demonstrate effective use of evidence based medicine tools for lifelong learning Implement ethical and professional research practices by adhering to research compliance standards and sound scientific methods.

Evidence Based Medicine Demonstrate effective use of evidence based medicine (EBM) tools for lifelong learning PubMed, Dynamed, Guidelines tools used routinely through all four years Medical information is increasing rapidly and changing Formulate a PICO research question, hypothesis, and a methodology to test the question Goal: clinicians should be able to formulate and resolve questions quickly Goal is not to create physician scientists. Scholarly Project important for all medical specialties

What is the Scholarly Project? Every student at the College of Medicine - Phoenix must design and successfully complete a Scholarly Project (SP). Students attempt to resolve a research question. The research question can be identified by the mentor, student, or both. PICO formatted with hypothesis Students work closely with mentors and the SP office throughout the four years of their project. Students have the opportunity to present their research at regional and national meetings.

Scholarly Project timeline Required for each medical student Graded Pass-Fail each year Year 1 Year 2 Year 3 Year 4 Acquire tools for scholarly project Pair with Mentor Develop research question with mentor Begin collaborative research with mentor Continue collaborative research with mentor Oral presentation of SP progress to a panel of faculty Continue collaborative research with mentor Finish data collection Analyze data Prepare final thesis and poster presentation Longitudinal Scholarly Inquiry

Scholarly Project milestones Pair with mentor. Students choose a mentor that fits with their goals and interests. PICO formatted research question and hypothesis. Testable/measurable outcomes. Prospectus Year 1 Oral presentation to a panel of faculty 50% of data collection Year 2 Continue data collection Maintain communication with the mentor Year 3 Finalize data collection and analyses Complete final thesis and poster Present poster during research symposium Year 4

Benefits of the Scholarly Project for students Allows students to be creative and active learners Allows students to shape and control their medical education. Scholarly inquiry is critical for becoming an effective physician. The Scholarly Project can make students more competitive for residency. A number of students publish their Scholarly Project. Allows students to gain valuable mentorship

Scholarly Projects are mentor driven Mentor meets with the student to discuss research ideas and assists in the clarification of the research question.  Communicates with the student periodically to monitor progress and encourage project completion.  Assists with interpretation of results. Reviews the poster and thesis.

Types of Scholarly Projects Hypothesis Driven Systematic Review          15% Retrospective chart data                          45% Prospective data (Surveys, data collection in clinic) 25% Basic science                                      10% Prospective + Retrospective                           5%

What makes a successful student-mentor relationship? Communication – timely responses Availability Articulate potential SP research questions Access to data or resources Assists with overcoming project barriers

What are some common issues for an SP? Communication – recommend consistent communication via email, both student and mentor Expectations – time commitment of project should be appropriate for MD candidate education (not PhD level research) Scope – smaller finite projects work best as a starting point Scheduling – discuss academic calendar, deadlines, and meeting times Project stalled – SP office can help problem solve (e.g., IRB)

Scholarly Project resources Statistics – Students have access to statistical resources for project design and analysis. Research Compliance and IRB – Student and mentor have access to research compliance consultation and the UA IRB.

Discussion Question Does your institution have Scholarly Project requirements or options for students/residents? If so, describe the format of the scholarly project curriculum/process

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Students’ Perspectives on the Scholarly Project (SP) Program @ the University of Arizona College of Medicine Phoenix Hello. Thank you having us. It is an honor and a privilege to be here today, and we are very appreciative for this opportunity to share our perspectives on the SP…[read title]

Michelle McQuilkin, MSII SPEAKERS Michelle McQuilkin, MSII Daniel Crawford, MSII There will be 2 student speakers. Michelle McQuilkin, who is standing to my (), and I am Daniel Crawford.

PLAN Michelle Keys to a successful SP Fitting SP into medical school Value of SP Daniel SP benefits to students The “ideal” project The exceptional mentor [just read the slide] Michelle will start with talking about... I will cover … And now I will turn it over to Michelle ~50 seconds

MY PERSPECTIVE by Michelle

KEYS TO A SUCCESSFUL SP Good communication Mutually agreed expectations Availability of mentor Project of interest The keys to a successful SP from my prospective

COMMUNICATION Clear & frequent Clarity of goals by mentor Clarity of SP milestones by students I find that it is beneficial for the communication to be clear and frequent between both the mentor and medical student. Clarity of goals by the mentor → by this I mean that there is a clear end goal of the SP that the mentor and medical student can work together towards. Clarity of SP milestones by students. We have milestones in the SP program to ensure we are on track with our curriculum. It is important that the student shares these milestones with the mentor so they can plan the project accordingly.

MUTUALLY AGREED EXPECTATIONS Time commitment Understanding of student’s schedule Deadlines The most important expectation to agree upon is the time commitment of the project. Specifically, a time commitment that is realistic with the medical students available time. This involves an understanding of a student’s schedule. I will touch upon this in the next slide. The next expectation is deadlines. As I mentioned before we do have milestones in the SP curriculum we need to meet. My mentor and I have found it is beneficial to set our own deadlines to review assignments prior to the curriculums due dates.

WHEN CAN WE WORK ON SP? Capstone blocks (shadowing & SP research time) Personalized Active Learning block In between class time & studying

AVAILABILITY OF MENTOR Timely response to emails Periodic personal meetings Assistance w/ challenges Successful SPs have a common quality and that is the availability of a mentor.

PROJECT OF INTEREST Clear research question Value to healthcare Shared curiosity medical education and pts

WHAT MAKES AN UNSUCCESSFUL SP? Poor communication Unreasonable expectations Unrealistic time commitment Unclear research question Another “U”

A CLASSMATE’S EXPERIENCE Unclear research goal Student’s role became unrealistic Communication ended Project fell apart Student began meeting with mentor before medical school started This may see a bit over ambitious. I cannot speak for all of the UACOMP students but myself and many other students I have spoken with chose UACOMP because of the SP program. It sets the school apart from other medical schools and students are eager to start right away. Especially in the first year as there are good time blocks to utilize for research. Clear goal of research was not established Student reports they felt like they were going to work as a lab assistant more than a mentee collaborating with the mentor Student’s role became unrealistic Medical student was to be at the hospital weekly to collect samples for analysis Dependent upon surgical schedule Communication fell through This was for the best because the expectations of the student were unrealistic. However, there was never an clear end in the communication and the student waited for the mentor to get back to them. Valuable time was lost

VALUE OF SP FOR STUDENTS Learning how to do research Enriches medical education Experience in speaking, writing, & publishing Stronger residency application Clinical pearls Presenting at conferences Publications Enriches medical education Give example of speaking with Dr. Stapczynski about Broselow pediatric emergency tape. Used knowledge in an Emergency Medicine Clinical Skills night with simulator patients Public speaking skills Stronger residency application

ANOTHER STUDENT’S PERSPECTIVE by Daniel

SP BENEFITS TO STUDENTS Gaining research experience Time management Introduction to clinical medicine Enhances residency application & interviews We’ll talk about the first three bullets in detail

GAINING RESEARCH EXPERIENCE Learn to ask relevant research questions Write research proposals Navigate IRB process Analyze & summarize clinical data Communicate scientific information Navigate: which can be a lengthy and cumbersome process but will help us in future research endeavors Analyze…+communicate: part of poster presentation during our 4th year and any publication submissions

TIME MANAGEMENT Balance lecture material, doctoring, research, volunteering, & family Milestones & assignments submitted for review by SP faculty Blocks of time dedicated to working on SP The next benefit we’re going to talk about is… Blocks of time: “As Michelle mentioned…”

INTRODUCTION TO CLINICAL MEDICINE Witnessing the milieu of the mentor Learning clinical medicine EMR navigation Witnessing: most meetings with my mentor take place in his office... -EMR navigation: 2 different chart records and 3 different imaging systems; see how well/not so well information is documented -physician integration: most meetings take place in my mentor’s office, so I am able to see how he interacts with colleagues and staff -learning and teaching opportunities: echo book example

THE “IDEAL” PROJECT Manageable size & complexity Clinically valuable Stimulating research question An exceptional mentor Ideal project from OUR perspective…. verbal: “exceptional mentor - we’ll get back to that later…”

A CLASSMATE’S EXPERIENCE Began project in subspecialty career choice Good communication initially Mentor gradually became unavailable & slow to communicate Student became disenchanted Project terminated by mentor

THEN HE... Switched to a project w/ primary care physician Mentor was accessible & communicated well Faced challenges together Very satisfied with new project & mentor

THE EXCEPTIONAL MENTOR Easily accessible & available Good communicator Interested in the research Helps problem solve Provides guidance for road blocks Becomes an advisor & friend 7:45 from “Another Student’s Perspective” to here

CONCLUSIONS SP benefits us students in so many ways Mentor availability & good communication are essential to project success Assuredly the SP experience will help us in our future careers! 4:45 with little additional talking 8:00 with much additional talking

5 MINUTES: QUESTIONS FROM THE AUDIENCE FOR THE STUDENTS 4:45 with little additional talking 8:00 with much additional talking

Family Medicine Attending Perspective Jennifer R. Hartmark-Hill, MD, FAAFP Director, Capstones Course Director, Community Faculty Development Programs Director, The Program for Narrative Medicine & Medical Humanities Sarah Coles, MD Clinical Educator, University of Arizona College of Medicine Family Medicine Residency Director, Longitudinal Patient Care Course

M3otivation Mentoring Momentum Family Medicine Advocacy!

What’s in it for me? Promote family medicine Educate and inspire Share and explore your passion Publish Advance your education/career Learn new stuff Improve patient outcomes

Anywhere, Anytime! Any practice setting: Medical School Residency-based Clinical Practice Hospital, Clinic, Nursing Home, Etc Research Facility Any setting a family physician is in would be appropriate to mentor a student in a scholarly project.

Opportunities Mentoring Medical Students in Research Residency-based Opportunities What was your plan for this slide? I would be happy to talk about the residency side of things.  Yes, was just going to say that if you are in a residency based setting with scholarly activity requirements for residents, consider reaching out to local med school to include med student – would turn it over to you to provide detailed examples

Role of the Residency ACGME Program Requirements: II.B.5. The faculty must establish and maintain an environment of inquiry and scholarship with an active research component. (Core) II.B.5.c) Faculty should encourage and support residents in scholarly activities. (Core) IV.B.2. Residents should participate in scholarly activity. (Core) IV.B.2.a) Residents should complete two scholarly activities, at least one of which should be a quality improvement project. (Outcome) Residents and faculty already are required to participate in research. This is an excellent opportunity to engage medical students in your specialty, promote your residency, and get additional man-power to conduct your research. YUP!!!

Examples of Residency Projects Quality Improvement Projects Curriculum Development and Implementation Skills and Procedures Discovery Based Research Integration and Application Community Outreach Population Health and Management

Project Examples “Watching” What We Eat: What television is modeling Readability and Content of After Visit Summaries in One Family Medicine Residency Clinic Transgender Reproductive and Preventive Health Awareness Improving HPV Vaccine Rates in Family Medicine Residency Clinic Translating Leadership Potential Into Reality: Development of Leadership Curriculum Mini-Medical School: Family Medicine Residents as Middle School Educators Program These are my current or past projects with medical students or residents 50

Opportunities: Mentoring Medical Students in Research Clinical Practice QI Projects Part IV—Performance in Practice MOC

Opportunities: Mentoring Medical Students in Research Clinical Practice PBRNs PBRN’s exist in all 50 states; they include a minimum of five practices and must have a majority of primary care physician members; Some are affiliated with the AAFP Research network  This is an “other opportunities idea” for non-residency based Fam Med docs who want to collaborate/get involved “Groups of primary care clinicians and practices working together to answer community-based health care questions and translate research findings into practice. PBRNs engage clinicians in quality improvement activities and an evidence-based culture in primary care practice to improve the health of all Americans.”

Develop a research question Identify research method How Do I Get Started? Develop a research question Identify research method Identify resources Identify collaborators Do it!

Developing a Research Question Keep a notebook Jot down clinical questions or observations from your practice Brainstorm Follow your passion Changed you to your

Key Features of a Research Question Important Interesting Answerable

Time Training Tall Tales Barriers To Research AKA: If this is so great, why doesn’t everyone do it? Tall Tales: Misconceptions about research. Assume that Research requires RCTs, grants, bench research when in fact it can be things we already do every day Presentation at this slide would then quickly discuss how to overcome barriers: Time: Medical student assistants help to reduce the time needed to conduct the research. Also can build the research into clinic or practice flow (ie: QI projects) Training: Tall Tales: Reinforce that research does not mean a huge trial with thousands of participants. Meaningful research occurs in lots of different settings and methods Matt asked us to identify any barriers to family docs conducting research? Any more that you think of?

Tool = SWOT Analysis Strengths – Weaknesses – Obstacles - Threats Example S: passion/interests W: limited active projects O: survey fatigue, curricular limits T: time, overcommitment Student interest Subcommittee approval/guidance -- > examples from my experiences Creative study design Scheduled check-ins Tools for prioritization (Rocks & Pebbles)

Discussion Small Groups Please complete your own SWOT analysis for engaging in research (and mentoring a medical students)! Tool = SWOT Analysis Strengths – Weaknesses – Obstacles - Threats

THANK YOU!!!

Appendix

“Pre-flight Checklist: The 5 R’s Relevant to stakeholders Rapid and recursive in application Redefines rigor Reports on resources Replicable This slide is really difficult to read. Maybe remove the table?  I’d be ok with removing. Was just meant as a visual, and may be fine a larger size display in conference setting. deGruy FVd, Ewigman B, DeVoe JE, Hughes L, James P, Schneider FD, Hickner J, Stange K, Fossen TV, Kuzel AJ, Mullen R, Peek C. A Plan for Useful and Timely Family Medicine and Primary Care Research. Fam Med 2015;47(8):636-642.

Identified Needs How primary care services are best organized How to maximize and prioritize care How to introduce and disseminate new discoveries so they work in real life How patients can best decide how and when to seek care Identified Needs

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