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Research Optimization and Implementation Trial of a User Centered Emergency Care Planning Tool for Infants with Medical Complexity
A Q&A With K23 Recipient Dr. Christian Pulcini
By Brian Milman, MD, on behalf of the SAEM Research Committee
Christian D. Pulcini, MD, MEd, MPH, is a pediatric emergency physician at the University of Vermont Medical Center and UVM Children’s Hospital, as well as an assistant professor of emergency medicine and pediatrics at the University of Vermont Larner College of Medicine. His current areas of research focus are emergency care of children with medical complexity,
Christian D. Pulcini childhood firearm injuries, and pediatric acute mental health.
Congratulations on your K23, “Optimization and Implementation Trial of a UserCentered Emergency Care Planning Tool for Infants with Medical Complexity.” Can you give a summary of your project?
Thank you, and of course. Who doesn’t like to talk about their research? The research portion of the K23 involves optimizing the Emergency Information Form (EIF) jointly recommended for children with special health care needs by the American College of Emergency Physicians (ACEP) and American Academy of Pediatrics (AAP) in 1999 and then reaffirmed in 2010. Despite this joint recommendation, there is little evidence supporting the efficacy of these forms. The targeted population for my project will be infants with medical complexity, notably infants graduating from the neonatal intensive care unit (NICU). This population has been shown to have higher rates of emergency department (ED) visits and admissions to acute care hospitals in the first year of life, therefore we felt our outcomes would be more adequately measured among this population. The first two years of the project will involve assessment of the key stakeholders in the emergency care of infants with medical complexity, with medical complexity defined as “children with multiple significant chronic health problems including multiple organ systems, which result in functional limitations, high health care needs or utilization, and often require need for, or use of, medical technology.” We will focus specifically on optimizing the EIF
to fit local needs, as well as barriers for implementation. The latter three years of the project will be a randomized controlled trial of the optimized EIF, comparing outcomes such as ED visits, inpatient visits, etc. The overall goal is to become an independent implementation scientist with the ability to implement and measure interventions for diverse populations receiving emergency care in a general, rural emergency department.
In 2020-2021, you completed SAEM’s Advanced Research Methodology Evaluation and Design (ARMED) course. How did ARMED impact your path to NIH funding?
ARMED certainly moved up my timeline as it made my application higher-quality in a faster timeframe than I expected. I am honored to receive this career development award two years out of fellowship, and I don’t think it would have been possible without the mentorship and guidance attained through the ARMED program. The ARMED course provided some needed accountability during a challenging time when I was transitioning to an attending role. There was a diverse group of individuals involved in the ARMED program who were always willing to review portions of the NIH application, which was instrumental in the grant development and writing process. It takes a village to submit a career development award, therefore in combination with local mentorship, the ARMED course certainly played an instrumental role in submitting the best possible K23 application in an accelerated timeframe.
How did you develop an interest in research?
As a medical student I did a research fellowship between my first and second year which kickstarted my interested in research. In full disclosure, the only reason I applied to the research fellowship is because I had a mentor who spoke to me about the impact of research on health policy and advocacy. I obtained an MPH prior to medical school with the goal of implementing programmatic interventions for at-risk and vulnerable populations. After witnessing my research mentor in a legislator’s office providing data from research they performed and watching it impact health policy, I was sold on it as a career focus. I still approach every research project from the 30,000-foot view before I engage, asking questions of “why does this matter?”, “who will be impacted by this research?”, and “how can I design this so it matters?”. This approach may be different than some researchers, but it is what keeps me actively engaged as a budding physician-scientist.
What has been the biggest milestone in your research career so far?
Certainly the receipt of the K23 is the biggest milestone. It felt like a confirmation that this is the road I should be on after some serious hard work and doubts. I also recently won a young investigator research award from the American Academy of Pediatrics (AAP) (named after Dr. Ken Graff), given to a pediatric emergency medicine researcher deemed to have a high potential for impactful research. This is a great honor and I look forward accepting this award at the national AAP meeting. Lastly, I recently published my first senior author paper in Academic Emergency Medicine journal focused on mental health boarding in rural EDs in Vermont. That certainly felt like a milestone as well.
If you could go back in time, what advice would you give yourself when you were a medical student?
I taught middle school science through the Teach for America program and obtained an Master of Public Health prior to medical school, therefore I was fairly goal-driven coming into medical school. I would probably tell myself to focus on what I enjoyed and worry less about five and ten years down the road. Initially I was surprised I liked research as much as I did, and that presented a crossroads for me. I think if I had not been resistant to committing to a career involving research, things may have been easier for me. With that said, I had a wonderful experience in medical school and am still in contact with my first research mentor. Some other unsolicited advice I recently gave a medical student, which has been instrumental to my own success, is always build bridges instead of letting them break down. It is a small community of academic EM and pediatric EM physicians, and it is so important to build and maintain positive relationships even if the basis of that relationship is not the highest priority at that point in time.
What does an average week look like for you?
I work 1-2 ED shifts a week now, which frees up time to do the certificate program in implementation science in my K23 training plan as well as coordinate 5-6 mixed-methods studies that are getting off the ground. I also do a fair bit of collaborative research through national research groups, and always have some local and national committee meetings each week. This is in addition to local teaching engagements and other projects which are ongoing focused on firearm violence prevention, acute mental health, and trauma-informed care. Although this sounds like a lot, I am still coaching soccer three times a week for my three kids and exploring Vermont with my family.
What has been the most challenging aspect of your research career?
It is the constant balance between clinical, administrative, teaching, and research. I am fortunate in that my institution and department is highly focused on bolstering the research portfolio in our ED, and I am seen as a central piece of achieving that goal. As a bit of advice for someone considering a similar career in research, I would highly encourage getting a feel for this balance while interviewing by asking specific questions of what this looks like in their division/department. I found that this varies quite a bit both before and after receipt of the award, and the interview can help future clinician-researchers better understand the expectations. Lastly, ensure that your goals align well with the division/department, and do not be afraid to ask this directly.
What has been the most rewarding aspect of your research career?
I have had patients, families, community, and national groups thank me for what I am doing. This affirms to me that what I am doing matters to the patients and families I am seeing in the ED, and that is the most meaningful and rewarding aspect for me personally. I am just embarking on this journey with the career development award, however, and I sincerely look forward to measuring how my future research can positively impact vulnerable populations seeking emergency care across diverse healthcare settings.
If you have additional questions about an NIH K23 award, you can contact Dr. Pulcini at christian.pulcini@uvmhealth.org.
ABOUT THE AUTHOR
Dr. Milman is an assistant professor of emergency medicine and associate residency program director at the University of Oklahoma School of Community Medicine.
