scholarly journals Overcoming barriers to the adoption and implementation of predictive modeling and machine learning in clinical care: what can we learn from US academic medical centers?

JAMIA Open ◽  
2020 ◽  
Vol 3 (2) ◽  
pp. 167-172
Author(s):  
Joshua Watson ◽  
Carolyn A Hutyra ◽  
Shayna M Clancy ◽  
Anisha Chandiramani ◽  
Armando Bedoya ◽  
...  
Keyword(s):  
Machine Learning ◽  
Best Practices ◽  
Predictive Modeling ◽  
Clinical Care ◽  
Data Access ◽  
Academic Medical Centers ◽  
Structured Interviews ◽  
Medical Centers ◽  
Adoption And Implementation ◽  
Academic Medical

Abstract There is little known about how academic medical centers (AMCs) in the US develop, implement, and maintain predictive modeling and machine learning (PM and ML) models. We conducted semi-structured interviews with leaders from AMCs to assess their use of PM and ML in clinical care, understand associated challenges, and determine recommended best practices. Each transcribed interview was iteratively coded and reconciled by a minimum of 2 investigators to identify key barriers to and facilitators of PM and ML adoption and implementation in clinical care. Interviews were conducted with 33 individuals from 19 AMCs nationally. AMCs varied greatly in the use of PM and ML within clinical care, from some just beginning to explore their utility to others with multiple models integrated into clinical care. Informants identified 5 key barriers to the adoption and implementation of PM and ML in clinical care: (1) culture and personnel, (2) clinical utility of the PM and ML tool, (3) financing, (4) technology, and (5) data. Recommendation to the informatics community to overcome these barriers included: (1) development of robust evaluation methodologies, (2) partnership with vendors, and (3) development and dissemination of best practices. For institutions developing clinical PM and ML applications, they are advised to: (1) develop appropriate governance, (2) strengthen data access, integrity, and provenance, and (3) adhere to the 5 rights of clinical decision support. This article highlights key challenges of implementing PM and ML in clinical care at AMCs and suggests best practices for development, implementation, and maintenance at these institutions.

scholarly journals Implementing Resident Team Assistant Programs at Academic Medical Centers: Lessons Learned

2020 ◽  
Vol 12 (6) ◽  
pp. 769-772
Author(s):  
Ryosuke Takei ◽  
George Dalembert ◽  
Jeanine Ronan ◽  
Nicole Washington ◽  
Stuti Tank ◽  
...  
Keyword(s):  
Job Satisfaction ◽  
Clinical Care ◽  
Lessons Learned ◽  
Academic Medical Centers ◽  
Institutional Goals ◽  
Medical Centers ◽  
Academic Medical ◽  
Medical Teams ◽  
Administrative Task ◽  
Administrative Tasks

ABSTRACT Background Excessive inpatient administrative tasks can lead to adverse consequences for residents and their patients. Furthermore, this burden has been linked to depersonalization, a major component of physician burnout. Objective To describe the development, implementation, feasibility, acceptability, and early outcomes of Resident Team Assistant (RTA) programs. Methods Three large academic medical centers created RTA programs in which administrative assistants are incorporated into inpatient medical teams. First steps included a needs assessment and driver diagram creation to identify key issues and to solidify goals. Program directors were assigned, and RTAs were hired, trained, and incorporated into inpatient teams at each institution (2003, 2016, 2018). Program leadership and institutional stakeholders met regularly to discuss development and quality assurance. Surveys and direct interviews were performed to evaluate impact and acceptability. Institutional goals in accordance to RTAs tasks were also investigated. Results Resident surveys and interviews have shown acceptability with RTAs completing a large percentage of resident administrative tasks while promoting time spent in direct clinical care and job satisfaction. Hospital-specific improvements have included increase in referring physician communication rate and decrease in work hour violations. The programs have maintained high feasibility and sustainability with a relatively low time commitment from leadership and cost for the institutions. Conclusions The RTA programs at the 3 institutions have continued to be sustained over time with perceived improvements in administrative task burden and job satisfaction for the residents. They have maintained high acceptability and feasibility in terms of effort and costs for the hospitals.

scholarly journals 2389

2017 ◽  
Vol 1 (S1) ◽  
pp. 38-39
Author(s):  
Molly Wasko ◽  
Elaine Morrato ◽  
Nicholas Kenyon ◽  
Suhrud Rajguru ◽  
Bruce Conway ◽  
...  
Keyword(s):  
Best Practices ◽  
Network Capacity ◽  
Lessons Learned ◽  
Academic Medical Centers ◽  
Conference Calls ◽  
Train The Trainer ◽  
Medical Centers ◽  
Academic Medical ◽  
Teaching Team ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: The goal of this abstract/presentation is to share lessons learned from participation in the NIH SBIR I-Corps Train-The-Trainer Program, discuss our experiences offering programs at our local institutions, and communicate our plans to develop an I-Corps@NCATS program that can be disseminated across the CTSA network. We believe that an I-Corps@NCATS program will enhance the process of scientific translation by taking best practices from NSF I-Corps and adapting the program to meet the needs of biomedical scientists in academic medical centers. By integrating I-Corps@NCATS training, we hypothesize that the clinical and translational investigator base will be better prepared to identify new innovations and to accelerate translation through commercialization. METHODS/STUDY POPULATION: The diverse, interdisciplinary team of investigators involved in this project span 9 CTSA Hubs, including UAB, Rockefeller, UC Denver, HMC-Penn State, UMass, UC Davis, Emory/Georgia Tech, Miami and Michigan. This team was funded by NCATS in 2015–2016 to participate in the CTSA I-Corps Train-The-Trainer Program in conjunction with the NIH-SBIR/STTR I-Corps national program. The goals were to observe the curriculum, interact with and learn from the NSF National Teaching Team and begin implementation of similar programs at our home institutions. Our I-Corps@NCATS team has been holding monthly, and more recently weekly, conference calls to discuss our experiences implementing local programs and to develop a strategy for expanding CTSA offerings that include innovation and entrepreneurship. Our experience revealed several challenges with the existing NSF/NIH I-Corps program offerings: (1) there is no standard curriculum tailored to academic clinical and translational research and biomedical innovations in the life sciences, and (2) the training process to certify instructors in the I-Corps methodology is a much more rigorous and structured process than just observing an I-Corps program (eg, requires mentored training with a national NSF I-Corps trainer). Our team is proposing to address these gaps by taking best practices from NSF I-Corps and adapting the program to create the I-Corps@NCATS Program, tailored to meet the needs of researchers and clinicians in academic medical centers. RESULTS/ANTICIPATED RESULTS: There are 3 primary anticipated results of our project. First, develop a uniform curriculum for the I-Corps@NCATS Program using the National Teaching Team of experts from the NIH’s SBIR I-Corps program. Second, build the I-Corps@NCATS network capacity through a regional Train-The-Trainer Program. Third, develop a set of common metrics to evaluate the effectiveness and impact of the I-Corps@NCATS Program across the community of CTSA Hubs and their respective collaborative networks. DISCUSSION/SIGNIFICANCE OF IMPACT: Over the past 10 years, CTSA Hubs have accelerated science by creating/supporting programs that provide research infrastructure, informatics, pilot funding, education/training, and research navigator services to investigators. These investments help to ensure that we are “doing science right” using the best practices in clinical research. Even so, it is equally important to make investments to ensure that we are “doing the right science.” Are our investigators tackling research problems that our stakeholders, patients, and communities want and need, to make sure that our investments in science have real-world impact? In order to accelerate discoveries toward better health, scientists need to have a better way to understand the needs, wants and desires of the people for whom their research will serve, and how to overcome key obstacles along the path of innovation and commercialization. To fill this gap, we propose that the CTSA Hubs should include in their portfolio of activities a hands-on, lean startup program tailored after the highly successful NSF Innovation Corps (I-Corps) program. We hypothesize that by adapting the NSF I-Corps program to create an I-Corps@NCATS program tailored to medical research, we will better prepare our scientists and engineers to extend their focus beyond the laboratory and broaden the impact of their research. Investigators trained through I-Corps@NCATS are expected to be able to produce more innovative ideas, take a more informed perspective about how to evaluate the clinical and commercial impact of an idea, and quickly prototype and test new solutions in clinical settings.

Confronting Conflict: Addressing Institutional Conflicts of Interest in Academic Medical Centers

2010 ◽  
Vol 36 (1) ◽  
pp. 136-187 ◽  
Author(s):  
Bryan A. Liang ◽  
Tim MacKey
Keyword(s):  
Conflicts Of Interest ◽  
Clinical Care ◽  
Study Participant ◽  
Academic Medical Centers ◽  
Public Healthcare ◽  
Federal Grant ◽  
Medical Centers ◽  
Academic Medical ◽  
Commercial Enterprise ◽  
Education Academic

Individual conflicts of interest are rife in healthcare, and substantial attention has been given to address them. Yet a more substantive concern-institutional conflicts of interest (“ICOIs”) in academic medical centers (“AMCs”) engaged in research and clinical care—have yet to garner sufficient attention, despite their higher stakes for patient safety and welfare. ICOIs are standard in AMCs, are virtually unregulated, and have led to patient deaths. Upon review of ICOIs, we find a clear absence of substantive efforts to confront these conflicts. We also assess the Jesse Gelsinger case, which resulted in the death of a study participant exemplifying a deep-seated culture of institutional indifference and complicity in unmanaged conflicts. Federal policy, particularly the Bayh-Dole Act, also creates and promotes ICOIs. Efforts to address ICOIs are narrow or abstract, and do not provide for a systemic infrastructure with effective enforcement mechanisms. Hence, in this paper, we provide a comprehensive proposal to address ICOIs utilizing a “Centralized System” model that would proactively review, manage, approve, and conduct assessments of conflicts, and would have independent power to evaluate and enforce any violations via sanctions. It would also manage any industry funds and pharmaceutical samples and be a condition of participation in public healthcare reimbursement and federal grant funding.The ICOI policy itself would provide for disclosure requirements, separate management of commercial enterprise units from academic units, voluntary remediation of conflicts, and education on ICOIs. Finally, we propose a new model of medical education—academic detailing—in place of current marketing-focused “education.” Using such a system, AMCs can wean themselves from industry reliance and promote a culture of accountability and independence from industry influence. By doing so, clinical research and treatment can return to a focus on patient care, not profits.

scholarly journals Marketing the Research Missions of Academic Medical Centers: Why Messages Blurring Lines Between Clinical Care and Research Are Bad for both Business and Ethics

2019 ◽  
Vol 28 (3) ◽  
pp. 468-475 ◽  
Author(s):  
MARK YARBOROUGH ◽  
TIMOTHY HOUK ◽  
SARAH TINKER PERRAULT ◽  
YAEL SCHENKER ◽  
RICHARD R. SHARP
Keyword(s):  
Science Communication ◽  
Clinical Care ◽  
Research Integrity ◽  
Informed Consent Process ◽  
Ethical Analysis ◽  
Academic Medical Centers ◽  
Therapeutic Misconception ◽  
The Public ◽  
Medical Centers ◽  
Academic Medical

Abstract:Academic Medical Centers (AMCs) offer patient care and perform research. Increasingly, AMCs advertise to the public in order to garner income that can support these dual missions. In what follows, we raise concerns about the ways that advertising blurs important distinctions between them. Such blurring is detrimental to AMC efforts to fulfill critically important ethical responsibilities pertaining both to science communication and clinical research, because marketing campaigns can employ hype that weakens research integrity and contributes to therapeutic misconception and misestimation, undermining the informed consent process that is essential to the ethical conduct of research. We offer ethical analysis of common advertising practices that justify these concerns. We also suggest the need for a deliberative body convened by the Association of American Medical Colleges and others to develop a set of voluntary guidelines that AMCs can use to avoid in the future, the problems found in many current AMC advertising practices.

scholarly journals Training medical educators to teach: bridging the gap between perception and reality

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Alison Trainor ◽  
Jeremy B. Richards
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Best Practices ◽  
Curriculum Design ◽  
Healthcare Providers ◽  
Policy Research ◽  
Educational Interventions ◽  
Academic Medical Centers ◽  
Medical Centers ◽  
Academic Medical

AbstractTeaching is a core expectation of physicians in academic hospitals and academic medical centers, but best practices for training physicians to teach have not been established. There is significant variability in how physicians are trained to teach medical students and residents across the world, and between Israeli hospitals. In an article published earlier this year in the Israel Journal of Health Policy Research, Nothman and colleagues describe a survey of 245 Israeli physicians in departments of internal medicine, pediatrics, and obstetrics and gynecology, at four different faculties of medicine across Israel. The majority of Israeli physicians responding to this survey reported receiving minimal training to teach, with only 35% receiving any training focused on medical education skills, most (55%) receiving training of only 1–2 days duration. In addition, the physicians surveyed perceived their training as inadequate and not aligned with their self-perceived educational needs. Furthermore, the respondents felt strongly that “compensation and appreciation” for medical education was less than for those involved in research. Despite the general lack of training in teaching skills and the perception that teaching physicians are less valued than researchers, survey respondents rated themselves as highly confident in most domains of medical education. In this context, this commentary reviews the disconnect between the general perception that all physicians can and should engage in teaching in the clinical setting with the well-described observation that competence in medical education requires dedicated and longitudinal training. Leveraging best practices in curriculum design by aligning educational interventions for teaching physicians with their self-perceived needs is discussed, and models for dedicated faculty development strategies for teaching medical education skills to physicians are reviewed. Finally, the importance of and potential strategies for assessing teaching physicians’ effectiveness in Israel and elsewhere are considered as a means to address these physicians’ perception that they are not as valued as researchers. Understanding teaching physicians’ perspectives on and motivations for training medical students and residents is critical for supporting the frontline teaching faculty who educate future healthcare providers at the bedside in medical schools, hospitals, and academic medical centers in Israel and beyond.

Unplanned Reoperation and Implant Revision After Total Wrist Arthroplasty

Hand ◽  
2020 ◽  
pp. 155894471989881 ◽  
Author(s):  
Taylor M. Pong ◽  
Wouter F. van Leeuwen ◽  
Kamil Oflazoglu ◽  
Philip E. Blazar ◽  
Neal Chen
Keyword(s):  
Risk Factors ◽  
Implant Removal ◽  
Academic Medical Centers ◽  
Implant Design ◽  
Factors Associated ◽  
Medical Centers ◽  
Total Wrist Arthroplasty ◽  
Academic Medical ◽  
Related Risk ◽  
Wrist Arthroplasty

Background: Total wrist arthroplasty (TWA) is a treatment option for many debilitating wrist conditions. With recent improvements in implant design, indications for TWA have broadened. However, despite these improvements, there are still complications associated with TWA, such as unplanned reoperation and eventual implant removal. The goal of this study was to identify risk factors for an unplanned reoperation or implant revision after a TWA at 2 academic medical centers between 2002 and 2015. Methods: In this retrospective study, 24 consecutive TWAs were identified using CPT codes. Medical records were manually reviewed to identify demographic, patient- or disease-related, and surgery-related risk factors for reoperation and implant removal after a primary TWA. Results: Forty-six percent of wrists (11 of 24 TWAs performed) had a reoperation after a median of 3.4 years, while 29% (7 of 24) underwent implant revision after a median of 5 years. Two patients had wrist surgery prior to their TWA, both eventually had their implant removed ( P = .08). There were no risk factors associated with reoperation or implant removal. Conclusion: Unplanned reoperation and implant removal after a primary TWA are common. Approximately 1 in 3 wrists are likely to undergo revision surgery. We found no factors associated with reoperation or implant removal; however, prior wrist surgery showed a trend toward risk of implant removal after TWA.

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