scholarship in medical education › documents › publish or perish.pdf · written scholarship 2 8...
TRANSCRIPT
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Publish or Perish:
Scholarship in
Medical Education
Mike Elnicki
Department of Medicine
University of Pittsburgh
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Advancing Educators &Education:
Defining the Components and
Evidence of Educational Scholarship
• By AAMC Group on Educational Affairs
Consensus Conference 2007
• Defining Educational Scholarship
• Broadening Educational Scholarship
• Largely ineffective
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Why Publish?
1. Academic ―coin of the realm.‖
2. Promotion and Tenure
3. Recognition among peers
4. We have ―an obligation to disseminate
our findings.‖ -Alan Halperin
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Why Publish Education?
We would never subject patients to
untested therapies, but we do it all the
time to learners.
-Frank Stritter
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―Let the students be your
laboratory.‖
Ted Kotchen
Chair of Medicine, WVU 1990
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Tasks of Academic Physicians
• Investigation: publication expected
• Education*
• Clinical activity*
• Administration*
• *The trick is to write about these three.
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Clinician-Educators’ ActivitiesSheffield. JGIM 1998
• Work week 59 hours
• Scholarship 7.6 hours (13%)
• Job description 20%
• Done outside week 42% scholarship
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Responsibilities & Activities of
Clerkship DirectorsHemmer. Acad. Med. 2001
• Duties
– 3.2 Clinic half days
– 2.9 Months inpatient attending
– 22% FTE on clerkship
– 2.5 other courses taught
• Scholarship
– 2.2 Papers (0-20)
– 0.7 Grants (0-4)
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Predictors of Scholarly
ProductivityPapers (p) Grants (p)
• Male Gender .l4 .01
• Fellowship .005 ---
• Less Clinic Days .06 .04
• Faculty Development ---- <.01
• Expectations Article .04 .01
• Teaching Courses .07 .07
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Ranking Importance of Clinician-Educator
Performance in Promotion DecisionsBeasley and Wright. JGIM 2003.
Clinician-Educators Promotion Committee Chairs
(N = 107) (N = 115)
Clinical Research 1 10
Written Scholarship 2 8
Reputation 3 5
Teaching Skills 4 1
Curriculum Development 5 6
Educational Research 8 11
Clinical Skills 11 2
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Clinical Faculty and Career
ProgressBuckley. Arch IM 2000
>50% clinical <50% clinical
• Professor 16% 40%
• Tenure 26% 52%
• Acad. Time 15 45 (hr/mo)
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Overview
1. Ask questions
2. Collect good data
3. Attend to methodology/analysis
4. Collaborate
5. Remember IRB
6. Where to publish (round pegs in round holes)
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Hit the ―Academic Home Run‖
• Give a talk
• Write an abstract
• Write a paper
• Get a grant
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Study what you need to do anyway
• Logging trainee experiences
(patients, procedures)
• Quality surveys
(new, old experiences)
• Remember: design to yield quality data
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Example
Create an early clinical exposure for
students that will stimulate their
interest in internal medicine.
- Rashida Khakoo, Chair
Department of Medicine
West Virginia University
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Early InterventionElnicki. JGIM 1999
Intervention: MS2 volunteers
8 weeks, mixed in/outpatient
Funding: ACP
Results: Higher ICM scores, more honors in
Ethics & IM clerkship (p<.05)
More matched in IM (54 v. 27%, p<.01)
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Pick Low Hanging Fruit
• CAMC evaluations at Pitt
- in a pile on the Office of Medical
Education floor
• Three papers later
- which teaching behaviors are associated
with high quality teaching
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Effective Teaching Behaviors• Elnicki M, Kolarik R, Bardella I. Third Year Medical
Students’ Perceptions of Effective Teaching Behaviors in a Multidisciplinary Ambulatory Clerkship. Acad Med 2003
• Elnicki M, Cooper A. Medical Students’ Perceptions of the Elements of Effective Inpatient Teaching by Attending Physicians and Housestaff. JGIM. 2005
• Torre D, Simpson D, Sebastian J, Elnicki M. Learning/Feedback Activities and High-Quality Teaching: Perceptions of 3rd Year Medical Students during an Inpatient Rotation. Acad Med 2005
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Outcomes Research in Medical Education Chen. Acad Med. 2004
―The primary goal of medical education
is to produce physicians who deliver
high-quality health care.‖
How can we tell if we do?
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Methodology
1. Surveys
Needs assessment
Outcome (satisfaction or knowledge)
2. Comparison of Groups
Demonstrate need/benefit
3. Curricular Innovation (intervention)
RCT, Pre/Post, Cohorts
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Education: Dissect the
Curriculum• New Didactic Sessions
– lectures, conferences, labs
• Clinical Encounters
– patients, diagnoses, procedures
• Communication (doc-pt, oral, written)
• Learning style
• Teaching/Learning Interactions
• Feedback & Evaluation
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Outcomes
• Learner Opinion (not enough)
• Exam Scores (MCQ, SP, others)
• Performance at Next Level (predictive)
• Career Choices
• Patient Evaluations
• Costs
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Collaborate: How to Initiate?
• Section meetings
– answer questions/problems
• Interest groups
– clinical or educational focus
• Committees
• Professional societies
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Collaborate: With Whom?
• Within department
– senior/junior, partners
• Inter-department
• Among institutions
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Collaborate across Disciplines
• Internal Medicine/OB-GYN Clinic
(Abby Spencer)
• Observed Teaching Behaviors in
IM, FM, Peds
(Inis Bardella)
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Multi-Institutional Studies
•Feedback in resident clinic
WVU and Texas A&M
•Medical student abuse
12 schools
•Procedures
Teddy Wu and 6 schools
•Physical Diagnosis
Scott Herrle and 3 schools
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Where to Publish Educational Research
1. Medical educational journals
Academic Medicine/RIME
Teaching and Learning in Medicine
Medical Education, Medical Teacher
2. Journals with interest
Journal General Internal Medicine
Journal of the American Medical Association
3. Regional/state journals
Southern Medical Journal
American Journal of Medical Science
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Rejection: Don’t Give Up!
It’s like dating - you’re going to get told “no”
sometimes, but keep asking
1. Go have a beer and cool down
2. Use reviewers’ feedback
3. Choosing a different journal
4. Timelines
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Funding Background
• Institute of Medicine has called for increased
rigor of medical education research
• Outcomes based: improving patients’ health
• New approaches to recognize and reward
teachers and educational researchers
• National funding is limited
- <.04% of federal spending in GME is used
for education research
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Funding Educational Scholarship
• Federal (HRSA)
• Foundations
– RWJ, Kaiser, Kellogg
• Shadyside Hospital Foundation
– unrestricted educational grants
• Professional Societies
– ACP, SGIM, AAMC
• ―Rob Peter to pay Paul‖
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Published Medical Education Research
Reed et al. Hopkins Bayview
Reviewed published medical education research
- between 9/2002 – 12/2003
- in 13 journals
- 290/665 articles were research studies
• Response rate 84% from authors
- Mean cost of studies $24,471
- Underestimated cost of study by >50% ($12,000)
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Funded & Published
• 30% of studies had funding (72/243)
- Median funding $15,000 (IQR $5,000- 66,500)
- Median cost $37,315 (IQR 18,731- 82,393)
• Private foundation grants
- Most common source of funding (42%)
- Median $21,500 (IQR 8,750-64,750)
• Government Grants
- Usually larger grants (24%)
- Median $158,000 (IQR 50,000-387,500)
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Institutions Successful at Med Ed
Research. Acad Med 10/04
1. High Profile (centers):
Wilson Center (University of Toronto)
Dept Med Ed (U Mich),
Academy (UCSF)
2. Used for Faculty Development
3. Support (consultations, stats, etc.)
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Bordage: RIME Wrap up
• Build themes to research
• Theory should drive research and vice versa
• Our research should better practice
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Example: Med Ed Research
• Building on a theme
• Real outcomes
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Curricular/Evaluation
Articles
• Papadakis MA, Osborn EH, Cooke M, Healy K.
A strategy for the detection and evaluation of
unprofessional behavior in medical students.
University of California, San Francisco School of
Medicine Clinical Clerkships Operation
Committee. Acad Med. 1999 Sep:74(9):980-90
• Papadakis MA, Loeser H, Healy K. Early
detection and evaluation of professionalism
deficiencies in medical students: one school’s
approach. Acad Med 2001 Nov;76(11):1100-6
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Papadakis MA, et al.
Unprofessional behavior in medical school
is associated with subsequent disciplinary
action by a state medical boardAcad Med. 2004
Outcomes
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Outcomes
• Papadakis MA, Teherani A, Banach MA, Knettler
TR, Rattner SL. Disciplinary action by medical
boards and prior behavior in medical school. N
Engl J Med. 2005;353:2673-82.
• Teherani A, Hodgson CS, Banach M, Papadakis
MA. Domains of unprofessional behavior during
medical school associated with future disciplinary
action by a state medical board. Acad Med. 2005;
80:S17-20
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Review/Commentary
Stern DT, Papadakis M
The developing physician—becoming a
professional. NEJM. 2006
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Summary
Publishing is a “coin of the realm”
1. Publish things you need to do anyway
2. Collaborate intra- and inter-institutionally
3. Develop themes to your work
4. Hit the academic ―home run‖
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