In November, P&S student Gregory Joice, P&S’14, was selected the overall winner among medical students for his talk, “Failure to Rescue and Inter-Hospital Transfer after Radical Cystectomy,” during the 11th annual AMA Research Symposium. The symposium, which took place as part of the AMA Interim Meeting included presentations from more than 330 of the country’s medical students, residents, fellows, and international medical graduates.
Greg spent December interviewing for urology residencies; when he returned to New York we caught up with him to learn more about his winning research, which he conducted for his Scholarly Project requirement.
Q: What is “failure to rescue”?
It’s a bit different from overall mortality. Failure to rescue is defined as the failure to prevent death in the 30 days after a complication has arisen. It comes from a study that found that low-mortality hospitals had low death rates not because they had low rates of complications, but because they were better than high-mortality hospitals at rescuing patients from complications.
Q: What did you investigate?
We wanted to look specifically at failure to rescue for radical cystectomy, which is the complete removal of the urinary bladder, usually for bladder cancer.
We also wanted to see how inter-hospital transfer affects the failure-to-rescue rate. Low-volume hospitals sometimes take on these larger complicated procedures, but if they come across complications that they can no longer treat, they may transfer those patients out to higher-volume hospitals.
Q: What did you learn about different hospitals?
This suggests that for radical cystectomy, which is a long and complicated procedure, patients may be better served if they start off in a high-volume hospital.Basically, we showed that, for radical cystectomy, the already known mortality gap between high-volume and low-volume hospitals may be somewhat underestimated by the fact that some low-volume hospitals transfer patients with complications to high-volume hospitals.
We used data from a national database that records 20 percent of all the hospital discharges in the U.S. We looked at all patients who had a radical cystectomy and found that the gap in failure to rescue between high- and low-volume hospitals is about 2 to 3 percent. But when you looked at failure to rescue plus transfer rate, the difference increases to approximately 5 percent.
This suggests that for radical cystectomy, which is a long and complicated procedure, patients may be better served if they start off in a high-volume hospital.
Q: How did you pick this topic for your Scholarly Project?
I got started in research during the summer after my first year. I knew I was interested in urology, and Drs. James McKiernan and Benjamin Spencer were eager to help me get started on some projects with the national database. Outcomes research gives you results much sooner than clinical trials or basic science, so it made sense for me to work on it as a medical student.
After my first project, they really encouraged me to come up with my own idea for my Scholarly Project. I was reading outcomes and health services research in other fields, and that’s where I came across failure to rescue. It went off from there.
Q: How did your time in the business world prior to medical school help with your project?
I spent two years as a management consultant after college, and that type of database work made a lot of sense to me. Even though the databases I worked on as a consultant had only thousands of entries, not millions like the hospital discharge database, it was still the same conceptual theory.
I took the consulting job because I wanted to get a real-life working experience prior to medical school. Medical education is a long road, and I wanted to make sure it was what I wanted to do. I didn’t want to question my choice when I got back to school.
It paid off. As a consultant, I worked on a lot of health-care projects, so it was still good exposure to medicine and the medical field. And then I made a pretty easy transition to medical school.