part i: study design

Transcription

Utilizing Journal Club to Enhance an
Understanding of Research Methodology
Dr. Suporn Sukpraprut-Braaten, MSc, MA, PhD
Dr. David Covey, MD, FACP
Graduate Medical Education
Unity Health
Searcy, Arkansas
INTRODUCTION
 Unity Health is the largest employer in an eight surrounding county area in with more than 2,000
associates located in Searcy, Newport, and Bradford, Arkansas.
 The facility has a combined total of 438 licensed beds and a medical staff of more than 150
physicians that specialize in various areas of healthcare.
Location of White County, Arkansas
Unity Health – White County Medical Center
2
Unity Health – Harris Medical Center
UNITY HEALTH – WHITE COUNTY MEDICAL CENTER
NYIT
ARCOM
104 miles to Memphis
54 miles to Little Rock
3
INTRODUCTION
 Dr. Suporn Sukpraprut-Braaten
 Assistant Professor for Research, Unity Health – White County Medical Center
 Vice Chair on the Scholarly Activity & Faculty Development Committee of Kansas City University
of Medicine and Biosciences (KCUMB) GME Consortium
 Adjunct Clinical Assistant Professor of Preventive Medicine, Department of Specialty Medicine,
KCUMB
 Adjunct Clinical Assistant Professor in the Department of Academic Affairs, Arkansas College of
Osteopathic Medicine (ARCOM), Fort Smith, AR
 Former Director of Preventive Medicine Research Center and Assistant Professor of Preventive
Medicine and Public Health at Edward Via College of Osteopathic Medicine (VCOM) – Virginia
Campus
4
KEY PERSONNEL
Unity Health’s Osteopathic Residency Program
Dr. Dewey McAfee
 Director of Medical Education
 Family Medicine Program Director
Dr. David Covey
 Internal Medicine Program Director
 Arkansas’s White County Health Officer
Dr. James S. Stanley
 Psychiatry Program Director
Dr. John Henderson
 Chief Medical Officer
Dr. Delaney Kinchen
 Institutional Education Officer
Dr. Williams White
 GME Faculty
Dennis Yecke, MBA
 Operations Director
5
RESIDENCY PROGRAM
Unity Health’s Osteopathic Residency Program:
 Unity Health’s Residency Program is affiliated with Kansas City University of
Medicine and Biosciences – Graduate Medical Education Consortium (KCU-GME
Consortium).
 The program is the first osteopathic residency program in the state of Arkansas.
 The program is the second residency program in the state after a residency program at
University of Arkansas Medical Center (UAMS).
6
RESIDENCY PROGRAM
Unity Health’s Osteopathic Residency Program:
 The program was started in July, 2015 and approved for three specialty programs
 Family Medicine – 3 PGY1 and 1 PGY2
 Internal Medicine – 5 PGY1 and 2 PGY2
 Psychiatry
– 3 PGY1 and 1 PGY2
7
Expectation for Graduation
Condition 1: Every resident is required to:
 Provide a noon didactic lecture at least twice per year
 Conduct literature review for his/her case report or research project
 Provide a presentation to patients support group
 Present and attend journal clubs
 Attend a medical conference
8
Expectation for Graduation
Condition 2: Every resident is required to accomplish one of the following four options of scholarly
activity in order to graduate from Unity Health’s residency program
Option 1: Two case reports for poster presentations (Level 3)
Option 2: An original research project for a poster presentation or publication (Level 4†)
Option 3: A grant application (Level 4†) or grant award (Level 5)
Option 4: Accomplish a submission of a text book chapter (Level 5)
†Level
4 is designed as a graduate target.
9
OBJECTIVES
Journal club is an educational intervention that can improve reading habits and research skills, the use of
medical literature in clinical practice for postgraduate physicians in training, and knowledge of clinical
epidemiology and biostatistics.
Learning Objectives:

Conduct structured critical appraisal of
research articles

Gain an understanding about statistical analyses
and interpretation of the results

Recognize and understand different research
study designs

Improve the presentation skill

Enhance the knowledge on how to practice
evidence based medicine

Distinguish strengths and limitations of
different study designs and statistical
analyses
Provide transparent expectations from the GME faculty on how to appraise the resident’s performances
10
in a journal club meeting in order to help the residents to prepare for a journal club presentation.
OBJECTIVES
Our purpose is to explain how Unity Health utilizes a journal club to enhance the residents
knowledge in evidence-based medicine practice.
I.
Journal club structure
II. Knowledge Assessment
 Research Quality Evaluation Worksheet
III. Transparent expectations from the residents and GME faculty on how to appraise the
resident’s performances in a journal club meeting in order to help the residents to prepare
for a journal club presentation
IV. AOA/ACGME Requirements
V. ACGME Milestones
11
I. Journal Club Structure
Journal Club Structure:
 Every resident must attend the monthly journal club
 Program director selects the main research article and assigns the journal club presenter
 Journal club presenter is expected to:
 Provide background information about the main article
 Seek for other evidence to support the main article
 Explain about the study design, methods, and statistical analyses
 Translate the evidence to patient care
 The GME faculty evaluate the presenting resident
 Other residents must systematically evaluate the main article using the Research Quality
Evaluation Worksheet
12
I. JOURNAL CLUB STRUCTURE
13
Research Quality Evaluation Worksheet
14
15
Journal Club Expectation
Journal club presenter is expected to:
 Provide background information about the main article
 Seek for other evidence to support the main article
 Explain about the study design, methods, and statistical analyses
 Translate the evidence to patient care
Other residents are expected to:
 Systematically evaluate the main article using the Research Quality Evaluation Worksheet
 Summarize the main article
 Explain how to utilize the information from the article to improve patient care
GME faculty are expected to:
 Evaluate the presenting residents
 Provide comments and recommendations
16
17
Common Program
AOA Requirements
AOA Basic Documents for Postdoctoral Training:
IX.D Research and Scholarly Activity
9.1 Each OPTI shall require each member institution to establish policies
and guidelines that govern scientific research activities in accordance
with local, state and federal guidelines.
9.2 Each OPTI shall facilitate and provide research education, assistance
and resources directly to trainees and institutions to encourage research
and to meeting the Specialty College requirements.
9.3 Each OPTI shall provide in collaboration with its member COM(S),
hospitals and other teaching institutions access to basic science and/or
clinical research mentorship.
ACGME Requirements
ACGME Common Program Requirements – Residents’ Scholarly
Activities:
IV.B Residents’ Scholarly Activities
IV.B.1 The curriculum must advance residents’ knowledge of the
basic principles of research, including how research is
conducted, evaluated, explained to patients, and applied to
patient care.
IV.B.2 Residents should participated in scholarly activity.
IV.B.3 The sponsoring institution and program shall allocate adequate
educational resources to facilitate resident involvement in
scholarly activities.
9.4 The OPTI shall support and provide a mechanism to recognize trainees
who conduct research activities.
9.5 The OPTI shall provide budgeted funding for OPTI-wide or program
specific research for its trainees.
9.6 The OPTI shall demonstrate its support of trainee scholarly activity.
18
Family Medicine Program:
 Residents should complete two scholarly activities, at least one of which should be a quality
improvement project. (IV.B.2.a)
Internal Medicine Program:
 Residents should participate in scholarly activity. (IV.B.2)
Psychiatry Program:
 All residents must be educated in research literacy and in the concepts and process of
evidence-based clinical practice to develop skills in question formulation, information
searching, critical appraisal, and medical decision-making. (IV.B.2.c)
19
Family Medicine ACGME – Milestones
 PBLI-1: Locates, appraises, and assimilates evidence from scientific studies related to the
patients’ health problems
20
PBLI = Practice-Based Learning and Improvement
†Level 4 is designed as the graduation target
 PBLI-1: (Continue)
21
 PBLI-2: Demonstrates Self-Directed Learning
22
Internal Medicine ACGME – Milestones
 PBLI-4: Learns and Improves at the Point of Care
†Ready for Unsupervised Practice: This level is designed as the graduation target
23
Psychiatry ACGME – Milestones
 PBLI-1: Development and execution of lifelong learning through constant self-evaluation, of
research and clinical evidence
A: Self-Assessment and self-improvement
B: Evidence in the clinical workflow
24
Psychiatry ACGME – Milestones
 PBLI-3: Teaching
A: Development as a teacher
B: Observable teaching skills
25
26
27
PART I: STUDY DESIGN
15
Clinical Trial
Part I: Study Design
Study Intervention
Study Endpoints
Meta-Analysis
Researh Articles
0
5
10
Journal Quality Score
15
Researh Articles
15
Clinical Trial
Meta-Analysis
Researh Articles
0
0
5
10
15
Sample size and Power Analysis
Meta-Analysis
10
Researh Articles
10
0
Clinical Trial
5
Meta-Analysis
Part 1: Study Design
 All residents accurately identify
the study types.
5
10
0
5
10
5
0
Clinical Trial
Study Population
15
Study Aims
15
Literature Review
Clinical Trial
Meta-Analysis
Researh Articles
Clinical Trial
Meta-Analysis
Researh Articles
 The residents recognizes the
potential bias in the clinical trial
due to the source of funding from
a pharmaceutical company.
 Study population is unclear to the
residents when evaluating metaanalysis.
 The endpoints are stated clearer
for the residents to recognize in
the clinical trial than the metaanalysis study.
PART II: RESEARCH METHOD
Meta-Analysis
15
Meta-Analysis
Part II: Research Methodology
Blinding
10
5
0
0
5
10
15
Source of Data
15
Researh Articles
Meta-Analysis
Researh Articles
10
0
Clinical Trial
Researh Articles
Clinical Trial
Part 2: Research Method
 The residents learned about the
difference in enrollment process
between a clinical trial vs. metaanalysis study.
5
10
0
5
10
5
0
Clinical Trial
Timeline
15
Randomization Process
15
Enrollment Process
Clinical Trial
Meta-Analysis
Researh Articles
Clinical Trial
Meta-Analysis
Researh Articles
 The residents recognize the benefit of
blinding process in clinical trial.
 The residents recognize metaanalysis is ranked as a higher level of
research evidence.
PART 3: RESULTS AND CONCLUSION
10
 Descriptive statistics
 Statistical analyses
0
Clinical Trial
Meta-Analysis
Clinical Trial
Meta-Analysis
Researh Articles
Part III: Results and Conclusion
Results
Conclusion
5
10
15
Clinical Trial
Meta-Analysis
Researh Articles
 Interpretation of the results
 Conclusion
 The residents are more comfortable in
interpreting clinical trial than meta-analysis
studies.
0
5
10
15
Researh Articles
0
Part 3: Results and Conclusion
 The residents evaluated the meta-analysis
study with lower quality scores in:
5
10
5
0
15
Statistical Analysis
15
Descriptive Statistics
Clinical Trial
Meta-Analysis
Researh Articles
STUDY COMPARISON: OVERALL
Meta-Analysis
Researh Articles
60
50
40
30
10
Clinical Trial
0
0
Clinical Trial
Meta-Analysis
Clinical Trial
20
Journal Quality Score (0-150 points)
50
40
30
10
20
50
40
30
20
10
Clinical Trial
0
Quality of Research Study Comparison
Part III: Conclusion
60
60
Meta-Analysis
Clinical Trial
Meta-Analysis
Researh Articles
Meta-Analysis
Clinical Trial
Meta-Analysis
Researh Articles
STUDY COMPARISON: OVERALL
Total Evaluation Score
100
50
Clinical trial study is evaluated as:
 to have an “Above Average” quality
 Score average is 114 ± 19 points
Clinical Trial
0
150
Quality of Research Score:
0-30
Poor
31-60 Below average
31-90 Average
91-120 Above Average
120-150 Excellent
P-value = 0.15
Meta-Analysis
Clinical Trial
Meta-Analysis
Researh Articles
Meta-Analysis study is evaluated as:
 an “Average” quality
 Score average is 88 ± 35 points
STUDY COMPARISON: INDIVIDUAL RESIDENT
Total Quality of Research Score Evaluated by the Residents
 Ray Montgomery, FACHE – Unity Health’s President and CEO
 John Henderson, M.D., FACC – Chief Medical Officer
 Dewey McAfee, D.O., FACOFP, PharmD – Director of Medical Education/Family Program Director
 James S. Stanley, M.D., FANP – Psychiatry Program Director
 Delaney Kinchen, D.O., FAEP – Institutional Education Officer
 Dennis Yecke, MBA – Operations Director, Graduate Medical Education Program
 Rachael Sowers, MBA – Program Coordinator , Graduate Medical Education Program
 Leslie Provence, MBA – Program Coordinator , Graduate Medical Education Program
 Kelly Bopp – Administrative Assistant , Graduate Medical Education Program
34
THANK YOU
35

part i: study design

Transcription

Similar documents

11.2 - Hosanna Community

Neat Document-Thumbsuckers Calendar

Order Form - Jack L. Marcus Company Institutional Sales Catalog

OPEN HOUSE PARTY 223 CLUB KICKOFF

July 2012 City Connection Newsletter

Solivita Brochure

in search of architecture

Rotary Club of Denver West | Golden, Colorado

Deerlake brochure - Deerlake Village

36th Annual In-Vette-Tational Fun Car Show

What is meta-analysis? Volume 1, number 8

What is meta-analysis? Volume 1, number 8 Published by Hayward Medical Communications

Document 6530584