Ashley Conroy ’20

NYU Langone Health, New York, NY

As a Clinical Research Associate for New York University Langone Health, I split my time this summer between the Ronald O. Perelman Department of Emergency Medicine at NYU Tisch Hospital and the research coordination office at Bellevue Hospital. I worked on a team of 14 other interns and administrative staff for the POISED (Program of Intensive Support in Emergency Departments) study by Dr. Chodosh. POISED is a longitudinal study, having been initially rolled out in May of 2018, and expected to be completed in approximately the spring of 2020. The goals of POISED are two-fold: improve the well-being of geriatric patients and their care partners, by means of improving patient care and decreasing the stress felt by a loved one who assists in the patient’s care, as well as reducing the frequency at which geriatric patients visit the emergency departments.

With the majority of my time being spent in the ED, my main role as a Research Associate was to recruit patients into the program by screening geriatrics that presented in the ED. Any patient over the age of 75 who came to the ED in a physical state deemed as not critical by the hospital nursing staff (as noted by an acuity rating of three or above on a five point scale) was eligible for screening in the study. Approaching patients required excellent and effective communication skills, such that I could perform the assessments that I needed to, while not disrupting hospital flow, patient care, or agitating any patients. Considering I was working solely with potential candidates who were 75 and older, there were often language, communication, and generational barriers that had to be overcome in order for me to do my job most effectively. For example, the majority of the patients on my chart were hard of hearing or had difficulty communicating; often times both. On more than one occasion I was questioned as to my validity as a researcher due to being a student and my lack of white coat or scrubs. Age gaps highlighted clashing political and cultural perspectives as several patients spoke with racial or sexist slurs, or made offensive jokes and comments. That being said, in no way can any of these factors influence patient care, and as a guest in a hospital, my role certainly comes after the role of treatment. Thus, I learned to operate as a “fly on the wall” when nurses and doctors were at work, and help patients feel heard and valued as they talked to me, while not letting any of their comments get in the way of performing the task at hand.

In my screening, I used two different assessments: the IQCODE and Mini-Cog. The IQCODE (Informant Questionnaire on Cognitive Decline in the Elderly) consists of 16 prompts in which a family member or friend of a patient can speak to the cognitive decline (or lack thereof) of the patient, by ranking their current ability in comparison to a few years prior on a Likert type scale with anchors of “much improved” to “much worse.” Alternatively, the Mini-Cog is performed directly with the patient in a series of steps. First, I would tell a patient three words (banana, sunrise, and chair) and have them repeat them back to me to ensure they were paying attention and had the necessary verbal communication skills to complete the assessment. I would then tell the patient to try to remember those words while handing them a pre-drawn circle on a sheet of paper and ask that they fill in the numbers on the circle to make the face of a clock. Once completed, I would instruct them to place the hands of the clock at the time 10 past 11. Finally, I would ask the patient if they could remember any of the three words from earlier. In order to screen negative on this test, indicating a low likelihood for dementia or cognitive impairment, patients would have to produce a “normal” clock with properly positioned numbers and hands, and remember at least two of the three words. While this task was often incredibly difficult for some, it was important that I ensured patients that they were not unintelligent, inferior, or that the results of the test would negatively influence the care that they receive. Of course, knowing that you performed poorly on a test of thinking and memory can make one feel embarrassed, ashamed, or even angry. And while I certainly encountered all of these reactions and more during my time in the ED this summer, I found that normalizing the assessment by approaching patients with a friendly attitude, genuine smile and kindness, and engaging in conversation such that they feel heard and respected often mediated any ill-feelings.

After screening positive and consenting to be enrolled in the program, patients and their loved ones would go on to participate in detailed phone interviews over the next six months assessing patient and care partner mental and physical well-being. Coordinators and nurses working on POISED have helped in their care intervention efforts with everything from medication delivery, transportation to and from the hospital and primary care appointments, substance abuse support, psychiatric treatment, and simply being a listening ear for those who felt they didn’t have any other sufficient outlet to express their feelings of stress or frustration. As the only full-time Research Associate, I had the unique opportunity to call many of these patients to check-in and schedule interviews. It was the conversations I had from these contacts, as well as those initial talks in the ED, that were the most meaningful to me. This internship has reinforced within me my desire to pursue medicine and strengthened my communication and research abilities. Particularly, I’m now far more interested in the field of geriatric medicine, a subset I hadn’t previously seriously considered pursuing.

Clinical Research Associates and Research Coordinators group photo.

Overall, my time as a research associate at NYU was enjoyable, insightful, and exciting. Though the field of Emergency Medicine, specifically when focusing on elderly populations, is full of uncertainty, chaos, and various moving parts, there is certainly never a dull moment. The constant learning curve and hustle of medicine has always intrigued me, but this immersive experience captivated me, piquing my curiosity and interest. Especially when considering elderly care, something as simple as advising a patient to get out of the house at least once a day, develop a routine, or talk to their friends or family, can have such a significant and near immediate impact on quality of life. This is why I found my work this summer to be so meaningful. The team of interns, researchers, and physicians that I was a part of was a diverse body of people, from various backgrounds and identities, all coming together for a single goal of improving the care given to the eldest members of our society. And truly, that is the type of work that I can confidently say inspires me most. I want to extend a sincere thank you to the ’68 Center for Career Exploration and the Class of 1972; for without their support I would likely not have been able to have this wonderful opportunity.