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Translational Research and Medical Education: Preparing Students to Interface Research and Patient Care. Templeton Smith Class of 2012, WVU SoM [email protected] Scott Cottrell, Ed.D. [email protected] Terry Stratton, Ph.D. [email protected] James Shumway, Ph.D.

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Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research and Medical Education:

Preparing Students to Interface Research and Patient Care

Templeton Smith

Class of 2012, WVU SoM

[email protected]

Scott Cottrell, Ed.D.

[email protected]

Terry Stratton, Ph.D.

[email protected]

James Shumway, Ph.D.

[email protected]

2010 SGEA Annual Meeting

Small Group Discussion

April 16, 2010

1:00-2:30 P.M.


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Objectives

To better understand translational research (TR) and identify strategies to prepare medical students for their roles in translational research through:

  • Identifying and discussing elements of TR that medical students should be expected to understand and apply;

  • Identifying TR learning outcomes essential to complying with Liaison Committee on Medical Education (LCME) Standard ED-17-A; and

  • Discussing optimal methods of teaching and assessing TR-related learning outcomes.


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Outline

  • Foundation of LCME Standard ED-17-A

    • Historical context of TR

    • Define TR

  • LCME and Standard ED-17-A

  • Identify and discuss TR learning objectives that fulfill the LCME Standard ED-17-A

  • Discuss how to teach and assess these learning objectives in a medical school curriculum

  • Identify and discuss TR learning objectives beyond those applicable to LCME Standard ED-17-A


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Foundation of

LCME Standard ED-17-A


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Historical Context

Of 101 articles, published between 1979-83 in six major basic science journalsa promising novel therapeutic or preventive therapies:1

  • 1:4 technologies resulted in a published randomized trial

  • < 1:10 entered routine clinical use within 20 years of the basic science index publication

  • By 2002, only ONE had had major clinical impact

a. Science, Nature, Cell, Journal of Experimental Medicine, Journal of Clinical Investigation, and Journal of Biological Chemistry


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

NIH Roadmap for Medical Research

  • Launched in September 2004

  • Address “roadblocks” to research

  • Re-engineer how biomedical research is conducted by:

    • Overcoming “specific hurdles”

    • Closing defined gaps in knowledge

    • Catalyzing translational research

http://nihroadmap.nih.gov/aboutroadmap.asp


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

Association of American Medical Colleges (AAMC):

Translational research (2003):

  • Identifies clinically relevant questions raised in the interpretation of results from animal and molecular or cellular research;

  • Targets questions raised by epidemiologic studies or clinical trials; and

  • Addresses data from basic research, clinical or population studies resulting from advances in genetics and genomics.3


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

Translational Research

  • While the goals of TR mirror those of traditional clinical research, the former focuses on expediting their clinical application4 by improving communication and reinforcing its bidirectionality among basic scientific research, clinical research, patient care, and healthcare policy.5, 6

  • TR strives to foster new therapeutic insights by enabling clinical research and medical observations to elucidate scientific research and strategic approaches for their clinical implimentation.7


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

Translational Research

  • Translational research “fosters the multidirectional and multidisciplinary integration of basic research, patient-oriented research, and population-based research, with the long-term aim of improving the health of the public.”

  • Types of translational research

    • T1 research catalyzes translation between basic research and patient-oriented research.

    • T2 research facilitates the movement between patient-oriented research and population-based research.

    • T3 research promotes interaction between laboratory-based research and population-based research.

Rubio et al.8


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

Translational Research

  • T1 research seeks to foster new or improved scientific understanding or patient care.

  • T2 research facilitates improved patient outcomes, optimization of medical practices, and improved community health.

  • T3 research promotes further scientific understanding of human health and disease.

Figure 1 Model for translational research, as proposed by the Evaluation Committee of the Association for Clinical Research Training.8


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Teaching Medical Students TR

Despite teaching the latest scientific advancements in the classroom, medical school curricula have struggled to prepare students for incorporating such new scientific discoveries into their future practices.9, 10, 11


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

LCME

Accrediting authority for medical education programs leading to the M.D. degree in the U.S. and Canada

  • Standard ED-17-A


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

LCME Standard ED-17-A

  • “The curriculum must introduce students to the including how such research is

basic principles of

clinical and translational research,

conducted,

evaluated,

and

explained to patients,

applied to patient care.


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

LCME Standard ED-17-A

  • Medical educators must now modify their schools’ current curricula accordingly.

  • However, the standard does not specify any required criteria, and only minimal suggestions as to how to address this standard, thus leaving much to the discretion of medical educators.


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Results of Discussion on How to Satisfy

LCME Standard ED-17-A


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

General Information

  • N = 6

  • 2 Ph.D., 1 Ed.D, 1 M.A., 1 M.H.A, 1 unknown

  • TR knowledge

    • 1 very knowledgeable

    • 2 somewhat knowledgeable

    • 2 not knowledgeable

    • 1 unknown

  • None have participated in TR studies or unknown.


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

Basic Principals of TR

E – essential

R – relevant

I – irrelevant

Please do not publish results without permission of T. Smith ([email protected]).


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

“Know how such research is conducted … ”

E – essential

R – relevant

I – irrelevant

Please do not publish results without permission of T. Smith ([email protected]).


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

“Know how such research is … evaluated… ”

E – essential

R – relevant

I – irrelevant

Please do not publish results without permission of T. Smith ([email protected]).


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

“Know how such research is …explained to patients, and applied to patient care.”

E – essential

R – relevant

I – irrelevant

Please do not publish results without permission of T. Smith ([email protected]).


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

Comments

  • “Communicate (2, 3, 4); Knowledge (1); Skill/Behavior (5, 6)”


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

What methods can validly assess

specific TR knowledge and skills?

  • Simulations or OSCEs with secretly expert patients (M.D., R.N., etc.), who can evaluate the encounter and the student’s technique, unbeknownst to the student.

  • Have students critique grants and classify types of TR.

  • Have students suggest appropriate tests (PCR, FISH, etc.) to solve simulated clinical problems and narrow a differential diagnosis.

  • Have students reflect on potential opportunities for TR in their patient portfolios.

  • Utilize journal clubs to teach TR.

  • Integrate TR studies into lecture.

  • Have students identify health disparities in the community.


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Translational Research

References

1. Contopoulos-Ioannidis D, Ntzani E, Ioannidis J. Translation of highly promising basic science research

into clinical applications. Am J Med. 2003;114:477-84.

2. National Institutes of Health. NIH Roadmap: Accelerating Medical Discovery to Improve Health

<http://nihroadmap.nih.gov/aboutroadmap.asp>. Accessed 14 Oct. 2009.

3. Association of American Medical Colleges. Information technology enabling clinical research. Washington, D.C.: Association of American Medical Colleges; 2003.

4. Littman BH, Di Mario L, Plebani M. What’s next in translational medicine? Clin Scien. 2007;112:217-27.

5. Kleinman MS, Mold JW. Defining the Components of the Research Pipeline. Clin and Transl Sci. 2009;2:312-14.

6. Crist TB, Schafer AI, Walsh RA. Translating basic discoveries into better health care: the APM’s recommendations for improving translational research. Am J Med. 2004;116:431-4.

7. Cosmatos D, Chow S-C (eds). Translational Medicine: Strategies and Statistical Methods. New York: CRC Press, 2009.

8. Rubio DM, Schoenbaum EE, Lee LS, Schteingart DE, Marantz PR, Anderson KE, Platt LD, Baez A, Esposito K. Defining translational research: implications for training. Acad Med. 2010;85:407-5.

9. Report IV – Contemporary issues in medicine: basic science and clinical research. AAMC Medical School Objectives Project. 2001.

10. NIH Roadmap for Medical Research. <http://nihroadmap.nih.gov/overview.asp>. Accessed October 14, 2009.

11. Westfall JM, Mold J, Fagnan L. Practice-based research – “Blue Highways” on the NIH roadmap. JAMA. 2007;297:403-6.


Templeton smith class of 2012 wvu som tsmith65 mix wvu scott cottrell ed d

Thank You!


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