Updates from Central Office and Note to the Community
Paying it Forward
February 9, 2024
By Corinne Voils, PhD
Corinne Voils, PhD
As a first-generation college student, I never had a clear path to follow. I applied to two universities, both chosen based on where my friends wanted to go. Little did I know that one of those was an expensive, private university whose annual cost was equivalent to my father’s salary. When that university held an information session in my city and my mom inquired about scholarships, we were told, “The financial aid deadline was yesterday.” We didn’t know what financial aid was, or that there was a deadline. That sealed my fate: I had to attend the only other university I had applied to, and I needed to apply for aid.
I didn’t realize until well into my adult life how being a first-generation student affected my approach to undergraduate and graduate college admissions, educational experience, and career. As an undergraduate, I knew that I wanted to go to graduate school, but I had no idea how to get there. An acquaintance was a member of the psychology honors society and urged me to join since I was a psychology major and had a good grade point average. Through that organization, I learned about an opportunity to do research with a faculty member. I started working with Dr. Michael Zarate, who let me run subjects and advised me on applying to graduate school. Unfortunately, I didn’t listen to all his advice. I didn’t study for the GRE because I didn’t think it was possible to improve my score; either you had it, or you didn’t. My score was okay, but not enough to get into the top graduate programs in my field. Against his advice, I only applied to those top programs the first time around and was not admitted. The next year, I listened to him and developed a more balanced list. I was admitted to two programs. When I see him today at conferences, he laughs and tells people, “She applied to X (highly distinguished) program as her back-up school. It was her back-up because she didn’t want to live there.”
While funny, this anecdote shows just how lost someone can be as a first-generation college student. I feel very fortunate to have been presented with mentorship and opportunities that set me down a productive path. One such opportunity was a postdoctoral fellowship at the Durham Veterans Affairs Medical Center (VAMC). In graduate school, I became disillusioned with academia because my professors did not seem to have work-life balance and undergraduates only seemed to care about grades. Through a professor, I found a job at a small consulting firm that analyzed quality of life and medication adherence data from pharmaceutical trials. Business did not do well following the September 2001 attacks, forcing me to look for another position. Through the same professor, I was connected to Dr. Hayden Bosworth at the Durham VAMC. He had a slot open for a postdoc position. I did not know what health services research was or what I would do after the postdoc. But I was familiar with Veterans and their healthcare struggles because my father had served in the Navy during Vietnam. I had heard many interesting stories about his military experience, and I had often tried to persuade him to stop smoking and to lose weight. During my postdoc, I learned that my background as a social psychologist could be used to develop behavioral interventions to help Veterans make and sustain lifestyle changes. Hayden guided me to develop collaborations with clinicians to ensure I was doing clinically relevant work; told me to trust my gut; and helped me prepare a successful application for the Merit Review Entry Program career development award available for non-clinicians at that time. Through his mentorship as well as that of Drs. Gene Oddone and Morris Weinberger, I started down a career path that I didn’t know existed.
As we know in health services research, sometimes we can change structures to help a lot of people; other times, we must help individuals navigate a suboptimal system. As a mentor, I recruit lab members from university organizations that serve students from underrepresented backgrounds. Even though they made it to college, I see that my students from more privileged backgrounds have an easier time figuring things out. First-generation students need guidance in identifying and creating paths they don’t yet know exist. When I think about what mark I want to leave, it is undoubtedly paying it forward.
Informatics Research and the Implementation Gap
January 18, 2024
By Maren Loe, PhD
Maren Loe, PhD
I was honored to join Health Systems Research (HSR) in mid-September 2023, as part of the 51st cohort of the American Association for the Advancement of Sciences (AAAS) Science and Technology Policy Fellowship (STPF). I spent the previous seven years in the combined MD/PhD Medical Scientist Training Program at Washington University in St. Louis. Having completed my PhD in Systems Science and Mathematics, I will return to complete my MD program in 2025. As a physician-scientist in training, I faced various obstacles in my research, some of which resulted from a lack of a unified infrastructure to facilitate the translation of clinical data into knowledge and practice behaviors. When I defended my dissertation, my PhD advisor estimated that it would take at least a decade for my work to change clinical practice. The literature suggests that is an optimistic timeline, and that the so-called “implementation gap” is closer to 17 years from bench to widespread implementation at the bedside. Here in HSR, reducing that gap is within our purview, as are some of the other structural challenges I faced. My job now includes considering questions like how we are using medical data to improve Veterans’ health through a Learning Health System.
Specifically, one of my projects this year is updating our priorities in informatics research, which is being dramatically impacted by the recent explosion of artificial intelligence research, specifically generative AI and large language models (LLMs). These tools hold great promise to improve clinical care through better treatments and interventions as well as for workforce support. As a medical trainee, I saw how time-intensive documentation—like writing insurance appeals letters against prior authorization denials—could take time away from the humanistic side of medical care. I watched many attending and resident physicians spend a large proportion of their time behind a computer, facing a tradeoff between charting during the outpatient visits to save time or working late to finish charts after the patients left. LLMs have already been proposed as a tool to reduce some of this burden of documentation, and start-ups have already begun creating software for electronic health records, while some clinicians have described using ChatGPT to write basic insurance appeal letters.
In this arena, HSR aims to understand questions of appropriateness, safety, and reliability. For example: When the use of a given tool is appropriate, what implementation strategy is best? How can that tool be used to promote patient safety while avoiding any adverse events? As a science and technology policy fellow, it has been fascinating to watch HSR and the National Artificial Intelligence Institute interpret and implement guidance from the White House (Executive Order). I have a front row seat to the creation and implementation of policy that will inform patient care and research that improves Veterans’ lives. I am excited to continue my work in this domain throughout the rest of my fellowship year here at HSR.