As a medical student at the University of Michigan, Nicole Mott, MD, developed an interest in health services research and investigating issues around cost, value, and quality.
“A lot of my research as a medical student was looking at low-value care in breast cancer surgery,” she says. “Women who are older and have breast cancer generally have a favorable prognosis, and there are guidelines that recommend against doing additional therapies like adjuvant radiation and axillary staging. Those practices are still common, however, so I investigated reasons for that from the patient perspective, the provider perspective, and the health-care-system perspective.”
National scholarship
Now a fourth-year resident in the University of Colorado Anschutz Department of Surgery, Mott continues to research value using implementation science approaches as a member of the National Clinician Scholars Program (NCSP), which immerses participants in a rigorous program of research, policy, and leadership training that equips them to partner with communities and health systems and engage and lead diverse teams to impact health policy.
Coincidentally, Mott is back at the University of Michigan for the two-year program, after which she will return to CU Anschutz this summer to resume her clinical training.
“I was interested in translating my research into policy and action, which is why I applied to the National Clinician Scholars Program,” she says. “Michigan has a good center for health services research in surgery, which is why I wanted to go there for the program.”
Issues of value
While part of the NCSP, Mott continued her research on low-value care — defined as medical treatments, tests, or procedures that provide little to no clinical benefit, or where potential harms outweigh benefits — with a focus on surgery.
“I’ve done research on reducing unnecessary preoperative testing, because getting preoperative testing before a low-risk surgery usually doesn't change clinical outcomes, but it can lead to unintended consequences like surgical delays and additional visits and costs for patients,” she says. “There are guidelines recommending against routine testing, but it's still common. I wanted to look at the patient-, provider- and system-level factors that account for that.”
In a recently published paper in the journal Surgery, Mott and her co-authors argue for a wider definition of surgical quality that takes into account the preoperative and perioperative care phases, as well as postoperative outcomes.
“We're designing new models of how to measure quality in the preoperative and perioperative phases, which more accurately represent the patient's journey through surgery,” she says. “We're looking at three common elective surgical procedures — hernia repair, carpal tunnel release, and knee replacement — and how we can incorporate preoperative measures like avoiding unnecessary labs or imaging prior to the procedure into quality measurement.”
Cardiothoracic focus
Mott, who has focused her residency on cardiothoracic surgery, has also worked with CU mentors like Robert Meguid, MD, MPH, FACS, professor of cardiothoracic surgery, on research including studies on financial and socioeconomic barriers to lung cancer screening and surgery.
“Dr. Mott is an outstanding surgical resident growing her skills and expertise in health services research through the National Clinician Scholars Program,” Meguid says. “It is exciting to work with such a talented and motivated surgeon-in-training.”
Investigating the roles of women in surgery
With another CU surgery mentor — Elizabeth David, MD, professor of cardiothoracic surgery, Mott also has conducted research on women in the field, focusing on such issues as workplace culture and burnout, mentorship, and the impact of a surgical career on the relationship, family, and personal well-being of surgeons’ partners.
“Increasing representation and diversity in the specialty is important, and it's good for patients as well,” Mott says. “I have a personal interest in mentorship, sponsorship, and leadership development and how they can be leveraged to improve the field.”
Perfect blend
Mott says she finds research and clinical work to be equally impactful. Her ideal career, she says, would allow her to continue to focus on both.
“I've always been interested in the science of medicine and surgery, but I’m also interested in investigating how social factors impact the delivery of care,” she says. “I like to learn and challenge myself, and medicine is something that allows you to do that.”
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