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Latest OHSU faculty papers in Academic Medicine Share This OHSU Content

Analyses and commentary produced by faculty, staff underscore patient care and research infrastructure concerns


February 21, 2013

Since we
last highlighted their work published in Academic Medicine, nine faculty and staff co-wrote five additional Academic Medicine articles. Below are synopses in chronological order. Academic Medicine serves as a global forum for the academic medicine community to discuss the issues it faces.

OHSU authors featured in this, and other journals, contribute to a global knowledge base about best practices in education. This educational research is an important aspect of fulfilling OHSU's mission of educating the next generation of scientists and health care professionals.

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.

 
Paradigm shift required for successful translational research

Paper title: A Roadmap for Academic Health Centers to Establish Good Laboratory Practice-Compliant Infrastructure

OHSU co-author: Kathryn G. Schuff, M.D., Associate Professor of Endocrinology and Director of Regulatory Support Services at Oregon Clinical and Translational Research Institute

Publication date: March 2012

March12AAMCSynopsis: As academic health centers (AHCs) embrace the charge to increase the translation of basic science research into clinical discoveries, researchers at these institutions increasingly will be conducting good laboratory practice (GLP) regulated nonclinical studies. These nonclinical safety and toxicology studies are required prior to human clinical trials to demonstrate that a new product appears safe for human testing. To successfully translate novel therapeutics from the bench to the bedside, expertise and infrastructure to support compliance with FDA regulations is critical.

The consequences for noncompliance are severe and many AHC researchers are unfamiliar with Food and Drug Administration regulations. In this article, the authors describe GLP regulatory requirements, propose four models for the development and implementation of a GLP-compliant infrastructure within an AHC governing structure, and identify and analyze several critical barriers, such as management control of documentation, to achieving that infrastructure.

The authors found that the immediate tangible benefits to successfully navigating these hurdles include additional research contracts, more control over the quality and reliability of study data, a lower cost for nonclinical studies, an increased opportunity for the pursuit of translational research involving novel products, and the ability to use highly specialized, locally developed assays. They conclude that the capability to perform GLP-compliant research will help AHCs build and maintain competitive research programs and facilitate the successful translation of faculty-initiated research from nonclinical data generation to first-inhuman clinical investigations.

Questions/comments? E-mail Joan E. Adamo, Ph.D. at joan_adamo@urmc.rochester.edu

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

Valuing residents' health and wellness

Paper title: A Comparison Between Physicians and Demographically Similar Peers in Accessing Personal Health Care

OHSU co-authors: Andrea S. Cedfeldt, M.D., Assistant Dean, Graduate Medical Education, and Assistant Professor, Department of Medicine; Elizabeth A. Bower, M.D., MPH, Assistant Dean, Continuing Medical Education and Assistant Professor, Department of Medicine; Tana A. Grady-Weliky, M.D.,Associate Dean of Undergraduate Medical Education and Professor, Department of Psychiatry; Donald E. Girard, M.D., MACP, Associate Dean, Graduate Medical Education and Continuing Medical Education and Professor, Department of Medicine; Christine Flores, Division of Graduate Medical Education; Dongseok Choi, Ph.D., Associate Professor, Department of Public Health and Preventive Medicine

Publication date: March 2012

March12AAMCSynopsis: Residents are a unique subpopulation of physicians, training in a complex work and educational environment that may create barriers to accessing preventive and illness-related health care. This study was designed to investigate residents' utilization of personal health care services and compare with those of demographically similar peers.

Of the 445 (out of 675) OHSU residents who responded to a 2008 survey, 44% reported having a primary care provider, as opposed to 83% of the demographically similar peers (from a 2008 CDC Behavioral Risk Factor Surveillance System survey). Interestingly, gender was the most significant contributor to differences in accessing health care:women were more likely both to identify that they had health care providers and to have seen their providers for routine health care within the last year. Overall, the authors found that residents in particular are significantly less likely than their demographically similar peers to have primary care providers or seek routine health care, including dental care.

The authors believe this difference is of considerable concern, especially if one believes that preventive health care is important to overall wellness. Because the literature also suggests that physical or emotional stress in physicians contributes to poorer patient outcomes, the authors propose that intervention early in the education of physicians is necessary to promote physician wellness and to improve patient care. Additionally, to prevent the continued training of physicians who do not prioritize their own health care, the authors state that both policy and cultural changes are needed. This article includes more information about barriers to resident health care and wellness and how OHSU is addressing these for its residents.

Questions/comments? E-mail Dongseok Choi, Ph.D. at choid@ohsu.edu

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

How to develop effective behavior change counseling curricula

Paper title: Behavior Change Counseling Curricula for Medical Trainees: A Systematic Review

OHSU co-author: Patricia A. Carney, Ph.D., Professor of Family Medicine and of Public Health and Preventive Medicine

Publication date: July 2012

July12AAMCSynopsis: Unhealthy behaviors contribute to half of U.S. deaths. However, research shows that physicians lack sufficient skill in counseling patients to change behaviors, despite the fact that addressing them could significantly reduce mortality and morbidity. Medical educators have expressed concerns that curricula inadequately prepare medical trainees to engage in behavior counseling with their patients, causing them to fall short of addressing critical health issues, including smoking, diet, alcohol and sedentary lifestyle.

The authors conducted a systematic literature search of studies published between 1965 and 2011 evaluating curricula on behavior change counseling for medical trainees in order to inform educators toward improved training. Included studies described behavior change counseling, teaching interventions for medical trainees, and assessment of interventions. Curricular topics for counseling included smoking (67 studies), nutrition (30), alcohol/drug use (26), and exercise (22). The studies with highest-level outcomes and quality employed multiple curricular techniques and included practice of counseling techniques in either simulated or actual clinical settings, suggesting that trainees best learn behavior change counseling through active, realistic practice and implementation of reminder and feedback systems within clinical practice settings, report the investigators.

Findings from this review also suggest multi-institutional medical education research on methods of teaching behavior change counseling that influence patients' health outcomes are needed to ensure trainees' clinical competence and improve patient care.

Questions/comments? E-mail Karen Hauer, M.D. at karen.hauer@ucsf.edu

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

Reading the room? Empathy is essential

Paper title: Medicine and the Arts: The Scarlet Letter [excerpt] by Nathaniel Hawthorne. Commentary.

OHSU author:David D. Clarke, M.D., Assistant Director, Center for Ethics

Publication date: August 2012

Aug12AAMCSynopsis: Looking to Dr. Roger Chillingworth from Hawthorne's The Scarlet Letter as a model, the author comments on the role of empathy in resolving clinical and ethical dilemmas. In the author's opinion, empathy is often essential to uncovering the source of such dilemmas, as well as in understanding the mindsets of stakeholders embroiled in conflict.

The author argues that development of empathic skill is not adequately emphasized in medical and professional training, increasing the risk of diagnostic errors; but he also states that empathic skill can be learned by paying attention to factors such as life stresses or the mindsets of stakeholders during patient evaluations, and that practicing perceiving with empathy leads to a growth in ability.

Questions/comments? Email David D. Clarke, M.D. at DrDave@stressillness.com

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

Advancing value and effectiveness in protecting human research subject participants

Paper title: Research Subject Advocacy: Program Implementation and Evaluation at Clinical and Translational Science Award Centers

OHSU co-author: Kathryn G. Schuff, M.D., associate professor of endocrinology and director of regulatory support services at the Oregon Clinical & Translational Research Institute

Publication date: September 2012

Sept12AAMCSynopsis: In 2000, the National Center for Research Resources mandated that general research centers create a research subject advocate (RSA) position. In 2008, the Clinical and Translational Science Award (CTSA) consortium endorsed a new advocacy model based on four RSA Best Practice Functions. The authors surveyed CTSA centers to learn about their implementation of programs to fulfill the RSA functions. In 2010, the RSA taskforce developed a two-part online survey to examine leadership, organizational structure, governance, scope, collaboration and integration, and funding and evaluation of RSA activities implemented at CTSA centers. The authors believe that this survey, an initial step in developing a more robust mechanism for evaluating RSA programs, collected valuable feedback.

Respondents from 45 RSA programs at 43 CTSA centers completed the online survey. Senior university or CTSA officials led all programs. Ninety-six percent (43/45) of programs were funded by a CTSA core. Eighty percent (36/45) designated an individual "RSA." Ninety-eight percent (44/45) provided diverse services either in collaboration with or complementary to other departments, including development of data and safety monitoring plans (16/45; 36%), informed consent observation (10/45; 22%), training responsive to audit findings (12/45; 27%), and direct advocacy services to participants (11/45; 24%). Eighty-six percent (24/28) reported qualitative evaluation methods for these activities.

The authors found that RSA programs conduct both collaborative and unique research protection activities. As a result, they recommend three steps to advance the development of methods to evaluate the value and impact of RSA programs. They also recommend defining and developing outcome-based evaluation measures that take the heterogeneity of the individual RSA programs into account while advancing their value and effectiveness in protecting human research subject participants.

Questions/comments? E-mail Rhonda G. Kost at kostr@rockefeller.edu

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