Amber Brown Keebler, MD | Foundations of Clinical Research
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When Amber Brown Keebler, MD, enrolled in medical school she knew her intent was to focus on primary care. Now board-certified in internal medicine and pediatrics, she practices at the University of Nebraska Medical Center. During the early years of her practice, Dr. Brown Keebler developed an interest in lipidology – the study of complex cholesterol management and cardiometabolic risk.
“I took some courses through the National Lipid Association, and it piqued my interest with regards to doing research in this area,” she says. Within the last year she has taken two significant steps to making that goal a reality, including participating in the inaugural Foundations of Clinical Research (FCR) program at Harvard Medical School.
Providing primary care to patients with mental illness
Dr. Brown Keebler also joined the faculty of the medical school where she started a collaborative project with the psychiatry department. “Patients that have more severe mental illness, such as schizophrenia and psychotic disorders, have a pretty high risk of cardiovascular bad outcomes even more than just the general population,” she explains. Adding on certain medications in that patient population can make the situation even worse.
“It is already a challenge trying to connect these patients with primary care doctors. And it can be hard to find primary care doctors who understand the needs of these patients who really know what to do,” she adds.
Towards that end, she and the team in the psychiatry clinic have established a reverse integrated care model where Dr. Brown Keebler provides primary care to these patients who are already receiving care for their mental health concerns. The model removes the barrier of requiring patients to travel to different locations for all their different health care needs. “I have the needed background knowledge and ultimately what we would like to do is buff up this multidisciplinary program to provide really good services to the patients and their families,” she says. She also hopes this approach creates a vibrant research model looking forward that will determine if what the team is doing as a practice model improves physical health and mental health.
Research certificate program provided more in-depth skills
“I had ideas to design a study but was not comfortable moving forward, particularly with the statistics component,” she recalls. After learning about FCR which was set to begin its inaugural class, Dr. Brown Keebler enrolled. “It seemed like it would be a great fit to get more in-depth knowledge on the different types of study design and how to move forward with my ideas.”
Having completed the six-month program she describes learning the tools needed to do substantive clinical research.
Appreciation of data and statistical programming
“The piece that is really unique to the program is that we learned a lot about data and programming,” she says. “A lot of clinical researchers do not get involved in the statistical programming for running their analyses. But I believe it is better to do a lot of the work yourself – it’s less costly, quicker, and satisfying to work with the data yourself and draw conclusions.”
She credits the course with helping deepen her statistical analysis skills with an eye toward moving her findings into publications – a professional milestone she has yet to achieve but is now on her near-horizon.
Envisioning a long-term research study
The program confirmed Dr. Brown Keebler’s interest in moving forward with clinical research with patients with severe mental health concerns. “I don't want to kind of just dabble in it; I really want to make this a part of my career.”
Currently, the majority of Dr. Brown Keebler’s time is clinical with a bit of academic teaching time. “But I really want to do a bigger project and spend a significant portion of my time doing research.” She hopes to establish a prospective cohort study of about 10 to 15 years looking to see if following the current guidelines that are in place for cardio metabolic monitoring, and acting appropriately on what is found, can impact the health of these patients with severe mental illness. The hope would be to decrease emergency room visits and the cost of care and improve interactions with primary care doctors that may influence patients’ mental health as well.
“I've always wanted to make an impactful change in medicine,” she says. And now after the FCR program, I believe I can affect things on a broader level. I can perform a basic research project, do the statistical analysis, and know how to collaborate with all the partners involved.”
Looking ahead, Dr. Brown Keebler plans on applying to a clinical translational research program at her home institution working towards a PhD and hopefully gain access to grant funding to kickstart her projects.
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Written by Alice McCarthy