Marion Sills, MD, MPHmarion.sills@childrenscolorado.org

Orientation: the Clinical Experience

Orientation Overview

• Clinical Experience• Goals • Structure • Policies• Your experience

Orientation Overview

• Clinical Experience• Goals • Structure• Policies• Your experience

Clinical Experience: Goals

• Silos • training• research • practice

Clinical Experience: Goals

Clinical Experience: Goals

• What: bridge silos • When:

• now: during training• future: sustained during your research career

• Why: translational research -> progress in combating human disease

Translational Introduction

Orientation Overview

• Clinical Experience• Goals • Structure• Policies• Your experience

• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation

Orientation Overview

• Clinical Experience• Goals • Structure• Policies• Your experience

• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation

Clinical Experience: Structure

• Clinic schedule• ~ 1/month • frequency tailored to

• your desires/needs• the clinical situation (e.g., clinical continuity may require varied frequency of clinic attendance)

• Attendance required every day you arrange with your clinical mentor unless illness or emergency

Orientation Overview

• Clinical Experience• Goals • Structure• Policies• Your experience

• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation

Clinical Experience: Structure

• Your role in clinic• shadow the clinical mentor

• discuss dynamics of this with mentor a priori, e.g.:• how would you like me to introduce myself?• when would we discuss my questions?

• no clinical responsibilities including translation

• patient encounters will be the starting point for discussing real patients’ medical problems relevant to your research

Orientation Overview

• Clinical Experience• Goals • Structure• Policies• Your experience

• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation

Clinical Experience: Structure

• Deliverables related to each clinic attendance• Students • Clinical mentors

Clinical Experience: Structure

• Student deliverables related to each clinic attendance• A1-2 page report based on each clinic attendance (journal)

• Why:• stimulate discussion with clinical mentor• provide notes for writing the clinical chapter in your thesis

• helps you and us discuss and advocate for your learning in clinic

• What:• submit report to

• clinical and basic mentors • the Clinical Experience Committee

Clinical Experience: Structure

• Example of a journal entry • In my July clinic attendance, I saw JB (no PHI) with Dr. Wu.

• JB was being seen for [medical condition] and presented with [some features of the history and exam and testing].

• Problems JB faces related to [medical condition] include [problem(s) that engaged your research interest].

• In considering JB’s [problem(s)], one approach to improving JB’s outcomes might be [propose a translational project approach to improving outcomes for the problem(s), including relevant references].

• Example only—explore formats with your mentors

Clinical Experience: Structure

• Clinical mentor deliverables related to each clinic attendance• >1 relevant peer-reviewed clinical research paper • You and your clinical mentor discuss the paper in the context of patient(s) seen in clinic

• a relevant clinical research protocol for the student to review and critique• You and your clinical mentor discuss the clinical protocol outside of the clinic

• Basic science mentor(s) will be invited to these meetings

Orientation Overview

• Clinical Experience• Goals • Structure• Policies• Your experience

• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation

Clinical Experience: Structure

• Clinical mentor • On your thesis committee • Attends regular meetings with you• Is encouraged to meet with you and your basic research mentor • Clinical and basic science mentors will have the opportunity to interact on different aspects of a student’s project which may result in additional translational collaborations.

• Attends your thesis defense• Is expected to model principles related to

• ethical conduct of research• privacy issues in research

Orientation Overview

• Clinical Experience• Goals • Structure• Policies• Your experience

• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation

Clinical Experience: Structure

• Certification• Online training in human subjects research and privacy

• http://www.ucdenver.edu/academics/research/AboutUs/comirb/Submissions-and-Training-Portal/investigator%20responsabilities/Pages/Completing-CITI-Education-and-Acessing-InfoEd.aspx#refresh_education• Scroll to “New Investigators and Research Coordinators” and follow instructions

Orientation Overview

• Clinical Experience• Goals • Structure• Policies• Your experience

• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation

Clinical Experience: Structure

• Meetings• National meeting of CTSA pre-doctoral trainees (TL1s) in St. Louis. This is an opportunity to • present research-in-progress posters• share experiences • develop networks of clinical translational researchers

• On campus: • professional development seminars, workshops, and Research-in-Progress meetings

• relevant clinical-translational seminars, such as • Grand Rounds• Dean’s Distinguished Speakers Seminar• Meetings and seminars at your clinical site

Orientation Overview

• Clinical Experience• Goals • Structure• Policies• Your experience

• Clinic schedule• Your role in clinic• Deliverables • Role of clinical mentor• Certification• Meetings• Evaluation

Clinical Experience: Structure

• Evaluation• Clinical mentors and students complete written evaluations on the clinical experience for CCTSI PhD trainees

• Annual CCTSI Clinical Experience Committee meeting with mentors to review each students’ goals, experiences and achievements

Orientation Overview

• Clinical Experience• Goals • Structure• Policies• Your experience

Clinical Experience: Policies

• Policies • Clinical core policy• Clinical dress code• Honor code*• Professionalism

• Settings vary• Badge access• Regulation• Dress code

*if non-MSTP seeGraduate Student Handbook

Clinical Experience: Policies

Clinical Experience: Policies

• It is about respecting the patient – not fashion• Always display ID badge; white coat optional• Clothes must cover shoulders to knees• Dresses, suits, collared shirts, skirts and tailored

trousers; scrubs if appropriate • No T-shirts, shorts and jeans• No slogans• Piercing jewelry limited to the ears• Cover tattoos• No open toed shoes • Heels <2”• Wear socks or hosiery • No strong perfume

Clinical Experience: Policies

Clinical Experience: Policies

Clinical Experience: Policies

Clinical Experience: Policies

Clinical Experience: Policies

• Clinical context varies• Four major hospitals: CHCO, UCH, DHMC, VA

• Others – AHEC, PSL, Rose, etc.

• All sites vary• policies, paper work and rules• EMR systems• organizational culture• other requirements: PPD, BLS

Orientation Overview

• Clinical Experience• Goals • Structure• Policies• Your experience

• It’s different in clinic• Communication• Self-knowledge

Your Clinical Experience

• It’s different in clinic• Patients entrust clinicians with

confidential and private matters• their nakedness• their pain• their stories• their struggles• their shame

• This trust is • an enormous privilege• a powerful opportunity to help• a terrifying responsibility• a source of many feelings• an inspiration• sometimes itself healing for the patient

Your Clinical Experience

• It’s different in clinic• Physician-patient privilege is easily and too often

violated• 30% of state medical boards have fielded complaints of online

breaches of confidentiality• Pitfalls

• social media

• partners, BFFs

• public space in clinical setting

• online platform for discussing cases

Your Clinical Experience

• It’s different in clinic• Learning opportunities are

opportunistic and unpredictable

• At times, your needs come second• your time is not always your own

• you may have to rearrange basic things like meals, bathroom breaks, checking in with family/friends

Your Clinical Experience

• Communication• Mentor:

• ask questions

• ask for feedback about your own communication

• Patient: • introduce yourself—learn how best do do this

• study how your clinical mentor communicates with and about patients

• Clinical staff: • introduce yourself

• an opportunity for learning about patients and about the system of patient care

• Other students: share experiences

Your Clinical Experience

• Self-knowledge• Clinical realm is a chance to learn about being

• patient-focused• team-player in a multi-disciplinary team• self-directed, independent• flexible• an active listener• a researcher collaborator on a clinical team• building relationships with colleagues

• It also can teach you about• your own limits• what works best for you to stay centered and balanced• other professional self-care skills key to professional longevity

• Ask for help, guidance, advice