• Medical training for health services researchers

    I get up on my soap box in my latest AcademyHealth post. Given the current emphasis on evidence-based care and comparative effectiveness research, I think it is high time health services researchers, health economists, and other health policy experts learned something about medical science. We may not have received such an education in school, but in my new post I tell you about some resources that can help you get up to speed.

    @afrakt

     

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    • I would suggest that this is where inter-disciplinary teams should come in. A good researcher need not know everything about their topic, so long as they work with others that do. Similar for management/delegation. Good managers will hire a trained accountant (or whatever) rather than learn the skills and do the work (poorly) themselves.

      • My best medical collaborators know something about econometrics. Similarly, I am much more productive when I internalize something about the subject I’m studying. All I’m advocating is a little cross-disciplinary study. I think it could help break down some misunderstandings about what comparative effectiveness research can and cannot (easily) do.

    • -One additional suggestion would be to shadow front line providers who use a particular clinical intervention, or set of clinical interventions, that one is studying. Studying the informal incentives and constraints that shape their decision making would be at least as valuable as understanding formal parameters like payment models, EBM guidelines, etc.

      • That sounds OK for researchers studying a particular set of interventions (e.g. cardiovascular diseases, mental illness, long term care).

        It does not sound good for someone getting a generalist degree like an MPP or an MPH – we’d need something broader (I have an MPH). Some things you can pick up on the job, of course, but a broad based Medicine 401 would help.

        • Totally agree on the benefits of a grounding in biomedical science, Necessary but not sufficient.

          IMO the primary handicap that policy specialists operating at a remove from the front line have to contend with is that formal knowledge – whether that’s payment incentives or the fine points of nephrology – often represents only a fraction of the consequential information that shapes clinical decision making, and that knowledge simply isn’t available to those that aren’t in the room.

          One example that I’ve heard multiple times involves admissions from the ER. I can tell you with 100% certainty that you can have two patients who have a virtually identical condition/presentation in the ER, but one will get admitted but the other will be sent home.

          Why the difference? In the former case the physician is concerned that the patient lives alone, has a partner/spouse/parent who is incapable of rendering adequate care, etc and and he/she cajoled the internist into accepting a marginal admit overnight until the social worker who was scheduled to arrive in the morning could figure out how to make sure that they can find a suitable outpatient setting to transfer the admit into or arrange for some kind of home-care.

          Exposure to front line decision making won’t supplant or invalidate analyses based on information that can be abstracted into numerical values and subjected to regressions, but I can’t help but conclude that it would help policy specialists interpret the said datasets.

    • The benefits of understanding the medical science include appreciating the complicated practice issue of all the moving targets, uncertainties, and judgment calls practitioners face. A real risk for researchers is that their findings are perceived as reductionist, which makes it easy to complain about evidence-based care as cookie-cutter, etc.