Over the course of their lives the average American will undergo nearly nine surgical procedures, many related to diseases of the digestive track or conditions associated with obesity. Despite being some of the most commonly performed interventions, most of these procedures have not been subjected to rigorous scientific evaluation. For almost all of these procedures, fundamental questions regarding surgical epidemiology, clinical effectiveness, best practices to accomplish best outcomes, population-level results, patient-reported perspectives, and cost considerations have yet to be addressed. As healthcare delivery is reformed and as we strive towards building a learning healthcare system, addressing these questions is critical. One reason for the shortfall in rigorous clinical research in surgery is a paucity of formal, health services and comparative effectiveness research training for surgeons. To address this need, we propose the continuation and expansion of the University of Washington's National Research Service Award (NRSA) fellowship in clinical, health services, comparative effectiveness and patient-centered outcomes research for surgeons. This fellowship involves didactic training and practical experience in advanced research methodology focused on interventions related to the gastrointestinal system, obesity, and obesity-associated conditions. The training is focused in 6 areas (research using observational data, patient-centered outcome and preference assessment, health economics and behavioral economics in healthcare, policy and implementation science research, clinical / translational research, and research operations management) and is intended to develop surgeon- scholars who will be successful scientists and help build and advance the goals of a learning healthcare system. The didactic component of this fellowship includes coursework that results in a Masters of Public Health (MPH) or Masters in Science (MS) degree through the University of Washington School of Public Health and Community Medicine, with additional coursework and certificate training in the PhD candidate-training program of the Departments of Health Services and Pharmacy. All trainees complete a set of projects and studies representing a wide spectrum of research methods and approaches. The trainee's experience is fostered by a structured mentorship program with seasoned investigators who have a career commitment to training and career success in high-level research and integrating evidence into practice change. The T32 Fellows also participate in unique community, regional and national learning healthcare system programs including Washington State's Comparative Effectiveness Research Translation Network (CERTAIN),3 the Surgical Care and Outcomes Assessment Program (SCOAP)4 and a program aimed at optimizing patients before hospitalization called Strong for Surgery (strongforsurgery.org). Trainees participate in the NRSA fellowship for two years and then serve an additional 5-7 years of additional postdoctoral clinical training as general or specialty surgeons in the fields of advanced laparoscopy, foregut, hepatobiliary, colorectal, or bariatric surgery before obtaining academic faculty positions. The current NRSA fellowship program supports one new trainee per year, and because of program success, mentor capacity and trainee demand we are requesting an expansion to two new trainees per year.

Public Health Relevance

Surgeons in training need formalized, rigorous programs to prepare them for academic careers and to create the type of high-impact research needed for a more effective and efficient healthcare delivery system. Our T32 training program prepares surgeons for successful careers in research, but also in leading the learning healthcare systems of the future. Our focus is on the gastrointestinal conditions and obesity-related diseases that are some of the most common reasons for surgery. With training in research methods, practical skills for research success, community and regional programs focused on quality improvement and structured mentorship, these trainees progress to become independently funded scientists and leaders in accelerating the production of high-impact surgical research.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Institutional National Research Service Award (T32)
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Kidney, Urologic and Hematologic Diseases D Subcommittee (DDK)
Program Officer
Densmore, Christine L
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University of Washington
Schools of Medicine
United States
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Thornblade, Lucas W; Arbabi, Saman; Flum, David R et al. (2018) Facility-Level Factors and Outcomes After Skilled Nursing Facility Admission for Trauma and Surgical Patients. J Am Med Dir Assoc 19:70-76.e1
Thornblade, Lucas W; Seo, Yongwoo D; Kwan, Tracy et al. (2018) Enhanced Recovery via Peripheral Nerve Block for Open Hepatectomy. J Gastrointest Surg 22:981-988
Thornblade, Lucas W; Flum, David R; Flaxman, Abraham D (2018) Predicting Future Elective Colon Resection for Diverticulitis Using Patterns of Health Care Utilization. EGEMS (Wash DC) 6:1
Ehlers, Anne P; Davidson, Giana H; Deeney, Kimberly et al. (2017) Methods for Incorporating Stakeholder Engagement into Clinical Trial Design. EGEMS (Wash DC) 5:4
Verdial, Francys C; Etzioni, Ruth; Duggan, Catherine et al. (2017) Demographic changes in breast cancer incidence, stage at diagnosis and age associated with population-based mammographic screening. J Surg Oncol 115:517-522
Comparative Effectiveness Research Translation Network's Collaborative for Healthcare Research in Behavioral Economics and Decision Sciences (CERTAIN-CHOICES) (2017) Factors influencing delayed hospital presentation in patients with appendicitis: the APPE survey. J Surg Res 207:123-130
Ehlers, Anne P; Oelschlager, Brant K; Pellegrini, Carlos A et al. (2017) Achalasia Treatment, Outcomes, Utilization, and Costs: A Population-Based Study from the United States. J Am Coll Surg 225:380-386
Ehlers, Anne P; Roy, Senjuti Basu; Khor, Sara et al. (2017) Improved Risk Prediction Following Surgery Using Machine Learning Algorithms. EGEMS (Wash DC) 5:3
Davidson, Giana H; Austin, Elizabeth; Thornblade, Lucas et al. (2017) Improving transitions of care across the spectrum of healthcare delivery: A multidisciplinary approach to understanding variability in outcomes across hospitals and skilled nursing facilities. Am J Surg 213:910-914
Thornblade, Lucas W; Cheng, Aaron M; Wood, Douglas E et al. (2017) A Nationwide Rise in the Use of Stents for Benign Esophageal Perforation. Ann Thorac Surg 104:227-233

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