1. Intro to Clinical Scholarship: Lessons From Walmart Daniel Eiferman, MD, FACS FAME Workshop November 10, 2015

2. What is the most important thing you have? 2

3. How did Walmart become Walmart? 3

4. Maximum Efficiency No Wasted Steps 4

5. My answer: 5

6. Better Title for This Talk You are doing it anyway! 6

7. What do these things have in common?  Lasix  Perioperative Value Analysis Team  Lymphedema  Patient Safety Indicators  Longitudinal Experience mentor 7

8. Real World Example #1  My clinical duties include covering the Surgical Intensive Care Unit  Felt (Still do) that the overwhelming majority of physicians do not use this drug correctly  Spent countless hours on rounds and lectures explaining physiology and appropriate use 8

9. Real World Example #1 continued  We have an outstanding critical care pharmacy residency program that require a research project to graduate  Pharmacy resident championed project to look at outcomes of patient who received diuretics during the ICU admission 9

10. I was doing the work anyway… This is clinical scholarship 10

11. Real World Example #2  Committee participation is a realtiy at Academic Medical Centers  I was asked to be on the Perioperative Value Analysis Team  Committee met once a month at 6 a.m. 11

12. Real World Example #2  I led a project that led to a cost savings to the medcial center of approximately $1,000,000  Required multiple meetings and a large time commitment  The project was very successful from a financial standpoint, but not necessiarly scholarly  Each meeting, multiple graphs, charts, and tables were generated (none of them by me) to track our progress 12

13. Real World Example #2 I was doing it anyway… Now it was clincal schloraship as well 13

14. Real World Example #3  Approached by a Plastic Surgeon to assist with a novel surgical treatment of lymphedema  I know NOTHING about the surgcial treatment of lymphedema…only needed my technical skills to harvest lymph nodes from the jejunal mesentery 14

15. Real World Exampe #3 I was doing the work anyway… Now it’s Scholarly 15 Resident writes 500 word abstract about our technique and results from first few surgeries I am now the world’s expert on vascularized jejunal lymph node transfers!!

16. Other Examples of things I have to do anyway:  Asked to be a preceptor for a medical student to come to my clinic every other week for their first 2 years of medical school to learn H&P skills  Asked to take another student after initial commitment fulfilled  I have to go to clinic regardless if a medical student is present or not  Mentoring a medical student is clinical schloraship and requires no extra time committment 16

17. Finally….  I review daily for the medical center the Patient Safety Indicators that contribute to our VBP score  Noticed that what was being considered poor quality did not actually represent poor quality of care  Surgical Resident creates spreadsheet to review all cases and submit results as an abstract  Recently accepted for oral presentation 17

18. Putting It All Together: 18 Maximum Efficiency Most valuable possesion The majority of the things you do already from being a part of an academic medical center can be made into scholarly projects

19. Take home message and your homework:  By working at a tertiary care, academic medical center, you are involved in clinical scholarship in multiple ways.  Be maximally efficient with your time (your most precious resource) and identify how you are going to take what you are doing already and make it into a clinical scholarship project 19