Chapter 14: Training Clinicians to Think Analytically about Research Problems

Chapter 14: Training Clinicians to Think Analytically about Research Problems

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Description

In this chapter, Dr. Elting talks about how expanding General Internal Medicine’s research program allowed her to train clinicians in analytical thinking. She explains how physician’s generally think about clinical problems, defines what analytical and quantitative thinking are, and the effect that training in these methods has on clinicians.

Dr. Elting ends this chapter by explaining what she learned from working with clinicians in this way. She notes that her role as Director of Research (1998-1999) in the Section of General Internal Medicine was simply an expansion of her role as Director of Clinical Epidemiology and Informatics.

Identifier

EltingL_03_20150326_C14

Publication Date

3-26-2015

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; The Researcher; The Administrator; Overview; Building/Transforming the Institution; Leadership; Understanding Cancer, the History of Science, Cancer Research; The Professional at Work; On Research and Researchers

Transcript

Tacey A. Rosolowski, PhD:

Now you served in that role for six years. What did you feel you had achieved at the end of that time?

Linda S. Elting, DrPh:

Well all the clinicians in the department were writing papers, andand doing research. That was a plus. I never got to a point where I believed that any of them could write a grant application. I just didn't have the time or the inclination. There was not enough time to train them to be able to write an application. Butso I spent my time after false starts in trying to help them learn how to write grants. I spent most of time trying to train them how to be good clinical researchers, and how to think analytically instead of clinically. And I think having done that, it was a muchI was getting much better products from them, after that.

Tacey A. Rosolowski, PhD:

Now tell me what you mean when you say "analytical thinking." I mean, last time we talked about the training program where you were teaching clinicians to think in terms of populations.

Linda S. Elting, DrPh:

Mm-hmm.

Tacey A. Rosolowski, PhD:

So, as you're talking now about analytical, as opposed to clinical thinking, what are you referring to?

Linda S. Elting, DrPh:

Um, two things really. Part of it is thinking in terms of populations. And the other part is thinking quantitatively rather than qualitatively. Most of the clinicians would come to me and say, "I want to study this." And I would say, "How often does it happen?" And they would say, "Pretty often." And I would say, "How bad is it?""Bad." "So, is it worse than this?""No." So, those kinds of things, it'sit's kind of the difference between getting a precise estimation of something, and having a rank order of something. And until you can think quantitatively, you can't measure things precisely, and you can't figure out where you're starting and when you're finished. So, the move tophysicians think in terms of "common"and "uncommon,"because they're going through this whole long list in their heads, of all the things this problem could be, and all the possible outcomes, and they're rank ordering it in their heads, about what they need to worry about, and what they don't need to worry about, or what they need to worry about first, and then what they'll worry about tomorrow if this doesn't work out; that kind of thing. So it's one patient to many possible outcomes, and trying to sift through that information. And when you think analytically about a research problem, you have to take many patients and find out the few things that are common. And the only way to do that is to think quantitatively, and to begin to compare things by, numerically. Because, when you have one person, you can say, "Oh, common and uncommon,"but a "common and an uncommon"multiplied by 20,000 patients and you don't know what you have. So, that's really where I focused my efforts, was getting people to think quantitatively, and getting them to recognize that an n of 1, one single person, did not make a trend. You couldn't make a statement of anything about one person that could be applied to someone else. So, that's mostly, you know, where I focused my work with them, in thinking.

Tacey A. Rosolowski, PhD:

Now, I'm not quite sure how tohow to ask this question, but it's kind of a culture question. Now you're trying to kind of shift this mentality within General Internal Medicine. Nowand that was a new way of thinking, sounds like, within General Internal Medicine. So, whatI guess what I'm wondering is, if there were people conducting quaquantitative research, I assume, outside of that department? And did shifting that culture within General Internal Medicine kind of change the way General Internal Medicine clinicians were able to communicate with people outside? You know, did that help collaboration? Did it help communication?

Linda S. Elting, DrPh:

I don't know that I would say it helped communication. I do believe it improved their ability to collaborate with other people in other departments, and itin their adopting that approach, raised their credibility within terms of research. You know, they got their research cred by doing that, because that's an important thing to have in this institution. So, I think it was a plus for them.

Tacey A. Rosolowski, PhD:

What was the impact that you saw on their careers?

Linda S. Elting, DrPh:

Some of themwell all of them did get promoted, and were able to do enough research to rise, now, to full professor. Some of them continued to do research, after they got to a point where they could have mostly fallen back on what they were doing. A couple of thema couple of them changed the way they mentored other faculty and potential students, andand involved them that way. And there is still a very strong program in General Internal Medicine, and in that area. So I think it became an important part of the department, which had been completely clinical up until then.

Tacey A. Rosolowski, PhD:

Who were some of the people who were involved in this period of time when you were developing this research program?

Linda S. Elting, DrPh:

It was a multidisciplinary program, so Ken Rolston was the Infectious Disease specialist, and he was part of our group. The person in General Internal Medicine other than Ed Rubenstein was Carmen Escalante, and she's the current chair. Ellen Manzullo was really involved. I think that's thethe primary people. And when Carmen took over as chair when Ed left, she started recruiting people to positions with protected time for research. You know, her new positions, she structured that way.

Tacey A. Rosolowski, PhD:

What did you feel you had ahad personally accomplished, and that you learned through thisthe end of this process, you know, which would then, went on to your next role?

Linda S. Elting, DrPh:

I learned a lot about working with clinicians, who have no background in research. I learned a lot aboutand in particular, about how to make expectations of them realistic, and help them frame a project around something they can really accomplish, instead of some perfect thing that would be the ideal study to do, that they'll never finish. And, I guess what's probably most important about it is that I learned that I didn't want to do that full-time. You know, II don't mind doing that a little bit, but I don't want to spendI didn't want to spend all of my time facilitating research for other people. (laughs)

Tacey A. Rosolowski, PhD:

But you went on to another Director of Research project after that. (laughs)

Linda S. Elting, DrPh:

Well I mean, I consider that all the same thing, together--

Tacey A. Rosolowski, PhD:

I see, okay.

Linda S. Elting, DrPh:

You know, when Iwhen I worked asit was just a change in title.

Tacey A. Rosolowski, PhD:

Change in title. And so, it was in 1998, and then inending in 1999 that you were--

Linda S. Elting, DrPh:

Mm-hmm, yeah.

Tacey A. Rosolowski, PhD:

--Director of Research in the Section of General Internal Medicine.

Linda S. Elting, DrPh:

Yeah. At that point, the other PhDs, the statistician and others were working for me, and I was directing that kind of thing, but it was still the same position.

Tacey A. Rosolowski, PhD:

Okay.

Linda S. Elting, DrPh:

You know, make research happen in that department.

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Chapter 14: Training Clinicians to Think Analytically about Research Problems

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