OHSU

The latest OHSU research in Academic Medicine

Analyses and commentary produced by faculty, staff highlight concerns with equity, technology, specialized training and cultural competency 

 

July 8, 2014

In the first half of 2014, eleven faculty and staff and one student have co-written new papers within the pages of Academic Medicine, the journal which serves as a global forum for the academic medicine community to discuss the issues it faces.

These co-authors join their OHSU colleagues as contributors to a global knowledge base for best practices in healthcare education. This educational research is an important aspect of fulfilling OHSU's mission of educating the next generation of scientists and healthcare professionals. This work is often part of a scientific collaboration; the entire research team may not be listed here.

Below are synopses in reverse chronological order. OHSU authors and titles at the time of publication are noted in the following summaries; for full papers and author listings, please click the links provided below.

Have you or will you publish in Academic Medicine? Please send abstracts to somdeansoffice@ohsu.edu

 

The case for community-based interprofessional training

Paper title: Interprofessional Global Health Education at Oregon Health & Science University: The interprofessional Community Health and Education Exchange (iCHEE) Experience

OHSU co-authors:
Valerie S. Palmer, director of interdisciplinary Community Health & Education Exchange (iCHEE) and senior research associate, Global Health Center; Rajarshi Mazumder, School of Medicine, M.D./M.P.H. program; Peter S. Spencer, M.D., professor of neurology and senior scientist, OHSU Center for Research on Occupational & Environmental Toxicology

Publication date: June 2014 (online) and August 2014 (print, forthcoming)

Synopsis: “The rapidly diversifying population of North America has disparate health needs that are addressed by creative, community-based training of health professions students. The authors report five years (2008–2012) of experience implementing a novel interprofessional Community Health and Education Exchange (iCHEE) elective course for dental, medical, nursing, nutrition, pharmacy, physician assistant, and public health students at Oregon Health & Science University (OHSU). This pioneering interprofessional course was created by the OHSU Global Health Center and is offered in fall, winter, and spring quarters. Students interact with individual clients drawn from community centers supporting refugees, recent immigrants, and other underserved people. In addition to health concerns, clients are encouraged to share backgrounds and experiences with student teams. Clients receive guidance on nutrition, exercise, pharmaceuticals, and accessible health services. Student teams perform a noninvasive health check on clients with the assistance of faculty mentors who, on finding a physical or mental health issue, refer the client from the educational setting to an appropriate health care facility. In addition to supporting health promotion and early intervention for medically underserved people, students reported gaining valuable cross-cultural knowledge, understanding, and experience from clients. Students also appreciated the value of diverse skills and knowledge available in their multidisciplinary teams. Through the end of 2012, over 300 health professions students worked with approximately 1,200 clients to complete the iCHEE course.”

Read more:
Find additional details, including a PDF link to the full paper, here.

Mentorship matters

PaAM_Mayper title: Gender differences in publication productivity, academic position, career duration, and funding among U.S. Academic radiation oncology faculty

OHSU co-authors: Charles R. Thomas, Jr., M.D., professor and chair of radiation medicine; Clifton D. Fuller, M.D., Ph.D., affiliate instructor of radiation medicine

Non-OHSU co-author: Emma B. Holliday, M.D., Reshma Jagsi, M.D., D.Phil.,  Lynn D. Wilson, M.D., M.P.H., Mehee Choi, M.D.

Publication date:
May 2014

Synopsis:
“This study aimed to analyze gender differences in rank, career duration, publication productivity, and research funding among radiation oncologists at U.S. academic institutions. Determinants of a successful career in academic medicine are multifactorial. Data from radiation oncologists show a systematic gender association, with fewer women achieving senior faculty rank. However, women achieving seniority have productivity metrics comparable to those of male counterparts. This suggests that early career development and mentorship of female faculty may narrow productivity disparities.”

Questions/comments?
E-mail Clifton D. Fuller at cdfuller@mdanderson.org

Read more:
Find additional details, including an OvidSP link to the full paper, here.
 

Examining the cultural context of medical professionalism

Paper title: Bushido and medical professionalism in JapanAM_April

OHSU co-authors: Rebecca Harrison, M.D., associate professor of medicine (hospital medicine)

Non-OHSU co-author: Hiroshi Nishigori, M.D., M.M.Ed., Jamiu Busari, M.D., Ph.D., M.H.P.E.; Tim Dornan, M.D., Ph.D., M.H.P.E.

Publication date: April 2014

Synopsis:
“Medical professionalism has become a core topic in medical education. As it has been considered mostly from a Western perspective, there is a need to examine how the same or similar concepts are reflected in a wider range of cultural contexts. To gain insights into medical professionalism concepts in Japanese culture, the authors compare the tenets of a frequently referenced Western guide to professionalism (the physician charter proposed by the American Board of Internal Medicine Foundation, American College of Physicians Foundation, and the European Federation of Internal Medicine) with the concepts of Bushido, a Japanese code of personal conduct originating from the ancient samurai warriors. The authors also present survey evidence about how a group of present-day Japanese doctors view the values of Bushido. Cultural scholars have demonstrated Bushido's continuing influence on Japanese people today. The authors explain the seven main virtues of Bushido (e.g., rectitude), describe the similarities and differences between Bushido and the physician charter, and speculate on factors that may account for the differences, including the influence of religion, how much the group versus the individual is emphasized in a culture, and what emphasis is given to virtue-based versus duty-based ethics. The authors suggest that for those who are teaching and practicing in Japan today, Bushido's virtues are applicable when considering medical professionalism and merit further study. They urge that there be a richer discussion, from the viewpoints of different cultures, on the meaning of professionalism in today's health care practice.”

Questions/comments? E-mail Hiroshi Nishigori at hiroshi.nishigori@gmail.com

Read more: Find additional details, including an OvidSP link to the full paper, here.
 

The place for EHR training in medical education

AM_MarchPaper title: Simulated electronic health record (Sim-EHR) curriculum: Teaching EHR skills and use of the EHR for disease management and prevention

OHSU co-authors: Christina E Milano M.D., assistant professor of family medicine; Joseph A. Hardman, M.D., assistant professor of general internal medicine and geriatrics; Rebecca E. Rdesinski, M.P.H., M.S.W., research associate in family medicine; Frances Emily Biagioli, M.D., associate professor of family medicine

Non-OHSU co-author: Adeline Plesiu, M.D.

Publication date: March 2014

Synopsis: “Electronic health records (EHRs) can improve many aspects of patient care, yet few formal EHR curricula exist to teach optimal use to students and other trainees. The Simulated EHR (Sim-EHR) curriculum was introduced in January 2011 at Oregon Health & Science University (OHSU) to provide learners with a safe hands-on environment in which to apply evidence-based guidelines while learning EHR skills. Using an EHR training platform identical to the OHSU EHR system, learners review and correct a simulated medical chart for a complex virtual patient with chronic diseases and years of fragmented care. They write orders and prescriptions, create an evidence-based plan of care for indicated disease prevention and management, and review their work in a small-group setting. Third-year students complete the Sim-EHR curriculum as part of the required family medicine clerkship; their chart work is assessed using a rubric tied to the curriculum's general and specific objectives. As of January 2014, 406 third-year OHSU medical students, on campus or at remote clerkship sites, and 21 OHSU internal medicine interns had completed simulated charts. In this article, the authors describe the development and implementation of the Sim-EHR curriculum, with a focus on use of the curriculum in the family medicine clerkship. They also share preliminary findings and lessons learned. They suggest that the Sim-EHR curriculum is an effective, interactive method for providing learners with EHR skills education while demonstrating how a well-organized chart helps ensure safe, efficient, and quality patient care.”

Questions/comments? E-mail Christina E Milano, M.D. at milanoc@ohsu.edu

Read more: Find additional details, including an OvidSP link to the full paper, here.
 

Lessons learned from the merger of diverse healthcare providers

AM_FebruaryPaper title: The development and maturation of a statewide academic health care system: Clarian Health Partners/Indiana University Health

OHSU author: Daniel A. Handel, M.D., associate professor and director of clinical operations of emergency medicine

Non-OHSU co-author: David J. Handel, M.B.A., Stuart A. Kleit, D.D.S., M.D.

Publication date: February 2014

Synopsis: “As health care reform continues, health care organizations are evolving both structurally and operationally to position themselves to meet the challenges ahead. Academic medical centers (i.e., teaching hospitals) particularly need an effective strategy that will allow them to meet their tripartite missions of patient care, education, and research in this time of increasing competition and resource constraints. Clarian Health Partners, recently renamed Indiana University Health, is a health care entity that developed from a partnership of the Indiana University Hospitals and Methodist Hospital of Indiana. This case study explores the history behind the development of Clarian Health Partners, the model employed, and the lessons learned. It discusses the governance and management models implemented, the steps taken to integrate the two partners in the new system, and the specific challenges of physician partnerships and collaborations. As mergers and consolidations continue in an era of health care reform, the lessons learned from previous endeavors, such as that of Clarian Health Partners, may be applicable.”

Questions/comments? Email Daniel A. Handel, M.D. at handeld@ohsu.edu

Read more:
Find additional details, including an OvidSP link to the full paper, here.
 

Procedural volume impacts technical competency

AM_JanuaryPaper title: Forceps delivery volumes in teaching and nonteaching hospitals: Are volumes sufficient for physicians to acquire and maintain competence?

OHSU co-authors: Aaron B. Caughey, M.D., Ph.D., M.P.P., and M.P.H., associate professor and chair of obstetrics and gynecology and associate dean for women’s health research and policy

Non-OHSU co-authors: Kathy L. Kyser, M.D., M.S.C.I., Xin Lu, M.S.; Donna Santillan, Ph.D., Mark Santillan, M.D., Mark C. Wilson, M.D., M.P.H., Peter  Cram, M.D., M.B.A.

Publication date:
January 2014

Synopsis: “The decline in the use of forceps in operative deliveries over the last two decades raises questions about teaching hospitals' ability to provide trainees with adequate experience in the use of forceps. Low forceps delivery volumes may preclude many trainees from acquiring adequate experience and proficiency. These findings highlighted broader challenges, faced by many specialties, in ensuring that trainees and practicing physicians acquire and maintain competence in infrequently performed, highly technical procedures.”

Questions/comments? E-mail Kathy L. Kyser at kathykyser@gmail.com

Read more: Find additional details, including an OvidSP link to the full paper, here.