Developing Research Capacity Within A Division or Program

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Developing Research Capacity Within A Division or
Program

• Focus on Academic Pediatrics
• Peter Szilagyi and Danielle Laraque

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Disclosure InformationDeveloping Research
CapacityDanielle Laraque, Peter Szilagyi

• we have no financial relationships to disclosure.

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Learning Objectives

• Improve my leadership skills in enhancing the
  research productivity of my division or program
• Enhance my ability to mentor faculty
• Broaden my understanding of research
  opportunities
• Understand the relevance of research to improving
  child health outcomes

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Agenda

• Introduction and Background (30 minutes)
• Research in Academic Pediatrics
• A Framework to evaluate and improve research
  capacity within your division
• The context of research in your division (e.g.
  community needs, demographics, cultural
  relevance)
• Break into 2 groups (60 minutes)
• Discuss the framework and common case scenarios
• Reconvene and Summarize (30 minutes)

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Major Goals of General Pediatrics Academic
Development Program

• In May, 1978, RWJ Foundation implemented
  fellowship training in academic general
  pediatrics to
• Improve the health of children and youth
• Conduct exciting research on common health
  problems
• Develop new methods of patient care to deal with
  major health problems
• Translate the findings of research into clinical
  practice
• Expand the reach of research to community based
  settings
• RJ Haggerty, The Academic Generalist An
  Endangered Species Revived. Pediatrics. 1990
  83(3)413-420.

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Unique Perspectives of Academic Pediatric
Researchers

• Understand clinical disease
• Understand epidemiology of child health
  conditions
• Understand determinants of health
• Confront research questions in practice settings
  clinic, ER, hospital
• Poised to answer relevant research questions
• Able to bring research back to practice or back
  to the community
• Bridges research and education

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Challenges to do Research

• Scientific merit and Impact (New NIH emphasis)
• Funding support
• Protected time
• Research mentors
• Clinical service reform
• Little effort to translate findings into practice

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Spectrum of research

• Clinical Clinical trials- treatment prevention
• Health Services
• Community Based Participatory Research
• Epidemiological
• Educational
• Qualitative
• Quality Improvement
• Translational research from bench to bedside to
  community

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Efforts to Sustain Academic Pediatrics

• Define, strengthen and expand fellowship training
  programs
• APA needs to take major role in standardizing the
  fellowship programs
• Consider certification for achievement of
  competencies for fellowship experience
• Research enterprise critical element of
  fellowship training
• S Ludwig, Academic General Pediatrics
  From Endangered Species to Advanced Scholars of
  General Pediatrics The Report of a Consensus
  Conference. Amb Pediatr. 20044(5)407-409.

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Benefits to Conducting Research

• Improve the health of children families
• Contribute to entity bigger than self
• Intellectual satisfaction
• Personal gratification
• National/international recognition
• Promotion
• Collaborations with others

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Missions of Divisions
TL Cheng. The Status of academic General
Pediatrics. No Longer Endangered? Pediatrics
2007, 11946-52
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Directors Top 3 Successes in Past 5 Years
TL Cheng. The Status of academic General
Pediatrics. No Longer Endangered? Pediatrics
2007, 11946-52
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NIH Roadmap for Medical Research

• Currently 36 of NIH funding committed to
  clinical research and training
• New emphasis on translating research into
  practice
• Clinical and Translational Science Awards (CTSAs)
• Academic homes for original clinical and
  translational science
• Novel interdisciplinary approaches
• E Zerhouni, Translational and Clinical
  Science-Time for a New Vision. NEJM, 2005
  3531621-1623.

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NIH RoadmapPractice-Based Research

• NIH review process (scientific merit and impact)
• Increased attention to translate research
  findings into practice
• Average of 17 years for 14 of new scientific
  findings to enter practice
• Individualize the delivery of right treatment to
  right patient to improve health in ambulatory
  care
• Test feasibility in real world of daily practice
• JM Westfall, Practice-Based Research-Blue
  Highways on the NIH Roadmap. JAMA. 2007
  297(4)403-406.

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Translating Research Into Practice

• National Pediatric Research Networks
• PROS
• CORNET
• PECARN
• PRIS
• Regional networks
• State, city, institutional networks
• CTSA regional networks
• CBPR approaches

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Opportunities for Involvement in PBRNs

• Serve as a site co-investigator and data
  collector
• Serve as a co-author
• Serve as the principal investigator and utilize
  sites to enhance sample size, demonstrate
  feasibility and generalizability

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A Framework to Evaluate and Improve the Research
Capacity in a Program
Program Components Strengths Weaknesses Simple Improvements Complex Improvements
Culture of Dept
Culture of Div
Organization
Time Allocation
Mentorship
Research Areas
Faculty , Types
Funding
Collaborations- In
Collaborations-Out
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Program Components(Refer to Handouts)

1. Culture of the Department
2. Culture of the Division or Program
3. Organization of the division
4. Time Allocation and Skill Sets of Faculty
5. Mentoring of faculty
6. Content areas of current research
7. Number and types of faculty (recruitment)
8. Funding
9. Collaborations within the institution
10. Collaborations- externally

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Culture of the Department (the only component
that refers to the department)

• What are the expectations for research from the
  chair and the department?
• What are the departmental priorities for research
  in comparison to other missions of clinical care
  and education?
• To what extent are other activities (clinical,
  teaching, administration) conflicting with
  research expectations?
• How effective is the departments infrastructure
  (e.g., statistician, programmers, fieldwork
  experts, small-grant program) to support research
  and does this include clinical research?
• How well does the department support general
  pediatric research (e.g., health services,
  clinical, community, behavioral?
• How knowledgeable is your IRB concerning clinical
  research?

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Culture of the Division or Program

• How much is research expected, emphasized,
  discussed at division meetings?
• Does your division have a research agenda, a
  strategic plan?
• What are expectations concerning research for
  individual faculty?
• Is your division in agreement on how to judge
  effectiveness of research performance as well as
  mentoring?
• Is unfunded research encouraged, and how
  effectively is it being done (e.g., small
  projects)?
• What is the emphasis on PAS abstracts, regional
  abstracts, and publications?
• What is the incentive for research (publications)
  that come from projects that are not
  independently funded?

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Organization of the Division or Program with
Respect to Research-1

• Does a research champion exist?
• How adequate is the support structure for
  research (programmers, data, fieldwork, stats,
  grant writing support)? Can these be found
  outside the division?
• Could the division better use summer, medical,
  and MPH and PhD students?
• To what extent are the clinical areas (e.g.
  Continuity Clinic) set up for research? Is it
  happening?
• To what extent are data sets available to do
  research, e.g. electronic patient records,
  billing data, quality measures, etc.

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Organization of the Division or Program with
Respect to Research-2

• How frequent and effective are research meetings,
  practice sessions (for PAS) and other venues to
  share ideas and critique?
• How well trained are the faculty in the core
  areas of research? Is more needed?
• What opportunities are available within your
  division/institution to enhance research
  methodology skills?
• By characteristic of the division
• For divisions with intent to improve research -
  how do you re-organize most effectively /
  efficiently?
• For divisions with many junior faculty - is the
  structure adequate for them to move to the next
  level?
• For mature research divisions - how do you
  maintain momentum, hold the line, prevent
  burn-out?

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Time Allocation and Skill Sets of Faculty

• How adequate (on paper and in practice) is the
  time allotted to research for the faculty?
• How much time is provided to junior faculty to
  jump-start research efforts? What about mid-level
  and senior faculty?
• To what extent are junior faculty protected
  from committee work, inpatient attending
  responsibilities?
• How effectively is time utilized by faculty who
  are doing research?
• Are the skill sets of faculty adequate for their
  content areas?
• Could courses, programs and workshops locally,
  regionally, or nationally help individual faculty
  members improve their skills?
• How effectively are PAS and other meetings
  utilized to improve specific skills of faculty?
• What is the availability of other
  disciplines/consultants for specific research
  areas?

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Mentorship of Faculty

• Does each research-oriented faculty have a
  mentor? Is adequate mentoring available?
• How effective is the mentoring of faculty
  (junior, mid-level, and senior faculty)?
• How effectively are senior faculty members
  utilized and incentivized for mentoring?
• How effective is the mentorship specifically for
  obtaining grantsto relevant institutions (e.g.,
  NIH, CDC, AHRQ, MCHB) and to foundations (local
  and national)?
• To what extent are career development awards
  being promoted how effective is mentorship for
  this pursuit?
• Are clear expectations delineated for research
  mentors?
• Do you need to pursue mentors outside your
  division, department, school of medicine,
  university?

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Content Areas of Current Research

• To what extent are the research topics being
  investigated critical for the health of children?
• How well do the current research topics
  capitalize on strengths of the division,
  department, and community?
• Has the division found a unique niche for
  research? A division unifying research theme?
• How well integrated are the research topics with
  the departments or institutions research
  priorities / strengths?
• What types of research are priorities in your
  division?

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Number and Types of Faculty

• Is the number of faculty adequate for research?
• Would a targeted recruitment help?
• Does targeted recruitment take place to fill in
  gaps in skills?
• How adequate are recruitment packages?
• To what extent are PhDs integrated into research
  activities of the division? Could they be?

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Funding

• To what extent do small grants exist within the
  department or division? How effectively are your
  faculty obtaining these grants?
• To what extent do small grants exist within your
  community? How effectively are your faculty
  obtaining these grants?
• Does the division chief have some discretionary
  money to fund small projects (or personnel)?
• To what extent are faculty in a catch-22 with
  having so many other responsibilities that they
  cant compete for funding?
• How effectively can (and do) faculty piggy-back
  research onto larger existing research efforts
  within the institution?
• How adequate are the grant-writing skills of
  faculty, and are there mechanisms to improve
  these skills?

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CollaborationsWithin the Institution

• How adequately are research projects linked with
  other specialties within the department,
  capitalizing on strengths?
• To what extent are strengths from other
  departments (e.g., the medical school,
  undergraduate campus, school of public health,
  other disciplines) utilized?

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CollaborationsExternally

• How effective are collaborations within the
  community (beyond the institution) e.g., DOH,
  community organizations
• Are community collaborations a priority?
• Are collaborations adequate with networks (E.g.,
  CORNET, PROS, PECARN, PRIS, regional
  practice-based research networks)?
• Do you take advantage of potential mentorship
  from the APA, (e-Connections, APA members, APA
  SIGs and groups)?

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Break Into Small Groups(60 minutes)

• Goals
• Review
• Components of the framework or
• Case scenarios (1-4)
• Discuss your programs strengths / weaknesses
• Develop ideas for improving research capacity
• In your division or program and generally
• Simple improvements (little or no funding needed)
• More complex and long-term improvements

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Reconvene(30 minutes)

• Goals
• Review
• Ideas for improving research capacity in our own
  divisions or programs MCII exercise ACTION
  STEPS
• Ideas for improved use of APA resources
• Next steps
• Homework assignment
• Fill in the framework grid for your program
• Simple improvements
• More complex or long-term improvements

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• Never doubt that a small group of thoughtful,
  committed citizens can change the world
• Indeed, it's the only thing that ever has.
• Margaret Meade