Research Associates Programs

Frank Illuzzi, MD, FACEP

Stephanie Carro-Kowalcyk, BS

Chava Freund, BS

Daniel Glaser, BS

Ryan King, BSEE

Michael Molloy, BS

Keith Bradley, MD

Research Associates (RA) Programs

Obstacles to research in the ED

"Once upon a time …"

An answer to some of these obstacles

RA programs

Keys to success

Future

Obstacles to Research in ED

?

Obstacles to Research in the ED $

“I was too busy”

“Not my job”

“All you have to do is this one more, little thing”

24/7

carrot and/or the stick

"Once Upon a Time…"

Lincoln Medical and Mental Health Center South Bronx, NY 1993

Emergency Medicine residency program Tremendously motivated faculty, residents and staff No clinical research papers in 12 years

Why?

165,000 patients per year

An Answer to Some Obstacles to Research

Needed: bright, motivated individuals primary responsibility = research focused experts on the details of the research on-site in the 24/7 ED available in large numbers "free“

= willing to be paid with something besides money

Who did we get for the job?

An Answer to Some Obstacles to Research

Needed: bright, motivated individuals primary responsibility = research focused experts on the details of the research on-site in the 24/7 ED available in large numbers "free“

= willing to be paid with something besides money

Medical Students!!!

Research Associates

Is there a practical difference in the ability to collect

focused clinical research data between:

today's freshman medical students

vs.

themselves one year prior as college seniors?

Research AssociatesIf not, is there a practical difference in the ability tocollect focused, clinical research data between:

today's freshman medical studentsvs.

themselves one year prior as college seniors… juniors … sophomores …freshman?

Research Associates

Functions

subject identification

demographic and historical information

physical parameters

read informed consent

facilitate the research

“stuff”

Research Associates Programat Lincoln

Process

recruited from local colleges– Fordham University– Lehman College– Manhattan College– Mount St. Vincent’s– Columbia University– Iona College

Research Associates Programat Lincoln

Process

recruit from local colleges

orientation sessions (8 hrs. / weekend day x 2)– basics of clinical research– ethical issues– safety– volunteer duties– specifics on data collection for each study

Research Associates Programat Lincoln

Process

recruit from local colleges

orientation sessions

a four hour shift / week / academic semester

faculty evaluation of RAs from each shift

letter of evaluation from program director

Do RA Programs Work?

Lincoln

first semester, 38 RAs covered 80% of 24/7

by the end of two years, > 60 RAs per semester

Bradley K, Osborn HH, Tang M.

"College research associates: a program to increase emergency

medicine clinical research productivity."

Ann Emer Med, September 1996.

Do RA Programs Work ?LincolnStudies

Asthma/Cocaine 112 participants enrolled

Window Guards 1088 participants

enrolled

Ankle 350 participants

enrolled9 page data form

Chest Pain Evaluationlimited to subject ID TB studies requiring CMV Meningitis universal precautions

Do RA Programs Work?Bridgeport Hospital

“Traditional” Studiesenrolled

C-Spine X-ray Clearance Protocol 102

Influenza Vaccine in the Elderly 134

ED Follow-Up Telephone Calls 113

Antibiotic Use in Children 377 1743

Do RA Programs Work?Bridgeport Hospital

Cardiac Studiesenrolled

Troponin T 856

QT-Prolongation with Erythromycin 63

CUPID ECG Analysis 100

1019

Do RA Programs Work?

Bridgeport Hospital 1° Health Screening Studies

enrolled

Women’s Health Screening 2676

including domestic violence questions

AMA’s Firearms Risk Assessment 3370

AHA’s Cardiovascular Risk Assessment 3276 9,322

Do RA Programs Work?St. Vincent’s Medical Center

Cancer Screening Studies enrolled

American Cancer Society recs. 3644

Cervical and Breast Cancer 2589

Prostate Cancer 521

Tobacco Cessation 3125

Colon-Rectal Cancer (to date) 127911,158

Do RA Programs Work?

20-50 RAs per semester during the school year

20-45 RAs from around the country

for the summer semesters

Do RA Programs Work?

27,575 participants

entered in research protocols by RAs

as of end of summer semester, 2010

Do RA Programs Work?

Sustainability

RAs provide service based on successful studies

(e.g., at St.Vincent’s: cervical, breast and prostate cancer screening and tobacco cessation)

To date, 5901 patients and visitors received such service

as of end of summer semester, 2010

Do RA Programs Work?

Research + Service interactions with

33,476 patients and visitors

as of end of summer semester, 2010

Do RA Programs Work?

Research + Service interactions with

33,476 patients and visitors

Institutional cost = $ 0

as of end of summer semester, 2010

Do RA Programs Work?

Research + Service interactions with

33,476 patients and visitors

Institutional cost = $ 0

Complaints about RAs = 0

as of end of summer semester, 2010

RA ProgramsBenefits?

Research is done effectively, efficiently, while minimizing impact on clinical care

RAs get clinical exposure and research experience

Advisers have a guaranteed evaluated clinical experience for their students

Patients and visitors get value-added to their ED visit

Win-Win-Win-Win

RA ProgramsKeys to Success

From the Medical Side preparation and organization dedicated director principle and associate investigators buy-in by faculty and residents enthusiasm welcoming teaching

RA ProgramsKeys to Success

From the College Side

linkage with health professions advisor

identifying target audience

recruiting lecture and materials

advisor = early warning of any problems

receive letters of evaluation

synergy

Chief RA

undergraduate degree already completed

applying to medical school

Program Director's assistant for the academic year

“first port of call” for RAs' on-line issues

involved in all aspects of clinical research

attends didactic sessions and research meetings

is the principal or associate investigator on a study

Chief RA

To date: 20 CRAs

15 accepted to medical school

1 accepted to dental school

1 accepted to PhD in clinical research

3 in the application cycle

RA Program Development

research requirements+

financial and personnel resources +

clinical pressures=

need for innovative solutions

Research Associates Programs

RA Program at St. Vincent’s Medical Center

65,000 patient visit ED

largest ED in largest city in CT

diverse patient population

residencies and fellowships

major teaching affiliate of University of Connecticut School of Medicine

RA Program at St. Vincent’s Medical Center

Focus of studies on 1 care screening in ED

→ each RA sees a large number of patients

Provides an evaluated clinical experience for large numbers of pre-health professions students

School year = RAs from local colleges Summer = RAs from around the country

Starting a Research Associates Program Guarantee clinical experience for large numbers of

pre-health professions students

Linkage between medical centers and colleges →

value added to ED visits by “free” research workers – residency programs in every specialty must do research– hospitals without residencies need data collection,

e.g., for continuous quality improvement (CQI) programs

Think of These Numbers > 1/2

– half the U.S. population goes to an emergency department each year as a patient or visitor

3.3- Average number of hours in an ED visit

500,000– college students and post-bacs interested in medical

school

Think of This Number

60 million

potential work hours at no institutional cost

if pre-meds served as RAs for one 4-hr shift per week

in the nation’s emergency departments

helping patients and visitors with their 1 care issues

What Would Coca-Cola Pay?

Access – to ½ the people in the U.S. – for several hours each year

Work force –hundreds of thousands of bright, committed

people– eager to work millions of hours – for compensation other than money

National Alliance of Research Associates Programs

(NARAP) RA programs in multiple hospitals around the U.S.

united in clinical research on the ED as a site to

facilitate primary care screening

tens of thousands of participants enrolled in clinical studies over short time periods

NARAPCharter Members

Connecticut New Jersey St Vincent’s Medical Center Hackensack Univ. Medical

Center

Hartford Hospital

Lawrence and Memorial Hospital

Massachusetts New York UMass Medical Center University of Rochester

Nebraska Pennsylvania Creighton U. Medical Center Thomas Jefferson Univ. Hospital

If You See the Potential as a RA in CT Summer semester, 2011

– Session One» orientation sessions = Saturday and Sunday, 4 and 5 June» Shifts = 6 June – 14 August

– Session Two» orientation sessions = Saturday and Sunday, 25 and 26 June» Shifts = 27 June – 5 September August

www.RAProgram.org - program details and application materials

If You See the Potential as a Chief RA Training Session

– 2 weeks at St. Vincent’s (21 May-5 June)– Learn techniques and protocols for

Recruiting Personnel Management Evaluating

Website Development and Maintenance

Database Management

– Serve as a line RA for tobacco cessation study

Ready to develop the RA Program at ________ for the tobacco cessation study in spring semester, 2012 and ________’s clinical studies

If You See the Potential as a Chief RA

www.theNARAP.org.

Future

RAs as primary health care screeners

RAs moving health care forward through clinical research

RAs as a preparatory step for careers in the health professions

Watch “ER” on TVand guess;

Be a Research Associate and know.

?