When in need of a solution to a challenging problem, Yale turned to its best resource: its own students.
As the administrative home of the university’s CTSA grant, YCCI is constantly looking for new ways to better support clinical trials. YCCI’s typical strategy for tackling large-scale institutional challenges is through targeted component reviews. In this process, YCCI hires industry consultants to come to Yale for a limited period to gather and analyze data, and offer solutions.
When YCCI’s question turned to the merits and demerits of centralizing research support services, Paul Taheri, MD, MBA, the CEO of Yale Medicine (the university’s 1,200 physician-strong clinical practice group) and Deputy Dean for Clinical Affairs at the Yale School of Medicine, had a novel idea: why not turn to students in the Yale School of Public Health?
Students in the school’s Health Care Management Program, Taheri figured, would “jump at the chance to have in-depth hands-on experience taking on a major issue in research medicine.” Not only would the students benefit from the experience, “YCCI would benefit from unbiased well-informed analysis from people who as students are truly invested in the success of the institution of which they are an integral part,” he says.
Taheri reached out to Howard Forman, MD, who directs the Health Care Management Program in the Yale School of Public Health. “Working with YCCI provides our students with a real-world opportunity to apply classroom learning from the spheres of Healthcare Operations and Healthcare Finance,” says Forman.
Forman put out a call to students; two, Cassandra Lincoln and Doug Streat, both students in Yale’s joint BS/MPH program, responded immediately. They graduated from Yale College with Bachelor of Science degrees in 2016, and from the School of Public Health with a Health Care Management Program in May 2017. The Health Care Management Program is operated in conjunction with the Yale School of Management, and course work is split between the two schools.
Lincoln and Streat were ready to delve into the challenge. “This was a really exciting opportunity to make a significant difference in the management space at the Yale Medicine practice, which is such an influential clinical practice in Connecticut and in this region of the country,” says Streat. Their project also fulfills an MPH degree requirement in which students must complete a substantial practicum in a degree-related subject.
The interns were tasked with compiling stakeholder views on centralization (or potential decentralization) of services, and whether centralization would help streamline YCCI operations. They sent a survey to all principal investigators, and conducted in-person interviews with leadership at YCCI, the Yale School of Medicine, and Yale Medicine’s eight clinical chairs.
They also looked at research support services at peer institutions and examined data from YCCI’s clinical trial management system, OnCore, as well as its research evaluation system. Through the spring, they met weekly with Taheri, their project mentor, and also met with YCCI Deputy Director and Chief Operating Officer Tesheia Johnson, MBA, MHS. They also sat in on meetings with senior administrators on a variety of issues, and were able to gain an understanding of the wide range of work YCCI does beyond the scope of their individual projects.
“Many students in health care management come to the program focused on two popular post-school career goals: consulting and health care administration,” says Forman. “One of the greatest benefits of the program was that it opened the students’ eyes to other career options. There are many important and substantive opportunities in research and research administration.”
“It was a win-win,” says Taheri. “Not only was it a really great educational experience for them, it also was phenomenal for us.” Last summer, Lincoln and Streat presented YCCI and Yale Medicine’s clinical chairs with an extensive report on their findings, and recommendations on how centralization might improve the delivery of their services.
As a result of their research, Lincoln and Streat recommended four areas that could benefit from centralization: research navigation, research finances, study coordination, and recruitment. “The next step for us is turning these recommendations into reality,” says Lincoln. Both students were asked to extend their relationship with YCCI through this past school year to work on implementing their suggested solutions. Their most recent focus is the development of a coordinator workload tool that is being piloted at YCCI.
“As a new Dean of Public Health attending my first YCCI External Scientific Advisory Board, I was immensely gratified that our student work was featured in presentations to the board,” said Sten Vermund, MD, PhD, Dean of the School of Public Health, and the Anna M.R. Lauder Professor of Public Health. “It’s a testament not only to the potential of our students to become future leaders in their fields, but of YCCI’s commitment to collaboration across the entire institution.”
The success of this project was the beginning of a valuable continuing partnership between YCCI and the School of Public Health. MPH candidate in Health Care Management Josh Tan worked with his mentor, Chief Medical Information Officer Allen Hsiao, MD, to conduct a review of the effectiveness of clinical trials recruitment methods. Tan compared the new Epic-directed recruitment system to traditional measures, and found that the Epic-enabled recruitment produced a significantly higher number of leads compared to such methods as newspaper advertising.
YCCI has two current interns from the MPH program completing evaluation projects. Asia Brown, YC ’16, is an MPH candidate in Health Care Management, and is an MDiv candidate as well. In line with her interest in community-engaged research, Brown is working with the Chief of General Internal Medicine, Patrick O’Connor, MD, on a needs assessment of YCCI’s services to investigators in this area, and presented her findings and recommendations to YCCI and other stakeholders this fall. As YCCI continually seeks to reevaluate and improve its services related to cultural engagement, Brown surveyed several faculty members, investigators, Cultural Ambassadors, and community members to understand what was important to them in the program as YCCI considers its next steps.
Igla Muskaj, an MPH candidate in Health Care Management, is working with the Chair of the Department of Laboratory Medicine, Brian Smith, MD, and YCCI Deputy Director Kevan Herold, MD, to conduct a review of YCCI’s laboratory services to determine how YCCI can improve efficiencies within its Core Lab and reduce any duplication of services with Yale New Haven Hospital’s clinical laboratory service. Through the project Muskaj was able to bridge her prior experience in basic science with her career goals in health care management, she says.
Both Brown and Muskaj have been asked to continue their work with YCCI in the coming year. “I love YCCI’s dedication to developing the next generation of leaders,” says Muskaj. “It’s not only a welcoming environment, but one in which you can grow and learn.”
“It pushes you to be self-directed,” says Brown. “You need to know the questions and ask them. You are not going to have someone holding your hand in the real world. It gives us a sense of independence.”
“It’s a mutually beneficial relationship,” says Taheri. “We are getting a great, thoughtful work, and the students are getting irreplaceable experience that will help them contribute in the future to their chosen field. This is an investment in Yale’s most valuable asset, its people.”