Team-based science is focus of new clinician scholars program

When the Robert Wood Johnson Foundation (RWJF) ended its longstanding Clinical Scholars program last year, it was a loss not only for the Yale community but for the city of New Haven as well. Since the program’s inception more than 40 years ago, scholars have worked on projects designed to address health inequities and improve health care throughout the city. The more than 160 Yale scholars who have graduated from the program since 1974 have had a strong impact on New Haven through community-based research that assessed a range of topics, including the availability of healthy foods in a New Haven neighborhood without a supermarket, HIV/AIDS status, gun violence, immigrant and refugee health, and access to health care for the homeless.

“I’ve never been part of a training program that is blessed with so much loyalty, appreciation, and dedication among the alumni, the faculty, and the institutional and community partners,” said Cary P. Gross, M.D., professor of medicine and co-director of the RWJF program at Yale. “That is why we simply had to find a way to continue training the next generation of scholars who will lead our efforts to improve the health care system and enhance the health of individual patients, our communities, and the nation.”

Though RWJF decided last year to stop funding the clinical scholars program, the four host sites‒the University of California, Los Angeles; the University of Michigan; the University of Pennsylvania; and Yale‒took up the mantle to begin a new independent fellowship in a spirit similar to that of the original program.

“Forging ahead was an unspoken mandate,” said Gross, as the four sites decided that the work of the program is not yet complete. “When we discussed the challenge with leadership at Yale, the question was never whether to continue training scholars; it was how to do it. Dean [Robert J.] Alpern has been incredibly supportive.” The new National Clinician Scholars Program (NCSP) will share many features with the original program, but the consortium made key changes in order to adapt to a new element of the changing health care landscape‒an increased emphasis on team-based approaches to research as well as clinical care. As a result, the NCSP will train doctoral-level nurse-scientists side by side with physicians.

In clinical practice, such team-based approaches as patient-centered medical homes are increasingly common, and they bring together physicians, nurses, physician associates, and others to collaborate with patients in making decisions about care. “Team-based care is a common and effective part of our health care system,” said Gross, who is leading the planning of the NCSP at Yale. The decision to include nurse-scholars in the NCSP builds upon the interdisciplinary framework of the RWJF program, which trained physicians from various specialties together, including internists, surgeons, pediatricians, and others.

“No profession can do it all themselves, and we each have important roles to play in the delivery of health care across the health continuum,” said Margaret Grey, Dr.P.H., M.S.W. ’76, who recently retired as dean of the Yale School of Nursing. “The more we educate people in silos‒whether for clinical practice, or clinical research, or health services research‒the less likely it is that they will work collaboratively when they get out in the real world.” In addition, she noted, postdoctoral training slots for nurses are limited, and the NCSP will provide a much-needed avenue for nurses who seek to combine clinical work with research.

The new two-year program will select approximately five physician- and nurse-scholars per year to complete coursework together at Yale, sharing mentors from across the professions. NCSP scholars will lead their own policy-relevant research projects, guided by faculty and community partners. They will also learn the value of collaboration as they participate as team members in their peers’ projects.

Scholars will be encouraged to translate their research discoveries into real-world change by working with community partners, health care providers, or government agencies to ensure that they are asking questions that are important to stakeholders and that the results of their studies will have an impact. Scholars will build upon collaborations that have grown with the existing clinical scholars program, which has included such partners as the VA Connecticut Healthcare System, Yale-New Haven Hospital, Columbus House, Integrated Refugee & Immigrant Services, Project Access of New Haven, and New Haven Family Alliance, among others. “One of the hallmark features of the scholars program has been the link between scholarship and action,” said Gross. “We place a great emphasis on teaching scholars not just how to do research but also how to instill change, working either from within the health care system or from outside the system.”

While the NCSP is aimed at early-career, post-training physician- and nurse-scientists, the trend toward interprofessional education, or IPE, increasingly appears at all levels of medical education. The Liaison Committee on Medical Education, an accreditation body, has established a new standard that requires medical schools to include collaborative education as part of their core curricula. At Yale, when the School of Medicine redesigned its curriculum, Eve R. Colson, M.D., professor of pediatrics, joined with colleagues from the School of Nursing and the Physician Associate Program to add an IPE component to the course she leads, the Longitudinal Clinical Experience. That program places medical students in community-based clinical settings from their first days of medical school. Now, first-year nursing and physician associate students are also included, said Colson.

Having the NCSP at Yale will contribute to IPE’s goal of collaboration, Colson said, by providing students with role models for how to work together across professions. “How many hours does a basketball team practice together before they play a game?” said Colson. “Whereas in medicine, all of us who take care of patients, we don’t really practice together. We just play the game.”

Gross said the four-member consortium is eager to get started on the NCSP, which will accept up to 25 scholars across all sites for the program’s first cohort in 2016, with the hope that new institutions will subsequently join the founding sites. “It was really exciting to see how the leadership at the four university sites really banded together,” Gross said, “and realized that the whole would be greater than the sum of our parts if we continued to work together. This really shows that the benefits of working in teams applies to large universities, just as it applies to individual clinicians and researchers.”