{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/183416vv3q/manifest","type":"Manifest","label":{"en":["Dr. Tom Vansaghi and Dr. Christina Hester"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2018-06-18 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Herbert Young (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine research","American Academy of Family Physicians","Family Medicine for America's Health"]}},{"label":{"en":["Subject"]},"value":{"en":["Tom Vansaghi, Ph.D (personal name)","Christina Hester, Ph.D (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["english (primary)"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162275/file/295063","type":"Canvas","label":{"en":["Media File 1 of 2 - VansaghiTomHesterChristina_01_Access.mp3"]},"duration":2690.3097,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162275/file/295063/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162275/file/295063/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/063/original/VansaghiTomHesterChristina_01_Access.mp3?1760556447","type":"Audio","format":"audio/mpeg","duration":2690.3097,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162275/file/295063","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162275/file/295063/transcript/85358","type":"AnnotationPage","label":{"en":["Vansaghi and Hester Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162275/file/295063/transcript/85358/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Side 1\n\nDr. Young: This is side 1 of tape 1 of the oral history of Dr. Tom Vansaghi, the leader of the Research Core Team and Christina Hester, a member of that team, as a part of the Family Medicine for America’s Health. We’re recording this on June 28th, 2018. I am Dr. Herbert Young, a volunteer at the Center for the History of Family Medicine.\n\nTom, do we have your permission to record this interview?\n\nDr. Vansaghi: Yes.\n\nDr. Young: And Christina, do we have your permission to record this interview?\n\nDr. Hester: Yes.\n\nDr. Young: Wonderful. Let me welcome you to this session. As we learn more about the Research Core Team’s activities in Family Medicine for America’s Health. \n\nTom, could we start with you and could you give us a little bit of background about your professional work and degrees and all?\n\nDr. Vansaghi: Sure, yes. I am the Executive Director of the North American Primary Care Research Group. I have a background that’s not in family medicine. I’m actually a Ph.D. in Political Science and most of my career has been in higher education, both administrative work and also faculty work but I’ve served as the Executive Director at NAPCRG for over 5 years, coming up on 6 years. The thing I would say about the specific work with the Core Team is that I did come late to the team. The team had been formed and was chaired by Dr. Lars Peterson with the American Board of Family Medicine and he had to step aside, step off the Core Team because of other professional responsibilities. I wasn’t even a member of the Core Team, was asked to join the Core Team and then within a couple of months was asked to chair the Core Team. I have kind of an interesting relationship with the Core Team, having not really been part of it but then was chairing it within literally a couple months of joining it and really, I think my purview of this work has been in the transition from the FMA Health model to the permanency of the work that will continue.\n\nDr. Young: And we’ll come back to that in a moment. \n\nChristina, can you tell us about your background?\n\nDr. Hester: I’m currently the Research Director of the National Research Network here at the AAFP. My history has been working in family medicine research since about 2010 as a faculty member in a family medicine department here in Kansas City at the University of Kansas Medical Center. I also ran the Residents Research Program in the Family Medicine Department and so I have been actively engaged in family medicine research for quite some time and I have experience with what resources and infrastructure exist and do not currently exist in this area.\n\nDr. Young: Did you have any exposure to medicine prior to your work at KU?\n\nDr. Hester: No. My Ph.D. is actually in Microbiology but I did do my graduate work at University of Kansas Medical Center in the context of the medical school and so I had taught medical students and learned with medical students and spent a lot of time in that.\n\nDr. Young: So, the two of you have had the advantage of actually having experience in areas well outside of family medicine initially. I would think that could be quite valuable sometimes when you come in to a new project area. \n\nTom, you mentioned how you became involved. Christina, how did you become involved in FMAH?\n\nDr. Hester: Actually, I was introduced to the project by the prior Research Director of the National Research Network, who was Dr. Kim , she was a colleague I worked with at the University of Kansas in the Family Medicine department and she knew that I had an interest in the space of what resources and activities were in place to support family medicine research, particularly because of my role as a researcher, as well as having seen what little support there is for the physicians who are in training to learn anything about research, to learn how to do research. So she introduced this idea to me and I was very interested in pursuing the opportunity to do this work and explore the research h capacity support within Family Medicine for America’s Health organizations.\n\nDr. Young: Tom, when you became leader of the Core Team, what was the Core Team doing at that time and where are you now?\n\nDr. Vansaghi: The Core Team, when I became involved in probably 2016, was really actually wrapping up. They had already kind of initiated three or four primary focus areas and were really kind of already in the execution and wrap-up phase. I can quickly highlight those if you’d like and then I think the one project that evolved completely under my tenure was the mapping project that Christina has totally led and is about to publish a paper summarizing the findings of and I think that to me is really the seminal work of the Research Core Team, although the other work is important, I think the Mapping Project is a much broader, comprehensive project that I think advances the discipline of family medicine. So when I joined, the projects that were underway were pursuing support for a National Academy of Medicine roundtable. The NAM, the National Academy, moved policy agenda by issuing reports that come from studies or roundtables. So these reports had been influential and can galvanize medicine into action and the goal of our work was to really look at how primary care could become permanently housed in a center within the National Institute of Health, so that’s been an ongoing agenda item that we have focused on, on and off. Not me personally, but the discipline has focused on, probably for 40 years and I think the renewed effort has become more important, I think, because of the current funding landscape, we’ve got some really ideal funding entities right now through and , both of which could end up sunsetting or not getting funded and so I think there’s this sense of how can we really establish a foothold within the premiere research funder in America, which obviously is the NIH. So that’s been a goal. Part of why I think, in terms of the enduring legacy of the work of the Core Team, this is one that I think we’re just keeping that alive and certainly keeping that conversation going and through advocacy efforts, through the Counsel of Academic Family Medicine or CAFM, I think we’re making some progress but again, I don’t know that I can say concretely, oh yeah, we have clear evidence that this is going to happen or if it will happen at all. That’s part of why I think that’s been a big initiative. It’s certainly not one that I would say that’s the cornerstone of our work. \n\nAnother one that I think has been really important and exciting, is really a landscape analysis that focuses on bright spots or exemplary primary care research and kind of creating an inventory of primary care studies in research projects that I think really have been kind of the cornerstone research in family medicine since its inception. This has been something that Dr. Andrew Bazemore at the Graham Center, again, Winston Liaw, who was also with the Graham Center and is now in Texas have really kind of been the champions of… essentially the landscape analysis would focus on exemplary primary care research and demonstrate the potential research of effective research on the achievement of the Triple Aim and determine how we can actually achieve the Triple Aim, with the sub goal of analyzing and disseminating the bright spots within family medicine. So that project is again, coming to fruition as we’re preparing to publish the paper that Christina will talk about in a minute on the Mapping Project, Andrew and Winston are wrapping up this project as well and will certainly be looking forward to publishing that within the next few months and will come out in a special issue of Family Medicine. \n\nThe other really important project that I want to highlight here, is the Starfield Summits. This Core Team, really before I joined the Core Team, had pretty much pulled together and executed, hosted what was the first Starfield Summit, which was an in-person policy summit to rally authors and editors around broader FMA Health topics. They held the first Starfield Summit, which was really a cross-border summit. As you know or not know, NAPCRG is an international organization. A third of our members are Canadian and so this fit really well within our wheelhouse because this particular summit focused on cross-border initiatives and was a particularly strong funder of that, as well as the Institutes of Medicine in Canada. So that was held in April of 2016 and then shortly thereafter, or within the next year, the second Starfield Summit was held in Oregon, I think it was April of 2017, which really focused on health inequities and really looking at… and again, FMA Health has a primary role in that as well and there was a lot of crossover within the two teams. That was a very successful summit and then the final summit was held in October of 2017 and it really focused on measurement and that was hosted by Dr. Becca  out of the Virginia Commonwealth University. Another very successful, well-funded, Starfield Summit. I can talk in a minute about all of those projects and how they will hopefully continue, because they all have life beyond the FMA Health Research Core Team and so the role that NAPCRG will play in keeping all three of those moving and alive. \n\nA couple of other things, we were successful in hiring a full time FMA Health Research fellow, Vivian Jiang, who also… there seems to be a lot of work here around Virginia Commonwealth. Vivian is working there under Dr. Alex Krist and Dr. Andrew Bazemore. She’s been very helpful on our projects, on the project that I mentioned and the project that Christina will address on the mapping and certainly appreciate that. She’s also supported the other tactic teams, or she was available to support them. And then she also worked under Dr. Krist in Virginia on some of th projects as well, so that was a big win for our team.\n\nDr. Young: Just to clarify a couple of things, one is the term Core Team has been used and the term Tactic Team. Are those synonymous?\n\nDr. Vansaghi: Yes, and that’s probably my own vernacular. I think the real verbiage is Tactic Team, I think, Research Tactic Team. It’s the same thing in my mind. I’m sorry if I confused you.\n\nDr. Young: No, I think having done a number of these interviews, there’s been a lot of evolution in lots of ways in terms of Family Medicine for America’s Health, terminology, directions to take, where to spend money, where to get money, who to work with. So just looking to make sure we were talking about the same thing. \n\nAny comments from either of you on Dr. Starfield and why were the conferences named after her?\n\nDr. Vansaghi: I can try to answer that question. Again, not having been directly involved in the early conversations, what I do know now and this kind of goes to the conversations that have been held, really in more recent history, in the last few months, last year. Dr. Barbara Starfield’s husband was very specific about her legacy being tied to the work that we were doing specifically, in primary care research and what’s happening really at this point is, we hope that the Starfield Summit will be a legacy that will continue. That there will be more Starfield Summits. There have been three so far but we want to protect the name and I think Tony, Barbara’s husband, has been working with us on this journey to ensure that… again, he’s been very clear that he wants NAPCRG to have some ownership of how a Starfield Summit becomes a Starfield Summit. If you wanted to just have your own summit that didn’t meet certain criteria, you would have to come to the NAPCRG and basically have a discussion, submit a proposal about what you’re hoping to do. We’re developing a set of criteria that we’ll be able to use to evaluate whether it really kind of meets the intent of the Starfield Family and kind of carries forth her legacy in this area. I should also say that the Starfield Summit concept was very interdisciplinary from the get-go. It wasn’t just a family medicine initiative but I know the first Starfield Summit certainly involved our colleagues across the border in Canada but also pediatricians as well as internal medicine physicians as well, so it was very much an inclusive idea and I think those are some of the parameters that we are working to preserve into the future.\n\nDr. Young: Why don’t we turn to the Mapping Project and Christina, if you could start with a little bit of how you got plugged in and how that idea evolved and then where is it today?\n\nDr. Hester: Sure. As I mentioned earlier, I learned about the project first from Dr. Kim and then also, Dr. Carroll, who is the director of the AAFP National Research Network. At the time I was working at the University of Kansas Medical Center in the Family Medicine Department there and really was excited by this opportunity, to start to explore how the national family medicine organizations were or thought they were, contributing to the research infrastructure that bolsters the family medicine research enterprise. I was invited to develop interview questions to explore with qualitative methods, some of the activities and priorities and roles of each of the organizations, what they do to support research. So I worked with the Research Core Team, Tactic Team, to put together to really define what areas we wanted to focus on in our interviews and then work to put together an interview guide and met with twelve leaders of the eight organizations that participate in Family Medicine for America’s Health. Do you want me to run through those?\n\nDr. Young: Yes, please.\n\nDr. Hester: I interviewed people from the American Academy of Family Physicians, I’m going to go in alphabetical order, the American Academy of Family Physicians Foundation, the American Board of Family Medicine, the American College of Osteopathic Family Practice, the Association for Departments of Family Medicine, the Association for Family Medicine Residency Directors and North American Primary Care Research Group and Society for Teachers of Family Medicine. I interviewed at least one, if not more than one, representative of the leadership in each of these organizations and tried to find someone who would know a little bit about intentional contributions to the research infrastructure. In addition, these were hour long interviews and they were semi-structured so I had a set of questions that I asked but we didn’t always cover all of the questions and sometimes the interviewee would take the lead and kind of expand on something in an area that I hadn’t necessarily anticipated. But this was a very rich source of information that we got from these participants. In addition to those formal interviews, I also spoke with a number of different people who were recommended by the interviewees to gather a little bit more information to bolster the data set that we had from the qualitative interviews and also reviewed materials, websites, literature, to supplement the information that we gained in these interviews. I worked primarily with our family medicine research fellow, Dr. Jiang, to review the notes from these interviews to identify what themes emerged from what the leaders were telling us. Vivian and I went through and refined the themes that we found. We came to consensus on what we identified as really the core themes and domains of what the interviewees told us. And then we brought the information to the research team, the Core Team, to determine if they agreed with us and really come to group consensus on what the core domains that emerged from the interview materials were. \n\nWhat we found is that all of the organizations are contributing in some way, or value showcasing scholarship, communication and dissemination of family medicine research, workforce development of family medicine researchers, data driven initiatives. So there is a lot of interest in supporting the use of big data for population health issues. Many organizations are performing… a few organizations are performing primary research themselves, so they’re actually leading and participating in research projects in the field of family medicine and that a key area of importance is advocacy of family medicine research and for family medicine research funding. We found that there are contributions to each of these domains that are occurring routinely and we also found that there are a number of opportunities for improving the support that the family medicine organizations in the U.S. have, that they can make contributions to supporting family medicine research in these key areas. \n\nAnother thread that actually wove its way through all of the domains that we identified is that there’s not enough funding and that family medicine research is really, largely supported by a volunteer army, so a lot of unpaid time goes into supporting family medicine research and that is an area of need.\n\nDr. Young: Can I just ask, is that in contrast to research in other medical specialties, in terms of the funding versus the volunteer?\n\nDr. Hester: I think it’s hard to say. I think it seems that way but I don’t particularly have data but a lot of people seem to feel that there may be more impassioned people who are willing to do more with less in family medicine than in other fields. Also, because many other disciplines… and family medicine as a discipline is not necessarily flush with additional clinical revenue that can be driven toward supporting faculty with protected time, pilot projects, things like that so people find ways to do it. They work with what they have and are often willing to do more with less and that can take its toll and there’s a limit to what can be done with less.\n\nWhat we found that was really interesting is that there is a lot of cross-collaboration on initiatives so things like journals are supported by multiple organizations, conferences are co-organized. There are a couple of initiatives that are particularly noteworthy, one of them is the Grant Generating Project, which is now led through the NAPCRG but also has support from other family medicine organizations and Tom, you can speak to that a little bit if you want to. That is a Research Workforce Development Program where family medicine faculty from physician, non-physician faculty can be supported in developing strong research grand proposals. This has been a highly successful program over the years.\n\nDr. Young: Do we want to hear a little bit more about that, Tom?\n\nDr. Vansaghi: Yeah, sure. That’s something that definitely I can speak to. The Grant Generating Project was started by NAPCRG as a project in the mid-nineties, like ’96 and we kind of just spun it out, let it kind of go its way. It had been housed at the University of Missouri for many years, University of Missouri Columbia and then eventually, Virginia Commonwealth hosted it. They ran into some funding issues a couple of years ago and we decided at NAPCRG that the Grant Generating Project was too important to just let fail and go away. Training researchers on how to write NIH quality or NIH level research proposals is a skill that needs to be addressed and as Christina mentioned, it’s an important workforce development tool, so we basically took it back on instead of letting it kind of putter out. We have been able to make it a sustainable program and to her point about volunteer and passion, we have a volunteer faculty now as opposed to a paid faculty and that seems to be doing quite well and it’s going very well, so it’s been a very successful project and I think the point of this whole this was just that it does enjoy support of several other family medicine organizations and certainly is seen kind of as the premier training ground in the United States for researchers that really need the funding. They all do, but the place where you go to get that training. Many of the current leaders in the discipline have gone through the Grant Generating Project so it’s kind of impressive to look through the alumni roles of people who did graduate and have been incredibly successful researchers in attracting funding. People like Jen DeVoe, who is just very successful at winning federal grants.\n\nDr. Young: Christina, some more insights from the Mapping Project?\n\nDr. Hester: Yes. Ultimately, I have to say, I’m also a Grant Generating Project alumni.\n\nDr. Young: And let me pause that, which points out then that we’re not talking about just one part of family medicine. It’s a very interdisciplinary endeavor.\n\nDr. Hester: Yes, it is. That’s the really nice thing about it and that’s another critical point that we found in the Mapping Project, is that we don’t just want to train family physicians to do research. In order to support the Family Medicine Research Enterprise, a number of different parties need to be brought to the table and included in being supported and enriching the work that’s possible.\n\nDr. Young: In that regard, is that somewhat reflective of where family medicine practice is going, in terms of team care, integration of behavioral science into practice, which I thought was always there but I guess it’s a new emphasis with more structure to it.\n\nDr. Hester: Right. It’s probably always been there in family medicine but now there’s a name for it because other disciplines are doing it too. Yes, it is, family medicine and family medicine research are collaborative by necessity. One of the important factors in building and sustaining family medicine research is having all of the right players at the table and that includes researchers who are trained in other disciplines outside of being a family physician. And that’s one of the nice things about the GGP, was that it supports the training and development of researchers who can bring additional skills and perspective to family medicine research.\n\nAnother noteworthy endeavor is the Building Research Capacity Initiatives that’s really led out of the AFM with support from NAPCRG and STFM. This project supports family medicine department chairs in strengthening and growing their department’s research focus and capacity. These are examples of cross-organizational initiates that we can look to for how the structure for business plans, for models or how to build robust workforce development tools that we can grow.\n\nDr. Young: And by workforce you’re saying research?\n\nDr. Hester: Family medicine research, yes.\n\nDr. Vansaghi: And I guess I would add a note to that. I think because of our experience with the GGP, I think sustainability is just crucial. It’s one thing to start a program, get it initially funded through a grant or something but to keep it going 20, 30 years later, I think the lessons we’ve learned through the GGP and we’re modeling that through the Building Research Capacity or BRC Project that Christina mentioned. We don’t have funding… nobody in family medicine has just money to throw at that so it’s about creating a fee for service model, where departments that need the training and the consultations, are willing to pay for that. That seems to be working so far. And again, it’s a total collaboration between NAPCRG and the AFM or the chairs of family medicine.\n\nDr. Young: Am I hearing that departments of family medicine are viewed as the basic structure of where research will be housed as opposed to other elements within the healthcare system, such as large, like Kaiser, they have a fair research enterprise as I understand it, but still, the emphasis today is academic departments of family medicine?\n\nDr. Hester:  I don’t know that that’s necessarily by design but that is the default at this point in time, is that most family medicine research is based in family medicine departments and academic institutions, however, the majority of family medicine is practiced outside of academic institutions and one of the other areas of importance that we identified here is the importance of growing and strengthening the capacity of our practice-based research networks, where research can be implemented in the clinical setting to drive real world improvements in care and physician well being and improvements to the healthcare system and testing different methods for even models of payment. We can test real world problems in practice-based research networks but what we need are practicing clinicians and practitioners who can perform this research and who can contribute to the research enterprise, so training and workforce development in that space is also important. And of the things, kind of in line with the volunteers, I think I mentioned earlier that really, one of the critical areas we identified is advocacy for family medicine research and then advocacy for family medicine research funding, not just at the governmental level where people will get more grants or the foundations would give more funding to perform initiatives but also at institutional and organizational levels, including the family medicine organizations themselves. But these volunteers who are giving their time to the GGP, that time is actually being paid for by someone, it’s being paid for by the university. Recognizing that, calling that out and giving kudos to those who are doing it and really making a call to action for institutions and organizations to support these volunteer positions by protecting the time of the people who can contribute to these initiatives In meaningful ways, will strengthen the workforce that’s available to help with these initiatives and lend diversity so that it’s not just people who happen to be free outside of work hours and don’t have anything else to do with that time on the weekends, but really, you can involve people who are busy and if universities and organizations would provide funding to protect the time, even in community settings, of family medicine researchers to contribute to these initiatives as “volunteers”, then that would really strengthen the family medicine research.\n\nDr. Young: Can you clarify for me, you said “advocacy for family medicine research” and “advocacy for family medicine research funding”. What you just said before, is that an example of the efficacy for research, separate from the issue of getting money out of the NIH or whoever?\n\nDr. Hester: It’s a little bit of both because again, the funding doesn’t need to just come from the government and from granting institutions and those who are funding research projects. It also needs to come from the public and again, institutions and organizations who are benefitting from family medicine and from family medicine research.\n\nDr. Young: And I think you’re saying, and recognized by the… I hate to use the word employer, but by the department of family medicine, the time spent by the faculty member in research is a contribution that that department is making by allowing that to occur.\n\nDr. Hester: That’s right.\n\nDr. Vansaghi: And I think the advocacy, like big A Advocacy and little a advocacy that separates the two kinds of advocacy, but I think sometimes that advocacy at the department level or maybe the dean level within an academic institution can be as important or more important than even lobbying Congress for additional appropriations to NIH because it’s convincing the institution that they need to prioritize research or even just family medicine over all the other competing priorities and as Christina mentioned, we rely so heavily on volunteers and the only way we can do that is if they have time allotted in their real jobs.\n\nDr. Hester: Or they spend the time outside of their real jobs. There’s a limited pool of people that can do that.\n\nDr. Young: Isn’t the… the triple Aim has a fourth component, which has to do with burnout?\n\nDr. Hester: Yes. I think quadruple Aim refers to it as physician burnout, but as a non-physician researcher, I can tell you it’s a real thing in other areas as well.\n\nDr. Young: Having worked for a department chair who came out of practice and then started the program at the University of Wisconsin that then became a department, but who valued research very early, I remember some people remarking that it was interesting that Dr. Runner did this because at that time they were still trying to establish just departments of family medicine and so it wasn’t a major effort, I can tell you. But then coming to the Academy and hearing about the continued evolution of who became chairs of departments and that there was a point at which researchers became valued by these department chairs, some of whom had research background, some of whom had no research background. Is that evolution continuing, did you discover at all in your… were you looking at just this moment in time or was there some looking back as well and more importantly, looking forward?\n\nDr. Hester: There was both looking back and looking forward. I think there is an increasing recognition that research is valuable, not only in terms of how research can advance the discipline of family medicine but also in how it can provide revenue in the form of both, direct costs for project funding as well as the indirect funding that can support the infrastructure of a department and a research program. There is value on that aspect.\n\nDr. Vansaghi: And I think there have been increasing requirements placed on students, residents, fellows, that research now has been elevated as requirements to actually complete their residencies or their training, so there’s added reasons why departments are paying more attention to that but the Building Research Capacity Project is really kind of speaking directly to the core of the question, in that there are great disparities between departments and their adeptness or capacity to do research. Some of them, as you alluded to, I can think of Frank D in Colorado who is a researcher and he’s built this on the back of Lee Green and some of these amazing researchers. They are doing it phenomenally well, but there are other places where it’s either a newer department or it just hasn’t been emphasized where, I think because of the newer heightened sense of research is now a thing and we’ve got to pay more attention to it, departments are trying to figure out how do we build our capacity? How do we build our infrastructure? And that’s part of why I think the BRC Project has become so important. And one of the biggest clients we’ve gotten is, I think it’s the University of Las Vegas has started a medical school and a department of family medicine. They’re really building it from scratch and so they have a large amount of money that they’re dedicating to building research, so it’s awesome that they’re consulting with us and saying help us build a premier research department. We really value that foresight and thinking at the very, very front end of, we’re starting a department of family medicine and we see research as so important that we’re willing to invest funds at getting the right consultations, the right thinking to help us shape that. Most departments are fully formed and if they aren’t fully invested in research, it’s about how do they build their game and their capacity?\n\nDr. Young: Other things you wish to share on the Mapping Project?\n\nDr. Hester: Yes. Probably the last thing is, just to talk about most of the individuals that I interviewed really appreciated the big A Advocacy of the Counsel for Academic Family Medicine, which represents the AFM, AFMRD, NAPCRG and STFM and promotes family medicine research as an official part of their advocacy program. One of the requests of those I interviewed was that the large organizations, particularly AAFP, ABFM and ACOFP, begin to actively incorporate a more prominent family medicine research advocacy into their broader family medicine advocacy agenda and I think there’s significant opportunity in that space if the organizations really just include research in their planning for advocacy in family medicine in general.\n\nDr. Young: And that advocacy, are we talking about for instance, the Government Relations offices?\n\nDr. Hester: Yes.\n\nDr. Young: And it’s going to the people who vote the money, Congress, as well as the decision makers or organizations?\n\nDr. Hester: That would be the goal, yes.\n\nDr. Vansaghi: Yes, Hope Wittenberg is our lobbyist, she calls herself a lobbyist and she helps, not only with tracking and attending and testifying at congressional hearings but she’s the person, there’s been a lot of turnover in the new administration with regard to . Who’s the new director? How do we get in the door with them? She’s actually helping us on both sides, so being able to… and she’s also been a big champion of the NAM effort to try to procure a center for primary care within NIH, so she’s sort of been able to help us navigate. She’s done this 30 years so she’s got a lot of history and a lot of relationships in DC. I know the AAFP and the ABFM have similar government relations teams so it’s about us, and Hope Wittenberg has been phenomenal with really having… she’s doing a lot of education, advocacy and other kinds of advocacy, but research has definitely been something she has spent a lot of time and effort on and we appreciate that and I think what Christina is saying is absolutely true, that we just need to continue to beat that drum with all of our colleagues. What we run into at NAPCRG is just how do we become effective advocates, big A Advocates, in the U.S. but also in Canada? It’s just totally different games and relationships. Canadian provinces are really where the power centers are as opposed to the federal government in Ottawa, so it’s a very different structure. We still try to do some level of engagement there as well.\n\nDr. Young: Is there some hope then, that NIH will get beyond the bench to bedside, to beyond bedside to community where most healthcare occurs?\n\nDr. Hester: Yes.  is taking that on right now and as we know, is probably not much longer for this world. NIH s beginning to realize the importance of dissemination and implementation work and where better to do that work than in practice-based research networks? There is a place for family medicine research in advancing from bedside to community and we’re really well poised to take on that charge as the NIH begins to dedicate more funding to this aspect of research.\n\nDr. Vansaghi: Yes, and I think patient engagement is something we’ve really been working closely with  if and when they sunset, how do we continue that conversation with the NIH? I think our biggest issue with the NIH and frankly, , is that they get very disease-specific and we really want to take a holistic approach, community approach.\n\nDr. Young: We’ll pause now and flip the tape.\n\nSide 2\n\nDr. Young: Anything else regarding the Mapping Project to share with us? And I do have a couple of other questions about it.\n\nDr. Hester: Sure. One last thing I wanted to highlight that emerged in these interviews is that, because advocacy is really valued and important for advancing family medicine research, the STFM, NAPCRG and AFM, under the umbrella of CAFM, have put together a series of primary research advocacy training workshops that are put on at annual meetings for STFM and NAPCRG. Anywhere else, Tom?\n\nDr. Vansaghi: I think Hope is doing those in ABFM, I believe as well. I’m certain she probably is.\n\nDr. Hester: And at these workshops, family medicine researchers are given exposure to effective means of making their voice hears with their elected representatives and really raising family medicine research on the advocacy stage at the local level and really indicating how valuable our experience and knowledge can be to our elected officials, even if we don’t necessarily agree with their policies, we can still inform them with our perspective and our experience and our background. So that’s been a really exciting advance and initiative that can start to speak to probably both advocacy on a larger stage as well as local and even some of those institutional organizational levels that we talked about earlier.\n\nDr. Young: Has there been interaction with large integrated healthcare systems? The one I’m thinking off right off is Kaiser but there are a number of others that I believe I have heard, have research activities going on. Has that been part of any of the Mapping or any of the discussions?\n\nDr. Vansaghi: No, and honestly, I’ve had conversations, anecdotal conversations with systems like that, not necessarily part of the FMA Health Research Core Team but again, kind of systems that are looking at adding or beefing up their research infrastructure and how can NAPCRG help with that? They’ve not really been part of the whole conversation really. If they’re members of one of the eight family medicine organizations, certainly that’s where their interests are being collected, collated, certainly the AAFP I’m sure has a lot of those members but we have not actually done any interface with any of them in particular.\n\nDr. Young: This may be the point to ask in the conversation about the future because Family Medicine for America’s Health will eventually sunset. There has been discussion, I know, about how will at that level, the board level, there be a continuing activity of some sort, at least conversation if not monitoring and poking people with their elbows saying hey, you’ve got to keep moving on that. Looking at the Research Core Team, what happens in the next year, two years, five years?\n\nDr. Vansaghi: We are already sunsetted. We’re a couple of zombies that you’re looking at here. We are officially not even in existence anymore. We sunsetted on December 31, 2017. The work that Christina is doing is just kind of the finishing up of this big project and so that’s really, I think where we’re at officially as a Core Team or Tactic Team. The work that I’ve specifically discussed is living on within the NAPCRG infrastructure, like the discussion around supporting the NAM round table to hopefully establish a center at NIH is specifically assigned to our NAPCRG research advocacy committee, that’s where a lot of this work for NAPCRG is done. We have a Canadian piece and then a U.S. piece. The landscape analysis is currently being continued by our Committee for Advancing the Science of Family Medicine. That’s kind of the committee that really looks at all kinds of things related to research methodologies and electronic medical records and just kind of anything related to how research is done. The Starfield Summits I mentioned already. That’s kind of more of a… we have an executive committee, that’s where that conversation has been held so far and we have been working on this criteria by which we would use to determine whether a proposal for a Starfield Summit meets that criteria and of course we’re working with Tony, Barbara’s husband, on that to ensure that he’s comfortable with that as well. Those are kind of the big projects. The Mapping Project obviously, we’re excited to see, literally July 1st. That was our deadline. You’ve already submitted the…\n\nDr. Hester: Getting there. Finalizing the manuscript for submission.\n\nDr. Vansaghi: I’ve seen drafts. Yes, so that’s kind of the big goal that’s been kind of front and center. The Core Team, even though we’re sunsetted, we actually did meet in person at the Graham Center in March and had a really good retreat, to really, I think, inform Christina and Vivian on this kind of last leg of the research project. I think what happens from here on the project, I think that’s probably… other than presenting it, discussing it among the family, that’s probably a conversation that we need to have within NAPCRG and I’d certainly be open to ideas or suggestions. I don’t necessarily have a, here’s the template we’re going to follow to take this and make it more actionable.\n\nDr. Hester: Yes.\n\nDr. Young: Let me ask then, some things that you’re talking about are very discreet projects, the Mapping Project will have implications and I’m sure will carry forward after publication, but in a sense, when you’re published, that particular task had an ending. Beginning of discussion, ending maybe of the project. Some of the things you mentioned, Tom, sounded like they’re ongoing because you have a structure within NAPCRG to carry those forward. The complaints about Future of Family Medicine for some areas was, there wasn’t a plan to hand things off, but it sounds like in this case, one should be pretty optimistic that the research activities do have an ongoing future, there’s just not the same group coming together to talk, representing different expertise and organizations, to talk globally about research. Its, here are the things we find have value, we’re continuing.\n\nDr. Vansaghi: Yes and I think for research, NAPCRG is just the organization with the family that owns that and I think everybody… this was a great sort of affirmation of NAPCRG’s existence that even the big guys, the AAFP, the ABFM, all said, this is NAPCRG’s wheelhouse and they weren’t saying, we want to own that space. It was really easy, I think, to say, as we’re transitioning, where does this land? The other Tactic Teams, I don’t think had such… some of them had cleaner, this belongs here, this belongs there. I think for us and I think strategically the reason why I was asked wasn’t because I’m smart or good looking, it was because I’m the Director of NAPCRG, this is the guy that probably should be involved and we’ll help transition. That was actually really good foresight on the Core Team’s part in terms of figuring out when we’re done, where does all this go? I don’t know or have a sense of how well that’s been done in other Core Teams but I feel really good about this work and having a really good landing space for NAPCRG and I think really that’s a conversation Christina and I need to have about this project. I think we were just trying to get this done and now we’re at that point where we can check the box that the Mapping Project is done but it’s such a great… I thin it’s such a great piece of work that it does sort of start a conversation about what do we do now?\n\nDr. Hester: We built ourselves a to-do list I think. And I think while NAPCRG is taking on the leadership of this, I also think we’ve uncovered that the AAFP already has a couple of resources that can be really utilized more meaningfully for workforce development and that’s the National Research Network, the Robert Graham Center Health Landscape and also the ABFM has a research program that we could tap into more, better than we have been and in a more integrated way. Ultimately the leading of the initiatives has moved to NAPCRG but I think we’ve also sort of recognized roles for all of the organizations or at least several of the organizations in implementing the work.\n\nDr. Young: Will there be conversations among those organizations? Or there already are.\n\nDr. Vansaghi: Yes, and that’s probably the one thing I neglected to say all along, was that we have convened a conversation at our NAPCRG annual meeting in November of each year. We’ve done that now for the last several years where we have invited all the leaders of the family medicine organizations to come around the table and share and talk about their research initiatives. I think what we’re doing from here is that table will be set with the research mapping project that I think will help shape the conversation going forward and the to-do list and what’s next.\n\nDr. Hester: I think we’ve also established a call to the foundation, who is the organization -- Family Medicine for America’s Health and supporting it, that they could play a strong role in funding and seeking funding on behalf of the family medicine discipline, to support some of the initiatives that we found would strengthen family medicine research.\n\nDr. Young: Any other things that you two think should be shared?\n\nDr. Vansaghi: I think we’ve covered it.\n\nDr. Young: The plan as it was outlined to me was that some years in the future, five to seven years, there’d be probably more interviews done to sort of say, where are we now? Who knows, you may be getting a phone call.\n\nDr. Vansaghi: If I’m alive, yeah, I’ll be happy to participate.\n\nDr. Hester: Here’s hoping, Tom.\n\n(End)","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162275/file/295063#t=0.0,2690.3097"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162275/file/295062","type":"Canvas","label":{"en":["Media File 2 of 2 - VansaghiTomHesterChristina_02_Access.mp3"]},"duration":734.3496,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162275/file/295062/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162275/file/295062/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/062/original/VansaghiTomHesterChristina_02_Access.mp3?1760556442","type":"Audio","format":"audio/mpeg","duration":734.3496,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3491/collection_resources/162275/file/295062","metadata":[]}]}],"annotations":[]}]}