Harkness Project Title:
Medical Professionalism and Disparities in Health and Health Care
Mentors: Troyen Brennan, M.D., J.D., Ph.D., and David Blumenthal. M.D.
Placement: Harvard School of Public Health
Biography at time of Harkness Fellowship: Russell L. Gruen, a 2002–03 Commonwealth Fund Harkness Fellow in Health Care Policy, is an advanced trainee in General and Trauma Surgery with the Royal Australasian College of Surgeons, and a research fellow at the Flinders University of South Australia and Menzies School of Health Research in Darwin, Australia. His doctoral thesis, which addresses the delivery of specialist services to remote and disadvantaged Aboriginal communities in northern Australia, has received several specialist society and university awards. Gruen has participated on national advisory committees relating to care of severely injured patients and rural specialist workforce issues. His major policy interests include the involvement of physicians and medical societies in addressing health inequalities; population models of specialist practice; the relationship between specialists and general physicians; trauma systems in nonurban settings; and rural workforce issues.
Project: Gruen’s study examined how physicians’ principles of professionalism guide their public activities and activism, particularly related to policies addressing disparities. He conducted a literature and analyzed focus group data on the relationship between professionalism and disparities, and conducted interviews with key informants from three professional medical societies. He then developed a conceptual framework for physicians’ roles in addressing disparities, which was used to develop a survey of over 3,000 physicians.
Career Activity Since Fellowship
- Professor of Surgery and Public Health, Monash University, and Consultant Surgeon, The Alfred Hospital, Melbourne, 2009
- General Surgeon and Trauma Surgeon, The Alfred Hospital, 2009
- Director, National Trauma Research Institute, 2007
- GJ Royal Medal, Victorian State Committee, Royal Australian College of Surgeons, 2006
- General Surgeons of Australia Medal, Congress Visitor in Rural Surgery, Royal Australian College of Surgeons Annual Scientific Congress, Perth, 2006
- Associate Professor of Surgery, University of Melbourne, 2006
- Associate Professor of Health Services Research, Menzies School of Health Research, Darwin & University of Queensland, 2005
- Professor of Surgery and Public Health, Monash University.
- Director of the National Trauma Registry Institute.
- Surgeon and Head of Trauma Quality Assurance, The Alfred Hospital.
Calthorpe, S., Barber, E.A., Holland, A.E., Kimmel, L.A., Webb, M.J., Hodgson, C.L., Gruen, R.L. An intensive physiotherapy program improves mobility for trauma patients, The Journal of Trauma and Acute Care Surgery 2013, vol 76, issue 1, Lippincott Williams & Wilkins, Baltimore, United States, pp. 101-106.
Tee, J.W., Chan, P., Gruen, R.L., Fitzgerald, M.C.B., Liew, S., Cameron, P., Rosenfeld, J.V. Early Predictors of Mortality After Spine Trauma, Spine 2013, vol 38, issue 2, Lippincott Williams & Wilkins, United States, pp. 169-177.
Clavisi, O.M., Bragge, P., Tavender, E.J., Turner, T.J., Gruen, R.L. Effective stakeholder participation in setting research priorities using a Global Evidence Mapping approach, Journal of Clinical Epidemiology 2013, vol 66, issue 5, Elsevier Inc., United States, pp. 496-502.
Bosch, M.C., Tavender, E.J., Gruen, R.L., Green, S.E, How to define 'best practice' for use in knowledge translation research: a practical, stepped and interactive process, Journal of Evaluation in Clinical Practice 2013, vol 19, issue 5.
Breen, D., Chavalertsakul, N., Paul, E., Gruen, R.L., Serpell, J.W. Perioperative complications in patients on low-molecular-weight heparin bridging therapy, ANZ Journal of Surgery 2013.
Jaramillo, A., Welch, V., Ueffing, E., Gruen, R.L., Bragge, P., Lyddiatt, A., Tugwell, P. Prevention and self-management interventions are top priorities for osteoarthritis systematic reviews, Journal of Clinical Epidemiology 2013, vol 66, issue 5.
Reeves, F., Batty, L., Pitt, V., Chau, M., Pattuwage, L., Gruen, R.L. Safety and efficacy of pharmacologic thromboprophylaxis following blunt head injury: A systematic review, The Journal of Trauma and Acute Care Surgery 2013, vol 75, issue 4.
Palmer, C.S., Davey, T.M., Mok, M.T., McClure, R.J., Farrow, N.C., Gruen, R.L., Pollard, C.W. Standardising trauma monitoring: the development of a minimum dataset for trauma registries in Australia and New Zealand, Injury-International Journal Of The Care Of The Injured 2013, vol 44, issue 6.
Gruen, R.L., Jacobs, I.G., Reade, M.C. Trauma and tranexamic acid, Medical Journal Of Australia 2013, vol 199, issue 5, Australasian Medical Publishing Company Pty. Ltd., Australia, pp. 310-311.
Moran, C., Kipen, E., Chan, P., Niggemeyer, L., Scharf, S.L., Hunter, P., Fitzgerald, M.C.B., Gruen, R.L. Understanding post-hospital morbidity associated with immobilisation of cervical spine fractures in older people using geriatric medicine assessment techniques: A pilot study, Injury-International Journal Of The Care Of The Injured 2013, vol 44, issue 12.
Santana, M.J., Straus, S.E., Gruen, R.L., Stelfox, H.T. A qualitative study to identify opportunities for improving trauma quality improvement, Journal of Critical Care 2012, vol 27, issue 6.
Gruen, R.L., Reade, M.C. Administer tranexamic acid early to injured patients at risk of substantial bleeding, BMJ 2012, vol 345, issue 7884.
Balogh, Z., Reumann, M.K., Gruen, R.L., Mayer-Kuckuk, P., Schuetz, M.A., Harris, I.A., Gabbe, B.J., Bhandari, M. Advances and future directions for management of trauma patients with musculoskeletal injuries, Lancet 2012, vol 380, issue 9847.
Mitra, B., Cameron, P., Gruen, R. Aggressive fresh frozen plasma (FFP) with massive blood transfusion in the absence of acute traumatic coagulopathy, Injury-International Journal Of The Care Of The Injured 2012, vol 43, issue 1.
Bragge, P., Chau, M., Pitt, V., Bayley, M., Eng, J.J., Teasell, R., Wolfe, D.L., Gruen, R.L. An overview of published research about the acute care and rehabilitation of traumatic brain injured and spinal cord injured patients, Journal of Neurotrauma 2012, vol 29, issue 8.
Cumpston, M.S., Tavender, E.J., Buchan, H.A., Gruen, R.L. Australian health policy makers' priorities for research synthesis: A survey, Australian Health Review 2012, vol 36, issue 4.
Gruen, R.L., Watters, D.A.K., Hollands, M.J. Authors' reply: surgical wisdom (Br J Surg 2012; 99: 3-5), British Journal Of Surgery 2012, vol 99, issue 5.
Rosenfeld, J.V., Bragge, P., Morganti-Kossmann, M.C., Gruen, R.L. Early management iof servere traumatic brain injury, Lancet 2012, vol 380, issue 9847.
Rosenfeld, J.V., Maas, A.I., Bragge, P., Manley, G.T., Morganti-Kossmann, M.C., Gruen, R.L. Early management of severe traumatic brain injury, Lancet 2012, vol 380, issue 9847.
Tee, J.W., Chan, P.C.H., Gruen, R.L., Fitzgerald, M., Liew, S.M., Cameron, P., Rosenfeld, J.V. Early predictors of mortality after spine trauma: a level 1 Australian trauma center study, Spine 2012, vol 38, issue 2.
Gauden, A.J., Pitt, V., Gruen, R.L. Excitatory amino acid inhibitors for traumatic brain injury, Cochrane Database of Systematic Reviews 2012, vol 2.
Gruen, R.L., Brohi, K., Schreiber, M., Balogh, Z., Pitt, V., Narayan, M., Maier, R.V., 2012, Haemorrhage control in severely injured patients, Lancet 2012, vol 380, issue 9847.
Fiore, J.F., Browning, L., Bialocerkowski, A., Gruen, R.L., Faragher, I.G., Denehy, L., 2012, Hospital discharge criteria following colorectal surgery: a systematic review, Colorectal Disease 2012, vol 14, issue 3, pp. 270-281.
Green, S.E., Bosch, M.C., McKenzie, J.E., O'Connor, D.A., Tavender, E.J., Bragge, P., Chau, M., Pitt, V., Rosenfeld, J.V., Gruen, R.L. Improving the care of people with traumatic brain injury through the Neurotrauma Evidence Translation (NET) program: protocol for a program of research, Implementation Science 2012, vol 7, issue Art. No: 74, pp. 1-14.
Tee, J.W., Chan, C.H.P., Gruen, R.L., Fitzgerald, M.C.B., Liew, S.M., Cameron, P., Rosenfeld, J.V., Inception of an Australian spine trauma registry: The minimum dataset, Global Spine Journal 2012, vol 2, pp. 71-78.
Gruen, R., Gabbe, B., Stelfox, H., Cameron, P.A. Indicators of the quality of trauma care and the performance of trauma systems, British Journal Of Surgery 2012, vol 99, issue S1, pp. 97-104.
Mahar, P., Wasiak, J., Batty, L.M., Fowler, S., Cleland, H.J., Gruen, R.L. Interventions for reducing wrong-site surgery and invasive procedures, Cochrane Database of Systematic Reviews 2012, vol 9, UK, pp. 1-43.
Bismark, M.M., Gogos, A.J., Clark, R., Gruen, R.L., Gawande, A.A., Studdert, D.M. Legal disputes over duties to disclose treatment risks to patients: a review of negligence claims and complaints in Australia, Plos Medicine 2012, vol 9, issue 8, pp. 1-6.
Bismark, M.M., Gogos, A.J., McCombe, D., Clark, R., Gruen, R.L., Studdert, D.M. Legal disputes over informed consent for cosmetic procedures: a descriptive study of negligence claims and complaints in Australia, Journal of Plastic, Reconstructive and Aesthetic Surgery 2012, vol 65, issue 11, pp. 1506-1512.
van Miert, C., Dwan, K., Hill, R., Hoenig, M.R., Gruen, R.L., Semple, M.G. Suction versus no suction for chest drain management, Cochrane Database of Systematic Reviews 2012, vol 7, pp. 1-21.
Gruen, R., Hollands, M., Watters, D. Surgical Wisdom, British Journal Of Surgery 2012, vol 99, issue 1, John Wiley & Sons Ltd., United Kingdom, pp. 3-5.
Gruen, R.L., Fitzgerald, M. Towards a maturation of trauma research, Lancet 2012, vol 380, issue 9847, pp. 1033-1034.
Kirkpatrick, A.W., Holcomb, J.B., van Wijngaarden Stephens, M.H., Gruen, R.L. Tranexamic acid effects in trauma patients with significant hemorrhage, Journal of the American College of Surgeons 2012, vol 215, issue 3, pp. 438-440.
Stelfox, H.T., Straus, S.E., Nathens, A.B., Gruen, R.L., Hameed, S.M., Kirkpatrick, A.W. Trauma center quality improvement programs in the United States, Canada, and Australasia, Annals Of Surgery 2012, vol 256, issue 1, pp. 163-169.
Stelfox, H.T., Joshipura, M., Chadbunchachai, W., Ellawala, R., O'Reilly, G.M., Nguyen, T., Gruen, R.L. Trauma quality improvement in low and middle income countries of the Asia-Pacific region: a mixed methods study, World Journal Of Surgery 2012, vol 36, issue 8, pp. 1978-1992.
Lavis, J., Wilson, M., Grimshaw, J., Haynes, R., Hanna, S., Raina, P., Gruen, R., Ouimet, M. Effects of an evidence service on health-system policy makers' use of research evidence: A protocol for a randomised controlled trial, Implementation Science 2011, vol 6, issue 51, pp. 1-8.
Kitto, S.C., Petrovic, A., Gruen, R.L., Smith, J.A., 2011, Evidence-based medicine training and implementation in surgery: The role of surgical cultures, Journal of Evaluation in Clinical Practice 2011, vol 17, issue 4,pp. 819-826.
Phillips, K., Pitt, V., O'Connor, D., Gruen, R. Interventions for managing skeletal muscle spasticity following traumatic brain injury, Cochrane Database of Systematic Reviews 2011, vol 1, pp. 1-9.
Kong, J., Bultitude, M., Royce, P., Gruen, R., Cato, A., Corcoran, N. Lower urinary tract injuries following blunt trauma: A review of contemporary management, Reviews in Urology 2011, vol 13, issue 3, pp. 119-130.
Khunpradit, S., Tavender, E., Lumbiganon, P., Laopaiboon, M., Wasiak, J., Gruen, R. Non-clinical interventions for reducing unnecessary caesarean section (Protocol), Cochrane Database of Systematic Reviews 2011, vol 6, issue CD005528, pp. 1-62.
Tavender, E., Bosch, M., Green, S.E., O'Connor, D., Pitt, V., Phillips, K., Bragge, P., Gruen, R. Quality and consistency of guidelines for the management of mild traumatic brain injury in the emergency department, Academic Emergency Medicine 2011, vol 18, issue 8, pp. 880-889.
Bismark, M.M., Spittal, M.J., Gogos, A.J., Gruen, R.L., Studdert, D.M. Remedies sought and obtained in healthcare complaints, BMJ Quality & Safety 2011, vol 20, issue 9, pp. 806-810.
Tan, P., Cincotta, M., Clavisi, O., Bragge, P., Wasiak, J., Pattuwage, L., Gruen, R. Review article: Prehospital fluid management in traumatic brain injury, EMA - Emergency Medicine Australasia 2011, vol 23, issue 6, pp. 665-676.
Kitto, S., Peller, J., Villanueva, E., Gruen, R., Smith, J. Rural surgeons' attitudes towards and usage of evidence-based medicine in rural surgical practice, Journal of Evaluation in Clinical Practice 2011, vol 17, issue 4, pp. 678-683.
Bragge, P., Gruen, R., Chau, M., Forbes, A., Taylor, H. Screening for presence or absence of diabetic retinopathy: A meta-analysis, Archives of Ophthalmology 2011, vol 129, issue 4, pp. 435-444.
Parkhill, A., Clavisi, O., Pattuwage, L., Chau, M., Turner, T.J., Bragge, P., Gruen, R. Searches for evidence mapping: Effective, shorter, cheaper, Journal Of The Medical Library Association 2011, vol 99, issue 2, pp. 157-160.
Tee, J., Chan, P., Gruen, R., Rosenfeld, J. Synoptic Reporting for Spine Trauma, Spine 2011, vol 36, issue 23, p. 1997.
Bragge, P., Clavisi, O., Turner, T., Tavender, E., Collie, A., Gruen, R. The Global Evidence Mapping Initiative: Scoping research in broad topic areas, BMC Medical Research Methodology 2011, vol 11, issue Art. No: 92, pp. 1-12.
Mitra, B., Cameron, P., Gruen, R., Mori, A., Fitzgerald, M., Street, A. The definition of massive transfusion in trauma: A critical variable in examining evidence for resuscitation, European Journal of Emergency Medicine 2011, vol 18, issue 3, pp. 137-142.
Gruen, R., Mitra, B. Tranexamic acid for trauma, The Lancet 2011, vol 377, pp. 1052-1053.
Hawthorne, G., Kaye, A., Gruen, R., Houseman, D., Bauer, I. Traumatic brain injury and quality of life: Initial Australian validation of the QOLIBRI, Journal of Clinical Neuroscience 2011, vol 18, issue 2, pp. 197-202.
Gogos, A.J., Clark, R., Bismark, M., Gruen, R., Studdert, D. When informed consent goes poorly: A descriptive study of medical negligence claims and patient complaints, Medical Journal Of Australia 2011, vol 195, issue 6, Australia, pp. 340-344.
Asadollahi, S., de Steiger, R.N., Gruen, R.L., Richardson, M.D. Management guideline in haemodynamically unstable patients with pelvic fractures: Outcomes and challenges, Emergency Medicine Australasia (Print) 2010, vol 22, issue 6, pp. 556-564.
Mikocka-Walus, A., Beevor, H.C., Gabbe, B.J., Gruen, R.L., Winnett, J., Cameron, P.J. Management of spleen injuries: The current profile, ANZ Journal of Surgery 2010, vol 80, issue 3, pp. 157-161.
Lavis, J., Oxman, A.D., Souza, N.M., Lewin, S., Gruen, R.L., Fretheim, A. SUPPORT Tools for evidence-informed health policymaking (STP) 9: Assessing the applicability of the findings of a systematic review, Chinese Journal of Evidence-Based Medicine 2010, vol 10, issue 4, pp. 398-404.
Lavis, J., Wilson, M., Grimshaw, J., Haynes, R., Ouimet, M., Raina, P., Gruen, R., Graham, I. Supporting the use of health technology assessments in policy making about health systems, International Journal Of Technology Assessment In Health Care 2010, vol 26, issue 4,, pp. 405-414.
Mitra, B., Fitzgerald, M., Cameron, P., Gruen, R. Tranexamic acid for trauma, Lancet 2010, vol 376, issue 9746, p. 1049.
Gruen, R. Trauma research: what is so special? Injury 2010, vol 41, issue Suppl 1, pp. 2-3.
Gruen, R.L., Crocodile attacks in Australia: Challenges for injury prevention and trauma care, World Journal Of Surgery 2009, vol 33, issue 8, pp. 1554-1561.
Gruen, R.L., Pitt, V.J., Green, S.E., Parkhill, A., Campbell, D.A., Jolley, D.J. The effect of provider case volume on cancer mortality: Systematic review and meta-analysis, CA: A Cancer Journal for Clinicians 2009, vol 59, issue 3, pp. 192-211.
Hawthorne, G., Gruen, R.L., Kaye, A.H. Traumatic brain injury and long-term quality of life: Findings from an Australian study, Journal of Neurotrauma 2009, vol 26, issue 10, pp. 1623-1633.
Kurniawan, E., Wong, M., Rose, A., Mou, A., Buchanan, M., Collins, J., Gruen, R., Mann, G. Predictors of surgical margin status in breast-conserving surgery within a breast screening program, Annals Of Surgical Oncology 2008, vol 15, issue 9, pp. 2542-2549.
Gruen, R., Elliott, J., Nolan, M., Lawton, P., Parkhill, A., McLaren, C., Lavis, J. Sustainability science: an integrated approach for health-programme planning, Lancet 2008, vol 372, issue 9649, pp. 1579-1589.
Gruen RL. “Evidence-based Advocacy: The Public Roles of Health-care Professionals.” Medical Journal of Australia 2008; 188 (12): 684-685.
Campbell, E., Gruen, R., Mountford, J., Miller, L., Cleary, P., Blumenthal, D. A National Survey of Physiciana??Industry Relationships, New England Journal Of Medicine 2007, vol 356, issue 17, pp. 1742-1750.
Roudsari, B.S., Nathens, A.B., Arreola-Risa, C., Cameron, P.A., Civil, I., Grigoriou, G., Gruen, R.L., Koepsell, T.D., Lecky, F.E., Lefering, R.L., Liberman, M., Mock, C.N., Oestern, H., Petridou, E., Schildhauer, T.A., Waydhas, C., Zargar, M., Rivara, F.P. Emergency Medical Service (EMS) systems in developed and developing countries, Injury 2007, vol 38, issue 9 pp. 1001-1013.
Roudsari, B.S., Nathens, A.B., Cameron, P.A., Civil, I., Gruen, R.L., Koepsell, T.D., Lecky, F.E., Lefering, R.L., Liberman, M., Mock, C.N., Oestern, H., Schildhauer, T.A., Waydhas, C., Rivara, F.P. International comparison of prehospital trauma care systems, Injury 2007, vol 38, issue 9, pp. 993-1000.
Campbell, E., Regan, S., Gruen, R., Ferris, T., Rao, S., Cleary, P., Blumenthal, D. Professionalism in medicine: Results of a national survey of physicians, Annals Of Internal Medicine 2006, vol 147, issue 11, pp. 795-802.
Gruen, R., Jurkovich, G., McIntyre, L., Foy, H., Maier, R. Patterns of errors contributing to trauma mortality: Lessons learned from 2594 deaths, Annals Of Surgery 2006, vol 244, issue 3, pp. 371-378.
Gruen, R., Campbell, E., Blumenthal, D. Public Roles of US PhysiciansCommunity Participation, Political Involvement, and Collective Advocacy, Jama-Journal Of The American Medical Association 2006, vol 296, issue 20, pp. 2467-2475.
Gruen, R., Bailie, R., Wang, Z., Heard, S., O'Rourke, I. Specialist outreach to isolated and disadvantaged communities: a population-based study, Lancet 2006, vol 368, issue 9530, pp. 130-138.
Campbell EG, Regan S, Gruen RL, Cleary PD, Blumenthal D. “Professionalism in Medicine: Results of a National Survey of Physicians,” Annals of Internal Medicine 2007; 147(11):795-802.
Campbell EG, Gruen RL, Mountford J, Miller LG, Clearly PD, Blumenthal D. “A National Survey of Physician–Industry Relationships,” New England Journal of Medicine 2007; 356: 1742-1750.
Studdert DM, Mello MM, Levy MK, Gruen RL, Dunn EJ, Orav EJ, Brennan TA. “Geographic Variation in Informed Consent Law: Two Standards for Disclosure of Treatment Risks,” Journal of Empirical Legal Studies 2007; 4:103-24.
Gruen RL, Campbell EC, Blumenthal D. “Political activity of US Physicians” (letter in reply), Journal of the American Medical Association 2007; 297(9):951-952.
Gruen RL, Campbell EC, Blumenthal D. “Public Roles of U.S. Physicians: Community Participation, Political Involvement and Collective Advocacy,” Journal of the American Medical Association 2006; 296:2467-2475.
Grant RW, Campbell EG, Gruen RL, Ferris TG, Blumenthal D. “Prevalence of Basic Information Technology Use by U.S. Physicians,” Journal of General Internal Medicine 2006; 11:1150-5.
Lavis JN, Davies HTO, Gruen RL, Walshe K, Farquhar CM. “Working Within and Beyond the Cochrane Collaboration to Make Systematic Reviews More Useful to Healthcare Managers and Policymakers,” Healthcare Policy 2006; 1(2):21-33.
Weiss EC, Gruen RL. “First principles: Substantive Ethics for Healthcare Organizations,” Journal of Healthcare Management 2005; 50(2).
Gruen RL, Pearson SE, Brennan TA. “Physician-Citizens: Public Roles and Professional Obligations,” Journal of the American Medical Association 2004; 291:94-98.
Gruen RL, Pearson SE, Brennan TA. “Physicians As Citizens – Reply” (Invited reply), Journal of the American Medical Association 2004; 291:2076-2077.
Gruen RL. “Professionalism In Surgery: The American Approach,” Aust NZ J Surg. 2004; 74(Suppl.):A19.
Gruen RL. “Commentary on: The Five-Fold Root of an Ethics in Surgery. (Invited Commentary)” In: A Miles Little Reader: Restoring Humane Values to Medicine; eds Kerridge I, Jordens C, Sayers E-J. Sydney: Desert Pea Press, 2003.
Gruen RL. “Medical Professionalism Charter” (letter), Medical Journal of Australia 2003;178:94.
Arya J, Cosgrove EM, Cruess RL, Cruess SR, Eastman AB, Fabri PJ, Friedman P, Gruen RL, et al. American College of Surgeons Task Force on Professionalism. “American College of Surgeons Code of Professional Conduct,” Journal of the American College of Surgeons 2003; 197:603-4.
Gruen RL, Arya J, Cosgrove EM, Cruess RL, Cruess SR, Eastman AB, Fabri PJ, Friedman P, Kirksey TD, Kodner IJ, Lewis FR, Liscum KR, Organ CH, Rosenfeld JC, Russell TH, Sachdeva A, Zook EG, Harken AH. “Professionalism in Surgery,” Journal of the American College of Surgeons 2003;197(4):605-608.