|
Administrative Impact
The present language
states:
(b) Clinician-Educators
have a substantial impact on preexisting educational, clinical, and
administrative practice at this institution. This standard is met when the candidate:
(i)
Ranks among the most distinguished educators or administrators at this
institution. Such cases must
include unambiguous and objective evidence of distinction, and document the
practices that have led to distinction.
and/or
(ii)
Through leadership, has achieved or maintained excellence in a significant
educational program (e.g., a clerkship, residency, or fellowship) or
administrative function (e.g., management of a clinic or multi-physician
practice, clinical laboratory, etc.).
Such cases must include unambiguous and objective evidence of
achieving or maintaining excellence, and document the practices that have led
to excellence.
and/or
(iii)
Has devised and/or implemented significant improvements in educational,
administrative, and/or clinical practices by, for example, curricular
revision, implementation of new programs and administrative practices,
creation of new educational or administrative tools, etc. Such impact should be documented
rigorously by describing in detail the preexisting practice, the revised
practice, and the impact the revisions have had.
Proposals
for promotion on the basis of (i), (ii), and/or (iii) must include written
statements from leading figures – educational, administrative, and/or
clinical, as approprate – in the candidate's field from outside this
institution. These statements
must analyze and evaluate the specific practices that have led to substantial
impact on preexisting educational, clinical, and administrative practice, and
cite the evidence for their conclusions. Great care must be taken to avoid the appearance of
gratitude or reward for faithful service as justification for promotion.
Following
are actual candidate's portions of eforms submitted in successful COAP cases
in which "internal impact" is invoked as a basis for promotion to
Associate Professor CE.
Disclaimer: The following information is drawn from
materials prepared by candidates for promotion to associate professor in the
Clinician-Educator track, and is presented with the candidates'
permission. It is intended to illustrate activities and materials that
might support promotion. In using these materials, please note the
following:
*The Provost (and, in some cases, the President) are the University officers
authorized to approve promotions. All levels of review below these
officers are advisory.
*Only Departments are empowered to propose promotions, and the Divisional
Dean is charged with transmitting such proposals to the Provost or returning
them to the Department.
*The judgment of the Department, Dean, and Provost will therefore
be critical to assessing qualification for promotion.
*Materials considered by the Department, Dean, and Provost will also (and
always) include confidential evaluations obtained from outside the
University. Materials considered by the Provost will include the
confidential evaluations of the Dean and Department, and those considered by
the Dean will include the confidential evaluations of the Department.
*Thus, the following materials are ONLY PART of a complete proposal for
promotion, whereas promotion is based on the ENTIRE proposal.
Therefore, it should not be assumed that a record comparable to that below
will necessarily result in promotion, or that a record not comparable to that
below will fail to result in promotion. The Departmental Chair is
likely to be the best source of advice as to whether promotion is feasible
and, when it is not, what additional activity may result in qualification for
promotion.
*This document has been prepared as a tool for use by assistant professors in
the Division of the Biological Sciences. Other individuals who may find
it informative are Department Chairmen, Section Heads, Committee Chairmen,
senior faculty and potential recruits. Its intent is to help guide individuals
and their departments as they think about promotion to Associate Professor in
the Clinician-Educator track. This document is not intended to list the
elements that every promotion proposal will be expected to address. The
following information is presented for information purposes only and is not
intended to create any contract or agreement, and its contents are subject to
addition, deletion, and change without prior notice.
IMPACT ON ADMINISTRATIVE PRACTICE:
a. Pre-existing practice.
|
1. AAALAC: The institution has been planning to become
AAALAC accredited for almost 20 years. The University of Chicago was one of the few top funded
research institutions without AAALAC Accreditation. A considerable amount of effort was
made toward accreditation between 1998 – 2000. I was a member of the
veterinary team that helped prepare the program during this time. The program was given Provisional
Accreditation in 2000. The Provisional Accreditation indicated a number of
areas of concern that needed to be addressed before Full Accreditation
would be given to the University.
Many items were addressed after the first site visit, however AAALAC
was still concerned about the program and mandated a re-site visit the
following year. The main
concern appeared to be due to the number of significant changes in the
animal program that had occurred prior to and after the first site
visit. A new Dean of the
BSD had been appointed, the previous IACUC chair stepped down, the ARC
Director resigned, the largest facility on campus was undergoing a major
renovation project and an entire new outsourced husbandry team had been put
in place a few months prior to the first site visit.
2.
Husbandry Contract: Prior to
the year 2000, the staff working in the animal facilities were inadequately
trained and repeated problems occurred resulting in damage to research
studies and disease outbreak problems. It was decided to outsource the husbandry staff to a
contract vendor. This occurred
in 2001, however within 2 months of the initiation of this project the
previous Director left for another position. At the time of his departure there were numerous
problems with implementing the husbandry contract and the quality of the
care provided was not to acceptable standards. This was likely one of the concerns from AAALAC that
necessitated the re-site visit describe above.
|
b. Intervention/innovation.
|
1. AAALAC:
After the departure of the previous ARC Director, I took over the efforts
to obtain AAALAC accreditation.
I rewrote the program description and prepared the program for the
accreditation visit. My goal
was to show AAALAC that the program was strong with the new leadership and
the institution was committed to AAALAC accreditation. The AAALAC program description for
the University of Chicago is over 100 pages and is a complete description
of every aspect of the animal care and use program on campus. The only way to complete the
description is to perform a complete self evaluation of the program. An important aspect of writing the
program description is that deficiencies in the program are identified and
then corrected. I made this
process a team effort and involved all of the ARC staff and individuals
from multiple areas of the institution. This ARC process was accomplished by conducting weekly
meetings with the staff to fully understand how we were providing care to
the animals, if the procedures and equipment we were using met regulatory
standards, and to address any mechanical or facility problems that required
repair or renovations.
Numerous standard operating procedures were revised and new standard
operating procedures were written.
The veterinary staff revised the way anesthetic, analgesic and
euthanasia sections were described to be more easily understood and we
reformatted and eliminated sections from the previous description to make
the description more concise and informative.
In addition to meeting with the ARC, meetings and
conferences with other individuals had to occur in preparation for the site
visit and completing the program description. I routinely met with staff of the Office of Research Services
involved with the Institutional Animal Care and Use Committee and
Institutional Biosafety Committee to accurately describe our process for
approving and managing their respective protocols. AAALAC requires the
institution to categorize all the protocols according to the type of
research and if hazardous materials are used. We updated and revised this description to more
accurately reflect the research performed at this institution. Although this was done for the
previous site visit, we also reformatted this information so it was more
informative and easier to understand.
One specific aspect we focused on was the occupational health and
safety program for the University.
The new University of Chicago Occupational Medicine office had just
opened and we were using this new program for all personnel working in the
animal facilities or exposed to animals in research. The previous occupational health
and safety program in place during the previous site visit, which utilized
an off site service, had not been fully implemented due to poor design and
great inefficiencies.
Occupational health and safety are typically closely looked at by
AAALAC and this was a very important item to address. We reviewed and fully
implemented this new program.
I also worked with the new IACUC chair and committee to
implement some of the changes that had been implemented or proposed to the
IACUC protocol review process as part of the provisional
accreditation. We spent time
at several of the regular IACUC meeting preparing for the site visit.
As the site visit approached, myself and the other two
veterinarians performed mock site visits to the animal facilities and
investigator laboratories.
These mock site visits help to train the staff and investigators on
what to expect and help us to identify problems and correct them.
2. Husbandry Contract: I began to manage the husbandry contract in 2001 and
began frequent meetings between myself, my operations manager Carol
Mathieu, my financial manager Paul Breider, and the contractor. We began to work together to
resolve the issues related to managing the contract. These resolutions involved setting
up clear lines of communication between the ARC and the contractor,
increasing the number and quality of staff in the facilities, modifying the
training requirements for the staff, implementing controls on hiring of
staff to work in the facilities, and removal of problem employees. The husbandry contract between The
University and the contractor was, and is still today, the largest
outsourcing of animal care staff at an academic institution.
The
training issues, which were identified as the cause of many of the problems
with care in the facilities, were addressed by setting up a training matrix
which provides basic requirements for reading standard operating
procedures, and hands-on training by an experience individual prior to
working independently.
It also provides for continuous refresher training. In addition to training, a problem
was identified regarding the experience of the staff at the time of
hiring. The contract currently
requires a bachelors degree or significant animal care experience. We modified the hiring
practice to assure that everyone hired had some animal related experience
regardless of their degree. This
was implemented by having someone from the ARC review the qualifications of
the staff prior to hiring.
This system has significantly improved the quality of the staff and
the care the technicians provide in the animal facilities. The final item addressed was
management of the contract.
The on-site management team and the individual at the corporate
office were not effective and this resulted in problems related to the care
provided to the animals, billing errors, low staff morale, and
inappropriate attention to important issues. The ARC management team worked with the contractor to
quickly resolve this situation and to put an effective on-site management
team in place. These
interventions significantly improved the husbandry contract and ultimately
the care provided to the animals and the services available to
investigators.
|
c. Outcome.
|
1. AAALAC:
In 2002 AAALAC performed their re-site visit. Three lab animal professionals
spent three days reviewing all aspects of the program. At the end of the site visit, the
site visitors indicated they were very impressed with the program and were
going to recommend Full Accreditation. The University received the letter from
AAALAC council a few months later that The University had been given Full
Accreditation for the first time. No mandatory items for correction were in the
final letter and we only received three suggestions for improvement. In receiving AAALAC
accreditation, The University of Chicago joined more than 700 organizations
and companies in 28 countries which are accredited by AAALAC. The University of Chicago and one
other institution were the only institutions of the top 100 funded
institutions that were not AAALAC accredited at the time of the site
visit. All 100 of the top 100
funded research institutions are now AAALAC accredited. Many private biomedical organizations strongly recommend that
grantees be supported by AAALAC-accredited animal programs. Government
agencies also regard AAALAC accreditation as evidence of a commitment to
excellence. Accreditation ensures private and public funding sources that
animal use will be justified and humane, and can have a favorable impact on
the funding proposal's review.
2. Husbandry Contract:
After a year of managing the contract we had significantly improved
the animal care staff in the facilities. Complaints from the researchers using the facilities
were significantly decreased.
The number of husbandry related problems has decreased significantly
and open and clear communication between ARC and the contractor now occurs.
The husbandry care
has been substantially improved compared to the previous animal care
staff. As a result of the
improved quality of the animal care staff, I have been able to offer
specialized technical services to a number of investigators using the
animal facilities. Animal
technicians are now managing breeding programs for investigators,
administering research compounds for investigators, and conducting other
technical procedures for investigators. This is a great benefit to the research faculty who use
our facilities. We hope to be
able to continue to expand these services, which are not typically
available at other institutions.
|
d. Evidence
|
1. AAALAC: The
evidence of this accomplishment is that we attained Full Accreditation by
AAALAC in 2002 and were given Full Accreditation again in 2005 with only
one minor suggestion for improvement.
We received great compliments again in 2005 on the condition of the
animal care program and how well the program description was prepared. It is not common for institutions
to receive just a few suggestions for improvement, especially those newly
accredited. This indicates the
strength of the program in place at The University of Chicago. The AAALAC Accreditation itself is
evidence of external recognition of the high quality of the animal research
program at The University of Chicago.
2. Husbandry Contract: There are numerous faculty which can attest to the
improvement of service provided by the contract staff compared to the
previous staff. They can also
attest to the quality of the technical services currently available.
My
general impact on the animal research program and in the operation of the
Animal Resources Center can also be seen in the recent survey of animal
users sent out in 2005 and mentioned in the clinical activity section.
|
IMPACT ON ADMINISTRATIVE PRACTICE:
a. Pre-existing practice
|
The Outpatient Senior Health Center at South Shore where
I serve as medical director had just opened when I was given the position.
|
b. Intervention/innovation.
|
Proving excellent standards of care, careful
recruitment of supporting personnel, strategic advertising and development
of a team concept both in patient care and in the work flow to support of
all the South Shore staff and faculty has been part of my shared work and
vision with my administrator, Craig Grudzien at South Shore.
One of the more significant interventions at the
South Shore practice is the use of a phone screening tool to help define
and organize our practice into those patients that enter our Frail ElderÕs
program as complex, frail or failing older adults. In addition, the use of
the phone screen to determine a complex, frail patient prior to the initial
medical evaluation has helped to galvanize the team-care concept for the
most vulnerable of older patients at our South Shore office practice.
Members of our multidisciplinary team (nurse practitioner, social worker,
doctor, nurse) see the patient on the same day, discuss and help to
coordinate the patientÕs care from the first visit.
Further background on the Frail ElderÕs program
and the frailty phone screening tool:
The South Shore clinicÕs Frail Elders Program
resembles a Comprehensive Geriatric Assessment (CGA) program model with
evaluation of cognition, function, sensory deficits and psychosocial
issues, in addition to the medical evaluation and a multidisciplinary team
for care and management. Unique to the Frail Elders Program is use of a
phone survey developed by investigators at the University of California Los
Angeles and the Rand Corporation (Vulnerable Elders Survey/VES-13) to
determine risk of frailty. Surveying through this phone screening tool
prior to the first patient visit has helped organize the South Shore
outpatient Geriatrics practice and allows for more accurate determination
of the need for specialty multidisciplinary team care prior to the new
patient visit. Using this phone screening tool in our outpatient practice
underscores the complexity and need for Geriatrics specialty care of our
frail patient population on the south side of Chicago. Greater than 70% of
our geriatric outpatient clinic population is either frail or at risk for
failing, requiring specialty team care, if not on the first visit then on
average within a few years of the initial visit.
|
c. Outcome
|
Under my medical directorship, the Outpatient Senior Health Center
at South Shore has provided a major expansion for the outpatient clinical and
educational experience in the Geriatrics section. Within three years of
opening, our patient visits approximated those of our founding outpatient
Geriatrics clinic, the Windermere. Currently, our clinic sees approximately
7,200 patient visits annually. The Urinary Incontinence Clinic, a
Geriatrics Oncology Clinic, and the Frail Elders Programs have been built
and flourished under my administration and have expanded specialty clinical
care, education and research. Working together as a team in all aspects of
supporting patient care has been evident in the degree of patient and
employee satisfaction at our South Shore office.
|
d. Evidence
|
The South Shore Clinic consistently receives excellent
reviews with regard to our physicians, nurses and coordinators by our
patients through the monthly patient satisfaction surveys. Patient
satisfaction results are consistently excellent with regard to a variety of
questions including: likelihood to recommend the practice, staff worked
together, and cleanliness of the clinic.
|
IMPACT ON ADMINISTRATIVE PRACTICE:
a. Pre-existing practice. Describe the
situation before your impact.
|
No VIR clinic and lack of formal inpatient roundings by
attendings and house staff.
|
b. Intervention/innovation. Describe what you
did to change the pre-existing situation.
|
Development of VIR clinic together with VIR inpatient
service.
|
c. Outcome
|
Enhancement of patient care. Patients could be evaluated prior to procedure, which could
establish appropriateness of procedures. Additional information could also alter patient care to
make procedures safer. In
addition, insurance pre-approval and lab work can be obtained prior to
procedures, thereby expediting the time patients spend in the hospital.
|
d. Evidence
|
We are currently evaluating the impact of patient care
in a QI project approved by our department.
|
IMPACT ON ADMINISTRATIVE PRACTICE:
a. Pre-existing practice
|
Dr. Charles Brendler, Professor and Chief for the Section
of Urology organized and developed the educational structure to residency
training program.
|
b. Intervention/innovation
|
In 2003 as assistant Program director I developed a
competency based educational curriculum for our residents with goals and objectives
depending on their level of training.
|
c. Outcome
|
These programmatic changes have led to a more structured
curriculum which in turn lends itself to a more objective assessment of
resident performance. This has helped substantiate altered education
patterns in individual cases and ensure appropriateness of promotion and
graduation from the residency program.
|
d. Evidence
|
In compliance with the ACGME and the Residency Review Committee
for Urology, the urology residency training program was granted full
accreditation for 5 years.
|
IMPACT ON ADMINISTRATIVE PRACTICE:
a. Pre-existing practice.
|
1. When I started as medical director of the
Executive Health Program, the main function of the clinic was simply to do
two executive physicals per day.
2. I have played an important role in the
development of the new Clinical Performance Center. The current Clinical Performance
Center is currently on the 4th floor of a church 3 blocks from the main
medical school building. When
the Liaison Committee on Medical Education reviewed the medical school for
re-accreditation, the fact that the CPC was not handicapped accessible was
an item that needed remedy.
|
b. Intervention/innovation.
|
1. The former administrative director and I expanded the program in a
number of ways:
a. We added a female physician who runs a womenÕs
executive physical day each week.
b. We implemented a continuity clinic within the
executive health suite to enable patients to maintain their relationship
with the Hospitals and its physicians.
c. We created a navigational service within the
program to assist trustees and other friends of the university in their
contact with the medical center.
d. We created a closer relationship with the Office of Medical
Center Development to help facilitate our patientsÕ philanthropic
interests.
2. After space was secured in the basement of the
medical school building, I worked with the Standardized Patient Coordinator
to design a state of the art facility in the space afforded to us. Our
input and feedback at various stages led to several revisions by the
architect.
|
c. Outcome.
|
1. The Executive Health Clinic is extremely busy, with
full schedules out 3 or 4 months in advance. We have contracts with some of the leading corporations
in Chicagoland, including McDonalds, Walgreens, Duchossois Industries,
Molex, and others. The continuity clinic is active as is the navigational
services. The staff size has doubled from two to four full time employees.
Most importantly, we provide outstanding preventive and diagnostic care to
our patients.
2. Our design creates a space that will allow for
ideal teaching and assessment of our physicians and physicians in training
using the newest technologies.
|
d. Evidence
|
1. Local: The
program has been a valuable asset to the medical center. We have worked closely with the
Board of Trustees, Dean of the BSD, and CEO of the Hospitals to provide care
and service to valued patients.
The relationships established by the physicians and the staff have
led directly to philanthropy on a number of occasions. We have also delivered excellent
care and made significant diagnoses in otherwise healthy individuals here
simply for an annual physical.
Regional/National: The former
administrative director and I met with administrators from the University
of Denver to discuss our program, and subsequently our program became a model
for theirs. The navigational services have been well received outside the
institution, as well. The CEO
of the Rehabilitation Institute of Chicago sent a letter complimenting the
service and noting his intent to institute a similar effort. I was also
interviewed for a local ABC Channel 7 news report on executive health
programs, and the program was featured in an article in Fortune magazine.
2. These efforts on the design of the new CPC
were highlighted in the Dr. Holly Humphrey, Dean of Medical EducationÕs
talk at the Department of Medicine Grand Rounds in September 2006.
|
IMPACT ON ADMINISTRATIVE PRACTICE:
a. Pre-existing practice.
|
The Medical Genetics residency program was certified in 2002
and the laboratory training program was established shortly after that in
the same year. Prior to that there was no program and no administrative
oversight of these programs.
|
b. Intervention/innovation
c. Outcome.
|
I was appointed the residency program director shortly
after the program received its initial certification and before the first
site visit. I have been the
program director of the laboratory training program shortly after its
approval in 2002. I have overseen
two site visits for the residency program. The first resulted in successful certification for 3
years. The second site visit
was in the summer of 2006 and we are waiting the results of that
visit. The laboratory training
program has been successful and continues full certification. Two fellows have successfully
completed the program and passed their respective boards. One fellow has completed the
program and two more will complete the program in the summer of 2007 and
all three will be eligible for the board exam in the fall of 2007. There is
one more fellow currently in the program and two more to start in the next
year.
|
d. Evidence
IMPACT ON ADMINISTRATIVE PRACTICE:
a. Pre-existing practice
|
1. Director of General Medicine Care Center. Prior to my becoming involved in
the General Medicine Care Center, it was a very informal role in which the
director would speak with the nurse director monthly. There were no formal quality or
improvement processes that were care center led, there were no venues for
multi-disciplinary sharing of process issues, and there was very little
visibility within the institution.
2. Director, Hospitalist Scholars Training Program
(HSTP). The HSTP is a new clinical/research
program designed to provide future academic hospitalists with time and
funding to develop the skills and training required to be a successful
academic hospitalist. This
novel program meets a clinical need for uncovered (no housestaff) inpatient
service given the residency workhour restrictions. A proposal was funded in December
2004 and we have implemented a new clinical service starting in July
2005. Prior to this program,
there was no mechanism for caring for general medicine patients without
housestaff coverage and there were very limited opportunities for future
academic hospitalists to receive the necessary training. There have been no similar models
at other institutions that have attempted this combined approach.
|
b. Intervention/innovation.
|
1. General Medicine Care Center: The innovations have been many and
ongoing. However, we have
formalized the meetings so that they occur at a standing time. The participation in these meetings
is much broader with representation from physicians, nurses, nursesÕ
assistants, radiology, lab services, nutrition, physical therapy, case
management, environmental services, and social work. We have also developed a formal
process by which projects are assigned to innovation teams with expected deadlines
and reports. We have
implemented housestaff and faculty debriefings and orientations for general
medicine to systematically collect and provide feedback about systems
issues related to caring for general medicine patients. Similar orientation and feedback
sessions occur for nursing as well.
Most importantly, in addition to process changes, we have instituted
many improvement projects that have improved the care in our hospital.
2. HSTP:
Proposed and implemented a model in which future academic
hospitalists would be hired as clinical associates to provide uncovered
inpatient care at a reduced clinical effort for reduced salary. This would be paired with protected
time and funding to identify and complete a mentored scholarly project as
well as obtain course work required to obtain the relevant skills.
|
c. Outcome.
|
1. General Medicine Care Center. The Care Center has been labeled an
institutional model for interdisciplinary quality improvement by the Center
for Quality. We have addressed
several minor and major issues with varying degrees of success through the
mechanisms we have developed.
Examples include:
a. Patient transportation improved efficiency
b. Improvement in correct attending identification
c. Efforts at improving MD/RN communication
d. Linen supplies
e. Improvement in ÒNPOÓ mechanism for patients who
should not eat before procedures
f. Pain improvement project
I have been able to present abstracts on the development
of our Care Center process as well as specific projects from the Care
Center at national meetings.
2. HSTP: We recruited two scholars who started in July
2005 and have successfully recruited our 2nd class of two
scholars. The clinical service
has been effectively caring for the proposed panel size of patients effectively.
|
d. Evidence
|
1. a. Through the use of an observed time study with
real time monitoring, we significantly reduced the delay in transport wait
time.
b. We have developed a multi-layer intervention that has improved the
correct identification of the inpatient attending on general medicine from
30% correct at baseline to 90% at last audit.
c. We have initiated training for nurses in the use of text pages
and batch pages which has resulted in improved satisfaction among
residents.
d. Based on an internal
audit, we identified that inadequate linen supplies was a significant
factor in nursing dissatisfaction that was under the control of the care
center. By creating a
mechanism for correct estimation and auditing of linen supplies, follow-up
surveys by nursing have reported significant improvement in satisfaction
with linen supplies.
e. Using a several step
ÒNPOÓ notification intervention for patients who should not eat prior to
procedures, we have reduced the number of patients who have to re-schedule
procedures due to being accidentally fed.
f. We have developed a
multi-disciplinary pain management working group. The first project to come out of that group was
described above under clinical improvement projects.
2. HSTP:
Formal evaluation of the program is ongoing as it is just 5 months
old. However, compared to
several of the other uncovered services initiated recently, this service
has been able to meet its proposed clinical workload effectively. Both scholars have active scholarly
projects ongoing. Dana Edelson
is continuing her work in resuscitation improvement. She has already presented work at
national meetings and has submitted a paper on the effects of delays to
first compression on clinical outcomes. Jeanne Farnan is focusing her work on the effects of
medical education policy on patient safety. Her major project will be examining the implications
(clinical, educational, and risk management) of varying levels of resident
supervision.
|
|
