Research Fellows Bring Equity to Surgery

How do research fellowships play a role in creating more equitable care for patients and their families?

The Surgical/Subspecialist Clinical Outcomes Research (SCORE) fellowship by ACCORDS at the University of Colorado empowers outstanding junior and midcareer physician-researchers through training and funding that allows them to pursue projects they’re passionate about. Now in its 10th year, the SCORE fellowship provides its fellows with a career development curriculum and support in writing research grants.

Research fellowship recipients further equity

Children’s Hospital Colorado team members Shannon Acker, MD, and Jose Diaz-Miron, MD, who completed the research fellowship during their first years as pediatric surgery faculty, are using their clinical research skills to improve equity for patients and their families.

During their fellowship experience, Drs. Acker and Diaz-Miron noticed that language barriers posed a persistent challenge for their patients. In fact, the state’s population of Hispanic and Latinx residents is expected to grow to 1 in 3 over the next two decades. Although a significant portion of the state population speaks Spanish as a primary language, there isn’t a standardized approach to translating important health information to families in a surgery setting.

Drs. Acker and Diaz-Miron set out to address this gap to ensure that all patients are more informed before, during and after surgery. Using the tools they learned during their time as SCORE fellows, they’re demonstrating what’s possible when surgeons are given an opportunity to research their areas of interest and put those findings directly into action.

Surgical research powers health literacy

Dr. Acker, a pediatric surgeon, is using her fellowship training to pursue a health literacy initiative that addresses the inequities resulting from language barriers during surgical consultations.

Current practice for surgical consultation involves the surgeon or team member visiting a patient’s hospital room, explaining key details in English with the help of an interpreter when needed and answering any questions. While educational materials are sometimes handed out, Dr. Acker says these are usually only available for common procedures, such as an appendectomy.

“This system is inefficient for clinicians, not ideal for families, and provides inequitable care for families with known health disparities, which often results in poor patient outcomes,” Dr. Acker says. To improve this system, Dr. Acker and her team developed the One-4-ALL Initiative. This work is designed to improve processes and employ technology to increase patient throughput, reduce clinician burden and address health disparities.

The project aims to shift the current model of care into an interactive, online, self-service program that educates families using health literacy materials in their preferred language. “This educational model was designed to ensure all families, independent of their level of health literacy or ability to read and understand English or Spanish, would have access to the same information and be able to access it on their own time,” Dr. Acker says.

Currently, she is leading a pilot study for families of patients who need a feeding gastrostomy tube, or G-tube, placement. The study involves providing families with access to an online portal where they can choose their preferred language and watch animated, medically accurate videos about why their child needs a G-tube and what to expect from the surgery. The team’s goal is to grow its library of health literacy videos so they can be distributed to surgical teams across the country.

Such work wouldn’t be possible without training from the SCORE fellowship, which helped Dr. Acker expand her experiences in clinical research. “My motivation to pursue a career in research was to obtain a health services research skillset — an opportunity that was never part of my clinical training,” she says.

Bilingual surgery clinic breaks down barriers

Dr. Diaz-Miron, a pediatric surgeon, is also applying his SCORE fellowship education to further a more equitable environment for pediatric surgery patients. He started Clínica de Cirugía Pediátrica, the first Spanish-speaking pediatric surgery clinic in the state of Colorado and in the mountain region. As a native Spanish speaker, Dr. Diaz-Miron created the clinic at Children’s Colorado to provide Spanish-speaking families with consultations regarding the medical conditions and surgeries their children may be facing.

These efforts serve a significant population. In 2020, Hispanic and Latinx patients accounted for 29% of total visits to the Department of Pediatric Surgery. Of those, 23% reported Spanish as their primary language, with 9% requiring interpreter services in Spanish.      

In addition to helping these families feel more informed and confident regarding their care, the clinic also serves as a research tool to help Dr. Diaz-Miron better understand how interpretation services decrease health disparities. “We are looking at the effect of language-concordant care for our Hispanic population, trying to figure out how that affects the care that they receive and the access to information that they have,” he says.             

Similar to Dr. Acker, Dr. Diaz-Miron credits the SCORE fellowship with helping him shape his future in medicine. Dr. Diaz-Miron also recently obtained a career development award as a K12 CCTSI scholar, a grant that will further support his research.

Both Drs. Acker and Diaz-Miron have a wide range of surgical research interests, but they share a common thread across each of their projects. They agree that the SCORE fellowship helped them define and launch their careers, so now, they can work toward the shared goals of improving patient outcomes, uniting research with clinical care and making patient education more equitable for all surgery patients.