Research Associates Programs

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Research Associates Programs

• Frank Illuzzi, MD, FACEP
• Melanie Dabakis, BS
• Ryan King, BSEE
• Ankur Talati, BS
• Jenna Turocy, BS
• Keith Bradley, MD
• St. Vincents Medical Center

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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

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Obstacles to Research in ED

• ?

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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

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"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

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An Answer to Some of the 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?

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An Answer to Some of the 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!!!

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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?

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Research Associates

• If not, 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
• juniors sophomores freshman?

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Research Associates

• Functions
• subject identification
• demographic and historical information
• physical parameters
• read informed consent
• facilitate the research
• stuff

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Research Associates Programat Lincoln

• Process
• recruited from local colleges
• Fordham University
• Lehman College
• Manhattan College
• Mount St. Vincents
• Columbia University
• Iona College

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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

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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

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Do RA Programs Work?

• Lincoln
• first semester, 38 RAs covered ? 80 of 24/7
• by the end of two years, gt 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.

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Do RA Programs Work ?

• Lincoln
• Studies 1995-1996 w/RA assistance
• Asthma/Cocaine 112 subjects enrolled
• Window Guards 1088 subjects enrolled
• Ankle 350 subjects enrolled
• 9 page data form
• Chest Pain Evaluation limited to subject ID
• TB studies requiring
• CMV Meningitis universal precautions

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Do RA Programs Work?

• Bridgeport Hospital
• Studies
• enrolled
• Troponin T 856
• QT-Prolongation with Erythromycin 63
• CUPID ECG Analysis 100
• 1019

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Do RA Programs Work?

• Bridgeport Hospital
• Studies
• enrolled
• 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

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Do RA Programs Work?

• Bridgeport Hospital
• 1 Health Screening Studies
• enrolled
• Womens Health Screening 2676 including
  domestic violence questions
• AMAs Firearms Risk Assessment 3370
• AHAs Cardiovascular Risk Assessment 3276
• 9,322

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Do RA Programs Work?

• St. Vincents 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) 1091
• 10,970

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Do RA Programs Work?

• 20-50 RAs per semester during the school year
• ? 20-45 RAs from around the country
• for each summer semester

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Do RA Programs Work?

• 24,441 subjects
• entered in research protocols by RAs

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Do RA Programs Work?

• Sustainability
• RAs continue providing service from successful
  studies
• (e.g., at St.Vincents
• cervical, breast and prostate cancer screening
• and tobacco cessation)
• To date, 2112 patients and visitors received such
  service
• e.g., 245 additional CT Tobacco Quitline
  referrals

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Do RA Programs Work?

• To date,
• Research and Service interactions with 26,553
  patients and visitors
• with
• Cost 0
• Patient complaints about RAs 0

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RA Programs

• Benefits?
• 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
• Win-Win-Win

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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

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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

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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

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Chief RA

• To date 18 CRAs
• 12 accepted to medical school
• 6 in the application cycle

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RA Program Development

• ? research requirements
• ? financial and personnel resources
• ? clinical pressures
• need for innovative solutions
• ?
• Research Associates Programs

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RA Program at St. Vincents 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

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RA Program at St. Vincents 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
  

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Starting a Research Associates Program

• Guarantee clinical experience for large numbers
  of pre-health professions students
• Linkage with local medical centers with
• value added free research workers
• residency programs in any specialty must do
  research
• hospitals without residencies need data
  collection for quality improvement programs

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Think of These Numbers

• gt 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

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Think of This Number

• 60 million
• potential work hours
• if pre-meds served as RAs for one 4-hr shift per
  week
• in the nations emergency departments
• helping patients and visitors
• with their primary health care issues

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What Would Coca-Cola Pay?

• Access to ½ the people in the U.S.
• For several hours each year
• With a work force numbering hundreds of thousands
  of bright, committed people
• Eager to work millions of hours for compensation
  other than money

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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

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Watch ER on TVand guess what its like Be a
Research Associate in the Emergency Department
and know the reality.
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If You See the Potential

• www.RAProgram.org
• - program details and application materials
• Fall semester 2009 orientation sessions
• Saturday and Sunday, 3 and 4 October
• Keith Bradley, MD
• Director, Research Associates Program,
• KeithBradleyConsult_at_gmail.com

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• ?