Around the emergency department, it’s known as “testing creep.” Conventionally, it’s called human nature — the more you have, the more you use, the more you want.
Kabir Yadav, M.D.C.M., assistant professor of Emergency Medicine at the George Washington University School of Medicine and Health Sciences (SMHS), knows the phenomenon well. Over the past several years, for example, he has watched the rates of CT scans triple.
“There is evidence that the same number of people have diseases or injuries year-to-year but we’re just doing more tests to find them.” he explains. “So are we diagnosing more problems, or are we just doing more tests?”
This question is just one of many that plagues emergency physicians who must make critically important decisions rapidly. Which test is the best test? Is a test better than no test at all? And, is the right test being used on the right person? In day-to-day practice, the evidenced-based answer isn’t always the prevailing one.
But Yadav, who is one of the first graduate students of the SMHS Clinical and Translational Research (CTR) graduate program, is exploring ways to change that. By developing tools that help bring answers to the doctors at the moment the question is asked, Yadav’s work is at the heart of the emerging field of translational research, or what’s often referred to as “bench to bedside.”
“Most of the time, information is disseminated by publishing it. So whether you hear about it at a conference, you actually read the article, or a colleague tells you about it, the way you learn can be a bit haphazard,” says Yadav. “The idea is to bring that synthesized information to the clinicians at the time that they need it.”
Yadav’s research, which specifically aims to translate the results of large-scale comparative effectiveness studies into decision-making tools used in high-priority pediatric conditions, is supported through a three-year KL2 grant from the Clinical and Translational Science Institute at Children's National (CTSI-CN), one of 60 prestigious national hubs for translational research funded by a $20 million Clinical and Translational Science Award (CTSA) from the National Institutes of Health (NIH).
A main component of the CTSI-CN, a collaboration between GW and Children’s National Medical Center, is the development of a generation of clinicians like Yadav to become experts in the emerging paradigm of translational research. By providing training, mentorship, and financial support, the KL2 award allows program participants to establish their footing in the increasingly competitive world of biomedical research — all while practicing medicine and earning a graduate degree.
“It’s hard as a clinician to do anything other than being a clinician,” notes Yadav. “Training grants are vital because they provide the structure and the means to really pursue a particular area of research.”
Though Yadav is young, he is hardly new to scientific research — or to the D.C. area. As a teen, the District native attended Thomas Jefferson High School for Science and Technology and completed two summer internships at the NIH. He continued his education at the Massachusetts Institute of Technology, where “most of what I did was try to figure out if there was something else [I’d rather do], but medicine always won out,” he remembers.
When he entered medical school at McGill University in Montreal, Yadav expected to be drawn to primary care. But, he says he “fell in love” with emergency medicine after his first rotation. “There's a lot of uncertainty in emergency medicine so it’s sort of like detective work,” he found. “I saw it as fact-finding amidst the chaos.”
While always intrigued by research, Yadav says his interest in it didn’t “hit full force” until his residency at State University of New York, Downstate Medical Center, where he was appointed chief resident in his final year. There Yadav learned that, contrary to common perception, the emergency department is ripe for research. “When you are in an environment where information is scarce, the more rigorous the information you have, the better the decisions we can make,” he explains.
Yadav joined the GW faculty in 2008 after completing a clinical research fellowship at the Jacobi Medical Center Department of Emergency Medicine in the Bronx, New York. During that time he became interested in clinical decision rules, a form of evidence-based decision aids that guide whether or not healthcare providers perform certain tests.
When he moved to GW, Yadav’s focus expanded from the rules themselves to the tools used to develop and implement them. Instead of creating rules using conventional paper-based methods, he is adapting electronic software to collect the data and deliver the rules — an area called biomedical informatics. Because CSTI-CN has extensive data collection systems and cross-disciplinary resources, it is the perfect place to conduct this type of research, he believes.
GW is also a good fit for Yadav’s interests because it offers a broad array of courses from which he can choose to pursue a second master’s degree, which will be granted by SMHS’s Health Sciences Programs. By supplementing his background in clinical research methods with computer science, decision science, and biomedical informatics courses, he is preparing to act as “an intermediary” between multiple fields, he says.
“What’s nice about being in a university environment is that my collaborators and my mentors are not only in emergency medicine and pediatrics, but they are also in nursing, computer science, and engineering,” Yadav explains. “It gives you the ability to get the diverse one-on-one mentoring you need in order to really become an effective translational researcher.”
Within the next five years, Yadav hopes to become an associate professor in SMHS’s Department of Emergency Medicine and a faculty member in the School of Public Health and Health Services’ Department of Health Policy. He envisions himself mentoring other aspiring scientists and building a research portfolio that will continue to gain the support of major funders like the NIH and the Agency for Healthcare Research and Quality.
Overall, his hopes match those of the CTSA’s: to improve patient and community health as effectively and efficiently as possible.
“The KL2 training grants are a much needed opportunity, and they would not be possible without the commitment on the part of the university and the GW Medical Faculty Associates,” Yadav says. “So for me, it’s not only an honor to have that support, but it’s also an obligation to make sure that I live up to my goals.”