A comprehensive 3-year internal medicine residency research curriculum

The Importance of Engaging in Scientific Research during Medical Training

Many components of required skills and competencies exist, and are felt to contribute to the successful completion of training for independent practice in the medical field as a physician. These requirements are documented and detailed in a temporal fashion during the training period and used for advancement during training as well as documentation of successful completion of that training. While clinical skill development that allows optimal care and treatment of patients is of utmost importance during this training, other components of the training are important and contribute to the ideal development of a well-rounded and credentialed physician. One of these other components which is very important and needs to be recognized is the engagement of medical trainees across disciplines in academic and research scholarly activity. This engagement is an important component of medical training, and the development of skills and didactics geared toward efficient and accurate performance of research is essential.

Curated collections for educators: Nine key articles and article series for teaching qualitative research methods

Background

Qualitative research explains observations, focusing on how and why phenomena and experiences occur. Qualitative methods go beyond quantitative data and provide critical information inaccessible through quantitative methods. However, at all levels of medical education, there is insufficient exposure to qualitative research. As a result, residents and fellows complete training ill-equipped to appraise and conduct qualitative studies. As a first step to increasing education in qualitative methods, we sought to create a curated collection of papers for faculty to use in teaching qualitative research at the graduate medical education (GME) level.

Methods

We conducted literature searches on the topic of teaching qualitative research to residents and fellows and queried virtual medical education and qualitative research communities for relevant articles. We searched the reference lists of all articles found through the literature searches and online queries for additional articles. We then conducted a three-round modified Delphi process to select papers most relevant to faculty teaching qualitative research.

Results

We found no articles describing qualitative research curricula at the GME level. We identified 74 articles on the topic of qualitative research methods. The modified Delphi process identified the top nine articles or article series most relevant for faculty teaching qualitative research. Several articles explain qualitative methods in the context of medical education, clinical care, or emergency care research. Two articles describe standards of high-quality qualitative studies, and one article discusses how to conduct the individual qualitative interview to collect data for a qualitative study.

Conclusions

While we identified no articles reporting already existing qualitative research curricula for residents and fellows, we were able to create a collection of papers on qualitative research relevant to faculty seeking to teach qualitative methods. These papers describe key qualitative research concepts important in instructing trainees as they appraise and begin to develop their own qualitative studies.

Determinants of research productivity during postgraduate medical education: a structured review

BACKGROUND

Although formal participation in research is an integral and often mandatory component of clinical training programs, resulting productivity is highly variable. The objective of this review was to identify determinants of successful research performance among graduate medical education trainees.

METHODS

A structured review of the published literature was performed by searching PubMed, CINAHL, and EMBASE from inception through to 7 April, 2021. Articles examining graduate medical education trainee research productivity evidenced by publications in peer-reviewed journals were included.

RESULTS

Eighty-five articles were included of which most (66; 78%) were reported from the USA or Canada (10; 12%). A wide range of disciplines were represented with the most common being general surgery, internal medicine, orthopedic surgery, and pediatrics. Themes (number of reports) included trainee characteristics (n = 24), project characteristics (n = 8), mentoring/supervision (n = 11), and programmatic aspects (n = 57). Although variable results were observed, research productivity tended to be higher with prior research experience, later years of training, male gender, and pursuit of a postgraduate degree. Few project related aspects of success were identified. Trainee publication was associated with mentors with higher rank, publication productivity, and supportive academic environments. Training programs with organised programs/curricula including protection of time for research were associated with increased productivity as were provision of incentives or rewards but not mandatory requirements.

CONCLUSION

This review identifies several trainee characteristics, project and mentor aspects, and programmatic aspects associated with increased productivity that may serve as a useful resource for trainees and graduate medical education training programs.

Development and Implementation of a Chief Resident for Research Role in a Psychiatry Residency Training Program

Psychiatry residency programs with robust research training can prepare physician-scientists to make contributions that advance the mental health field. Our psychiatry residency developed a chief resident for research position to help provide mentorship, community building, and advising around scholarly activities for residents. We present the process of implementing this new position in our residency to offer a model for engaging psychiatry residents in research.

A Structured Mentorship Elective Deepens Personal Connections and Increases Scholarly Achievements of Senior Surgery Residents

OBJECTIVES

Surgery residents have few opportunities to work closely with attending surgeons or conduct research during clinical time. We hypothesized that a mentorship elective with a required research project would benefit residents' career development, including their personal connections with faculty mentors, and would help them build their academic portfolio.

DESIGN

We created a mentorship elective designed as a one-on-one apprenticeship. Completion of a scholarly project was a core component of the elective. Residents, faculty, and the most senior resident ('non-mentee') on the same service as the elective resident were interviewed after the completion of their rotation.

SETTING

University-based surgery residency at Boston Medical Center, Boston, MA.

PARTICIPANTS

All 5 residents in postgraduate year 4 (PGY-4) participated in the mentorship elective during the 2019 to 2020 academic year. Residents identified their faculty mentor. All mentees (5/5), most mentors (4/5), and all non-mentees (4/4) were interviewed.

RESULTS

All mentees reported interacting with their mentor daily, performing clinical duties or discussing their research project. For mentees, the top factor when selecting their mentor was the mentor's clinical expertise, and the most valuable aspect of the rotation was developing a relationship with their mentor. All mentors responded that their mentee gained an understanding of running an academic surgical practice and developed research skills. Four of 5 mentees completed critical portions of their scholarly project during the elective with one publishing in a peer-reviewed journal, 2 having their work accepted to a national conference, and one creating vascular surgery educational videos. All stated the elective was valuable.

CONCLUSIONS

A structured apprenticeship rotation allowed for closer relationships with attending surgeons and increased the scholarly achievement of PGY-4 surgery residents. We provide an example of how to incorporate a successful elective rotation into the surgery curriculum that strengthens resident career development and research productivity.

Rapid exponential increase in neurosurgery departmental scholarly output following an intensive research initiative

There has been extensive research into methods of increasing academic departmental scholarly activity (DSA) through targeted interventions. Residency programmes are responsible for ensuring sufficient scholarly opportunities for residents. We sought to discover the outcomes of an intensive research initiative (IRI) on DSA in our department in a short-time interval. IRI was implemented, consisting of multiple interventions, to rapidly produce an increase in DSA through resident/medical student faculty engagement. We compare pre-IRI (8 years) and post-IRI (2 years) research products (RP), defined as the sum of oral presentations and publications, to evaluate the IRI. The study was performed in 2020. The IRI resulted in an exponential increase in DSA with an annual RP increase of 350% from 2017 (3 RP) to 2018 (14 RP), with another 92% from 2018 (14 RP) to 2019 (27 RP). RP/year exponentially increased from 2.1/year to 10.5/year for residents and 0.5/year to 10/year for medical students, resulting in a 400% and 1900% increase in RP/year, respectively. The common methods in literature to increase DSA included instituting protected research time (23.8%) and research curriculum (21.5%). We share our department's increase in DSA over a short 2-year period after implementing our IRI. Our goal in reporting our experience is to provide an example for departments that need to rapidly increase their DSA. By reporting the shortest time interval to achieve exponential DSA growth, we hope this example can support programmes in petitioning hospitals and medical colleges for academic support resources.

Best Practices in Resident Research- A National Survey of High Functioning Internal Medicine Residency Programs in Resident Research in USA

PURPOSE

Meaningful participation in research for both faculty and residents is generally viewed to be an essential component of residency training. To better understand best practices in residency research, the authors conducted a survey among Internal Medicine (IM) Residency Programs with experience in research.

METHODS

Phone interviews were conducted with a convenience sample of Residency Program Directors (PDs). Survey responses were analyzed across the following domains: size and makeup of the residency and research programs, resources for research, role of the PD/research director (RD), profile of trainees doing research, curriculum description, scope of research, role of mentors, career choices and determinants of success.

RESULTS

Fifteen programs were included in the study. Across these programs, approximately two-thirds of residents were involved in research during their training . Eighty percent of the programs required an application for residents to engage in research. Ninety-two percent of the programs had a RD but only 58% had a formal research curriculum. Clinical research projects were the most common types of research. On average, two-thirds of residents involved in research submitted abstracts to regional and/or national meetings. The factor most frequently associated with resident research success was an effective faculty research mentor.

CONCLUSIONS

Research success during residency is multifactorial. The authors propose that having a robust structure for research that is led by a residency RD, and the presence of effective mentors and strong administrative support are critical for success.

Residents Take the Lead: A Modern Collaborative Approach to Research During Residency

BACKGROUND

Participation in scholarship is a requirement for Internal Medicine (IM) residencies, but programs struggle to successfully integrate research into busy clinical schedules. In 2013, the IM residency at Brigham and Women's Hospital implemented the Housestaff Research Project (HRP)- a novel residency-wide research initiative designed to facilitate participation in scholarship. The HRP had two components-a formal research curriculum and an infrastructure that provided funding and mentorship for resident-led, housestaff wide projects.

METHODS

This is a mixed-methods study of 190 IM residents and two HRP-supported research projects. Seventy-seven residents responded to an electronic survey about their interests in research exposure in residency. Fifty-six residents responded to an electronic survey about their participation in the HRP. The success of HRP-supported projects was evaluated through resident comments, interviews with three residents leading the first two HRPs and a description of the success of the projects based on resident involvement and dissemination of the results.

RESULTS

Eighty-seven percent (n= 67/77) of residents were interested in additional research exposure during residency. Ninety-five percent (n = 53/56) of residents had heard of the HRP, and 77% had participate in at least one aspect of it. Approximately 20 residents were directly involved in the two resident-led projects. HRP-supported projects resulted in presentations at three local and three national conferences, one manuscript in press, and one manuscript in preparation. The resident project leaders felt that a strength and unique aspect of the HRP was the collaboration with co-residents.

CONCLUSION

The HRP successfully created a culture of research and scholarship within the residency. The HRP leaders and residents that participated in HRP-supported projects expressed the most direct benefits from the program. All residents were exposed to research concepts and methods. Future directions for the HRP include selecting projects that maximize the number of resident participants and integrating a more robust research curriculum.

A Program to Support Scholarship During Internal Medicine Residency Training: Impact on Academic Productivity and Resident Experiences

Problem: Although scholarship during residency training is an important requirement from the Accreditation Council for Graduate Medical Education, efforts to support resident scholarship have demonstrated inconsistent effects and have not comprehensively evaluated resident experiences. Intervention: We developed the Leadership and Discovery Program (LEAD) to facilitate scholarship among all non-research-track categorical internal medicine (IM) residents. This multifaceted program set expectations for all residents to participate in a scholarly project, supported faculty to manage the program, facilitated access to faculty mentors, established a local resident research day to highlight scholarship, and developed a didactic lecture series. Context: We implemented LEAD at a large university training program. We assessed resident scholarship before and after LEAD implementation using objective metrics of academic productivity (i.e., scientific presentations, peer-reviewed publications, and both presentations and publications). We compared these metrics in LEAD participants and a similar historical group of pre-LEAD controls. We also assessed these outcomes over the same two periods in research track residents who participated in research training independent from and predating LEAD (research track controls and pre-LEAD research track controls). We conducted focus groups to qualitatively assess resident experiences with LEAD. Outcome: Compared to 63 pre-LEAD controls, greater proportions of 52 LEAD participants completed scientific presentations (48.1% vs. 28.6%, p = .03) and scientific presentations and peer-reviewed publications (23.1% vs. 9.5%, p = .05). No significant differences existed for any academic productivity metrics among research track controls and pre-LEAD research track controls (p > .23, all comparisons). Perceived facilitators of participation in LEAD included residents' desire for research experiences and opportunities to publish prior to fellowship training; the main barrier to participation was feeling overwhelmed due to the time constraints imposed by clinical training. Suggestions for improvement included establishing clearer programmatic expectations and providing lists of potential mentors and projects. Lessons Learned: Implementation of a multifaceted program to support scholarship during residency was associated with significant increases in academic productivity among IM residents. Residents perceived that programs to support scholarship during residency training should outline clear expectations and identify available mentors and projects for residents who are challenged by the time constraints of clinical training.

Interventions to increase research publications in graduate medical education trainees: a systematic review

INTRODUCTION

Competency-based educational models recommend trainee exposure to research, but the best methods for Graduate Medical Education (GME) programs to accomplish this have not been clarified. The objective of this study was to quantify published interventions to generate resident research and compare effectiveness among those interventions.

MATERIAL AND METHODS

A systematic review of English-language articles of studies of GME programs was performed, describing resident research interventions and quantifying the number of publications as an outcome.

RESULTS

The search produced 13,688 potentially relevant articles, and included 47 articles in the final synthesis. Publication effectiveness was calculated as publications per year. The top ten programs for publication effectiveness were compared to others for interventions chosen. Interventions were characterized as research director, protected time, research requirement, research mentor, curricula, research assistant, biostatistician, information technology support, research fund, pay-for-performance plans, and celebration of accomplishments. Total number of different interventions was not significantly associated with primary outcome (r = 0.20, p = 0.18). When comparing the top ten programs to the others, appointment of a research director was statistically more prevalent in those programs (70% vs. 30%, p = 0.02), while presence of a defined curriculum was more common (90% vs. 57%, p = 0.052) but not statistically significantly.

CONCLUSIONS

Leadership interventions (directors, curricula) are associated with successful GME research efforts.

Graduate medical education scholarly activities initiatives: a systematic review and meta-analysis

BACKGROUND

According to the Accreditation Council for Graduate Medical Education residents "should participate in scholarly activity." The development of a sustainable, successful resident scholarship program is a difficult task faced by graduate medical education leadership.

METHODS

A medical librarian conducted a systematic literature search for English language articles published on scholarly activities initiatives in Graduate Medical Education (GME) between January 2003 and March 31 2017. Inclusion criteria included implementing a graduate medical education research curriculum or initiative designed to enhance intern, resident, or fellow scholarly activities using a control or comparison group. We defined major outcomes as increases in publications or presentations. Random effects meta-analysis was used to compare the rate of publications before and after implementation of curriculum or initiative.

RESULTS

We identified 32 relevant articles. Twenty-nine (91%) reported on resident publications, with 35% (10/29) reporting statistically significant increases. Fifteen articles (47%) reported on regional, national, or international presentations, with only 13% (2/15) reporting a statistically significant increase in productivity. Nineteen studies were eligible for inclusion in the meta-analysis; for these studies, the post-initiative publication rate was estimated to be 2.6 times the pre-intervention rate (95% CI: 1.6 to 4.3; p < 0.001).

CONCLUSIONS

Our systematic review identified 32 articles describing curricula and initiatives used by GME programs to increase scholarly activity. The three most frequently reported initiatives were mentors (88%), curriculum (59%), and protected time (59%). Although no specific strategy was identified as paramount to improved productivity, meta-analysis revealed that the publication rate was significantly higher following the implementation of an initiative. Thus, we conclude that a culture of emphasis on resident scholarship is the most important step. We call for well-designed research studies with control or comparison groups and a power analysis focused on identifying best practices for future scholarly activities curricula and initiatives.

Supporting Resident Research Learning in the Workplace: A Rapid Realist Review

PURPOSE

Residents are increasingly expected to engage in practice-based research; however, engagement in research whilst also fulfilling clinical duties is often challenging. Evidence suggests that residents require specific developmental experiences, along with clinical practice, to become effective researchers. The authors therefore conducted a rapid realist review to explore strategies and key mechanisms supporting effective resident research activities in clinical settings. They examined relationships amongst different clinical contexts, learning mechanisms, and research engagement outcomes to provide evidence-based, theory-informed recommendations for improving resident research engagement and extending understandings of workplace learning in health care settings.

METHOD

In 2015-2016, the authors used a rapid realist methodology informed by workplace learning theory to review international literature published between January 2005 and December 2015. The review drew upon sources from OVID Medline, ERIC, Embase, and AustHealth. The authors screened articles for eligibility using inclusion criteria and appraised articles using realist review quality criteria.

RESULTS

The authors included 51 articles in the review. The review process identified three key mechanisms for effective integration and support of resident research engagement, as informed by workplace learning theory: (1) opportunities to engage in practice-informed research supported by longitudinal curricula, (2) guidance by clinician-researchers, and (3) assessing residents' research readiness and promoting their intentionality for engagement.

CONCLUSIONS

This review extends existing literature and informs workplace-based research engagement strategies for residents whilst demonstrating the applicability of workplace learning theory to improving residents' research engagement. The authors propose a learning model to support effective resident research engagement through clinical practice.

Promoting scholarship in a community-based internal medicine residency

The University of South Dakota Sanford School of Medicine Internal Medicine residency implemented a program to enhance scholarship among residents. This residency is part of a small Mid-Western community-based school.

Background: A Director of Research was hired and developed a structured approach consisting of: 1. Independent study regarding research methods and statistical testing and 2. Mentoring of residents and faculty in scholarly pursuits starting in the first months of residency.

Methods: Scholarship for two cohorts of residents for years July 2011–2014 and January 2014–2017 were followed. Products included papers accepted/published and papers accepted/presented at national or international meetings.

Results: 7 (14.8%) of 47 residents in the first cohort published 12 papers (0.25 papers/resident) with 18 faculty as co-authors (1.5/paper). 20 (43.4%) of 46 residents in the second cohort (structured program) published 39 papers (0.85 papers/resident) with 80 faculty as co-authors (2.1/paper). The difference in papers was significant by chi-square analysis.

Conclusion: A structured program requiring independent study in conjunction with individualized mentoring of scholarship starting early in the first postgraduate year was successful in significantly increasing the scholarly activity of our community-based internal medicine residents and faculty. With this program, the percentage of residents publishing exceeds national statistics recently reported.

Increasing Scholarly Activity Productivity During Residency: A Systematic Review

PURPOSE

Although resident participation in scholarly activity is mandated by the Accreditation Council for Graduate Medical Education, programmatic factors associated with success are not defined. This systematic review's objective was to determine which interventions are effective in increasing resident scholarly activity productivity (RSAP), as measured by participation in scholarly activity, presentations, or publications.

METHOD

The PubMed, MEDLINE, Cochrane Library of Systematic Reviews, PsycINFO, CINAHL, and ERIC databases were searched through October 2013. English-language articles evaluating interventions to increase RSAP in U.S. or Canadian residency programs were included, without date limits. Two independent reviewers selected articles for inclusion and extracted data. Discrepancies were resolved by consensus.

RESULTS

Of the 6,248 records screened, 80 studies underwent data abstraction. Twenty-six described outcomes without a comparison group, leaving 54 studies representing 13 medical and surgical specialties. Interventions included required scholarly activity participation, protected research time, research curricula, research directors, dedicated research days, and research tracks. Focusing on the 35 studies reporting statistical analysis, RSAP was associated with all interventions. There were some differences in intervention effectiveness between medical and surgical specialties.

CONCLUSIONS

Interventions, including protected time, research curricula, or specialized research tracks, generally result in increased participation in scholarly activity in residency programs, with mixed effects on resident presentations or publications. In many studies, interventions were bundled, suggesting that programs may need to provide increased structure and rigor through multiple pathways. The findings highlight the need for a clear definition of resident scholarly activity success aligned specifically to individual program and resident aims.

Successful adaptation of a research methods course in South America

BACKGROUND

South America has low research productivity. The lack of a structured research curriculum is one of the barriers to conducting research.

OBJECTIVE

To report our experience adapting an active learning-based research methods curriculum to improve research productivity at a university in Ecuador.

DESIGN

We used a mixed-method approach to test the adaptation of the research curriculum at Universidad Catolica Santiago de Guayaquil. The curriculum uses a flipped classroom and active learning approach to teach research methods. When adapted, it was longitudinal and had 16-hour programme of in-person teaching and a six-month follow-up online component. Learners were organized in theme groups according to interest, and each group had a faculty leader. Our primary outcome was research productivity, which was measured by the succesful presentation of the research project at a national meeting, or publication in a peer-review journal. Our secondary outcomes were knowledge and perceived competence before and after course completion. We conducted qualitative interviews of faculty members and students to evaluate themes related to participation in research.

RESULTS

Fifty university students and 10 faculty members attended the course. We had a total of 15 groups. Both knowledge and perceived competence increased by 17 and 18 percentage points, respectively. The presentation or publication rate for the entire group was 50%. The qualitative analysis showed that a lack of research culture and curriculum were common barriers to research.

CONCLUSIONS

A US-based curriculum can be successfully adapted in low-middle income countries. A research curriculum aids in achieving pre-determined milestones.

ABBREVIATIONS

UCSG: Universidad Catolica Santiago de Guayaquil; UM: University of Miami.

Resident research: why some do and others don't

INTRODUCTION

Although research is widely considered to be a relevant and essential skill to resident development, the actual participation rate of residents in research remains low, and the factors associated with participation are unclear.

METHODS

We examined the participation rate of junior residents in research, and their attitudes and perceived barriers toward research, via an anonymised survey carried out from October to November 2013. The residents were from an established Accreditation Council for Graduate Medical Education-accredited internal medicine residency training programme in Singapore.

RESULTS

The overall response rate was 64.1% (82/128 residents). The most frequently cited barrier was lack of time. Only a third of the residents surveyed were actively participating in research. Those with postgraduate qualifications were more likely to be involved in research (odds ratio 4.71, p = 0.015). Among the 82 residents, 40.2% reported an interest in research as part of their career; these were mainly graduates from overseas universities or postgraduates. A belief that research is an intrinsically valuable activity distinguished residents who chose research as a career path from those who were undecided (p = 0.004). The belief that research is a means to better clinical practice also divided those who chose research from those who rejected it (p = 0.02).

CONCLUSION

Our findings suggest that specific beliefs determine the level of research activity and career interest among residents. Novel strategies may be incorporated in training programmes to improve the interest and participation of residents in research, and to facilitate the development of academic clinicians.

Impact of the Surgical Research Methodology Program on surgical residents' research profiles

OBJECTIVE

To evaluate whether implementing the formal Surgical Research Methodology (SRM) Program in the surgical residency curriculum improved research productivity compared with the preceding informal Research Seminar Series (RSS).

METHODS

The SRM Program replaced the RSS in July 2009. In the SRM Program, the curriculum in Year-1 consisted of 12 teaching sessions on the principles of clinical epidemiology and biostatistics, whereas the focus in Year-2 was on the design, conduct, and presentation of a research project. The RSS consisted of 8 research methodology sessions repeated annually for 2 years along with the design, conduct, and presentation of a research project. Research productivity was measured as the number of peer-reviewed publications and the generation of studies with higher levels of evidence. Outcome measures were independently assessed by 2 authors to avoid bias. Student t test and chi-square test were used for the analysis. Frequencies, mean differences with 95% CI, and effect sizes have been reported.

RESULTS

In this study, 81 SRM residents were compared with 126 RSS residents. The performance of the SRM residents was superior on all metrics in our evaluation. They were significantly more productive and published more articles than the RSS residents (mean difference = 1.0 [95% CI: 0.5-1.5], p < 0.001) with an effect size of 0.26. The SRM residents presented significantly more projects that were of higher levels of evidence (systematic reviews/meta-analyses, randomized controlled trials, and prospective cohorts) than the RSS residents (52.5% vs 29%, p = 0.005). In addition, the research performance improved 11.0 grades (95% CI: 8.5%-13.5%, p < 0.001) with an effect size of 0.51 in favor of the SRM Program.

CONCLUSION

Although not all surgeons opt for a career as surgeon-scientist, knowledge of research methodology is crucial to appropriately apply evidence-based findings in clinical practice. The SRM Program has significantly improved the research productivity and performance of the surgical residents from all disciplines. The implementation of a similar research methodology program is highly recommended for the benefit of residents' future careers and ultimately, evidence-based patient care.