Public Health Sciences offers five new Advanced Certificates

The Department of Public Health Sciences is now offering five Advanced Certificate programs covering a range of public health issues.JimDolan

“These could be a good fit for working professionals who want to acquire these sort of skills to help them in their current job who don’t have the time or inclination to get a full degree,” said James G. Dolan, associate professor of Public Health Sciences. “These smaller-sized versions of our degree programs that are easier, more accessible, and perhaps more appropriate for a lot of people.”

Though certificate applications are closed for this fall, those wanting to get a jump can still take non-matriculated classes and then enroll in Spring 2016, which will allow them to apply the credits retroactively. The five certificates:

Analytic epidemiology (12 credits)

-Provides a practical understanding of quantitative research methods through a selection of epidemiology courses.

Clinical research methods (12 credits)

-Designed to give a broad overview of both quantitative and qualitative research.

Trial-based clinical research (12 credits)

-Designed for those who want to learn more about conducting controlled trials.

Health services research (12 credits)

-Designed for those looking to navigate the changing health care landscape.

Public health (15 credits)

-A less intensive version of the Master’s in Public Health; designed for people who are interested in sitting for the American Board of Public Health certification exam.

Learn more about the programs, or email James_Dolan@urmc.rochester.edu for more information.

The Department of Public Health Sciences has also partnered with the CTSI on an Advanced Certificate of Biomedical Informatics. Learn more.

UR CTSI Working to Advance Regulatory Science Training

Dr. Joan Adamo and Dr. Scott Steele recently published an article in the Clinical and Translational Sciencecover june 2015 Journal entitled “Advancing a Vision for Regulatory Science Training.” Regulatory science is a new and burgeoning field and is defined by the FDA as “the science of developing new tools, standards, and approaches to assess the safety, efficacy, quality and performance of FDA-regulated products.” Training programs in regulatory affairs, which is learning what the regulations are and how to apply them to projects is very common. However, training in regulatory science is less developed. In this article, Drs. Adamo and Steele advance regulatory science by identifying 11 thematic areas of training that contribute to regulatory science. These themes were identified by a Regulatory Science workgroup and then vetted by a group of interdisciplinary experts during a workshop in Washington, DC last fall. In support of this workshop, an extensive Regulatory Science survey was conducted of experts from industry, academia, government, not-for-profit organizations, associations and foundations to further prioritize and refine the proposed Regulatory Science competencies. Some examples of the Regulatory Science competencies include regulatory policies and process, research ethics, drug discovery and development, clinical trials, post-marketing and compliance, and communication.

This work was done in collaboration with other CTSAs. Future plans include developing a training network by identifying which academic institutions have expertise in the various thematic training areas, creating opportunities to share training amongst institutions and providing experiential learning opportunities in the training areas. In the future, “investigators will be able to pick and choose training topics related to regulatory science that will bolster the work they do in their field of expertise”, says Adamo.

Many investigators engage in regulatory science and don’t realize they are doing it. “The CTSI is helping faculty realize that their research often impacts this field, even if their work does not directly involve the regulation of a product” says Steele. What scientists work on now may help speed the development of other drugs or devices in the future. Put simply, “Regulatory science is any science that comes up with new ways so that products can be regulated and be brought out safely”, says Adamo. This includes reducing costs and the time it takes to get a safe and effective product approved. Steele notes, “A key element to advancing regulatory science and translational science is enabling research and educational collaborations across FDA, NIH, industry, academia and foundations.”

Stay tuned. In the fall, the UR CTSI will offer a series of seminars on regulatory science. Experts from academia, industry and the FDA will be here to present their latest work in the field of regulatory science.

CTSI welcomes new KL2 scholars

KL2 Collage

(L. Auerbach, R. Chen)

The CTSI KL2 Career Development Program welcomed two new scholars on July 1st. The program provides two years of support for new investigators interested in a career in clinical or translational research

David Auerbach, PhD is a Senior Instructor in the Department of Medicine, Aab Cardiovascular Research Institute. He will be working on a project titled, “Electrical Disturbances in the Brain and Heart in Long QT Syndrome: A Dangerous Synergy.” He takes a multidisciplinary, translational approach to investigating genetic ion channel diseases of the brain and heart. His mentor is Arthur Moss, MD.

Wei Chen, MD is a Assistant Professor in the Department of Medicine, Nephrology. She will be working on a project titled, “Does Metabolic Acidosis Protect Against Arterial Calcification in Patients with CKD?” Her research focuses on identifying and correcting the risk factors that contribute to the high cardiovascular mortality in patients with chronic kidney disease. Her mentor is David Bushinsky, MD.

Click here for more information on current and past KL2 scholars.

Silence in the exam room: a CTSI scholar reflects on his year out

Josef Bartels spent a year at the CTSI as a medical year-out student, where he studied the role of silence in doctor-patient interactions and completed his MPH. He recently spoke with CTSI Stories about his year.

JosefBartels

Thanks for taking the time to chat, Josef. How did you come to apply for the Year-Out program?

It was early third year of medical school and I had an elective rotation in palliative care with Dr. Ronald Epstein. I really enjoyed what I did there because it struck a chord with my humanities background. In palliative care, you’re often at the point where there’s not much more you can do to cure. Instead, you’re dealing in issues that people have written about and physicians have been witness to for centuries – like the meaning of life, the meaning of suffering, and how to die with dignity. The lack of solid answers and the human messiness of it all really resonated within me.

I also realized there was something going on in those conversations that I wasn’t hearing as often in other medical settings. I have a musical background, and realized that there was a lot going on with tone and silence. It all reminded me of a Radiolab podcast I heard called The Musical Language, where they were talking about how mothers all over the world talk to their babies in the same notes – that if you take out the words and play it on a piano, it sounds similar even when from widely different linguistic lineages.

I wondered if there was also some musicality within medical conversations. Are there common patterns? Is silence meaningful? I told Dr. Epstein I wanted to study this, and he said he didn’t think I could pull off what I was considering in my spare time. So that’s when I applied for the Year Out.  Dr. Epstein agreed to be my mentor and helped me put together a research team with fellow year out scholar Rachel Rodenbach and Eastman School of Music professor of Voice Katherine Ciesinski.

Tell me more about these conversational moments that you mentioned.

I didn’t set out to study specific moments. I wanted to focus on the rhythm of medical conversations, and specifically the silence in these conversations. There has been a lot written about silence in psychology, linguistics, and neuroscience — so it was a wonderful exploration of a number of different fields in order to focus in on this one phenomenon that happens to be present in medical communication. When I started hearing different types of silences, there was one specific type that was fascinating, and that seemed to occur during these particular moments where there is shared meaning without words. These moments exist in medicine everywhere, but I think they’re more common in situations with mortal consequences and an opportunity for shared decision making, which includes almost every specialty.

So how did you design your study on these silences?

There was another type of silence that popped up a lot, and it was always associated with exam-room computer usage. There has been a lot written on computers and electronic health records, including some work that demonstrates a lot more silence now that there are computers in the exam room. That extra silence, the particular flavor associated with computing, is controversial. Does it give the patient the chance to ask questions? Does it indicate imperfect multitasking?

I set out to measure how long these silences were and how many there are, and I correlated those with counts of specific physician communication tasks. The results are intriguing and suggestive, though the confidence intervals are wide. If I had designed it from the beginning, I would’ve tried hard to find an outcome variable with a normal distribution. Either way it was valuable experience to learn statistics and practice quantitative analyses and manage a large data set, and the results were recently accepted for oral presentation at the International Conference on Communication in Healthcare.

I see. And the other part?

We’re calling these seemingly meaningful pauses in conversation “connectional silences,” because they seem to represent some kind of connection between the physician and the patient – or sometimes between a caregiver and the physician.

How did you define a “connectional silence” for the study? How did you know what to include?

This analysis relied heavily on grounded qualitative methods, which allowed us to develop a rigorous way of identifying a previously unstudied phenomenon. We developed inclusion and exclusion criteria, and then measured interrater reliability between three people identifying these silences to validate these criteria. For example, one of the inclusion criterion is there’s some emotion expressed by the patient which the physician recognized and then acknowledged. Then we ran it by a panel of physicians for additional validation that we weren’t just making these differences up.

For the analysis, I worked with Katherine Ciesinski to define these silences using musical notation, because it is designed to capture the data we were interested in; volume, pitch, rhythm, and tone. When you listen to these moments, they just sound special – they were qualitatively different, and we wanted to know why. We had to define what, exactly, was it that we were hearing in these silences? What is the sonic environment within which these pauses exist? We looked at pitch, volume, intensity, and then we looked at rhythm.

Rhythm was where patterns leapt out and connections became clear. Once we visualized the audio environment of the conversation, we could see that as the “connectional” moments approached, the length of time that each person spoke for began to merge. One person would talk for 5 seconds, then the other would talk for 5 seconds, then 2 and 2, then just a word each. The doctor and patient would match the length of their sentences. Other literature which focused on successful business deals and even successful courting showed similar rhythm in successful conversation patterns – they called it mirroring. Contrast that with a moment where the physician is providing a lot of info, giving a monologue for a minute or two, and then the patient just replies “OK, got it” – and not to put a higher value on one or the other, but they are qualitatively different, and we’ve been able to show that through a new window called dialog rhythm.

We think these patterns might be linked to mirror neurons, which are a hot topic these days. These neurons might light up when you really listen to someone, so a part of your motor cortex actually models what you are listening to, as if you’re moving your mouth and your own tongue. When you begin to respond, you match pitch, volume, and rhythm, because your motor neurons have just practiced it. It that sense, we might be getting close to another channel that can measure engagement, in addition to body position and eye contact.

Where do you go from here? Can you make a career studying silence in medicine?

The short answer is yes. Patient centered communication and a therapeutic relationship are gaining empiric support daily. From issues of medication adherence to physician burnout, we are recognizing that communication and the connection between people is the foundation of medicine, and leads to measurable and meaningful gains in health outcomes. Federal funding through NIH, PCORI, AHRQ and others are interested in exploring how the human experience affects and interacts with more “objective” data like BMI and blood pressure. It’s a relief to me that after a century of trying to control for the placebo effect, the mechanisms and pathways of this and other psychosocial effects of giving care and attention to a fellow human being are getting some attention. Medicine is going to be relationship-centered, because quality communication and caring relationships promote health and wellbeing, and have the potential to act before, during, and after a patient develops disease. Our research took us one step closer to measuring the quality of engagement between patient and doctor, a connection that can then be linked to any number of health outcomes.

In terms of next steps, I’d really like to see if a computer can pick out the silences that are associated with computer use, in order to give a non-invasive and simple measure of computer-centered vs patient-centered care. Then we could measure patient outcomes that might lead to computer redesign or the realization that it might be more effective to pay the physician (or a data expert) to manage the patient’s data separately from interacting with the patient. Electronic medical records have gone far beyond the charting of diagnostic rationale and are really entering the realm of big data. The task of forming a trusting relationship to facilitate preventive, diagnostic, and curative procedures is complex, and managing big data simultaneously may be dangerous in as many ways as it’s helpful. We’re really struggling to measure things like this that affect nearly every medical interaction every day. This is what motivates me to continue research in medical communication.

CTSI Welcomes New Year Out Trainees

New ART

(L. Erika Snow, R. Leigh Sundem)

The CTSI Year Out Program for Medical Students welcomed two new trainees on July 1st. The CTSI supports medical students interested in a year-out experience of mentored research in clinical or translational research; most students enter through the Academic Research Track (ART) program.

Erika Snow will be working with Dr. Scott McIntosh on a project titled “The Role of E-cigarettes as a Barrier to Smoking Cessation.” Dr. McIntosh’s research focuses on stop-smoking interventions with various populations and the training of physicians and other medical professionals in guideline-based nicotine dependence interventions. Erika will also pursue a Masters in Public Health during her year out.

Leigh Sundem will be working with Dr. John Elfar on a project titled “Erythropoietin for Compression Neuropathy: Preclinical Efficacy and Cellular Site of Action.” Dr. Elfar specializes in the treatment of sports and hand, wrist, elbow, and shoulder problems. His clinical interests include all aspects of upper extremity trauma and reconstruction as well as injuries in the competitive and recreational athlete.

Click here to view all previous CTSI trainees.

For more information on CTSI education programs like the Year Out program , contact Katie Libby, CTSI Education Program Manager, at katherine_libby@urmc.rochester.edu.

 

Need Study Coordinator Support for a Clinical Trial? We Can Help!

UR Connected is an application that supports connections between research coordinators and plug-ininvestigators or administrators. Coordinators can: post information about qualifications; advertise availability for new or additional projects; browse for job titles and HRMS IDs for posted jobs; Browse for opportunities to contribute in their spare time. Investigators and Administrators can: search for coordinators with qualifications and availability that match current needs; post HRMS jobs to make it easier for coordinators to find positions that involve research coordination; and advertise opportunities that are more limited than a posted position in HRMS. For more information contact researchhelp@urmc.rochester.edu.

Trying to find a collaborator at the URMC? We Can Help!!

The URMC Research Network website is a tool supported by the URMC that contains information from research clusterfaculty profiles and publications. You can search the database using key words to identify faculty with particular research interests. The faculty information displayed on the website comes from several sources including eCV, the SMD Dean’s Office, and PubMed. All people with a faculty appointment in the URMC School of Medicine and Dentistry are included in the URMC Research Network website except for those with only a “Primary Administrative” appointment.