Anne Marie Weber-Main

Identifying and aligning expectations in a mentoring relationship.

The mentoring relationship between a scholar and their primary mentor is a core feature of research training. Anecdotal evidence suggests this relationship is adversely affected when scholar and mentor expectations are not aligned. We examined three questions: (1) What is the value in assuring that the expectations of scholars and mentors are mutually identified and aligned? (2) What types of programmatic interventions facilitate this process? (3) What types of expectations are important to identify and align? We addressed these questions through a systematic literature review, focus group interviews of mentors and scholars, a survey of Clinical and Translational Science Award (CTSA) KL2 program directors, and review of formal programmatic mechanisms used by KL2 programs. We found broad support for the importance of identifying and aligning the expectations of scholars and mentors and evidence that mentoring contracts, agreements, and training programs facilitate this process. These tools focus on aligning expectations with respect to the scholar’s research, education, professional development and career advancement as well as support, communication, and personal conduct and interpersonal relations. Research is needed to assess test the efficacy of formal alignment activities. Clin Trans Sci 2011; Volume 4: 439–447

Effect of an End-of-Life Planning Intervention on the Completion of Advance Directives in Homeless Persons: A Randomized Trial

BACKGROUND Few interventions have focused on improving end-of-life care for underserved populations, such as homeless persons. OBJECTIVE To determine whether homeless persons will complete a counseling session on advance care planning and fill out a legal advance directive designed to assess care preferences and preserve the dignity of marginalized persons. DESIGN Prospective, single-blind, randomized trial comparing self-guided completion of an advance directive with professionally assisted advance care planning. (ClinicalTrials.gov registration number: NCT00546884) SETTING 8 sites serving homeless persons in Minneapolis, Minnesota. PARTICIPANTS 262 homeless persons recruited between November 2007 and August 2008. INTERVENTION Minimal, self-guided intervention consisting of advance directive forms and written educational information versus a one-on-one advance planning intervention consisting of counseling and completing an advance directive with a social worker. MEASUREMENTS Rate of advance directive completion, assessed by inspection of completed documents. RESULTS The overall completion rate for advance directives was 26.7% (95% CI, 21.5% to 32.5%), with a higher rate in the counselor-guided group (37.9%) than in the self-guided group (12.8%) (CI of adjusted difference, 15.3 to 34.3 percentage points). This difference persisted across all sites and most subgroups. The advance directives 4 clinical scenarios found a preference for surrogate decision making in 29% to 34% of written responses. LIMITATIONS Sampling was limited to a more stable subset of the homeless population in Minneapolis and may have been subject to selection bias. Modest compensation to complete the preintervention survey could have influenced participants to complete advance directives. CONCLUSION Both a simple and complex intervention successfully engaged a diverse sample of homeless persons in advance care planning. One-on-one assistance significantly increased the completion rate. Homeless persons can respond to an intervention to plan for end-of-life care and can express specific preferences for care or a surrogate decision maker, but additional studies are needed to assess the effect of these directives on subsequent care. PRIMARY FUNDING SOURCE National Institute for Nursing Research and National Center on Minority Health and Health Disparities.

Application of the sexual health model in the long-term treatment of hypoactive sexual desire and female orgasmic disorder

Using the Sexual Health Model as a framework, this case study illustrates the treatment of female orgasmic and low desire disorder in a long-term case with numerous complexities and other co-morbid mental health diagnoses. Derived from a sexological approach to education, the Sexual Health Model defines 10 key components posited to be essential aspects of healthy human sexuality: talking about sex, culture and sexual identity, sexual anatomy and functioning, sexual health care and safer sex, challenges to sexual health, body image, masturbation and fantasy, positive sexuality, intimacy and relationships, and spirituality. The client was selected because of the commonality of her initial presenting concerns and the etiological and treatment complexity of the case, which necessitated the use of all the sexual health treatment modalities provided at our center—individual, couple, and group therapy, sexual medicine, and psychiatric care. Her case is distinct in that her sexual dysfunctions and negative cognitions, while common, occurred in the context of serious relational, family sexual abuse, depression, and life-threatening medical problems, which necessitated long-term treatment. This case illustrates the multifactoral etiology of complex sexual dysfunctions requiring treatment that deals with varied psychosocial and biological factors.

An adaptive approach to facilitating research productivity in a primary care clinical department.

Efforts to foster the growth of a department’s or school’s research mission can be informed by known correlates of research productivity, but the specific strategies to be adopted will be highly context-dependent, influenced by local, national, and discipline-specific needs and resources. The authors describe a multifaceted approach—informed by a working model of organizational research productivity—by which the University of Minnesota Department of Family Medicine and Community Health (Twin Cities campus) successfully increased its collective research productivity during a 10-year period (1997–2007) and maintained these increases over time. Facing barriers to recruitment of faculty investigators, the department focused instead on nurturing high-potential investigators among their current faculty via a new, centrally coordinated research program, with provision of training, protected time, technical resources, mentoring, and a scholarly culture to support faculty research productivity. Success of these initiatives is documented by the following: substantial increases in the department’s external research funding, rise to a sustained top-five ranking based on National Institutes of Health funding to U.S. family medicine departments, later-stage growth in the faculty’s publishing record, increased research capacity among the faculty, and a definitive maturation of the department’s research mission. The authors offer their perspectives on three apparent drivers of success with broad applicability—namely, effective leadership, systemic culture change, and the self-awareness to adapt to changes in the local, institutional, and national research environment.

‘‘Quit & Win’’ Contests Among College Students Predictors of Long-Term Smoking Abstinence

Purpose: To determine smoking abstinence rates and predictors of abstinence among college students enrolled in a campus-based Quit & Win contest. Design: Pre-post measure with no comparison group. Setting: Contests conducted on seven college campuses in 2007. Subjects: Subjects (N = 484) were 23.7 ± 6.8 years of age, 61% female, 16.3% nonwhite, and smoked 12.5 ± 7.8 cigarettes per day on 28.0 ± 4.8 days in the past month. Intervention: Participants abstinent for the 30-day contest were eligible for a lottery-based prize. Assessments were completed at baseline, end of contest, and 6 months after enrollment. Measures: The 6-month survey assessed retrospective abstinence during the contest period and the prior 6 months and 7- and 30-day point prevalence abstinence at the time of the survey. Analysis: Chi-square test was used to compare baseline characteristics among participants from 2-versus 4-year schools. Smoking abstinence was assessed by participant self-report. Both a simple imputation method (i.e., missing = smoking) and completers-only analyses were conducted. Stepwise logistic regression was used to determine baseline predictors of abstinence. Results: Thirty-day abstinence rate was 52.5% during the contest month and 20.5% at the 6-month follow-up. Baseline intention to stay quit (odds ratio [OR] = 1.56, p = .01), cigarettes smoked per day (OR = .67, p = .04), and 2-year (vs. 4-year) college (OR = 1.65, p = .05) predicted abstinence at 6 months. Conclusion: Intention to stay quit even without winning a prize, a measure of intrinsic motivation, predicted both short- and long-term abstinence.

Summaries for patients. End-of-Life Planning intervention and the Completion of Advance Directives in homeless persons.

and L. Gelberg. What is the problem and what is known about it so far? Everyone has the right to decide what types of medical care to receive. An advance directive is a legal document that lets people choose what medical treatment to receive in different situations. This is especially important if, at some point, a person is unable to tell their health care providers their wishes because of serious illness or injury. Unfortunately, most Americans have not completed an advance directive, but some groups, like homeless persons, are especially unlikely to have an advanced directive.

Enhancing research careers: an example of a US national diversity-focused, grant-writing training and coaching experiment

Background and purposePreparing a successful research proposal is one of the most complex skills required of professional scientists, yet this skill is rarely if ever, taught. A major goal of the National Research Mentoring Network (NRMN) in the United States (U.S.) is to support the professional advancement of postdoctoral fellows and junior faculty from diverse populations by offering intensive coaching in the development of grant proposals early in their careers. This article highlights the National Institutes of Health’s (NIH) NRMN initiative to prepare diverse constituencies of early-stage biomedicine scientists for research careers by implementation of an evidence-based nationwide program of comprehensive grant writing and professional development.Program and key highlightsNRMN delivers four unique but complementary coaching models: the Proposal Preparation Program from the University of Minnesota (UMN); Grantwriters Coaching Groups from Northwestern University (NU); Grantwriting Uncovered: Maximizing Strategies, Help, Opportunities, Experiences from the University of Colorado Anschutz Medical Campus (UC) and Washington State University (WSU); and Steps Towards Academic Research from the University of North Texas Health Science Center (UNTHSC). Because these programs cater to scientists at different career stages, rather than employ a single approach, each is uniquely tailored to test its efficacy at the national level. The first two models prioritize scientists with reasonably well-developed research projects who are ready to write proposals for specific NIH research competitions. The other two models target postdoctoral fellows and early-career faculty who need more extensive guidance in proposal development plans. To achieve scalability, all programs also recruit faculty as Coaches-in-Training to learn approaches and acquire particular group facilitation skills required by each model.ImplicationsThese efforts exemplify NRMN’s potential to enhance the career development of diverse trainees on a national scale, building research skills, competitiveness for obtaining faculty positions and capacities that will result in high quality research proposals from a diverse pool of applicants, thereby advancing innovations in science and diversifying the U.S. biomedical workforce.