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VPMA Focus Forum:Integrating Research, Education into Clinical Care

Sept. 30, 2019

Brooks Jackson, MD, MBAUI Vice President for Medical Affairs andthe Tyrone D. Artz Dean, Carver College of Medicine

Patricia Winokur, MDExecutive Dean, Carver College of Medicine

Integrating Research and Education into Clinical Care

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Curiosity Leads to OpportunityIntegrating Research and Education into Clinical Care

Every patient care encounter is an opportunity to:

§ Ask

§ Gather

§ Discover

§ Teach

§ Learn

§ Improve

§ Evaluate

§ Consider

§ Innovate

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Spotlight: Manish Suneja, MDIntegrating Research and Education into Clinical Care

§ Clinical Professor, Internal Medicine–Nephrology

§ 55+ published journal articles—based on teaching & clinical duties and without external grant funding

§ “If I see something interesting in the clinic, it becomes a question ... I try to find answers to the question and ultimately convert it into a paper.”

§ Published papers cover a variety of topics beyond nephrology. Examples:― Estimating how much time residents spend with patients in ICU – Am J Med (Aug. 2018)― Hydralazine-associated vasculitis – Semin Arthritis Rheum (Oct. 2018)― Small split pediatric kidneys to expand the donor pool – Transplantation (Mar 2019)― Assessing professional activities using an orientation OSCE – J Grad Med Educ (Apr 2019)

§ Collaborative culture at Iowa is special: “Everyone is willing to help.”

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Building a Culture of ExcellenceVPMA Focus Forum: Overview

§ Ensuring our faculty and staff are successful and on track for promotion

§ Producing impactful scholarship§ Securing research and philanthropic funding§ Recruiting and training outstanding learners§ Ensuring top-quality care and service compared with peers§ Achieving strong financial performance§ Maintaining regulatory compliance§ Ensuring diversity, equity, inclusion§ Driving innovation

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Culture of Excellence: Diversity, Equity, and InclusionVPMA Focus Forum: Overview

UI Health Care’s FY20 institutional goal is to increase by 1% the combined number of:

§ Underrepresented racial and ethnic minorities among faculty/residents/fellows/postdocs/graduate students/medical students across the enterprise

§ Women faculty in the biomedical sciences

Focus on faculty recruitment, retention and inclusion

Develop diversity organization for underrepresented residents and fellows

§ There are new ACGME Diversity requirements and we will be working with each department to create strategy around recruitment and retention

Renew the PREP (Post-Baccalaureate Research Education Program) grant from NIH

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Spotlight: Marygrace Elson, MD, MMEIntegrating Research and Education into Clinical Care

§ Clinical Professor, Obstetrics and Gynecology

§ Published curriculum resource on cultural competency for AAMC Med Ed

Portal; developed resident-focused materials on social determinants of

health for use across the USA

§ Research has included student perception of different formats of feedback

on OSCE (Objective Structured Clinical Exam) performance; effectiveness

of task-based simulation training for students/residents

§ In clinic, works with medical and PA students one-on-one, using “teaching in

the presence of the patient” model

§ On Labor and Delivery Unit, routinely consults and debriefs residents

immediately following each case and at end of shift. Leads

multidisciplinary team-based simulations for OB emergencies.

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$50M in Strategic Investments Over Next 5 YearsVPMA Focus Forum: Overview

§ $50M research investment over the next five years in the following major areas:― Cancer

― Metabolism

― Immunology

― Biology of Aging

― Investments in: § seed grants§ research scholars program§ bioinformatics§ clinical trials support§ core lab support

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Additional $2.5M for FY20: AllocationsVPMA Focus Forum: Overview

1. Scholarships for med students: $500K

2. High-risk research grants 20 $10K grants: $200K

3. Small Core facility equipment: $650K

4. Global health research seed grants/education support for Uganda and China hubs: $400K

5. Research support to obtain data for resubmission of highly scored but not funded projects : $300K

6. IP/translational innovation funds: $200K

7. Grad student recruitment bonus: five $10K awards per year for five years: $250K

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Spotlight: Yousef Zakharia, MDIntegrating Research and Education into Clinical Care

§ Clinical Associate Professor, Internal Medicine–Hematology-Oncology

§ Clinical trial: High-dose selenium in metastatic renal cell carcinoma (RCC)

§ Based on pre-clinical data (Roswell Park Cancer Institute), Zakharia and colleagues designed the first phase 1 clinical trial combining high-dose selenium with axitinib (a standard of care treatment for metastatic RCC)― Supported by PACT (Pipeline Acceleration for Cancer Therapeutics) Initiative through Holden

Comprehensive Cancer Center, Rock ‘N’ Ride Foundation

§ Twenty-two patients treated to date, showing the combination is safe, with encouraging clinical activity in RCC patients refractory to prior lines of treatment

§ Phase 2 clinical trial underway at Holden Comprehensive Cancer Center, supported by Pfizer Pharmaceutical

§ Preliminary data presented at Genitourinary American Society of Clinical Oncology (GU ASCO) in San Francisco (Jan. 2019) and at European Society of Medical Oncology (ESMO) in Barcelona (Sept. 2019)

§ Application for R01 grant from NIH has been submitted

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Clinical TrialsIntegrating Research and Education into Clinical Care

§ Clinical trials are a hallmark of an academic health system and an important part of patient care

§ Clinical trials provide patients access to new drugs and therapies that may become standards of care for future patients

§ Helping patients search for and/or enroll in clinical trials offer hope and underscores our expertise in advancing new treatments

§ Our new clinical trials website makes searching easier for staff, referring providers and the public: clinicaltrials.uihealthcare.org

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Clinicaltrials.uihealthcare.org

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Spotlight: Jordan Schultz, PharmDIntegrating Research and Education into Clinical Care

§ Assistant Professor, Psychiatry, Neurology, Pharmacy Practice and Science – Health Services Research

§ Clinical duties: Clinical Pharmacy Specialist in Huntington’s Disease Clinic― Multi-disciplinary team that includes pharmacist, neurologist, psychiatrist, genetic counselors, social

workers, neuropsychologists

§ KL2 Scholar through the Institute for Clinical and Translational Science

§ Clinical research focus: Huntington’s disease (HD)― KL2-funded research: AUTO-HD study, focused on how pharmacologic modulation of the autonomic

nervous system affects the progression of HD― Research effort also focus on how certain medications affect the progression and symptoms of HD ― Serves as a research mentor for pharmacy residents, graduate students, research interns, and

undergraduate students on research projects focused on HD and other neurodegenerative diseases

§ Lectures on the therapeutics of Huntington’s at the College of Pharmacy

§ Also part of Parkinson’s disease research group (Narayanan, Welsh, et al) investigating prostate drug for treating Parkinson’s disease

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Spotlight: Gen Shinozaki, MDIntegrating Research and Education into Clinical Care

§ Associate Professor, Psychiatry, Neurosurgery

§ Research focuses on delirium (sudden onset of confusion after surgery or while in the ICU)― Based on clinical encounters as a consultation-liaison psychiatrist who takes care of patients in

medical or surgery service with psychiatric issues

§ Developing a screening device using simplified EEG technology to identify patients at high risk

§ Research team includes many medical students, residents, and undergrads that lead patient recruitment and data-gathering efforts― Through these activities, these young, bright individuals are exposed to a clinical environment—

learning to interact with patients and boosting their interest in medicine as a career― For past four years among his lab’s medical students, many have joined psych residency programs—

one at Stanford and others here at Iowa

§ Just received pre-notification of NIH R01 funding

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Spotlight: Nursing Research, QI—Reducing HAPIsIntegrating Research and Education into Clinical Care

§ Nurse-led research and quality improvement team initiatives to reduce hospital-acquired pressure injuries (HAPIs) generated in the operating room (OR)― Interdisciplinary team included nursing staff from all perioperative areas, adult and pediatric wound

nurses, Anesthesia, Surgery, HCIS and Nursing Information Systems, and procurement specialists― Included five separate Doctor of Nursing Practice and Certified Nurse Anesthetist projects― A subset of the team conducted a study to look at all HAPI cases that occurred in a five-year span and

compared them to similar patients who had not had a HAPI to identify intraoperative risk factors

§ The research and quality improvement projects led to:― Total rewrite of UI Hospitals & Clinics surgical positioning policy― Replacement of all table mattresses in the OR― Purchase of gel positioners― Implementation of special positioning procedures for all surgeries scheduled for longer than 3 hours

§ Result: ― Incidence of OR related HAPIs have been reduced― Nursing quality measures for HAPI remain below benchmark for comparably sized academic medical

centers― The research and collaborative work has been presented at multiple national conferences

• Several of the members of the perioperative division HAPI committee.

― L to R (front) Michelle Mathias, BSN, RN, CNOR; Linda Abbott, DNP, RN, CWON, AOCN; Donna Dolezal, MSN, RN, CPAN; Lori Stebral, BSN RN, CNOR; Laura Phearman, BSN, RN, CWON, CPNP

― L to R (back) Amos Schonrock, MAN, RN, CNOR, CSSM; Cormac O’Sullivan, PhD, RN, CRNA ; Jerrod Keith, MD

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Spotlight: Nursing Research—Pain Distraction AppIntegrating Research and Education into Clinical Care

§ Nurse-led interdisciplinary research team conducted series of NIH-funded studies on the use of distraction to reduce stress in pediatric patients undergoing needle stick procedures.― Team was led by Ann Marie McCarthy, PhD; RN, FAAN; Charmaine Kleiber, PhD, RN, FAAN; and

Kirsten Hanrahan, DNP, ARNP, CPNP-PC

§ Research led to development of Distraction in Action web-based app (uichildrens.org/distraction-in-action) plus training videos and distraction resources

§ Clinical leaders in nursing and child life specialists have been key partners in informing the research and implementing evidence-based interventions into practice at UI Stead Family Children’s Hospital― Clinical leaders: Deb Bruene, MAS, RN-BC, and Mary Beth Hovda Davis, MSN, RN, VA-BC― Child life specialists: Jodi Bauers, MM, CCLS, and Gwen Senio, MM, CCLS

§ Work has been widely published and presented worldwide― Current research is focused on a NIH R01 grant application and implementation of the DistrAction

toolkit in community hospitals

Kirsten Hanrahan Charmaine Kleiber

Ann Marie McCarthy

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Spotlight: Virginia Willour, PhDIntegrating Research and Education into Clinical Care

§ Associate Professor, Psychiatry

§ Primary research focus: Understanding the biological basis of suicidal behavior― Identify genes and biological pathways influencing suicidal behavior; identify new therapeutic targets― Develop genetic profiles that help identify individuals at high risk for suicidal behavior― Identify brain imaging differences associated with high genetic risk of suicidal behavior and prioritize

brain regions for additional study and therapeutic interventions

§ Conducting large-scale sequencing project that includes genetic data from over 30,000 patients

§ One of the patient sample sets used in this study was collected here at Iowa by William Coryell, MD, professor in the Dept. of Psychiatry― Dr. Willour was part of the Johns Hopkins lab that collaborated with Dr. Coryell in the collection of

these samples

§ Project recently funded by the American Foundation for Suicide Prevention

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Spotlight: Physical Therapy Faculty Bridge Education and Clinical Science Integrating Research and Education into Clinical Care § Ruth Chimenti, Assistant Professor, Physical Therapy and Rehab Science

§ Course Director: Evidence-Based Practice in Rehabilitation.§ NIH R00 Funding

§ Laura Frey Law, Associate Professor, Physical Therapy and Rehab Science§ Course Director: Health Promotion, Critical Inquiry II§ NIH R0-1 Funding

§ Darren Casey, Associate Professor, Physical Therapy and Rehab Science§ Course Director: Cardiovascular Physiology and Therapy, Pharmacology§ NIH R00 Funding

§ Rich Shields, Professor, Physical Therapy and Rehab Science§ Course Director: Movement Based Neuro-musculoskeletal Plasticity, IPEII§ NIH R0-1 Funding

§ Kathleen Sluka, Professor, Physical Therapy and Rehab Science§ Course Director: Pain Mechanisms and Treatment§ NIH R0-1 Funding

§ Jason Wilken, Associate Professor, Physical Therapy and Rehab Science§ Course Director: Radiology and Imaging§ DOD Funding

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Thought leadership, public serviceIntegrating Research and Education into Clinical Care

Your expertise, experience, and insight is valuable—share it with your colleagues, your profession, and the public§ Write an opinion piece for your society’s newsletter, the AAMC, or

Becker’s Hospital Review

§ Participate in a community seminar or public events

§ Work with news media (in collaboration with UI Health Care media relations professionals)

§ Get involved with professional society related to your area of expertise

Questions or comments?

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Thank you!