Education/Research 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

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 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

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 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 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 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 Evaluation to Date 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 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) 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) 2005 & 2006 Pre- and Post- Knowledge Test % 70% 60% 50% 40% 30% 20% 10% 0% Pre Post Gains in Self-Reported Knowledge (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”) 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 “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 2005 Extent Realized n/N (mean) 2006 Extent Realized n/N (mean) With CRs from other areas12/12 (4.6)12/15 (4.1) With geriatrics faculty12/12 (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) Extent of Connections Made with Others (n=number answering 4 or 5 on 5-pt scale, ) with 5 high) Topic Pre- mean Post- mean P-valuePre- mean Post- mean P-value Assessment of decision-making capacity <.000 Recognizing dementia Managing dementia3.33.5NS Recognizing delirium Managing delirium NS Assessment of living arrangements / support Value of interdisciplinary, collaborative teams Functional assessment3.43.8NS2.33.9<.000 Principles of geri-rehab2.83.5NS2.33.7<.000 Long-term care services3.03.3NS2.33.8<.000 Curriculum Topic Above line: covered formally Below line: not covered formally Retro Pre- mean Post- mean Retro Pre- mean Post- mean Insurance coverage2.03.3***2.03.5*** Functional assessment2.33.8***2.63.9*** Long-term care services2.33.8***2.53.8*** Principles of geri-rehab2.53.9**2.53.8*** Discharge planning2.73.8***2.93.9*** Pre-op assessment2.74.0**3.04.1*** Assessment of living arrangements / support **2.84.1*** Decision-making capacity3.34.4**3.14.2*** Value of interdisciplinary, collaborative teams **3.54.5*** Recognizing dementia3.64.6**3.44.3*** Managing dementia2.83.7**3.34.0** Recognizing delirium3.84.7*3.64.9** Managing delirium3.34.4**3.54.6** Reviewing medications for evidence of polypharmacy N/A *** Managing diabetes Managing coronary artery disease Recognizing, evaluating, and treating urinary incontinence ** Assessing/reducing risk of falls2.73.4**2.93.7* Accounting for cultural differences in decision making & 2006 Resident 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) n=28 *Includes one PGY3 resident **Includes one fellow *=p<.05, **=p<.01, ***p=<.001

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

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 xx X0 XX 00 IMPACT EFFORTEFFORT High Low High Low  IIIIIIIIIIII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 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