Academic Physicians Research Articles

Physician Perceptions of Advanced Practice Providers on Hospitalist Teams

Abstract Little is known about physician perceptions of nurse practitioners (NPs) and physician assistants (PAs) on hospitalist teams and the factors that impact their perceptions. Academic physician hospitalists were surveyed to better understand those factors, focusing on NP/PA experience, training, and physician experience with NPs/PAs. Perceptions by hospitalist physicians of NPs/PAs were strongly positive. Notable findings include the perceived positive impacts of NPs/PAs on clinical care provided, practice efficiency, and physician satisfaction. Most respondents prefer working with NPs and PAs with multiple years of clinical experience, particularly those who have participated in training beyond NP/PA graduate programs of study.

Faculty Development Program for Emergency Medicine Physicians in India: A Pilot Program.

The specialty of emergency medicine (EM) is developing worldwide at a rapid pace. While more and more postgraduate training programs are developing, a major gap persists in numbers and availability of well-trained academic faculty members. This article describes a pilot faculty development program (FDP) aimed to develop advanced academic skills among a group of EM physicians in India. A FDP was developed with foundations in adult learning principles, using a combined approach of online and in-person didactic sessions. Specific expectations were established regarding academic contributions to participants' home institutions. Mentorship relationships were established between academic emergency physicians and program participants. A 12-month pilot program was implemented across four EM training programs in India. Nine faculty members completed the full requirements of the pilot program, eight of whom have continued to work as academic faculty members in EM training programs. Academic productivity among these physicians since completion of the program includes 11 abstract publications, six peer-reviewed articles, and 71 mentorship relationships. Program challenges included participant attrition, connectivity issues, and low rates of completion of evaluation requirements by both participants and mentors. This pilot program in faculty development provides a foundation from which further programs may be developed in the international sector. Effective faculty development is a cornerstone of good academic medicine, which is of particular relevance, importance, and challenge in the global context of a developing specialty.

A Conceptual Model for Understanding Academic Physicians' Performances of Identity: Findings From the University of Utah.

To explore how academic physicians perform social and professional identities and how their personal experiences inform professional identity formation. Semistructured interviews and observations were conducted with 25 academic physicians of diverse gender and racial/ethnic backgrounds at the University of Utah School of Medicine from 2015 to 2016. Interviews explored the domains of social identity, professional identity, and relationships with patients and colleagues. Patient interactions were observed. Interviews and observations were audio-recorded, transcribed, and analyzed using grounded theory. Three major themes emerged: Physicians' descriptions of identity differed based on social identities, as women and racially/ethnically minoritized participants linked their gender and racial/ethnic identities, respectively, to their professional roles more than men and white, non-Latino/a participants; physicians' descriptions of professional practice differed based on social identities, as participants who associated professional practices with personal experiences often drew from events connected to their minoritized identities; and physicians' interactions with patients corresponded to their self-described actions. Professional identity formation is an ongoing process, and the negotiation of personal experiences is integral to this process. This negotiation may be more complex for physicians with minoritized identities. Implications for medical education include providing students, trainees, and practicing physicians with intentional opportunities for reflection and instruction on connecting personal experiences and professional practice.

Developing internal medicine subspecialty fellows\u2019 teaching skills: a needs assessment

BackgroundFor academic physicians, teaching represents an essential skill. The proliferation of educator training programs aimed at residents and medical students signals the increasing commitment of training programs to develop teaching skills in their trainees as early as possible. However, clinical fellowships represent an important opportunity to advance training as educators. In addition to enriching the pipeline of future teachers, developing fellows as teachers augments the training experience for more junior trainees and may impact patient care. Fellows’ needs for programs to improve teaching skills have been largely unexplored.MethodsWe conducted a multi-institutional needs assessment of internal medicine (IM) subspecialty fellows to gauge interest in teaching and improvement of teaching skills. We surveyed IM subspecialty fellows at three academic medical centers about their access to fellow-as-teacher programs and other mechanisms to improve their teaching skills during fellowship. We also elicited their attitudes towards teaching and interest in training related to teaching skills.ResultsOne hundred eighty-three fellows representing 20 programs and nine different subspecialties responded to the survey (48% response rate). The majority of participants (67%) reported having no specific training focused on teaching skills and only 12% reported receiving regular feedback about their teaching during their fellowship. Seventy-nine percent of fellows anticipated teaching to be part of their careers, and 22% planned to participate in medical education scholarship. Fellows reported a strong interest in teaching and programs aimed at improving their teaching skills.ConclusionsThe majority of fellows reported a lack of mechanisms to advance their teaching skills as fellows, despite anticipating teaching to be an important aspect of their future careers and having strong interest in such programs. Our findings at three academic medical centers confirm a lost opportunity among subspecialty fellowships to accelerate teaching skills development for future educators.

Infections in Older Adults: A Case-Based Discussion Series Emphasizing Antibiotic Stewardship.

Compared with younger populations, adults 65 years and older are more likely to suffer infection-related morbidity and mortality, experience antibiotic-related adverse events, and acquire multidrug-resistant organisms. We developed a series of case-based discussions that stressed antibiotic stewardship while addressing management of common infections in older adults. Five 1-hour case-based discussions address recognition, diagnosis, and management of infections common in older adults, including those living in long-term care settings: urinary tract infections, upper respiratory tract infections, lower respiratory tract infections, skin and soft tissue infections, and Clostridium difficile infection. The education was implemented at the skilled nursing centers at 15 Veterans Affairs medical centers. Participants from an array of disciplines completed an educational evaluation for each session as well as a pre- and postcourse knowledge assessment. The number of respondents to the educational evaluation administered following each session ranged from 68 to 108. Learners agreed that each session met its learning objectives (4.80-4.89 on a 5-point Likert scale, 5 = strongly agree) and that they were likely to make changes (2.50-2.89 on a 3-point scale, 3 = highly likely to make changes). The average score on the five-question knowledge assessment increased from 3.6 (72%) to 3.9 (78%, p = .06). By stressing recognition of atypical signs and symptoms of infection in older adults, diagnostic tests, and antibiotic stewardship, this series of five case-based discussions enhanced clinical training of learners from several disciplines.

Gender Disparity in Authorship of Peer Reviewed Medical Publications

Background: Women are underrepresented in academic medicine despite an increase in the percentage of female physicians and residents. Publications, grant funding, and leadership experience are considered when hiring and promoting physicians. Our primary objective was to determine whether gender disparity exists in authorship in selected peer-reviewed literature in medical and in surgical specialties in the United States from 2000-2017. Methods: Medical and surgical original research articles from the United States were identified using PubMed. Manuscripts were randomly selected within four different time periods: 2000-2005, 2006-2010, 2011-2015 and 2016-2017. The gender of the first and last authors determined and the journal's impact factor recorded. The ACGME and AAMC databases were used to determine the percent of female residents, attendings, and academic leadership positions. Findings: Within the 1120 articles reviewed, 31.6% of first authors and 19.4% of last authors were women. Female first and last authors increased over time and authorship was proportional to the number of women in academic medicine in the studied specialties (p-value=0.78). There was no difference in the journal's impact factors when comparing male and female authors (p-value= 0.64). On subgroup analysis of medical and surgical subspecialties, results remained unchanged. Interpretation: Gender disparities in medicine have improved but substantial disparities in leadership persist. Women publish research at a rate proportional to the number of academic female physicians. Disparities in leadership roles are unlikely explained by differences in publications. Funding Statement: None of the authors received any funding in order to conduct this study. Declaration of Interests: None of the listed authors have any conflict of interest to disclose. Ethics Approval Statement: Missing

Emergency medicine practice environment and impact on concert examination performance

ObjectiveThe ABEM ConCert Examination is a summative examination that ABEM-certified physicians are required to pass once in every 10-year cycle to maintain certification. This study was undertaken to identify practice settings of emergency physicians, and to determine if there was a difference in performance on the 2017 ConCert between physicians of differing practice types and settings. MethodsThis was a mixed methods cross sectional-study, using a post-examination survey and test performance data. All physicians taking the 2017 ConCert Examination who completed three survey questions pertaining to practice type, practice locations, and teaching were included. These three questions address different aspects of academia: self-identification, an academic setting, and whether the physician teaches. ResultsAmong 2796 test administrations of the 2017 ConCert Examination, 2693 (96.3%) completed the three survey questions about practice environment. The majority (N = 2054; 76.3%) self-identified as primarily being a community physician, 528 (19.6%) as academic, and 111 (4.1%) as other. The average ConCert Examination score for community physicians was 83.5 (95% CI, 83.3–83.8); the academic group was 84.8 (95% CI, 84.3–85.3); and the other group was 82.3 (95% CI, 81.1–83.6). After controlling for initial ability as measured by the Qualifying Examination score, there was no significant difference in performance between academic and community physicians (p = .10). ConclusionsAcademic emergency physicians and community emergency physicians scored similarly on the ConCert. Working at a community teaching hospital was associated with higher examination performance. Teaching medical learners, especially non-emergency medicine residents, was also associated with better examination performance.

Postoperative pain management after sinus surgery: a survey of the American Rhinologic Society.

Postoperative pain management is controversial as there are no current guidelines to direct clinical practice. The purpose of this study was to demonstrate prescribing patterns for pain management after functional endoscopic sinus surgery (FESS). A 15-item web-based survey was electronically distributed to 1770 members of the American Rhinologic Society (ARS). Linear regression analysis was used to determine associations between providers and prescribing patterns. The survey was completed by 168 members (9.49%), representing all regions of the United States. The most commonly prescribed medications were opioid/non-opioid combination pills. One hundred fifty-seven of 168 members (94.05%) prescribed at least one kind of opioid after FESS, with an average of 27.38 pills. The majority of surveyed members worked in private or academic settings. Academic physicians were less likely to prescribe ibuprofen (p = 0.0407), and nonsteroidal anti-inflammatory drugs (NSAIDs) in general (p = 0.032). Physicians in private practice were less likely to refer patients to pain management (p = 0.0117), but more likely to refer patients to nontraditional forms of pain management (p = 0.0164). Academic physicians were more likely to refer patients to pain management (p = 0.00121). There was no association between perception of pain control and the prescription of NSAIDs or with number of opioid pills prescribed. Most providers prescribed opioids after FESS. There was no significant difference in the number of opioids prescribed based on geography or practice setting. There was significant heterogeneity in the adjuvant pain management strategy between academic and private practitioners. Most members provided patient education and few reported poor pain control. However, there was a gap in understanding of appropriate medication disposal and evidence-based postoperative pain management.

Technology Courage: Implications for Faculty Development.

This article was migrated. The article was marked as recommended. Purpose: From a decade of technology-focused faculty development, the authors recognized that academic physicians adopt educational technology at varying rates and with variable confidence. This work is an exploration of the phenomenon of technology courage and how the concept can inform faculty development. Method: Qualitative methods of interpretative phenomenological analysis (IPA) were used. Faculty interviews were transcribed using Google Docs voice typing. Data were analyzed, themes developed, and supportive narratives were identified using IPA methodology. Results: Two themes emerged. The theme of Willingness includes willingness to try, explore, or risk learning a new technology; and willingness to persist in the face of fear or anxiety. The theme of Benefit Evaluation relates to motivators for technology courage, i.e., assessing benefit to self and learners before learning and using a new technology. Conclusions: From a theme analysis, a definition of technology courage has emerged: willingness to try and to persist when using a new technology because of perceived benefit to self and/or others. The authors discuss how further research of the construct might be guided by theoretical frameworks of grit, self-efficacy, teacher identity, and generational learning differences. Recommendations are offered on how the construct of technology courage can be valuable for technology-focused faculty development.

Michael Kleerekoper (August 18, 1944 to May 10, 2018): In Relentless Pursuit of a Better Way.

Michael Kleerekoper (August 18, 1944 to May 10, 2018): In Relentless Pursuit of a Better Way.

Scholarship in Emergency Medicine: A Primer for Junior Academics: Part II: Promoting Your Career and Achieving Your Goals.

Scholarship is an important component of success for academic emergency physicians. Scholarship can take many forms, but all require careful planning. In this article, we provide expert consensus recommendations for improving junior faculty’s scholarship in emergency medicine (EM). Specific focus is given to promoting your research career, obtaining additional training opportunities, networking in EM, and other strategies for strategically directing a long-term career in academic medicine.

Treatment and outcome patterns in European patients with Waldenström's macroglobulinaemia: a large, observational, retrospective chart review

Treatment options for Waldenström's macroglobulinaemia are heterogeneous, and no well established treatment standards exist. Although guidelines from the Eighth International Workshop on Waldenstrom's Macroglobulinemia were published in 2016, inconsistent awareness and budget constraints have prevented their widespread implementation, and real-life treatment patterns might differ across health-care systems. We aimed to generate information about treatment and outcome patterns for patients with Waldenström's macroglobulinaemia outside of clinical trials. In this large, observational, retrospective chart review, academic and community physicians in ten European countries were invited to retrospectively complete electronic records for patients with symptomatic Waldenström's macroglobulinaemia who had begun treatment after Jan 1, 2000, and before Jan 1, 2014, and had available clinical and biological data. The primary endpoints were reasons for treatment initiation, treatment choices, progression-free survival, and overall survival. We assessed the variables that affected choice of front-line therapy, progression-free survival, and overall survival in multivariate analyses. Electronic records were reviewed for 454 eligible patients. The most frequent reasons for starting front-line treatment were anaemia (in 328 [72%] patients) and constitutional symptoms (in 264 [58%] patients). Choice of therapy varied between front-line, second-line, and third-line approaches; age; and type of institution. In the front-line setting, 193 (43%) of 454 patients received monotherapy, 164 (36%) received chemoimmunotherapy, and 95 (21%) received other combination regimens (data on front-line treatment were missing for one patient, and another patient received only steroids). After front-line treatment, median progression-free survival was 29 months (95% CI 25-31), median overall survival was not reached (not reached-not reached), and 10-year overall survival was 69% (62-74). In multivariate analyses, patients who were high risk according to the International Prognostic Scoring System for Waldenström Macroglobulinemia had significantly worse progression-free survival and overall survival than did those who were low risk. Additionally, progression-free survival was shortened in patients treated with monotherapy compared with those treated with chemoimmunotherapy or other combination therapies and in those treated at an academic institution compared with those treated in the community. Constitutional symptoms (excluding fatigue) were associated with worsened overall survival. This large observational dataset should inform and help set guidelines, and improve understanding of treatment practices and outcomes, for European patients with Waldenström's macroglobulinaemia. Pharmacyclics LLC (an AbbVie company).

Impact of Pocket Insulin Dosing Guide on Utilization of Basal/Bolus Insulin by Internal Medicine Resident Physicians.

IntroductionBasal/bolus insulin (BBI) is superior to sliding scale insulin (SSI) for diabetic patients admitted to hospital general medicine and surgery services, but little has been published on strategies to promote the utilization of BBI by resident physicians. New approaches that promote the effective management of hyperglycemia in hospitals need to be developed.Materials and methods A prospective study with historical controls was conducted to evaluate the impact of a pocket insulin dosing guide on the diabetes management practices of internal medicine resident physicians at the Southern Illinois University (SIU) School of Medicine, rotating on general medicine. The primary endpoint was the proportion of patients with preexisting diabetes mellitus managed with BBI. Pocket insulin dosing guides with instructions for initiating BBI and daily insulin adjustments were provided to all internal medicine residents in November 2010. BBI utilization rates were monitored over the period November 2010-February 2011 and were compared to the corresponding four-month period over the previous academic year (November 2009-February 2010), which was before the pocket insulin dosing guides were introduced (pilot study). Internal medicine house staff insulin ordering practices were subsequently evaluated for a 12-month period between October 2010-November 2011, with November 2009-October 2010 used as a historical control (study extension). New interns that were starting their residency training from July 2011 were provided with the pocket insulin dosing guides and given the same instructions as the previous academic year’s resident physicians.Results Historical controls (N = 579) and study patients (N = 584) were well matched, with the exception of the male gender (49% vs. 41%, P = 0.01) and diet-managed diabetes (10.5% vs. 6.4%, P = 0.01). During the pilot study, BBI increased from 12.8% of all resident insulin orders in November 2010 to 58.1% of all orders in February 2011 (P < 0.01 for trend). Overall, BBI as a proportion of all resident insulin orders was 35.7% during the pilot phase, which is a six-fold increase over the previous academic year (6%), and was also statistically significant (P<0.01). For the 12-month period of evaluation between November 2010 and October 2011, internal medicine residents ordered BBI for 41.9% of diabetes patients, compared to 16.7% of patients in the 12 months before the pocket insulin dosing guide was introduced (P < 0.01). Patients managed with BBI had higher blood glucose values at admission than patients managed with SSI (195 ± 95 mg/dL vs. 178 ± 83 mg/dL, P < 0.01) and experienced a 41 mg/dL improvement in mean daily capillary blood glucose (CBG) as compared to no change for patients managed with SSI (P = 0.01 for trend). The rate of hypoglycemia, defined as CBG < 70 mg/dL, was 2.4% for both BBI and SSI managed patients (P = 0.93).ConclusionThe SIU pocket insulin dosing guide significantly increased the utilization of BBI, decreased SSI orders, and improved hospital glycemic control for patients with diabetes mellitus. However, over half of the general medicine patients were still managed with SSI despite the pocket insulin dosing guides. Conversion of the insulin dosing guide to a smartphone app might improve utilization of the protocol and further increase the use of BBI for inpatient diabetes management by internal medicine house staff.

How to Find an Academic Position After Residency: Who, What, When, Where, Why, and How.

Transitioning from trainee to practicing physician is a process that is not frequently discussed during postgraduate training, but such a discussion is necessary if the number of academic physicians is to increase and physicians from underrepresented communities are to gain insight about the varied opportunities to join academe. This workshop combines a case-based format in its didactic portion with a step-by-step guide and time line to introduce the process for securing an academic position postresidency. Kern's six-step model was used as the framework for the workshop's design, delivery, and assessment. The workshop was presented to medical students and residents at a series of programs fostering the development of the next generation of academic physicians that were offered at host medical schools across the US between July 2016 and May 2017. Evaluation data were collected from 64 participants from nine academic medicine conferences across the nation. In comparing pre- and postworkshop responses, there was a statistically significant increase in confidence to find an academic position after residency (1.95 vs. 3.18, paired-sample t test, p < .001). More than 90% of respondents agreed or strongly agreed that the workshop's three objectives were met. Participants commented that they appreciated discussions on contracts and the steps they should take following residency in order to successfully obtain an academic position. This workshop may assist trainees in making better-informed decisions about considerations that are important for finding and retaining an academic position long-term.

Plafond de verre pour les femmes dans les carrières hospitalo-universitaires en France

ObjectiveTo determine whether career development in academic medicine is more difficult for women than for men, and, if any, the nature and level of barriers to this progression. MethodsExtraction of full-time medical staff in a Parisian hospital group, through the SIGAPS platform; an online questionnaire survey of career choices and barriers experienced by full-time male and female physicians. The study population comprises 181 hospital practitioners and 141 academic physicians (49 associate professors and 92 full professors). ResultsWomen represent 49% of the medical staff but 15% of full professors. This underrepresentation of women is more important among intensivists/anesthesiologists than technique-based specialists (such as radiologists, biologists…). There is no difference in scientific output, marital status and parenthood between women and men. On the other hand, there is a difference in attitudes highlighted by the EVAR risk-taking scale as well as in the burden of familial involvement and the prejudices felt by women during the academic selection process. ConclusionThe glass ceiling exists in one of the largest French hospital group. Career development principles promote merit, but should decrease the benefit of “masculine” attitudes in the competition for academic positions. Academic selection criteria should evolve to limit the disadvantage of women related to deeper familial involvement and less competitive strategies and risk-taking attitudes.

James Neil Gilliam, MD-the career arc of a patient-oriented translational clinical investigation changemaker in rheumatologic skin disease.

James Neil Gilliam, MD, was an American academic physician who was trained in internal medicine, dermatology, dermatopathology and rheumatology. This "quadruple-threat" profile of postgraduate medical training provided him with a rather unique perspective on genetically-complex, environmentally-impacted human autoimmune disorders such as lupus erythematosus (LE). Both the skin and vital internal organs can be damaged by LE autoimmunity. And, LE is clinically-expressed quite variably from one individual to another making prognosis difficult. As such it can be very challenging to know what the optimal treatment approach might be for new patients presenting with this potentially-fatal disorder. Dr. Gilliam's major career focus was to better understand the complex relationships that exist between the clinical expression of LE in the skin and vital internal organs. In the late 1970s, Dr. Gilliam first described a new clinical form of LE skin disease that he designated as "subacute cutaneous LE." Subacute cutaneous LE would subsequently serve as the linchpin for a new classification scheme for LE skin disease that would later become known as the "Gilliam classification" of LE skin disease. In addition, he was among the first to apply modern immunologic insight to the classification of cutaneous LE. This work was carried out in the Divisions of Dermatology and Rheumatology and the Department of Dermatology at the University of Texas Southwestern Medical School in Dallas, Texas (UT Southwestern) starting in 1972. Dr. Gilliam served as the Founding Chairman of the Department of Dermatology at UT Southwestern in 1982, 2 years before his untimely death. Dr. Gilliam's clinical research accomplishments were matched by his ability to identify and encourage like-minded young people. A high percentage of his trainees went on to successful academic research careers and leadership positions in American Dermatology. Dr. Gilliam's untimely death from cancer deprived several generations of dermatologists and rheumatologists the benefit of his warm support and insightful guidance. In addition, American Dermatology and Rheumatology leadership organizations were deprived of his strong leadership skills.

Mo1674 DIFFERENCES IN DETECTION OF POLYP PATHOLOGY BASED ON ENDOSCOPIST CHARACTERISTICS AND EXAMINATION OF THE ROLE OF WITHDRAWAL TIME IN EXPLAINING THESE DIFFERENCES

Previous studies have demonstrated adenoma detection (AD) to be operator dependent. In this study we examined endoscopist characteristics not only as they relate to AD, but also to sessile serrated adenoma detection (SSPD), and advanced adenoma detection (AAD--defined as ≥1cm diam., having villous component or high-grade dysplasia). Further, we examined the role of withdrawal time (amount of time spent viewing as colonoscope is withdrawn) as a possible explanation of these differences. Outpatient screening colonoscopies performed on average risk patients by providers who have performed ≥100 colonoscopies in the Cleveland Clinic between January 2015-August 2017 were reviewed. Patient and colonoscopic characteristics along with various endoscopist characteristics were obtained. Descriptive statistics were performed to compute differences in SSPD, AD, AAD, and withdrawal times (WT) based on endoscopist characteristics. This was followed by multivariate (MV) analysis adjusting for various endoscopist characteristics, as well as various patient and colonoscopy based characteristics: age, gender, ethnicity, insurance, BMI, comorbidities (diabetes, cirrhosis, dementia, stroke, constipation, CAD, CHF), aspirin use, opiate use, quality of bowel preparation, location/timing (AM v. PM) of colonoscopy, and number of polyps seen. MV analysis was repeated with inclusion of WT as a variable. N=18,501 colonoscopies were performed by 122 providers. Baseline characteristics and differences in SSPD, AD, AAD, and WT based on various endoscopist characteristics, were obtained (Table 1). MV analysis excluding the effect of WT but adjusting to afore mentioned variables (Table 2a) and including the effect of WT (Table 2b) is presented. Most notable of these associations include: After controlling for WT, odds of SSPD compared to gastroenterologists (GI) has increased from 56% to 67% in general surgeons(GS) and from 53% to 61% in colorectal surgeons (CS). Whereas GS had 17% decreased chance of AD compared to GI, this difference has become insignificant after adjusting to WT. Odds of AD for CS improved by 14% after adjusting for WT. Female providers noted to have higher WT (table-1) have seen 5% decreased chance of SSP after adjusting to WT. Compared to academic physicians, the odds of SSPD among private physicians increased 4% after adjusting to WT. After adjusting for multiple known risk factors, our study revealed significant differences in AD, SSPD, and AAD based on endoscopist characteristics. Comparison of these characteristics before and after controlling for WT demonstrated that many of the differences polyp detection may be partially or fully related to WT. This study emphasizes the need to educate endoscopists about appropriate WT during colonoscopy—especially in providers with characteristics associated lower polyp detection.Table 2- Adjusted analysis of factors associated with sessile serrated polyp detection rate (SSP), adenoma detection rate (AD), advanced adenoma detection rate (AAD)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

PC114. Accessing Trends in Academic Impact of Vascular Surgeons Within the National Institutes of Health iCite Database

A diverse array of measures are used to evaluate academic physicians. One critical factor is the scholarly impact an author has upon the research discourse within a field. Recently, the National Institutes of Health (NIH) developed the relative citation ratio (RCR) as a method to quantify the impact of published research. The aim of this study was to examine the academic impact of vascular surgeons using RCR within common vascular disease research fields. Using the PubMed and NIH iCite database, the scientific fields of abdominal aortic aneurysm, thoracic aneurysm, peripheral arterial disease, carotid disease, deep venous thrombosis, and venous insufficiency were queried for the twenty highest rated articles in each category (1997-2012). Article categories were divided into basic science, health services, and clinical research. To calculate the RCR, article citation rates are divided by an expected citation rate derived from performance of articles in the same field. The resulting RCR is article level and field independent and provides a validated and more accurate measure than journal impact factors. For articles, academic background of the first and last author (influential authors) were collected analyzing procedural specialty: surgery, medicine subspecialty (cardiology, neurology, nephrology), engineering/radiology, and other (anesthesia and pediatrics). Statistical significance between scientific fields and academic background were determined using Student t tests or analysis of variance followed by the Newman-Keuls post hoc test. The academic impact of vascular surgeons varied substantially based on the scientific field (Table). Vascular surgeons as compared with medical specialists were found to have the highest academic impact in the field of abdominal aortic aneurysm research comprising 51% of the influential authors on the highest rated RCR studies (5.9 ± 0.8 vs 5.6 ± 0.8; P = .6). In contrast, vascular surgeons only comprised 13% of influential authors as compared with medical specialists in deep venous thrombosis (RCR of 2.6 ± 0.3 vs RCR of 15.7 ± 1.7; P < .003) and 18% in peripheral arterial disease (RCR of 1.9 ± 0.5 vs RCR of 2.1 ± 0.2; P = .78). Grouping all vascular fields of study together, no difference in RCR was found between vascular surgery and radiology/engineering. However, the mean RCR was significantly lower for vascular surgeons compared with medical subspecialties (4.5 ± 0.4 vs 6.8 ± 0.5, P < .05). Vascular surgeons exhibit a moderate academic impact in the field of aneurysmal disease but lag behind medical subspecialists in quantity of highest impact scientific contributions to the fields of peripheral arterial disease and deep venous thrombosis.TableImpact of vascular surgeons versus medical specialists by relative citation ratio (RCR) in vascular disease research fieldsScientific fieldStudies with surgery influential authorship, %RCR score vascular surgeryRCR score medical specialtiesPAAA515.9 ± 0.85.6 ± 0.8.60PAD181.9 ± 0.52.1 ± 0.2.78TA465.6 ± 0.54.1 ± 0.5.03CVOD333.1 ± 0.68.9 ± 1.3.002CVI292.9 ± 0.22.0 ± 0.2.005DVT132.6 ± 0.315.7 ± 1.7.003AAA, abdominal aortic aneurysm; CVI, chronic venous insufficiency; CVOD, cerebral vascular occlusive disease; DVT, deep vein thrombosis; PAD, peripheral vascular disease; TA, thoracic aorta.RCR scores reported as mean ± standard error of the mean. P value determined by the Student test. Open table in a new tab

Experience with external review panels to validate a large clinical pharmacy intervention study

ABSTRACT Assessment of the true impact al pharmacists' interventions in pharmaceutical care is crucial to the justification of investment in resources for clinical pharmacy services. In a large study of clinical pharmacy interventions in hospitals, intervening pharmacists and attending physicians assessed the impact of the intervention on three aspects: therapeutic benefit, risks, and drug costs. The study showed that hospitals providing the highest level at pharmacotherapy monitoring made more interventions per patient and that, in these institutions, the impact was greater on therapeutic benefit and risk reduction. Both pharmacists and physicians caring for the patient had assessed the impact. It was deemed important to validate these results. External panels of academic clinical pharmacists and clinical pharmacology physicians were chosen to review a sampling of cases to determine their level of agreement with their professional colleague (pharmacist or physician) at the original site. Differences were found in the assessments for both the pharmacist panel reviewing the site pharmacists and the physician panel reviewing the site physicians. In general, the review panels tended to be less positive about therapeutic benefit and risk reduction, but similar about the impact on drug costs. Although validation exercises are desirable in such research, it remains to be established whether the expert panel approach is preferred to other methods such as the more arduous measurements of health outcomes, or even the subjective impression of the physician and pharmacist involved with the care of that patient.

Teaching Competencies for Community Preceptors.

Although community physicians provide one-fourth of the outpatient training received in medical school, usually there is no formal training of the preceptor. Currently there is no agreed-upon list of teaching competencies for community physician-preceptors. Using a modified Delphi process, the authors aimed to identify core teaching competencies for community preceptors for use in training and evaluation. A medical educator and three faculty members with expertise in faculty development created a list of teaching competencies organized in five domains. These competencies were finalized through a multiround modified Delphi technique with key stakeholder groups including (1) nonphysician medical educators, (2) academic physicians involved in faculty development, (3) community physicians who regularly precept medical students, (4) family medicine residents, (5) third-year medical students in a 9-month-long longitudinal clerkship. Proposed competencies were retained if 70% of the participants ranked it as "very or extremely important." In the first round, 24 competencies were evaluated by 40 physician preceptors participating in a rural faculty development conference. These were refined, and four additional competencies were added by the cohort. Subsequent rounds utilized a survey approach with broader audiences resulting in a final list of 21 competencies in five domains. Five competency domains with 21 teaching competencies can now be used to guide community preceptors' training and evaluation.