Q&A with Dr. Abra Fant, MD, MS

Dr. Abra Fant received her medical degree at Rush University. She subsequently completed residency at New York Presbyterian Hospital and first came to Northwestern in 2015. Following completion of the Medical Education Scholarship Fellowship in 2016, she joined the faculty of emergency medicine, serving first as an Assistant Program Director before starting her current role as Program Director. She additionally serves as the Central Region Medical Director for the Northwestern Medicine Academy for Quality and Safety Improvement (AQSI) program.

While best known as an educator, Dr. Fant has also participated in research throughout her career. Her research interests include education assessment and milestones as well as healthcare quality and safety education. In 2020, she was part of a research team awarded a $1.3M grant from the American Medical Association. This “Reimaging Residency” Grant is led by Dr. Caretta-Weyer from Stanford with Dr. Fant serving as the Northwestern Site-PI. The team will focus on redesigning assessment across the continuum of emergency medicine training and introducing predictive learning analytics to the process.

You have published on a variety of topics over the last 6 years, tell us about your favorite publication thus far in your career.

The BMJ AQSI paper is really special because it is a great merger of both my education and quality interests. It also is, at its heart, a program evaluation paper that tries to make connections to clinical outcomes, which is a really tricky thing to do. So much medical education program evaluation literature stops at knowledge acquisition; being able to track sustained changes in patient care linked directly to AQSI is such a wonderful illustration of why education is so important. I also really loved working on the gender bias papers because it was a new type of analysis for me and a fantastic group of women researchers.

Many of the projects you have supported through your role with the NM AQSI program are rapid cycle quality interventions with the primary intent of quality improvement (rather than research publication per se). What challenges have encountered in publishing quality improvement research?

The main difficulty with publishing in quality improvement is that the methods are inherently messy and randomization is typically ethically difficult to achieve. Equipoise is hard to establish when you are working with the premise that the baseline process needs to be improved. Another issue is that each clinical environment is very unique so results are often not easy to generalize. This doesn’t mean that good projects should not be published but they are often hard for traditional medical journal reviewers, who are more used to classic research methods, to review and they often don’t fit accepted manuscript guidelines. At this point, a lot of what gets published in QI is relegated to low impact journals and limited to single site interventions with short term outcomes, but I hope this tide is changing.

You were a co-investigator on two recent publications evaluating the effects of the AQSI program for the health system. What are the key take-aways from these studies?

The two AQSI papers follow similar themes and look at the central region and the system, respectively. The biggest take away is that a coaching model and templated milestones are a really effective way to help people first engage with QI projects, regardless of their level of training or profession in healthcare. In a lot of ways, this mirrors what we are trying to do in graduate medical education by having experts guide new learners through hand-on experiences, and we provide learning targets along the way. We haven’t yet matured to the level of competency-based assessments in QI (at least not with AQSI) but it would be a natural extension of our work and something that could hold potential in medical and nursing education settings.

Tell us about the “Reimagining Residency” Grant and your role in the project.

I am so excited about the grant and am going to have to limit my response here so as not to bore the readers! The premise is that we need better tools in order to evolve into true competency-based assessment in graduate medical education in general and EM in specific. The first iteration of this was the Milestone Project which is limited most by its inaccessibility. It is hard for an individual attending on a solitary shift to provide milestone anchored assessments-they just aren’t designed to do that. The day to day assessment data we do have often times isn’t enough to make a determination within the milestone framework, so Clinical Competency Committees arrive at a lot of subjective judgements. We want to bridge that gap with our grant by first creating Observable Professional Activities (OPAs) that are the tasks that make up the job of an Emergency Physician. (For example “create and prioritize a differential diagnosis”). When an attending observes a resident performing one of these tasks they can rate their level of entrustment of that resident on the given OPA (“I had to do it” all the way up to “I didn’t need to be there at all”). This will provide hopefully thousands of data points for each resident over the course of a year. We are also anchoring the OPAs to the level of a starting intern, transition to senior resident, and transition to practice to help alleviate some of the positive bias we all experience when assessing learners. My role was to help create and anchor these OPAs and, in the next phase, beta test the system at Northwestern. Because the grant is multi-site we hope to really create a practical and useable tool that encourages attendings to provide assessment and creates meaningful data points to drive residents’ own learning plans.