These findings were shared and discussed with the Internal Medicine Residency Wellness Committee — composed primarily of current residents — and “everyone we identified as important to resident well-being.” The result? A multifaceted approach to wellness and burnout built on five pillars that Delgado-Carrasco believes “touch different aspects of residents’ lives.”

Fostering RESILIENCY with Laughter
Resiliency — the ability to recover, and learn from, stressful circumstances and adversity — is a prized characteristic in the medical field, and one that’s difficult to cultivate during stressful residency years. REACH is taking steps to change that through a monthly lecture series entitled “Residency Resilience” and other initiatives.

It’s a crisp, bright Sunday morning in Palo Alto, and over a dozen residents have congregated at the entrance to the Dish, a satellite structure reached by a popular 3.9-mile hiking trail that winds through the foothills behind Stanford’s campus. They’re joined by Bob Harrington, MD, the Arthur L. Bloomfield Professor of Medicine; Angela Rogers, MD, assistant professor of pulmonary and critical care medicine; Shriram Nallamshetty, MD, clinical assistant professor of cardiology; and several staff members from the Internal Medicine Residency Program.

This group has gathered for the pleasure of exercising and socializing, of course, but also to recognize the importance of well-being.

Over the last year, events like this one have happened with increasing frequency. They’re part of a new initiative called REACH (Resiliency, Education, Advocacy, Community, Health), which is committed, broadly, to resident wellness.

It’s no secret that medical residency training is intense, and the structure — long hours, compromised sleep, packed schedules — leaves little time for self-care. REACH, Karina Delgado-Carrasco, the residency program manager, says, is designed to help mitigate these stressors.

The program began as many in academia do: with a review of current research on the topic. “We read lots of publications on residency wellness and identified several domains that we wanted to cover,” Delgado-Carrasco details. These findings were shared and discussed with the Internal Medicine Residency Wellness Committee — composed primarily of current residents — and “everyone we identified as important to resident well-being.” The result? A multifaceted approach to wellness and burnout built on five pillars that Delgado-Carrasco believes “touch different aspects of residents’ lives.”

Fostering RESILIENCY with Laughter
Resiliency — the ability to recover, and learn from, stressful circumstances and adversity — is a prized characteristic in the medical field, and one that’s difficult to cultivate during stressful residency years. REACH is taking steps to change that through a monthly lecture series entitled “Residency Resilience” and other initiatives.

“Building resiliency skills can help prevent burnout and also promote a consistent feeling of wellness,” notes Neera Ahuja, MD, clinical professor of hospital medicine and associate residency program director. “A large part of resilience is being able to see life through a positive lens: being optimistic about the future and believing that one can overcome any obstacle and learn from the process.”

A key component to fostering this mindset, Ahuja explains, is to “seek and savor positive moments throughout one’s day.” To that end, the REACH program strives to “creatively sprinkle” exciting team-building activities throughout a resident’s work day. These moments create an opportunity for house staff to “laugh and bond together — even for only 15 minutes before returning to the wards — which can have a lasting, positive impact.”

Prioritizing EDUCATION through Mentorship
Faculty mentorship is seen as a way to supplement residents’ education and propel them into successful professional and academic careers. Mentors meet with mentees throughout a resident’s career, collaborating on research and providing career guidance. Other events, like the first-ever Residency Research Symposium, provide a forum for trainees to share their work with the broader Stanford community.

Supporting ADVOCACY by Providing a Seat at the Table
Through internal REACH advocacy committees, such as the Committee on Residency Reform and the Diversity Group, residents are provided avenues to effect change and make their voices heard.

“The committee is composed of elected resident class representatives, chief residents, and program directors and administration,” says Ron Witteles, MD, associate professor of cardiology and the residency program director. “It allows for a true ‘ground-up’ approach to program reform and is designed to turn feedback quickly into action. Residents work really hard; it’s important for them to know they have an outlet to effect change.”

Additional opportunities for advocacy abound and extend beyond the Stanford campus: A new diversity lecture series trains residents to better care for diverse patients, and tracks like Homeless Outreach and Social Medicine prime residents to care for the broader Bay Area community.

Building COMMUNITY over Quality Coffee
On September 28, 2018, as bleary-eyed residents filed into Stanford’s Grant building for their morning report, they were met with a small surprise: artisanal coffee that had been brought in for them to celebrate National Coffee Day. Another morning, they received boba tea. At a scheduled lunch, unknowing residents were paired to complete an Amazing Race–style scavenger hunt all over campus.

These events, known informally as “pop-ups,” are an important tenet of REACH and have a marked positive impact on residents. Delgado-Carrasco explains the thought process behind these small gestures: “It’s about surprising residents to show that we appreciate them, to let them know that we know how hard they’re working.”

Other, larger events — like free tickets to Stanford’s homecoming football game — are specifically designed to connect residents with each other and the community around them, to carve out space for them to build rapport.

“These events bring people together so they can meet and support each other,” Delgado-Carrasco says. “That’s how we build community.”

Prioritizing EDUCATION through Mentorship
Faculty mentorship is seen as a way to supplement residents’ education and propel them into successful professional and academic careers. Mentors meet with mentees throughout a resident’s career, collaborating on research and providing career guidance. Other events, like the first-ever Residency Research Symposium, provide a forum for trainees to share their work with the broader Stanford community.

Supporting ADVOCACY by Providing a Seat at the Table
Through internal REACH advocacy committees, such as the Committee on Residency Reform and the Diversity Group, residents are provided avenues to effect change and make their voices heard.

“The committee is composed of elected resident class representatives, chief residents, and program directors and administration,” says Ron Witteles, MD, associate professor of cardiology and the residency program director. “It allows for a true ‘ground-up’ approach to program reform and is designed to turn feedback quickly into action. Residents work really hard; it’s important for them to know they have an outlet to effect change.”

Additional opportunities for advocacy abound and extend beyond the Stanford campus: A new diversity lecture series trains residents to better care for diverse patients, and tracks like Homeless Outreach and Social Medicine prime residents to care for the broader Bay Area community.

Caring for Residents’ HEALTH on — and off — the Yoga Mat
REACH provides myriad ways for residents to care for their physical — and mental — health. Yoga aficionados will have the opportunity to unroll their mats and take a private yoga class taught by Ahuja later this spring. And each year, residents can lace up their sneakers and hit the softball field with their families, interns, program directors, and faculty for annual softball days. “It’s fun to get everyone and their families out to that event,” Delgado-Carrasco says.

REACH prioritizes mental health by clearly communicating available resources and destigmatizing the process of asking for help. Delgado-Carrasco elaborates: “We let all the residents know what’s available to them through Stanford Hospital — like access to mental health programs and wellness coaches. We post these resources on a poster board every day. We want them to know that if you need to reach out to someone, there are people — and resources — available.”

At the end of the Dish hike, residents, faculty, and program administrators chat with each other before heading home to enjoy the rest of their respective weekends. Pictures from the event broadcast the group’s enthusiasm — everyone has wide grins and cheeks flushed from outdoor exercise. This happy image is one Delgado-Carrasco is committed to continuing as REACH looks into the future. “We’re committed to supporting our residents during their time here and promoting their wellness, and we want them to know that everyone is invested in their well-being.”

Building COMMUNITY over Quality Coffee
On September 28, 2018, as bleary-eyed residents filed into Stanford’s Grant building for their morning report, they were met with a small surprise: artisanal coffee that had been brought in for them to celebrate National Coffee Day. Another morning, they received boba tea. At a scheduled lunch, unknowing residents were paired to complete an Amazing Race–style scavenger hunt all over campus.

These events, known informally as “pop-ups,” are an important tenet of REACH and have a marked positive impact on residents. Delgado-Carrasco explains the thought process behind these small gestures: “It’s about surprising residents to show that we appreciate them, to let them know that we know how hard they’re working.”

Other, larger events — like free tickets to Stanford’s homecoming football game — are specifically designed to connect residents with each other and the community around them, to carve out space for them to build rapport.

“These events bring people together so they can meet and support each other,” Delgado-Carrasco says. “That’s how we build community.”

Caring for Residents’ HEALTH on — and off — the Yoga Mat
REACH provides myriad ways for residents to care for their physical — and mental — health. Yoga aficionados will have the opportunity to unroll their mats and take a private yoga class taught by Ahuja later this spring. And each year, residents can lace up their sneakers and hit the softball field with their families, interns, program directors, and faculty for annual softball days. “It’s fun to get everyone and their families out to that event,” Delgado-Carrasco says.

REACH prioritizes mental health by clearly communicating available resources and destigmatizing the process of asking for help. Delgado-Carrasco elaborates: “We let all the residents know what’s available to them through Stanford Hospital — like access to mental health programs and wellness coaches. We post these resources on a poster board every day. We want them to know that if you need to reach out to someone, there are people — and resources — available.”

At the end of the Dish hike, residents, faculty, and program administrators chat with each other before heading home to enjoy the rest of their respective weekends. Pictures from the event broadcast the group’s enthusiasm — everyone has wide grins and cheeks flushed from outdoor exercise. This happy image is one Delgado-Carrasco is committed to continuing as REACH looks into the future. “We’re committed to supporting our residents during their time here and promoting their wellness, and we want them to know that everyone is invested in their well-being.”

While at UC San Francisco, he helped develop and publish a new technique to control the rhythm of the heart in patients with persistent Afib. This technique uses a catheter-based approach through a vein in the leg to tie off the left atrial appendage. A multicenter clinical trial called the aMAZE trial is currently testing the technique. “The trial is very near and dear to my heart,” says Badhwar. “Stanford is recruiting patients now.”

Leading a Fellowship Program
The fellowship program for electrophysiology (EP) trainees plays a large role in Badhwar’s work. “Because I had enjoyed training EP fellows at UCSF, I wanted to develop the electrophysiology training program here. One of my passions is teaching fellows, and it’s been very satisfying for me since I’ve been here. At UCSF I worked with Dr. Melvin Scheinman, one of the pioneers in this field, and I was very proud to use unique training tools such as teaching anatomy using cadaveric hearts in collaboration with pathology. I’ve also started intracardiac conferences for EP fellows and a national cardiology EP fellows program.”

The EP training program is also likely to expand because, says Badhwar, “It is clear that we are going to be doing more complex and novel procedures. My focus will be to make Stanford a magnet for US and international fellows for world class electrophysiology training.”

The influences in Fatima Rodriguez’s life began early. A child of immigrants, she was raised by a single mother who developed a pivotal illness: “My mom had rheumatic heart disease discovered when I was 15. I wanted to be just like her cardiologist who had made a life-changing diagnosis with just the use of his stethoscope.” Additional influences came her way at Harvard Medical School, where she arrived wanting to “just be a good clinical doctor.”

“There I had wonderful mentors who opened my eyes to public health research as well as taking care of individual patients. I received a Zuckerman Public Policy Fellowship in the John F. Kennedy School of Government, where I got to work with people across such sectors as business and law with a common goal of improving parts of health care that are not related to the medical system.”

Today, Rodriguez is a new assistant professor in the cardiovascular division with a particular interest in health disparities and improving cardiovascular risk prediction for understudied populations. As a general and preventive cardiologist, she encounters her research subjects at every clinic and during each two-week period of inpatient care. “My clinical work always influences my research questions,” she says. And, with 75 percent of her time devoted to research, she is able to think broadly about, and often test, new approaches to improving the health outcomes of her patients.

As a general cardiologist in a tertiary care center, Rodriguez works on the general cardiology service as an inpatient consultant and as part of a team that includes residents and medical students. She also has two weekly clinics: “I have an outpatient clinic in prevention focusing on risk factor control and risk assessment, and I see patients with advanced lipid disorders. I also have a general cardiology clinic, where I have a particular interest in caring for Spanish-speaking patients, since limited English proficiency directly impacts patient health and adherence.”

Dealing with patients’ medications is often a challenge. She explains: “In cardiology we have many very wonderful medications, and most of them are generic and therefore cheap and readily accessible. But they can’t work if you don’t take them. I often struggle with patients about their resistance to taking statins, which unfortunately get such bad press. I have a deal with my patients where I usually don’t start a new medication without taking something else away.”

Taking on Telemedicine
Proximity to Silicon Valley has had an effect on Rodriguez as well.

“I am the research director of our telemedicine clinic, which is called CardioClick. We are piloting it in the Stanford South Asian Translational Heart Initiative (SSATHI), a program designed for South Asians because of their higher risk of heart and vascular disease than any other ethnic group. Once CardioClick shows that it helps the SSATHI population understand their risk factors and develops targeted treatment plans for them, we will expand the services to the rest of preventive cardiology. We want to show not only that it’s convenient, because our patients can access us on the computer or iPhone, but also that it improves clinical outcomes. We’re also tracking patient satisfaction and engagement, factors that are important for the expansion of the program.”

Having had wonderful mentoring throughout her early career, Rodriguez naturally drifted toward passing it forward. “What is becoming important to me now is mentoring others,” she says, “especially underrepresented minorities and women. I hope to be able to continue to support people in that way.”

As a general cardiologist in a tertiary care center, Rodriguez works on the general cardiology service as an inpatient consultant and as part of a team that includes residents and medical students. She also has two weekly clinics: “I have an outpatient clinic in prevention focusing on risk factor control and risk assessment, and I see patients with advanced lipid disorders. I also have a general cardiology clinic, where I have a particular interest in caring for Spanish-speaking patients, since limited English proficiency directly impacts patient health and adherence.”

Dealing with patients’ medications is often a challenge. She explains: “In cardiology we have many very wonderful medications, and most of them are generic and therefore cheap and readily accessible. But they can’t work if you don’t take them. I often struggle with patients about their resistance to taking statins, which unfortunately get such bad press. I have a deal with my patients where I usually don’t start a new medication without taking something else away.”

Taking on Telemedicine
Proximity to Silicon Valley has had an effect on Rodriguez as well.

“I am the research director of our telemedicine clinic, which is called CardioClick. We are piloting it in the Stanford South Asian Translational Heart Initiative (SSATHI), a program designed for South Asians because of their higher risk of heart and vascular disease than any other ethnic group. Once CardioClick shows that it helps the SSATHI population understand their risk factors and develops targeted treatment plans for them, we will expand the services to the rest of preventive cardiology. We want to show not only that it’s convenient, because our patients can access us on the computer or iPhone, but also that it improves clinical outcomes. We’re also tracking patient satisfaction and engagement, factors that are important for the expansion of the program.”

Having had wonderful mentoring throughout her early career, Rodriguez naturally drifted toward passing it forward. “What is becoming important to me now is mentoring others,” she says, “especially underrepresented minorities and women. I hope to be able to continue to support people in that way.”

After exhaustively gathering data about accommodation costs and the distribution of patients in different levels of accommodation, Shieh and Svec estimated that assigning patients to more intensive levels of care than necessary was costing Stanford Hospital millions every year. They designed a project that would ensure appropriate levels of care for all patients by engaging physicians responsible for patients’ levels of care.

To effect meaningful change, they first had to get buy-in from all departments that assign accommodations, which meant meeting with the chairpeople of those departments and convincing them to delegate a faculty member to drive their part of the project.

Shieh and Svec’s next step was to create a set of alerts to increase awareness about levels of care.

As Stanford Health Care strives to be increasingly innovative and efficient, front-line providers develop and implement collaborative initiatives aimed at saving money and increasing high-value care. Two such programs illustrate those efforts.

The Cost Savings Reinvestment Program
Leaders at Stanford Hospital expend a fair amount of time and energy figuring out how to improve the delivery of high-value care and patient outcomes and, when possible, to reduce costs. One such effort is the Cost Savings Reinvestment Program (CSRP), which Paul Heidenreich, MD, professor of cardiovascular medicine and vice chair for quality in the Department of Medicine, describes as a “Stanford Health Care–led initiative which asks faculty to come up with a cost-saving idea or intervention, and if it is approved and put in place, rewards those who carry it out with a 25 to 50 percent share of the savings in the first year.”

The funds cannot be used as any form of salary support or compensation for physicians, but they can be used at the discretion of the departments for supplies, research-related expenses, and continuing education.

The Appropriate Use of Accommodations Project
One project under the CSRP addressed a significant source of inpatient costs: the level of in-hospital care to which patients are assigned. A patient occupying an intensive care unit bed who does not require specialized personnel and equipment associated with such accommodations is mismatched. Lisa Shieh, MD, PhD, clinical professor of hospital medicine, and David Svec, MD, MBA, assistant professor of hospital medicine, saw mismatching as expensive and wasteful. Besides simply saving money, says Svec, “We believed that using these extremely expensive resources appropriately would improve the value of the care patients receive.”

After exhaustively gathering data about accommodation costs and the distribution of patients in different levels of accommodation, Shieh and Svec estimated that assigning patients to more intensive levels of care than necessary was costing Stanford Hospital millions every year. They designed a project that would ensure appropriate levels of care for all patients by engaging physicians responsible for patients’ levels of care.

To effect meaningful change, they first had to get buy-in from all departments that assign accommodations, which meant meeting with the chairpeople of those departments and convincing them to delegate a faculty member to drive their part of the project.

Shieh and Svec’s next step was to create a set of alerts to increase awareness about levels of care. The first alert they created asks — every day — whether a patient who is on cardiac monitoring still needs it. A response from a caregiver is required, causing that caregiver to think about whether the use is appropriate according to Stanford and national guidelines. A second alert reminds caregivers that their patient’s level of care is the intermediate intensive care unit, a fact sometimes missed because rooms on different levels look the same.

The results are positive so far. The CSRP project is likely to save the millions Shieh and Svec estimated, and they look forward to working on additional projects to provide higher value care for Stanford patients.

The Improvement Capability Development Program
The Improvement Capability Development Program (ICDP) is a joint venture between the Department of Quality for Stanford Health Care and the School of Medicine. Its premise: Stanford Health Care commits to returning 1 to 2 percent of a department’s clinical revenue to help develop and execute far-reaching quality improvement (QI) projects, depending on its level of commitment and outcomes or deliverables. Although these funds cannot be distributed as a bonus to department faculty, they can support faculty conducting improvement work, including research and education related to quality.

According to Stephanie Harman, MD, clinical associate professor of primary care and population health, it has been a challenge for clinical departments to fund QI initiatives “because clinicians are bootstrapping projects with unfunded time and no project management support. With ICDP, Stanford Health Care is funding the time and project management it takes to lift up a new project that aims to improve the care we give.”

According to Stephanie Harman, MD, clinical associate professor of primary care and population health, it has been a challenge for clinical departments to fund QI initiatives “because clinicians are bootstrapping projects with unfunded time and no project management support. With ICDP, Stanford Health Care is funding the time and project management it takes to lift up a new project that aims to improve the care we give.”

Difficult Conversations with Seriously Ill Patients
One ICDP project has to do with seriously ill patients. After learning that there are many patients with serious illness who have no advanced directives or other documentation of what matters most to them, Harman realized that important conversations with patients were not happening. “These are conversations that many physicians see as challenging and time-intensive, but the system wasn’t built for them to happen in busy clinic settings,” she says. The serious illness conversation project was developed to bring advance care planning to more patients and families and to integrate it into the standard work of the clinic.

To get the project off the ground, its leaders entered into a partnership with Ariadne Labs — a joint health system innovation center of Brigham & Women’s Hospital and the Harvard T. H. Chan School of Public Health — founded by Atul Gawande, MD, to help with training and workflow redesign. Harman explains the need for such help: “Left to our own devices, we would have been reinventing the wheel. We didn’t know what resources it would take to carry out the project on a large scale, for instance. The ICDP project funding has paid a fee to join, which covers team training and coaching, the implementation of workflow redesign, and our membership in a collaborative national group. Those funds also support part of a physician leader’s time as well as true project management support.”

Difficult Conversations with Seriously Ill Patients
One ICDP project has to do with seriously ill patients. After learning that there are many patients with serious illness who have no advanced directives or other documentation of what matters most to them, Harman realized that important conversations with patients were not happening. “These are conversations that many physicians see as challenging and time-intensive, but the system wasn’t built for them to happen in busy clinic settings,” she says. The serious illness conversation project was developed to bring advance care planning to more patients and families and to integrate it into the standard work of the clinic.

To get the project off the ground, its leaders entered into a partnership with Ariadne Labs — a joint health system innovation center of Brigham & Women’s Hospital and the Harvard T. H. Chan School of Public Health — founded by Atul Gawande, MD, to help with training and workflow redesign. Harman explains the need for such help: “Left to our own devices, we would have been reinventing the wheel. We didn’t know what resources it would take to carry out the project on a large scale, for instance. The ICDP project funding has paid a fee to join, which covers team training and coaching, the implementation of workflow redesign, and our membership in a collaborative national group. Those funds also support part of a physician leader’s time as well as true project management support.”

Harman says that while the program is still in the early stages, “it’s going well. The emphasis on implementation and workflow redesign ensures that physicians aren’t the sole holders of these conversations and ensures that they happen. Everything else we do in the clinic is team-based, and so should this be. The feedback from several groups of physicians, nurses, social workers, and clinic managers who underwent training is that they are 100 percent likely to recommend it.”

The physician leader of the project is Winnie Teuteberg, MD, clinical associate professor of primary care and population health. Her responsibility entails partnering with the project manager to implement the program. The hardest part, she believes, “is selling the program. We’re asking doctors to change a part of their job that deals with an emotionally-charged subject.”

The project uses a guide developed by Ariadne Labs, which Teuteberg describes as “having a list of about 10 questions that go through information sharing and patient preferences. It includes ways for providers to share a prognosis if that’s appropriate. Then it talks about hopes and goals, fears and worries. The ultimate wrap-up is the physician pulling the information together and making a recommendation about where to go next.”

Ann Weinacker, MD, senior vice chair of medicine for clinical affairs, reflects on the fundamental value of programs such as the CSRP and ICDP: “What is really exciting about these programs is that they actively engage physicians and School of Medicine clinical departments in improvement work that aligns with the goals of Stanford Medicine, an alliance between the School of Medicine and the hospitals. The development of ICDP and CSRP was born of the recognition that the commitment of physicians to this work is essential to increasing the value of the care we deliver.”

Harman says that while the program is still in the early stages, “it’s going well. The emphasis on implementation and workflow redesign ensures that physicians aren’t the sole holders of these conversations and ensures that they happen. Everything else we do in the clinic is team-based, and so should this be. The feedback from several groups of physicians, nurses, social workers, and clinic managers who underwent training is that they are 100 percent likely to recommend it.”

The physician leader of the project is Winnie Teuteberg, MD, clinical associate professor of primary care and population health. Her responsibility entails partnering with the project manager to implement the program. The hardest part, she believes, “is selling the program. We’re asking doctors to change a part of their job that deals with an emotionally-charged subject.”

The project uses a guide developed by Ariadne Labs, which Teuteberg describes as “having a list of about 10 questions that go through information sharing and patient preferences. It includes ways for providers to share a prognosis if that’s appropriate. Then it talks about hopes and goals, fears and worries. The ultimate wrap-up is the physician pulling the information together and making a recommendation about where to go next.”

Ann Weinacker, MD, senior vice chair of medicine for clinical affairs, reflects on the fundamental value of programs such as the CSRP and ICDP: “What is really exciting about these programs is that they actively engage physicians and School of Medicine clinical departments in improvement work that aligns with the goals of Stanford Medicine, an alliance between the School of Medicine and the hospitals. The development of ICDP and CSRP was born of the recognition that the commitment of physicians to this work is essential to increasing the value of the care we deliver.”

Key achievements for the division include: collaboration with the Research Management Group to determine the appropriate funding for studies, a streamlined budgeting and contract process that has led to earlier initiation of studies, improved financial metrics, the adoption of a central Institutional Review Board process, and a culture of collaboration and efficiency.

SCCR teams support many types of research — drug, medical device, and mobile/digital technology trials; investigator-initiated studies; and multisite registries. Investigators collaborate across divisions and departments in the School of Medicine, with groups such as neurosurgery; vascular surgery; radiology; biodesign; athletics; infectious diseases; and Spectrum, the Stanford Center for Clinical and Translational Research and Education — furthering a holistic and multidisciplinary approach.

The Stanford Center for Clinical Research (SCCR) is the “operational engine” that enables many faculty throughout Stanford to drive robust clinical research enterprises, according to Kenneth Mahaffey, MD, professor of cardiovascular medicine, vice chair of clinical research in the Department of Medicine, and director of SCCR.

Since its inception in late 2014, SCCR has grown to 70 staff and partnered with more than 50 faculty and 25 fellows on 82 research projects.

SCCR has three foundational enterprises:

1. A site-based research program led by Rebecca McCue to support projects in which Stanford researchers enroll Stanford patients in clinical trials.
2. A coordinating center led by Amol Rajmane, MD, to help design and conduct multicenter registries, trials, and outcome programs.
3. An educational component led by Kiera Larsen, RN, which has created preceptorships and a large portfolio of educational opportunities — including scientific seminars and Good Clinical Practice workshops for research staff — and educational events for industry.

Supporting Faculty across the School of Medicine for Site-Based Research
SCCR works with faculty to understand research interests and then develop their research portfolios to support the desired vision. SCCR hires, trains, manages, and mentors research staff to navigate complex processes, letting faculty focus on their scientific and clinical care activities.

“SCCR doesn’t remove the faculty member from the key relationship with research coordinators, but we take on a lot of the administrative burden,” McCue, the associate director for SCCR’s site-based research projects, points out.

In just a few years, SCCR’s partnership with the division of gastroenterology and hepatology has helped the division’s research portfolio grow from 10 studies to more than 50. The SCCR team works with 22 principal investigators and 11 dedicated research staff in the division. Key achievements for the division include: collaboration with the Research Management Group to determine the appropriate funding for studies, a streamlined budgeting and contract process that has led to earlier initiation of studies, improved financial metrics, the adoption of a central Institutional Review Board process, and a culture of collaboration and efficiency.

SCCR teams support many types of research — drug, medical device, and mobile/digital technology trials; investigator-initiated studies; and multisite registries. Investigators collaborate across divisions and departments in the School of Medicine, with groups such as neurosurgery; vascular surgery; radiology; biodesign; athletics; infectious diseases; and Spectrum, the Stanford Center for Clinical and Translational Research and Education — furthering a holistic and multidisciplinary approach.

Sanjiv (Sam) Gambhir, MD, PhD, professor and chairman of radiology, helped launch Project Baseline, one of the largest projects that SCCR works on. Project Baseline is a collaborative effort among Stanford Medicine, Duke University School of Medicine, Verily, and Google. The researchers plan to enroll approximately 10,000 participants with an extraordinarily detailed evaluation of each participant; the idea is to characterize what it means to be healthy and to capture changes during a transition to disease.

“A large part of Project Baseline deals with trying to understand the transition from health to disease on a personal level, which integrates precision medicine, preventive health, and mobile and digital technologies,” Mahaffey says.

To help with study recruitment, SCCR leaders launched a Community Advisory Board for Clinical Research in 2015, which allows faculty to engage community members as partners. The aim of the advisory board is to bridge the gap between researchers and the community to enhance clinical research.

Multisite Research Project Coordination
SCCR’s Coordinating Center helps faculty design and run multisite research projects, as its project managers provide input on protocols, assist with FDA and Institutional Review Board submissions, shape sustainable study budgets, and manage sites. It also offers core lab administration, safety desk work, event adjudication, and data safety monitoring committee management.

The Apple Heart Study, conducted to learn if an app can use data from the Apple Watch to identify irregular heart rhythms, is one example of how SCCR works with Stanford researchers and sponsors to leverage technology and innovation to rigorously test drugs, devices, and other interventions.

“We have a portfolio of five studies relating to mobile and digital technologies created in part by an intense interest in these technologies by many Stanford faculty and by a strategic partnership with the Center for Digital Health,” says Rajmane, SCCR’s associate director for the Coordinating Center.

The Coordinating Center is also managing the research operations for a study evaluating concussions using an innovative mouth guard with local high school football programs. Partners include leading concussion experts from Stanford: bioengineer David Camarillo, PhD; neurosurgeon Gerald Grant, MD; and neuroradiologist Michael Zeineh, MD, PhD.

Every clinical research project involves tasks like project management, site start-up and initiation, oversight for recruitment and retention, data collection, core lab activities, safety event reporting, and quality and compliance oversight. For faculty who want to lead multicenter clinical research projects, SCCR eliminates the need to outsource those tasks.

“Faculty can lead these large projects without worrying about the operational administration and coordination, and as the activities are performed by a Stanford team and not by an outside entity, it’s easy for them to coordinate and work with the team. Faculty can have a much higher profile in these projects because all the research activities are being done here at Stanford,” Mahaffey says.

David Maron, MD, a clinical professor of cardiovascular medicine, notes how SCCR is readily available to round out his research team by helping complete proposals. He recalls an instance when a research application required detailed information about a committee to adjudicate clinical events and notes how “SCCR provided a description of the organization, the budget, and the personnel that was required in the application.”

Partnerships and Team Science
Mahaffey describes the importance of having SCCR collaborate with institutional resources like the Research Management Group, the Institutional Review Board, and the Privacy Office.

“We work with these resources to understand how to oversee new types of research protocols to make sure processes are appropriate. We want them to adhere not only to institution policies and standards, but also to external requirements from the FDA and NIH,” he says.

On the subject of partnership, Mintu Turakhia, MD, associate professor of cardiovascular medicine and director of the Center for Digital Health, describes his relationship with SCCR.

“Working with SCCR has been seminal to my career progression. I’ve had the privilege of working with Ken [Mahaffey] and his outstanding team for over four years now on a series of clinical trials that range from traditional small, single-center trials all the way to the Apple Heart Study, a massive virtual clinical trial. In the early days of SCCR, it was a handful of us working together — much like a startup — to get the job done. Now the group has about 70 people and is a remarkably well-oiled machine,” Turakhia says.

SCCR is involved with faculty who are experts in a variety of therapeutic subjects and areas of practice. “We have projects that really epitomize team science, with faculty from multiple disciplines and research staff from multiple areas, including data scientists, project managers, information technology experts, biostatisticians, and bioinformaticians,” Mahaffey says.

He describes how SCCR’s activities over the past four years speak to its mission of “conducting and promoting high-impact, innovative clinical research to improve human health.”

Multisite Research Project Coordination
SCCR’s Coordinating Center helps faculty design and run multisite research projects, as its project managers provide input on protocols, assist with FDA and Institutional Review Board submissions, shape sustainable study budgets, and manage sites. It also offers core lab administration, safety desk work, event adjudication, and data safety monitoring committee management.

The Apple Heart Study, conducted to learn if an app can use data from the Apple Watch to identify irregular heart rhythms, is one example of how SCCR works with Stanford researchers and sponsors to leverage technology and innovation to rigorously test drugs, devices, and other interventions.

“We have a portfolio of five studies relating to mobile and digital technologies created in part by an intense interest in these technologies by many Stanford faculty and by a strategic partnership with the Center for Digital Health,” says Rajmane, SCCR’s associate director for the Coordinating Center.

The Coordinating Center is also managing the research operations for a study evaluating concussions using an innovative mouth guard with local high school football programs. Partners include leading concussion experts from Stanford: bioengineer David Camarillo, PhD; neurosurgeon Gerald Grant, MD; and neuroradiologist Michael Zeineh, MD, PhD.

Every clinical research project involves tasks like project management, site start-up and initiation, oversight for recruitment and retention, data collection, core lab activities, safety event reporting, and quality and compliance oversight. For faculty who want to lead multicenter clinical research projects, SCCR eliminates the need to outsource those tasks.

“Faculty can lead these large projects without worrying about the operational administration and coordination, and as the activities are performed by a Stanford team and not by an outside entity, it’s easy for them to coordinate and work with the team. Faculty can have a much higher profile in these projects because all the research activities are being done here at Stanford,” Mahaffey says.

David Maron, MD, a clinical professor of cardiovascular medicine, notes how SCCR is readily available to round out his research team by helping complete proposals. He recalls an instance when a research application required detailed information about a committee to adjudicate clinical events and notes how “SCCR provided a description of the organization, the budget, and the personnel that was required in the application.”

Partnerships and Team Science
Mahaffey describes the importance of having SCCR collaborate with institutional resources like the Research Management Group, the Institutional Review Board, and the Privacy Office.

“We work with these resources to understand how to oversee new types of research protocols to make sure processes are appropriate. We want them to adhere not only to institution policies and standards, but also to external requirements from the FDA and NIH,” he says.

On the subject of partnership, Mintu Turakhia, MD, associate professor of cardiovascular medicine and director of the Center for Digital Health, describes his relationship with SCCR.

“Working with SCCR has been seminal to my career progression. I’ve had the privilege of working with Ken [Mahaffey] and his outstanding team for over four years now on a series of clinical trials that range from traditional small, single-center trials all the way to the Apple Heart Study, a massive virtual clinical trial. In the early days of SCCR, it was a handful of us working together — much like a startup — to get the job done. Now the group has about 70 people and is a remarkably well-oiled machine,” Turakhia says.

SCCR is involved with faculty who are experts in a variety of therapeutic subjects and areas of practice. “We have projects that really epitomize team science, with faculty from multiple disciplines and research staff from multiple areas, including data scientists, project managers, information technology experts, biostatisticians, and bioinformaticians,” Mahaffey says.

He describes how SCCR’s activities over the past four years speak to its mission of “conducting and promoting high-impact, innovative clinical research to improve human health.”

The projects on display spanned disciplines, fields, and diseases — investigating topics ranging from advanced care planning to complications of cirrhosis. “Essentially every specialty within medicine was represented,” recalls Rogers. “It was an opportunity for residents to show each other their work, and there aren’t a lot of avenues for that.”

It was also an opportunity to highlight the important role that mentorship and guidance play throughout the Stanford residency experience. “The projects that were presented involved 25 mentors — it’s a testament to how many faculty give their time,” says Rogers. “This type of long-term relationship with a single mentor can be instrumental, and it’s something we pride ourselves on.”

Wearing a black Stanford Medicine fleece over his blue scrubs, third-year internal medicine resident Gilad Jaffe, MD, stood in front of a poster that described his research on screening rates for primary aldosteronism in patients with resistant hypertension.

He shared the specifics of his findings with a roomful of attendees at the first-ever Stanford Medicine Residency Research Symposium.

Jaffe was one of 49 residents who participated in the event, which was designed to “highlight the remarkable things our residents are doing,” says Angela Rogers, MD, an assistant professor of pulmonary and critical care medicine and the associate program director of the Stanford Internal Medicine Residency Program, who oversaw the symposium.

“More than 80 percent of Stanford residents take a dedicated research month during their time here,” she explains, “and they are amazingly productive. The amount of work and research that they do on their nights and weekends is worth celebrating.”

Resident Jimmy Tooley, MD, one of the leaders of the Stanford Internal Medicine Research Interest Group who helped organize the event, agreed with Rogers, adding: “There is a lot of great mentorship and research going on. I am so impressed and inspired by all the amazing work being done by my peers.”

During the event, faculty judges, mentors, and fellow residents walked up and down several aisles of poster boards, pausing to ask questions, give insights and feedback, and take notes.

The projects on display spanned disciplines, fields, and diseases — investigating topics ranging from advanced care planning to complications of cirrhosis. “Essentially every specialty within medicine was represented,” recalls Rogers. “It was an opportunity for residents to show each other their work, and there aren’t a lot of avenues for that.”

It was also an opportunity to highlight the important role that mentorship and guidance play throughout the Stanford residency experience. “The projects that were presented involved 25 mentors — it’s a testament to how many faculty give their time,” says Rogers. “This type of long-term relationship with a single mentor can be instrumental, and it’s something we pride ourselves on.”

Jaffe has seen the benefits of this long-term mentorship firsthand. He’s been working alongside his mentor, Vivek Bhalla, MD, an assistant professor of nephrology, since the start of his intern year in 2016. “Dr. Bhalla is an outstanding teacher, mentor, and physician,” Jaffe explains. “He is extremely supportive of me and my goals. He worked with me closely and guided me through the process, but also gave me room to spread my wings and figure out the research landscape. He always made time for our research, even if it meant talking to him on his personal time at home.”

At the end of the event, the judges picked 10 winners who received small monetary prizes, but it was clear from the palpable energy and excitement in the room that it was a valuable experience for all involved. “It was spectacularly successful, and we plan to host it every year,” Rogers confirms. “The enthusiastic response from residents and faculty made the event celebratory and supportive.”