Andy Auerbach, MD

Program Setting

During years 2010 to 2013, the time period captured by our survey, the DHM at UCSF grew from 37 to 46 full‐time hospitalists, with 76% primarily clinical faculty (nonresearchers) and 24% primarily clinician‐investigators (researchers), defined as individuals having completed a 2‐year clinical research fellowship and/or dedicating 70% time in their faculty position to clinical research. In addition, there were between 1 and 3 hospitalist fellows per year. In 2012, a PhD researcher joined the division to support research and academic activities within the division as well as to pursue an independent research career.

Program Description

The DHM WIP, named the Incubator, was initially developed in 2007 when researchers recognized the need and desire for a forum where scholarly projects could be reviewed and evaluated. In the first year, the Incubator was primarily utilized by junior research‐trained mentees applying for National Institutes of Health career development awards. However, it soon became clear that nonresearch trained junior fellow and faculty members were pursuing scholarly projects needing additional guidance and input. In particular, the Incubator became frequently utilized by academic hospital medicine fellows and resident trainees pursuing QI and education projects. Over time, more DHM faculty, and junior faculty in particular, began to present their projects and receive structured feedback from researchers as well as other senior members of the group.

Incubator is structured as a 50‐minute session held from 1:10 to 2:00 _pm on Thursdays in a DHM conference room. The time was selected because it did not conflict with other divisional conferences and to reserve mornings for clinical responsibilities. Incubator is held on most weeks of the year except for holidays or when there is no scheduled presenter. Presenting at Incubator is voluntary, and presenters sign up for open spots in advance with the upcoming presenter schedule sent out to the division in advance of the conference. Incubator is also used as a forum to provide feedback on anticipated abstract submissions for professional society meetings. For the purposes of the survey described in this article, we did not include Incubator sessions on reviewing abstracts/posters. Trainees and hospitalists present a broad range of projects at any stage of preparation. These include project ideas, grant applications, manuscripts, abstracts, and oral presentations at any stage of completion for feedback. Our mission was to create a forum where researchers, clinicians, and educators meet to provide the tools and guidance necessary to promote scholarly projects across the range of the division's activities by connecting individuals with complementary skills and interests and providing necessary mentorship and peer support. We have defined scholarship broadly, including evaluation of QI, global health, or other health system innovations, as well as advancements in medical education and traditional clinical research.

All faculty are invited to Incubator, and attendees include senior and junior faculty, researchers in the division, fellows, and occasionally residents and medical students. One week prior to the session, an administrative assistant solicits project information, including any related materials and questions the presenter may have for the group using a prespecified template, and emails this information to division members for review. In addition, the same materials are also printed prior to Incubator for any attendees who may not have reviewed the material in advance. Also, prior to the session, a physician is specified to serve as moderator of the discussion, and another physician is assigned the role of primary reviewer to provide the initial specific feedback and recommendations. The role of the moderator is to manage the discussion and keep the focus on time, and is assigned to a researcher or senior clinical faculty member. The role of primary reviewer is assigned to provide more junior faculty (both researchers and nonresearchers) the opportunity to practice their editing and critiquing skills by providing the initial feedback. Presenters and moderators receive worksheets outlining the structure of Incubator and their respective roles (see Supporting Information, Appendix 1, in the online version of this article).

Incubator begins with the presenter providing a brief synopsis of their project and their specific goals and objectives for the session. The moderator then leads the discussion and guides the format, often starting with any questions the group may have for the presenter followed by the specific feedback from the primary reviewer. The primary reviewer, having reviewed the materials in advance of the session, answers the prespecified questions as listed by the presenter, occasionally providing additional targeted feedback. The session is then opened to the rest of the group for feedback and suggestions. Meanwhile, the presenter is encouraged to wait until the end of the hour to summarize their take on the feedback and what their initial thoughts on the next to do items would be (Table 1).

Program Evaluation

Survey Respondent Characteristics

We received 51 completed surveys from presenters at an Incubator session, for a total survey response rate of 70%. Of the 51 presentations, 26 (51%) of the projects were led by physicians in training or junior faculty, and 35 (69%) of the presenters were nonresearchers.

Project Characteristics

The most frequently presented topic areas were QI (N = 20), clinical research (N = 14), medical education (N = 6), and global health (N = 6). Whereas researchers were more likely to present clinical research topics and grant applications, nonresearchers more often presented on QI or medical education projects (Table 2). Projects were presented at all stages of development, with the middle stage, where presenters presented initial results, being the most common phase.

Impact of Incubator

The reaction to the session was very positive, with 100% of respondents recommending Incubator to others (Table 3), and 35% reported learning as a result of the session. Twenty‐three (45%) of respondents reported that the session helped reframe the project idea and changed the study design, and 20 (39%) reported improved written or oral presentation style. A majority (45, 88%) reported that Incubator was valuable in advancing the project to completion.

Survey results of researchers compared to nonresearchers were similar overall, although nonresearchers were more likely to report changes in behavior and in improved mentoring as a result of presenting at Incubator. Notably, 17 (49%) of nonresearchers reported that Incubator changed their approach to future projects as opposed to only 2 (13%) researchers (P = 0.01). In addition, 24 (69%) nonresearchers reported value in mentorship and peer support compared to 5 (31%) researchers (P = 0.01). A reasonably large proportion of projects originally presented during the Incubator sessions became published articles at the time of survey completion (N = 19, 37%) or were publications in progress (N = 14, 27%). For all remaining items, there were no statistically significant differences in the survey responses among junior faculty/trainees (N = 26) compared to nonjunior faculty (N = 25) presenters (P > 0.05).

Attendance at Incubator During the Study Period

Attendance at Incubator was open and voluntary for all DHM faculty, fellows, and collaborating UCSF trainees. From July 2012, when we began tracking attendance, through the end of the survey period in November 2013, the average number of attendees for each session was 10.7 (standard deviation [SD] 3.8). On average, 50% (SD 16%) of attendees at Incubator were career researchers.

Challenges, Setbacks, Updated Approaches

The creation of a successful Incubator session, however, was not without its challenges. At initial inception, the WIP was attended primarily by researchers and had low overall attendance. Members of the division who were primarily clinicians initially perceived the conferences as largely inapplicable to their career objectives and had competing demands from patient care, educational, or administrative responsibilities. However, over time and with encouragement from divisional leaders and service line directors, increasing numbers of hospitalists began to participate in Incubator. The timing of Incubator during afternoons after the Department of Medicine Grand Rounds was chosen specifically to allow clinicians to complete their responsibilities, including morning rounds and teaching, to allow better attendance.

In addition, the results of our survey informed changes to the structure of Incubator. The efficacy of assigning a primary reviewer for each session was not clear, so this component was eventually dropped. The finding that nonresearchers in particular reported a benefit from mentoring and peer‐support at Incubator led to the implementation of querying the presenter for a wish list of faculty attendees at their Incubator session. We then sent a special invitation to those faculty members thought to have special insights on the project. This gave junior faculty the opportunity to present their projects to more senior faculty members within their areas of research, as well as to receive focused expert feedback.

Finally, we have initiated special Incubator sessions focused more on didactics to teach the process of writing manuscripts and brainstorming workshop ideas for national meetings.

Limitations

Our study has limitations. It is a single‐center study based on a small overall sample size, and it is not certain whether a similar innovation would have comparable effects at another institution. In addition, generalizability of our results may be limited for hospital medicine groups without a robust research program. We did not have a control group nor do we know whether participants would have been equally successful without Incubator. We also were unable to assess how Incubator affected long‐term outcomes such as promotion and overall publication record, as we do not have detailed data on productivity prior to the survey period. Finally, we are unable to quantify the effect of Incubator on scholarly success in the division. Although the numbers of published articles and grant funding has increased since the Incubator began (data not shown), the division also grew both in number of research‐focused and nonresearch‐focused faculty, and this study does not account for other temporal changes that may have contributed to improvements in the scholarly output of the division.

Program Setting

During years 2010 to 2013, the time period captured by our survey, the DHM at UCSF grew from 37 to 46 full‐time hospitalists, with 76% primarily clinical faculty (nonresearchers) and 24% primarily clinician‐investigators (researchers), defined as individuals having completed a 2‐year clinical research fellowship and/or dedicating 70% time in their faculty position to clinical research. In addition, there were between 1 and 3 hospitalist fellows per year. In 2012, a PhD researcher joined the division to support research and academic activities within the division as well as to pursue an independent research career.

Program Description

The DHM WIP, named the Incubator, was initially developed in 2007 when researchers recognized the need and desire for a forum where scholarly projects could be reviewed and evaluated. In the first year, the Incubator was primarily utilized by junior research‐trained mentees applying for National Institutes of Health career development awards. However, it soon became clear that nonresearch trained junior fellow and faculty members were pursuing scholarly projects needing additional guidance and input. In particular, the Incubator became frequently utilized by academic hospital medicine fellows and resident trainees pursuing QI and education projects. Over time, more DHM faculty, and junior faculty in particular, began to present their projects and receive structured feedback from researchers as well as other senior members of the group.

Incubator is structured as a 50‐minute session held from 1:10 to 2:00 _pm on Thursdays in a DHM conference room. The time was selected because it did not conflict with other divisional conferences and to reserve mornings for clinical responsibilities. Incubator is held on most weeks of the year except for holidays or when there is no scheduled presenter. Presenting at Incubator is voluntary, and presenters sign up for open spots in advance with the upcoming presenter schedule sent out to the division in advance of the conference. Incubator is also used as a forum to provide feedback on anticipated abstract submissions for professional society meetings. For the purposes of the survey described in this article, we did not include Incubator sessions on reviewing abstracts/posters. Trainees and hospitalists present a broad range of projects at any stage of preparation. These include project ideas, grant applications, manuscripts, abstracts, and oral presentations at any stage of completion for feedback. Our mission was to create a forum where researchers, clinicians, and educators meet to provide the tools and guidance necessary to promote scholarly projects across the range of the division's activities by connecting individuals with complementary skills and interests and providing necessary mentorship and peer support. We have defined scholarship broadly, including evaluation of QI, global health, or other health system innovations, as well as advancements in medical education and traditional clinical research.

All faculty are invited to Incubator, and attendees include senior and junior faculty, researchers in the division, fellows, and occasionally residents and medical students. One week prior to the session, an administrative assistant solicits project information, including any related materials and questions the presenter may have for the group using a prespecified template, and emails this information to division members for review. In addition, the same materials are also printed prior to Incubator for any attendees who may not have reviewed the material in advance. Also, prior to the session, a physician is specified to serve as moderator of the discussion, and another physician is assigned the role of primary reviewer to provide the initial specific feedback and recommendations. The role of the moderator is to manage the discussion and keep the focus on time, and is assigned to a researcher or senior clinical faculty member. The role of primary reviewer is assigned to provide more junior faculty (both researchers and nonresearchers) the opportunity to practice their editing and critiquing skills by providing the initial feedback. Presenters and moderators receive worksheets outlining the structure of Incubator and their respective roles (see Supporting Information, Appendix 1, in the online version of this article).

Incubator begins with the presenter providing a brief synopsis of their project and their specific goals and objectives for the session. The moderator then leads the discussion and guides the format, often starting with any questions the group may have for the presenter followed by the specific feedback from the primary reviewer. The primary reviewer, having reviewed the materials in advance of the session, answers the prespecified questions as listed by the presenter, occasionally providing additional targeted feedback. The session is then opened to the rest of the group for feedback and suggestions. Meanwhile, the presenter is encouraged to wait until the end of the hour to summarize their take on the feedback and what their initial thoughts on the next to do items would be (Table 1).

Program Evaluation

Survey Respondent Characteristics

We received 51 completed surveys from presenters at an Incubator session, for a total survey response rate of 70%. Of the 51 presentations, 26 (51%) of the projects were led by physicians in training or junior faculty, and 35 (69%) of the presenters were nonresearchers.

Project Characteristics

The most frequently presented topic areas were QI (N = 20), clinical research (N = 14), medical education (N = 6), and global health (N = 6). Whereas researchers were more likely to present clinical research topics and grant applications, nonresearchers more often presented on QI or medical education projects (Table 2). Projects were presented at all stages of development, with the middle stage, where presenters presented initial results, being the most common phase.

Impact of Incubator

The reaction to the session was very positive, with 100% of respondents recommending Incubator to others (Table 3), and 35% reported learning as a result of the session. Twenty‐three (45%) of respondents reported that the session helped reframe the project idea and changed the study design, and 20 (39%) reported improved written or oral presentation style. A majority (45, 88%) reported that Incubator was valuable in advancing the project to completion.

Survey results of researchers compared to nonresearchers were similar overall, although nonresearchers were more likely to report changes in behavior and in improved mentoring as a result of presenting at Incubator. Notably, 17 (49%) of nonresearchers reported that Incubator changed their approach to future projects as opposed to only 2 (13%) researchers (P = 0.01). In addition, 24 (69%) nonresearchers reported value in mentorship and peer support compared to 5 (31%) researchers (P = 0.01). A reasonably large proportion of projects originally presented during the Incubator sessions became published articles at the time of survey completion (N = 19, 37%) or were publications in progress (N = 14, 27%). For all remaining items, there were no statistically significant differences in the survey responses among junior faculty/trainees (N = 26) compared to nonjunior faculty (N = 25) presenters (P > 0.05).

Attendance at Incubator During the Study Period

Attendance at Incubator was open and voluntary for all DHM faculty, fellows, and collaborating UCSF trainees. From July 2012, when we began tracking attendance, through the end of the survey period in November 2013, the average number of attendees for each session was 10.7 (standard deviation [SD] 3.8). On average, 50% (SD 16%) of attendees at Incubator were career researchers.

Challenges, Setbacks, Updated Approaches

The creation of a successful Incubator session, however, was not without its challenges. At initial inception, the WIP was attended primarily by researchers and had low overall attendance. Members of the division who were primarily clinicians initially perceived the conferences as largely inapplicable to their career objectives and had competing demands from patient care, educational, or administrative responsibilities. However, over time and with encouragement from divisional leaders and service line directors, increasing numbers of hospitalists began to participate in Incubator. The timing of Incubator during afternoons after the Department of Medicine Grand Rounds was chosen specifically to allow clinicians to complete their responsibilities, including morning rounds and teaching, to allow better attendance.

In addition, the results of our survey informed changes to the structure of Incubator. The efficacy of assigning a primary reviewer for each session was not clear, so this component was eventually dropped. The finding that nonresearchers in particular reported a benefit from mentoring and peer‐support at Incubator led to the implementation of querying the presenter for a wish list of faculty attendees at their Incubator session. We then sent a special invitation to those faculty members thought to have special insights on the project. This gave junior faculty the opportunity to present their projects to more senior faculty members within their areas of research, as well as to receive focused expert feedback.

Finally, we have initiated special Incubator sessions focused more on didactics to teach the process of writing manuscripts and brainstorming workshop ideas for national meetings.

Limitations

Our study has limitations. It is a single‐center study based on a small overall sample size, and it is not certain whether a similar innovation would have comparable effects at another institution. In addition, generalizability of our results may be limited for hospital medicine groups without a robust research program. We did not have a control group nor do we know whether participants would have been equally successful without Incubator. We also were unable to assess how Incubator affected long‐term outcomes such as promotion and overall publication record, as we do not have detailed data on productivity prior to the survey period. Finally, we are unable to quantify the effect of Incubator on scholarly success in the division. Although the numbers of published articles and grant funding has increased since the Incubator began (data not shown), the division also grew both in number of research‐focused and nonresearch‐focused faculty, and this study does not account for other temporal changes that may have contributed to improvements in the scholarly output of the division.

Program Setting

During years 2010 to 2013, the time period captured by our survey, the DHM at UCSF grew from 37 to 46 full‐time hospitalists, with 76% primarily clinical faculty (nonresearchers) and 24% primarily clinician‐investigators (researchers), defined as individuals having completed a 2‐year clinical research fellowship and/or dedicating 70% time in their faculty position to clinical research. In addition, there were between 1 and 3 hospitalist fellows per year. In 2012, a PhD researcher joined the division to support research and academic activities within the division as well as to pursue an independent research career.

Program Description

The DHM WIP, named the Incubator, was initially developed in 2007 when researchers recognized the need and desire for a forum where scholarly projects could be reviewed and evaluated. In the first year, the Incubator was primarily utilized by junior research‐trained mentees applying for National Institutes of Health career development awards. However, it soon became clear that nonresearch trained junior fellow and faculty members were pursuing scholarly projects needing additional guidance and input. In particular, the Incubator became frequently utilized by academic hospital medicine fellows and resident trainees pursuing QI and education projects. Over time, more DHM faculty, and junior faculty in particular, began to present their projects and receive structured feedback from researchers as well as other senior members of the group.

Incubator is structured as a 50‐minute session held from 1:10 to 2:00 _pm on Thursdays in a DHM conference room. The time was selected because it did not conflict with other divisional conferences and to reserve mornings for clinical responsibilities. Incubator is held on most weeks of the year except for holidays or when there is no scheduled presenter. Presenting at Incubator is voluntary, and presenters sign up for open spots in advance with the upcoming presenter schedule sent out to the division in advance of the conference. Incubator is also used as a forum to provide feedback on anticipated abstract submissions for professional society meetings. For the purposes of the survey described in this article, we did not include Incubator sessions on reviewing abstracts/posters. Trainees and hospitalists present a broad range of projects at any stage of preparation. These include project ideas, grant applications, manuscripts, abstracts, and oral presentations at any stage of completion for feedback. Our mission was to create a forum where researchers, clinicians, and educators meet to provide the tools and guidance necessary to promote scholarly projects across the range of the division's activities by connecting individuals with complementary skills and interests and providing necessary mentorship and peer support. We have defined scholarship broadly, including evaluation of QI, global health, or other health system innovations, as well as advancements in medical education and traditional clinical research.

All faculty are invited to Incubator, and attendees include senior and junior faculty, researchers in the division, fellows, and occasionally residents and medical students. One week prior to the session, an administrative assistant solicits project information, including any related materials and questions the presenter may have for the group using a prespecified template, and emails this information to division members for review. In addition, the same materials are also printed prior to Incubator for any attendees who may not have reviewed the material in advance. Also, prior to the session, a physician is specified to serve as moderator of the discussion, and another physician is assigned the role of primary reviewer to provide the initial specific feedback and recommendations. The role of the moderator is to manage the discussion and keep the focus on time, and is assigned to a researcher or senior clinical faculty member. The role of primary reviewer is assigned to provide more junior faculty (both researchers and nonresearchers) the opportunity to practice their editing and critiquing skills by providing the initial feedback. Presenters and moderators receive worksheets outlining the structure of Incubator and their respective roles (see Supporting Information, Appendix 1, in the online version of this article).

Incubator begins with the presenter providing a brief synopsis of their project and their specific goals and objectives for the session. The moderator then leads the discussion and guides the format, often starting with any questions the group may have for the presenter followed by the specific feedback from the primary reviewer. The primary reviewer, having reviewed the materials in advance of the session, answers the prespecified questions as listed by the presenter, occasionally providing additional targeted feedback. The session is then opened to the rest of the group for feedback and suggestions. Meanwhile, the presenter is encouraged to wait until the end of the hour to summarize their take on the feedback and what their initial thoughts on the next to do items would be (Table 1).

Program Evaluation

Survey Respondent Characteristics

We received 51 completed surveys from presenters at an Incubator session, for a total survey response rate of 70%. Of the 51 presentations, 26 (51%) of the projects were led by physicians in training or junior faculty, and 35 (69%) of the presenters were nonresearchers.

Project Characteristics

The most frequently presented topic areas were QI (N = 20), clinical research (N = 14), medical education (N = 6), and global health (N = 6). Whereas researchers were more likely to present clinical research topics and grant applications, nonresearchers more often presented on QI or medical education projects (Table 2). Projects were presented at all stages of development, with the middle stage, where presenters presented initial results, being the most common phase.

Impact of Incubator

The reaction to the session was very positive, with 100% of respondents recommending Incubator to others (Table 3), and 35% reported learning as a result of the session. Twenty‐three (45%) of respondents reported that the session helped reframe the project idea and changed the study design, and 20 (39%) reported improved written or oral presentation style. A majority (45, 88%) reported that Incubator was valuable in advancing the project to completion.

Survey results of researchers compared to nonresearchers were similar overall, although nonresearchers were more likely to report changes in behavior and in improved mentoring as a result of presenting at Incubator. Notably, 17 (49%) of nonresearchers reported that Incubator changed their approach to future projects as opposed to only 2 (13%) researchers (P = 0.01). In addition, 24 (69%) nonresearchers reported value in mentorship and peer support compared to 5 (31%) researchers (P = 0.01). A reasonably large proportion of projects originally presented during the Incubator sessions became published articles at the time of survey completion (N = 19, 37%) or were publications in progress (N = 14, 27%). For all remaining items, there were no statistically significant differences in the survey responses among junior faculty/trainees (N = 26) compared to nonjunior faculty (N = 25) presenters (P > 0.05).

Attendance at Incubator During the Study Period

Attendance at Incubator was open and voluntary for all DHM faculty, fellows, and collaborating UCSF trainees. From July 2012, when we began tracking attendance, through the end of the survey period in November 2013, the average number of attendees for each session was 10.7 (standard deviation [SD] 3.8). On average, 50% (SD 16%) of attendees at Incubator were career researchers.

Challenges, Setbacks, Updated Approaches

The creation of a successful Incubator session, however, was not without its challenges. At initial inception, the WIP was attended primarily by researchers and had low overall attendance. Members of the division who were primarily clinicians initially perceived the conferences as largely inapplicable to their career objectives and had competing demands from patient care, educational, or administrative responsibilities. However, over time and with encouragement from divisional leaders and service line directors, increasing numbers of hospitalists began to participate in Incubator. The timing of Incubator during afternoons after the Department of Medicine Grand Rounds was chosen specifically to allow clinicians to complete their responsibilities, including morning rounds and teaching, to allow better attendance.

In addition, the results of our survey informed changes to the structure of Incubator. The efficacy of assigning a primary reviewer for each session was not clear, so this component was eventually dropped. The finding that nonresearchers in particular reported a benefit from mentoring and peer‐support at Incubator led to the implementation of querying the presenter for a wish list of faculty attendees at their Incubator session. We then sent a special invitation to those faculty members thought to have special insights on the project. This gave junior faculty the opportunity to present their projects to more senior faculty members within their areas of research, as well as to receive focused expert feedback.

Finally, we have initiated special Incubator sessions focused more on didactics to teach the process of writing manuscripts and brainstorming workshop ideas for national meetings.

Limitations

Our study has limitations. It is a single‐center study based on a small overall sample size, and it is not certain whether a similar innovation would have comparable effects at another institution. In addition, generalizability of our results may be limited for hospital medicine groups without a robust research program. We did not have a control group nor do we know whether participants would have been equally successful without Incubator. We also were unable to assess how Incubator affected long‐term outcomes such as promotion and overall publication record, as we do not have detailed data on productivity prior to the survey period. Finally, we are unable to quantify the effect of Incubator on scholarly success in the division. Although the numbers of published articles and grant funding has increased since the Incubator began (data not shown), the division also grew both in number of research‐focused and nonresearch‐focused faculty, and this study does not account for other temporal changes that may have contributed to improvements in the scholarly output of the division.