Latest from Academic Medicine: Low enrollment in clinical studies, improving state Medicaid policies

Analyses produced by faculty, staff underscore key issues of the past year.

Busy, busy. That’s been the modus operandi of OHSU investigators since we last highlighted their work published in Academic Medicine. Since then, 16 faculty and staff co-wrote six more Academic Medicine articles. Below are synopses in chronological order.

Have you or will you publish in Academic Medicine? Please send abstracts to

OHSU authors featured in this and other journals contribute to a global forum illuminating pertinent issues in their respective fields. They also help fulfill OHSU’s mission of educating the next generation of scientists and healthcare providers. Papers are subjected to rigorous criteria when undergoing consideration for publication. Their work is often part of a scientific collaboration; the entire team may not be listed here.

Yes, low enrollment matters

Paper title: “The Prevalence and Economic Impact of Low-Enrolling Clinical Studies at an Academic Medical Center”

OHSU co-authors: Darlene R. Kitterman, MBA, Director of Investigator Support and Integration Services, OCTRI; Steven K. Cheng, PhD, Senior Research Associate, Knight Cancer Institute; David M. Dilts, PhD, MBA, Professor of Management in the Management Division, Director of Strategy Integration at the Knight; Eric S. Orwoll, MD, Professor of Medicine

Publication date: November 2011

AM cover Nov 2011Synopsis: SoM Research Voice and other blogs first reported the findings of this paper on November 14, and since then we’ve linked to online tools provided by OCTRI to help you assess study feasibility and identify participants.

Results from an OHSU study found that a “substantial proportion of clinical studies incurred high institutional and departmental expense but resulted in little scientific benefit.” Almost one out of three terminated clinical studies at OHSU enrolled zero or one participant during FY 2006 to FY 2009, the period of the research study. Of the 837 clinical studies terminated during that time, the authors found that 260 of them were due to low enrollment.

Investigators analyzed uncompensated costs associated with this low enrollment and estimated them to be about $1 million per year—a conservative estimate because it excludes certain costs difficult to calculate, such as the time and effort of the Principal Investigator. While some low-enrolling studies would be expected at any institution, the co-authors concluded that “effective, proactive interventions” to bring this number—and cost—down could help ensure that resources are being applied in ways that support maximum scientific benefit.

Questions/comments? E-mail Darlene Kitterman, MBA at

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



State decision-makers need you

Paper title: “Improving State Medicaid Policies With Comparative Effectiveness Research: A Key Role for Academic Health Centers”

OHSU co-author: Mark Gibson, Director of the Center for Evidence-based Policy

Publication date: June 2011

AM cover Jun 2011Synopsis: Comparative effectiveness research (CER) can offer important knowledge to state health care policymakers, the authors of this study find. “The Drug Effectiveness Review Project” and the “Medicaid Evidence-based Decisions Project” are two examples of multi-state collaborations that leverage CER to answer policy-relevant research questions.

The pipeline of knowledge from academic health centers to state capitols should grow larger, urge the co-authors, in anticipation of the full implementation of the federal Patient Protection and Affordable Care Act in 2014. Because of the anticipated flood of new patients, states will have to maximize the beneficial health effect of their Medicaid dollars more than ever, and CER-driven, benefit-design choices can help states meet their cost and quality needs. In turn, the state Medicaid experience of providing high-quality care under explicit financial limits can inform Medicare and private payers of measures that can improve health outcomes and control per-capita costs without adversely affecting health incomes. 

Questions/comments? E-mail Judy Zerzan, MD, MPH at

Read more: Find additional details, including the full paper, here. 



Meager reporting of medical errors? Incentives help

Paper title: “A Novel Approach to Increase Residents’ Involvement in Reporting Adverse Events”

OHSU co-authors: David R. Scott, MD, Department of Medicine Instructor; Melissa Weimer, DO, Department of Medicine Instructor;  Clea English, MPH, Division Manager of General Internal Medicine and Geriatrics; Lynn Shaker, RN, MPH, Patient Safety Officer; Dongseok Choi, PhD, Associate Professor of Public Health and Preventative Medicine; Andrea Cedfeldt, MD, Assistant Professor of Medicine; Donald Girard, MD, Professor of Medicine

Publication date: June 2011

AM cover Jun 2011Synopsis:  As all those in health care know, the reporting of medical errors is crucial to identifying systems changes in order to improve patient safety and the quality of care.  Yet the literature identifies only meager participation of attending and resident physicians in adverse-event reporting.

In 2008–2009, the authors measured participation in adverse-event reporting at OHSU before and after implementing a quality improvement initiative. The initiative consisted of a financial incentive (in the form of a retirement benefit) and multifaceted educational campaign.

The average number of adverse events reported by residents increased from 1.6 to 9% of the institution’s overall event reports, representing a 5.6-fold increase during the initiative (P<.001). The relative percentage of resident-submitted reports defined as “near misses” increased from 6 to 27% during the same period (P<.001). The novel approach yielded a successful change in behavior, report the investigators.

Questions/comments? E-mail David Scott, MD, at

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



How to make core competencies meaningful to trainees

Paper title: “Perspective: Competencies, Outcomes, and Controversy—Linking Professional Activities to Competencies to Improve Resident Education and Practice”

OHSU co-author: Joseph T. Gilhooly, MD, Professor, Department of Pediatrics

Publication date: February 2011

AM cover Feb 2011Synopsis: Regulatory organizations have recently emphasized the importance of structuring graduate medical education around mastery of core competencies. The difficulty is that core competencies attempt to distill a range of professional behaviors into arguable abstractions. As such, competencies can be difficult to grasp for trainees and faculty, who see them as unrelated to the intricacies of daily patient care.

In this article, the authors describe how two initiatives are converging in a way that should make competencies tangible and relevant. One initiative is based on the idea that competencies will be more meaningful if trainees understand specifically how they relate to important professional activities in their own specialty. The authors suggest that there is a dyadic relationship between competencies and major professional activities in pediatric medicine. They also suggest that these relationships should be discussed as part of the process by which trainees are entrusted to perform clinical activities without direct supervision.

The other initiative proposes to construct narrative milestones that provide a picture of what progression toward mastery of core competencies might look like. Together, the authors argue, these two initiatives should illuminate the core competencies by providing relevant clinical context and valuable educational substance.

Questions/comments? E-mail M. Douglas Jones, Jr., MD, at

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




Merging career development into medical school curricula

Paper title: “Three Innovative Curricula for Addressing Medical Students’ Career Development”

Co-authors: Anita M. Navarro, MEd, Research Analyst, Association of American Medical Colleges; Anita D. Taylor, MAEd, OHSU Associate Professor, Department of Family Medicine and OHSU Assistant Dean for Student Development; Anita P. Pokorny, MEd, Director of Career Development and Advising, Northeastern Ohio Universities School of Medicine and Pharmacy

Publication date: January 2011

AM cover Jan 2011Synopsis: Medical students make specialty decisions that are critically important to their long-term career satisfaction and overall well-being. The dynamic of larger class sizes set against stagnant numbers of residency positions creates an imperative for students to make and test specialty decisions earlier in medical school. Ideally, formal career advising begins the first months of medical school.

Medical schools typically offer career development programs as extracurricular offerings. The authors describe three curricular approaches and the innovative courses developed to address medical students’ career development needs.

The first model is a student-organized specialties elective. To earn course credit, students must complete questionnaires for the sessions, submit results from two self-assessments, and report on two physician informational interviews. The second model comprises two second-year career development courses that have evolved into a longitudinal career development program. The third model integrates career topics through a doctoring course and advising teams. The authors discuss challenges and lessons learned from implementing each of the programs. With a curricular approach, the authors found that it normalized the tasks associated with career development and put them on a par in importance with other medical school endeavors.

Questions/comments? E-mail Anita M. Navarro, MEd at

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




We also wanted to highlight the contribution of Kathryn G. Schuff, MD, Associate Professor of Medicine, to the paper, “Support for Investigator-Initiated Clinical Research Involving Investigational Drugs or Devices: The Clinical and Translational Science Award Experience,” which was published in the February 2011 issue of Academic Medicine. Schuff is a member of the IND/IDE Taskforce of the Clinical and Translational Science Award Consortium; Schuff and others submitted the paper on behalf of the taskforce. Find additional details, including an OvidSP link to the full paper, here.