Research Workshop

Erica Frank, MD, MPH

Professor and Canada Research Chair

School of Population and Public Health

University of British Columbia

Bottom line:

Don’t try this at home without supervision

Summary of Principles:

1. Pick a question that matters

2. Build it strong

3. Put your data in context

4. Extrapolate/build

5. Milk it

Principle 1:

Pick a question that matters:

• Big implications (but doable)

• Interesting no matter the outcome

Principle 2:

Build it strong to withstand:

• grant-givers

• colleagues / participants

• reviewers

• editors

• the test of time

Principle 3:

Put your data in context:

• Use Qs with comparison populations

Examples:

Put your data in context:

• 4% of U.S. women physicians smoke!!!!!

Not high SES High SES Women Characteristic BRFSS BRFSS PhysiciansCigarette smoking

Smoking (%)Never 52.9(0.4)** 64.0(1.9)** 77.7(0.7)

Current 25.0(0.4)** 8.0(1.0)** 3.7(0.4)

Average cigarettes/day 17.6(0.2)** 16.0(0.2) 12.0(1.1)1 cigarette-abstinent day 50.5(0.9)** 47.0(6.1)** 75.3(4.0) in last year (%)Number of years quit (%)

<1 year 11.9(0.5)** 6.7(2.1) 3.5(0.8)

1 - <5 yrs. 20.8(0.7) 14.0(2.3) 16.2(1.7)

>5 yrs. 67.3(0.8)** 79.3(2.9) 80.3(1.9)

*p<0.01 for the difference between this BRFSS category and WPHS

**p<0.0001 for the difference between this BRFSS category and WPHS Frank, et al

Arch Intern Med 2/1998

Physicians’ Personal Health Practices vs. Her Counseling or Screening Patients at Least 1x/yr.

Physician’s fat consumption % counseling on cholesterol at least 1x/year**Below median fat score 30.2%Median fat score 22.6%

Physicians’ exercise % counseling on exercise at least 1x/year**Complies with ACSM rec. 46.1%Doesn’t comply with ACSM rec. 39.6%

Physicians’ alcohol consumption % counseling on alcohol at least 1x/year**< 2 drinks per week 41.7%> 2 drinks per week+ 31.9%

Physicians’ cigarette smoking % counseling on tobacco at least 1x/yearNon-smoker 63.4%Current smoker 47.8%

**p<0.01

Frank, et al Arch Fam Med, 4/2000; Res Q Ex Sport, 6/2004

Principle 4:

Extrapolate / build

• Women Physicians’ Health Study

• Healthy Doc = Healthy Patient

• Colombia

• Deans

• Canadian Physicians’ Health Study

• Laos

• Cambodia

STUDY DESIGN: Healthy Doc=Healthy Patient

• Population: the Class of 2003 at 17 medical schools from freshman orientation through fourth year

• Two parallel studies

• 228-item, self-reported questionnaire

• Demographics & personal and clinic prevention practices of US medical students

• Comparable with national surveys

Principle 4:

Extrapolate / build

• Healthy Doc = Healthy Patient

• Colombia

• Deans

• Canadian Physicians’ Health Study

• Laos

• Cambodia

Pilot Study in Bogotá, Colombia• 44% of regularly active students (RAS) vs. 21% of

sedentary students (S) “usually or always” counseled patients about exercise or physical activity (p=0.006)

• 50% of RAS vs. 32% of S reported “having had extensive training on the topic of physical activity and exercise” (p=0.009).

• 27% of current smokers (CS) vs. 52% of never/non-current smokers (NCS) “usually or always” counseled patients on smoking cessation (p=0.002)

• 16.9% CS vs. 4.8% NCS disagree with the statement “I will be able to provide more credible and effective counseling if I don’t use tobacco” (p=0.001)

Principle 4:

Extrapolate / build

• Healthy Doc = Healthy Patient

• Colombia

• Deans

• Canadian Physicians’ Health Study

• Laos

• Cambodia

Dean and student opinions about HD Principles

Dean’s avg (n=17)

Students’ avg (n=1336)

Medical school faculty members should set a good example for medical students by practicing a healthy lifestyle.

1.4 2.1

Medical schools should encourage their students and residents to practice healthy lifestyles.

1.3 1.9

In order to effectively encourage patient adherence to a healthy lifestyle, a physician must adhere to one him/herself.

2.1 2.2

Scale = 1 (strongly agree) to 5 (strongly disagree)

Principle 4:

Extrapolate / build

• Healthy Doc = Healthy Patient

• Colombia

• Deans

• Canadian Physicians’ Health Study

• Laos

• Cambodia

Principle 5:

Milk it for all it’s worth

• But no more

Milking: say itAspects of “The Healthy Doc – Healthy Patient Project” (1999-present)• Plenary speaker, AMA meeting, Section on Medical Schools, 1999• Plenary speaker, Medical Society of Wisc’s Regional Summit on Women Physicians, 2000 • Invited speaker, Grand Rounds, University of Wisconsin, 2000• Invited speaker, AMWA annual meeting, 2000• Invited speaker, AMA/CMA International Conf. on Physician Health, 2000, 2002, 2004• Invited speaker, CDC, National Ctr for Chronic Dis. Prevention & Health Promotion, 2001• Invited speaker, National Medical Association annual student meeting, 2001• Invited speaker, American Cancer Society National Office, 2001• Invited speaker, Grand Rounds, Tulane University, 2002• Invited speaker, Grand Rounds, University of Washington, 2002• Invited speaker, Grand Rounds, University of British Columbia, 2002 • Invited speaker, Grand Rounds, Family Planning, Emory University, 2003• Invited speaker, Grand Rounds, Surgery, Emory University, 2004• Plenary speaker, Federation of State Physician Health Programs’ Annual Mtg, 2004• Plenary speaker, International Healthy Lifestyles Seminar, Bogota, Colombia, 2004• Keynote speaker, NH Academy of Family Physicians Annual Meeting, 2004• Invited speaker, Grand Rounds, Dartmouth Medical School, 2004• Keynote speaker, Ontario Physician Health Program Annual Meeting, 2004• Plenary speaker, AMA meeting, Section on Medical Schools, 2004• Keynote speaker, Annual Scientific Assembly, Alberta College of Family Physicians, 2005• Invited speaker, Grand Rounds, Advocate Health System, 2005• Invited speaker, CDC, Cancer Control Division, 2005• Invited speaker, AAMC Physician Workforce Research Conference, 2005• Invited speaker, Alabama Physician Health Program, 2005• Invited speaker, Massachusetts Medical Society, 2005• Podium presenter, annual mtg., American College of Preventive Medicine, Reno, NV, 2006• Invited speaker, Grand Rounds, University of British Columbia, 2006• Keynote speaker, Physician Health Program of British Columbia, Vancouver, 2006• Moderator and panelist, Association of American Medical Colleges, Seattle, WA, 2006``

Milking: write it – chapter 1• (24) Frank E, Rothenberg R, Brown V, Maibach H. 1997. “Basic demographic and professional characteristics of U.S. women physicians.”

Western Journal of Medicine, Vol. 166, pgs. 179-184.• (25) McNagny S, Wenger N, Frank E. 1997. “Personal use of postmenopausal hormone replacement therapy by women physicians in the United

States.” Annals of Internal Medicine, Vol. 127, pgs. 1093-1096.• (26) Frank E, Brogan D, Mokdad AH, Simoes E, Kahn H, Greenberg RS. 1998. “Health-related behaviors of women physicians vs other women

in the United States.” Archives of Internal Medicine, Vol.158, pgs. 342-348.• (27) Frank E, Brogan D, Schiffman M. 1998. “Prevalence and correlates of harassment among U.S. women physicians.” Archives of Internal

Medicine, Vol. 158, pgs. 352-358.• (28) Baldwin G, Frank E, Fielding B. 1998. “U.S. women physicians’ residential radon testing practices.” American Journal of Preventive

Medicine, Vol. 15, pgs. 49-53. • (29) Justice AC, Cho MK, Winker MA, Berlin JA, Rennie D, and the PEER Investigators (Berkwits M, Callaham M, Fontanarosa P, Frank E,

Goldman D, Goodman S, Pitkin R, Varma R, and Waeckerle J). 1998. “Does masking author identity improve peer review quality? A randomized controlled trial.” Journal of the American Medical Association, Vol. 280, pgs. 240-242.

• (30) Cho MK, Justice AC, Winker MA, Berlin JA, Waeckerle J, Callaham M, Rennie D, and the PEER Investigators (Berkwits M, Fontanarosa P, Frank E, Goldman D, Goodman S, Pitkin R, and Varma R). 1998. “Masking author identity in peer review: What factors influence masking success?” Journal of the American Medical Association, Vol. 280, pgs. 243-245.

• (31) Frank E, Brownstein M, Ephgrave L, Neumayer L. 1998. “Characteristics of women surgeons in the United States.” American Journal of Surgery, Vol. 176, pgs. 244-250.

• (32) Frank E. 1998. “Breastfeeding and maternal employment.” Lancet, Vol. 352, pgs. 1083-1084. (Also, a letter to the editor responding to comments on the article, Lancet, Vol. 352, pg. 1936)

• (33) White R, Seymour J, Frank E. 1999. “Prevalence and effects of vegetarianism in U.S. women physicians.” Journal of the American Dietetic Association, Vol. 99, pgs. 595-597.

• (34) Frank E. 1999. “Political self-characterization of U.S. women physicians.” Social Science and Medicine, Vol. 48, pgs. 1475-1481.• (35) Frank E, Hudgins P. 1999. “Academic vs. nonacademic women physicians: data from the Women Physicians’ Health Study.” Academic

Medicine, Vol. 74, pgs. 553-556.• (36) Frank E, Clancy C. 1999. “U.S. women physicians’ assessment of the health care quality they receive.” Journal of Women’s Health, Vol. 8,

pgs. 95-102.• (37) Frank E, McMurray J, Linzer M, Elon L, Society of General Medicine Career Satisfaction Study Group. 1999. “Career satisfaction of U.S.

women physicians: Results from the Women Physicians’ Health Study.” Archives of Internal Medicine, Vol. 159, pgs. 1417-1426.• (38) Frank E, Lutz L. 1999. “Characteristics of women US family physicians.” Archives of Family Medicine, Vol. 8, pgs, 313-318.• (39) Brogan DJ, Frank E, Elon L, Sivanesan SP, O’Hanlan KA. 1999. “Harassment of lesbians as medical students and physicians.” MS Journal

of the American Medical Association, Vol. 282, pgs. 1290-1292. Full electronic report http://www.ama-assn.org/sci pubs/m…/articles/vol_282/no_13/brogan.htm.

• (40) Corbie-Smith G, Frank E, Nickens H, Elon L. 1999. “Prevalences and correlates of ethnic based harassment in U.S. women physicians.” Academic Medicine, Vol. 74, pgs. 695-701.

• (41) Frank E, Feinglass S. 1999. “Student loan debt does not predict choosing a primary care specialty for US women physicians.” Journal of General Internal Medicine, Vol. 14, pgs. 347-350.

• (42) Doyle J, Frank E, Saltzman LE, McMahon PM, Fielding BD. 1999. “Domestic violence and sexual abuse in women physicians: associated medical, psychiatric, and professional difficulties.” Journal of Women’s Health, Vol. 8, pgs. 955-965.

• (43) Frank E, Kellerman A. 1999. “Firearm ownership among female physicians in the United States.” Southern Medical Journal, Vol. 92, pgs. 1083-1088.

• (44) Frank E, Vydareny K. 1999. “Characteristics of women radiologists in the United States.” American Journal of Roentgenology, Vol. 173, pgs. 531-536.

• (45) Frank E, Rock J, Sara D. 1999. “Characteristics of female obstetrician-gynecologists in the United States.” Obstetrics and Gynecology, Vol. 94, pgs. 659-665.

Milking: write it – chapter 2• (46) Frank E. 1999. “Contraceptive use by female physicians in the United States.” Obstetrics and Gynecology, Vol. 94, pgs. 666-671.• (47) Frank E, Dell ML, Chopp R. 1999. “Religious characteristics of U.S. women physicians.” Social Science and Medicine, Vol. 49, pgs.

1717-1722.• (48) Frank E, Dingle AD. 1999. “Self-reported depression and suicide attempts among U.S. women physicians.” American Journal of

Psychiatry, Vol. 156, pgs. 1887-1894.• (49) Frank E, Breyan J, Elon L. 2000. “Physician disclosure of healthy personal behaviors improves credibility and ability to motivate.”

Archives of Family Medicine, Vol. 9. Pgs. 287-290.• (50) Frank E, Harvey L. 2000. “Family responsibilities and domestic activities of U.S. women physicians.” Archives of Family Medicine,

Vol. 9, pgs. 134-140.• (51) Frank E, Baldwin G, Langleib A. 2000. “Continuing medical education habits of U.S. women physicians.” Journal of the American

Medical Women’s Association, Vol. 55, pgs. 27-28.• (52) Roberts LW, Warner TD, Carter D, Frank E, Ganzini L, Lykestos C, and the Collaborative Research Group on Medical Student Health

Care. 2000. “Caring for medical students as patients: health concerns, access to services, and care-seeking practices of 1027 students at nine medical schools.” Academic Medicine, Vol. 75, pgs. 272-277.

• (53) Frank E, Rothenberg R, Lewis C, Belodoff B. 2000. “Correlates of physicians’ prevention-related practices; findings from the Women Physicians’ Health Study.” Archives of Family Medicine, Vol. 9, pgs. 359-367.

• (54) Saraiya M, Frank E, Elon L, Baldwin G, McAlpine BE. 2000. “Personal and clinical skin cancer prevention practices of U.S. women physicians.” Archives of Dermatology, Vol. 136, pgs. 633-642.

• (55) Baranowski T, Mendlein J, Resnikow K, Frank E, Cullen KW, Baranowski J. 2000. “Physical activity and nutrition in children and youth: an overview of obesity prevention.” Preventive Medicine, Vol. 31, pgs. S1-S10.

• (56) Sallis JF, Patrick K, Frank E, Pratt M, Wechsler H, Galuska DA. 2000. “Interventions in health care settings to promote healthful eating and physical activity in children and adolescents.” Preventive Medicine, Vol. 31, pgs. S112-S120.

• (57) Frank E, Cone K. 2000. “Characteristics of pregnant vs. nonpregnant women physicians: findings from the Women Physicians’ Health Study.” International Journal of Gynecology and Obstetrics, Vol. 69, pgs. 37-46.

• (58) Frank E, Sperling L, Wu K. 2000. “Aspirin use among women physicians in the United States.” American Journal of Cardiology, Vol. 86, pgs. 465-466.

• (59) Frank E, Totten V, Andrew L. 2000. “Characteristics of women emergency physicians.” • The Internet Journal of Emergency and Intensive Care Medicine, Volume 4 Number 2.

http://www.ispub.com/journals/IJEICM/vol4N2/women.html.• (60) Frank E, Biola H, Burnett CA. 2000. “Mortality rates and causes among U.S. physicians.”• American Journal of Preventive Medicine, Vol. 19, pgs. 155-159.• (61) Frank E, Rimer BK, Brogan D, Elon L. 2000. “U.S. women physicians’ personal and clinical breast cancer screening practices.”

Journal of Women’s Health, Vol. 9, pgs. 791-801.• (62) Frank E, Dunlop AL. 2000. “What does a patient’s outfit weigh?” Family Medicine, Vol. 32, pgs. 595-596.• (63) Frank E, Bendich A, Denniston M. 2000. “Use of vitamin-mineral supplements by female physicians in the United States.” American

Journal of Clinical Nutrition, Vol. 72, pgs. 969-975.• (64) Corbie-Smith G, Frank E, Nickens H. 2000 “The intersection of race, gender, and primary care: results from the Women Physicians’

Health Study.” Journal of the National Medical Association, Vol. 92, pgs. 472-480.• (65) Frank E, Meacham L. 2001. “Characteristics of U.S. women pediatricians.” Clinical Pediatrics, Vol. 40, pgs. 17-25.

Milking: write it – chapter 3• (66) Roberts LW, Warner TD, Lykestos C, Frank E, Ganzini L, Carter D, and the Collaborative Research Group on Medical Students Health

Care. 2001. “Perceptions of academic vulnerability associated with personal illness: A study of 1027 medical students at nine medical schools.” Comprehensive Psychiatry, Vol. 42, pgs. 1-15.

• (67) Frank E, Boswell L, Dickstein L, Chapman D. 2001. “Characteristics of female psychiatrists.” American Journal of Psychiatry, Vol. 158, pgs. 205-215.

• (68) Brogan D, Frank E, Elon L, O’Hanlan K. 2001. “Methodologic concerns in defining lesbian for health research.” Epidemiology, Vol. 12, pgs. 109-113.

• (69) Easton A, Husten C, Malarcher A, Elon L, Caraballo R, Ahluwalia I, Frank E. 2001. “Smoking cessation counseling by primary care women physicians: Women Physicians’ Health Study.” Women & Health, Vol. 32(4), pgs. 77-91.

• (70) Frank E, Singh S. 2001. “Personal and practice-related characteristics of a subsample of U.S. women dermatologists: data from the Women Physicians’ Health Study.” International Journal of Dermatology, Vol. 40(6), pgs. 393-400.

• (71) Dunlop A, Allen A, Frank E. 2001. “Involving the male partner for interpreting the basal body temperature graph.” Obstetrics & Gynecology, Vol. 98 (1), pgs. 133-138.

• (72) Saraiya M, Coughlin S, Burke W, Elon L, Frank E. 2001. “The Role of Family History in Personal and Clinical Cancer Prevention Practices Among U.S. Women Physicians.” Community Genetics, Vol. 4, pgs. 102-108.

• (73) Easton A, Husten C, Elon L, Frank E. 2001. “Non-primary care physicians and smoking cessation counseling: Women Physicians’ Health Study.” Women & Health, Vol. 34(4), pgs. 15-29.

• (74) Frank E, Wright E, Serdula M, Elon L, Baldwin G. 2002. “Personal and professional nutrition-related practices of US female physicians.” American Journal of Clinical Nutrition, Vol. 75(2), pgs. 326-332.

• (75) Frank E, Kunovich-Frieze T, Corbie-Smith G. 2002. “Characteristics of women internists.” Medscape General Medicine, Vol. 4(1), pg. 11.

• (76) Frank E, Denniston M, Pederson L. 2002. “Decline in smokers’ understanding of tobacco’s hazards between 1986 and 1998: a report from North Georgia.” Southern Medical Journal, Vol. 95(7), pgs. 675-680.

• (77) Malarcher A, Easton A, Husten C, Frank E. 2002. “Smoking cessation counseling: training and practice among women pediatricians.” Clinical Pediatrics, Vol. 41 (5), pgs. 341-349.

• (78) Brogan DJ, O’Hanlan KA, Elon L, Frank E. 2003. “Health and professional characteristics of lesbian and heterosexual women physicians.” Journal of the American Medical Women’s Association, Vol. 58, pgs. 10-19.

• (79) Frank E, Elon L. 2003. “Clinical and personal relationships between oral contraceptive and hormone replacement therapy use among U.S. women physicians.” Menopause, Vol. 10, pgs. 133-141.

• (80) Mariotto A, Frank E. 2003. “A more objective approach for selecting the journal to which one submits a manuscript.” McGill Journal of Medicine, Vol 7 (1), pgs. 21-25.

• (81) Frank E, Schelbert KB, Elon L.  2003.  “Exercise counseling and personal exercise habits of U.S. women physicians.”  Journal of Women’s Health, Vol. 58 (3), pgs. 178-84.(82) Frank E, Breyan J, Elon L.   2003.  “Pro bono work and non-medical volunteerism among U.S. women physicians.”  Journal of Women’s Health, Vol. 12 (6), pgs. 589-98.(83) Frank E, Elon L, Hogue C.  2003.  “Transgenerational persistence of education as a health risk: findings from the Women Physicians’ Health Study.” Journal of Women’s Health, Vol. 12 (5), pgs. 505-12. (84) Frank E.  2004.  “Physician health and patient care.”  Journal of the American Medical Association, Vol. 291 (5), pg. 637.

• (85) Frank E, Galuska DA, Elon L, Wright EH.  2004. “Personal and clinical exercise related attitudes and behaviors of freshman U.S. medical students.” Research Quarterly in Exercise and Spor, Vol.75 (2), pgs 112-121.

• (86) Frank E, McLendon L, Elon LK, Denniston M, Fitzmaurice D, Hertzberg V. 2005. “Medical students’ self-reported typical counseling practices are similar to those assessed using Standardized Patients.” Medscape General Medicine, http://www.medscape.com/viewarticle/497041.

Summary of Principles:

1. Pick a question that matters

2. Build it strong

3. Put your data in context

4. Extrapolate/build

5. Milk it

Erica Frank, MD, MPH

Professor and Canada Research Chair

School of Population and Public Health

University of British Columbia

erica.frank@ubc.ca

Agenda – understanding the rudiments

10-10:50 – brief case studies with questions

10:50-11:15– break into small groups, to discuss potential research projects

11:15-11:30–share principles